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AndroGel2 Unused gel should be disposed of by thoroughly rinsing down the sink or
(testosterone gel) throw in the trash in a manner to avoid accidental exposure or ingestion
by household members or pets.
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Copyright 2007 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #230401: Page 2 of 9)
Daytrana5 Fold the patch in half so that the adhesive side adheres to itself and flush
(methylphenidate) down the toilet or dispose of in an appropriate lidded container.
Diastat AcuDial7 Any diazepam rectal gel remaining in the AcuDial applicator after use
(diazepam rectal gel) should be disposed of before the applicator is discarded.
With the applicator tip pointed over the sink or toilet, the plunger should
be pulled back then gently depressed until it stops to force gel from the
applicator tip into the sink or toilet.
Flush the toilet or rinse the sink with water until gel is no longer visible.
Duragesic11 Fold sticky sides of the patch together and flush down the toilet.
(fentanyl)
Estrogel12 Unused gel should be disposed of by thoroughly rinsing down the sink or
(estradiol gel) throw in the trash in a manner to avoid accidental exposure or ingestion
by household members or pets.
Ionsys14 Handle Ionsys by the side or the top housing only since contact with
(transdermal fentanyl) hydrogel in Ionsys can be harmful to humans and animals.
Disposal should be in accordance with state or federal regulations.
Wear gloves to dispose of a used Ionsys unit:
1. Pull the red tab to separate bottom and top housing.
2. Fold the hydrogel-containing bottom housing in half with sticky side
facing in.
3. Dispose of the bottom housing containing fentanyl by flushing down
the toilet with another healthcare professional as a witness.
4. Dispose of the top housing containing electronics according to
hospital procedures for battery-containing waste.
5. If hydrogel accidentally contacts the skin, rinse with water
thoroughly. Do not use soap.
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Copyright 2007 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #230401: Page 3 of 9)
Zerit25/Zerit XR26 Flush capsules down the toilet or pour oral solution down the sink.
(stavudine) (Please note Zerit XR has been discontinued)
a. This list is not all-inclusive.
b. Patients should follow specific drug disposal instructions found in the patient information from
the manufacturer.
c. Many Schedule II drugs have special instructions to flush the drug down the toilet or pour down
the sink.
d. Unless listed above, most topical patches, including hormone patches, are to be folded in half so
that the sticky side sticks to itself and discard in the trash in a manner to prevent accidental
ingestion by children or pets.
e. Estring, Femring, and Nuvaring are to be disposed of in the trash. For Femring, wrap the used
ring in tissue paper before throwing in the trash. For Nuvaring, wrap the used ring in the foil
pouch it came with before throwing in the trash.
Users of this document are cautioned to use their own professional judgment and consult any other necessary or
appropriate sources prior to making clinical judgments based on the content of this document. Our editors have
researched the information with input from experts, government agencies, and national organizations. Information
and Internet links in this article were current as of the date of publication.
More. . .
Copyright 2007 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208
Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #230401: Page 4 of 9)
packing medications for disposal, sample press prohibited by federal or state laws. In some
release and fliers, law enforcement requirements, states, nursing homes that can prove unused
controlled substances and privacy law summaries medications have been handled properly can
and much more information. It is available at: potentially reuse them. The medication has to go
http://www.nerc.org/adobe/setting.up.draftFINAL back through a pharmacy that then has to ensure
.pdf. Users of this document should keep in mind the integrity of the drug.38,39 To reduce
that some disposal instructions are not consistent pharmaceutical waste, some states, including
with ONDCP guidelines and that any legal and California, Oklahoma, Louisiana, and Ohio, allow
safety information should be verified with the unused drugs from nursing homes, wholesalers,
appropriate state and federal regulatory bodies if and manufacturers to be distributed to the poor or
in question. uninsured.38
In clinic settings, sewage disposal of expired
Proper Disposal - Healthcare Facilities drug samples should be avoided. It is
Healthcare facilities such as hospitals, skilled recommended to check expiration dates prior to
nursing facilities, and clinics are the largest bulk accepting drug samples. Typically manufacturers
users of medications. Although most hospital do not accept drug sample returns. Consider
facilities utilize pharmaceutical returns/disposal using a pharmaceutical waste management service
services to discard non-reusable or expired (e.g., EXP Pharmaceutical Services Corp., etc) to
medications, many dispose of unused contents of properly dispose of expired drug samples.
syringes and IV bags into drains. States such as
California and Washington prohibit disposal of Expiration Date vs. Beyond Use Date
virtually any drugs down the sewage system.36 It Patients often wonder whether to dispose of
is recommended to consult local wastewater expired medications or keep them on hand for
treatment plants to determine what pharmaceutical future use. The question of whether it is safe to
wastes are appropriate to dispose of down the take expired medications often comes up.
sewer system in healthcare facilities.36 Expiration dates on prescription drugs in their
In general, wastes that are acceptable for original packaging are set by the manufacturer
sewage disposal include IV bags containing saline based on stability testing results.40-42 Most
solution, lactate, nutrients such as glucose, added pharmaceutical manufacturers choose two to three
salts such as potassium, vitamins, and/or other years after the date of manufacture as the
electrolytes. Avoid disposing of other IV expiration date. The expiration date assigned to a
solutions containing antibiotics, painkillers, medication by the manufacturer is not the date
chemotherapeutic agents, controlled substances, after which it has gone bad. It is the date after
or other pharmaceutical wastes down the sewage which the manufacturer cannot guarantee that the
system.37 Its recommended to dispose of excess product meets FDA standards.40
medication (solid and liquid, including The FDA requires that a product pass
injectables) into a pharmaceutical waste stability tests.41 These tests analyze the ability
container.37 of the drug to meet the FDA standards of
The best way to dispose of pharmaceutical maintaining identity, strength, quality, and purity
waste is through incineration. For details on how for the duration of a chosen expiration period.41
to manage pharmaceutical wastes in hospital For example, if a drug manufacturer chooses the
settings, please refer to Hospitals for a Healthy expiration date of a given drug to be three years,
Environments Managing pharmaceutical wastes: then the drug must be tested during this period
A 10-step blueprint for healthcare facilities in the and at the end of three years, to affirm that the
United States, available at drug meets the standards. These determinations
http://www.premierinc.com/safety/topics/pharma- must be made using the packaging that the drug is
waste/downloads/h2e-pharma-blueprint-04-15- to be marketed in and under the storage conditions
06.pdf. that are appropriate for the product. Usually,
In long-term care settings, some states allow maintenance of at least 90% potency is
unopened drugs (except for controlled substances) acceptable.41,43
in sealed containers to be returned to the A beyond-use date is different from an
dispensing pharmacy for disposal unless expiration date set by the drug manufacturer.
More. . .
Copyright 2007 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #230401: Page 6 of 9)
formulations tend not be as stable as solid dosage Users of this document are cautioned to use their own
forms. Some liquids containing sugar or other professional judgment and consult any other necessary
flavoring additives can grow mold or other or appropriate sources prior to making clinical
contaminants if left too long. Injectable liquids judgments based on the content of this document. Our
editors have researched the information with input
(e.g., EpiPen, Twinject, etc) should be visually
from experts, government agencies, and national
inspected periodically and be replaced if organizations. Information and Internet links in this
discolorations or particulates are evident.55,56 article were current as of the date of publication.
Antibiotic suspensions prepared from powders are
relatively unstable and should be properly
discarded once expired. Eye drops come in sterile
formulations and once expired, the potency of Project Leader in preparation of this Detail-
preservative cannot be guaranteed even though the Document: Wan-Chih Tom, Pharm.D.
drug may still be active. Other drugs that tend to
degrade quickly include nitroglycerin and insulin
and should not be used beyond expiration date.47
Advise patients that drugs with narrow therapeutic References
index (e.g., warfarin, digoxin, phenytoin, 1. Prescribing information for Actiq. Cephalon, Inc.
carbamazepine, levothyroxine, etc) may not Salt Lake City, UT 84116. February 2007.
2. Prescribing information for AndroGel. Solvay
produce adequate therapeutic response even with Pharmaceuticals, Inc. Marietta, GA 30062. March
a small loss of potency. 2004.
3. Prescribing information for Avinza. Ligand
Conclusion Pharmaceuticals Inc. San Diego, CA 92121.
February 2003.
Many medications are found to be stable 4. Prescribing information for Baraclude. Bristol-
beyond expiration date when stored under ideal Myers Squibb Company. Princeton, NJ 08543.
conditions.45 However, the stability of February 2007.
medications cannot be guaranteed once the 5. Prescribing information for Daytrana. Shire US Inc.
medication has been dispensed to the patient. Wayne, PA 19087. January 2007.
6. Prescribing information for Demerol. Sanofi-
Counsel patients to store medications in their Synthelabo Inc. New York, NY 10016. December
original containers in a cool dry place (e.g., linen 2005.
closet, etc) to prevent rapid degradation and to 7. Prescribing information for Diastat Acu-Dial.
keep out of reach of children. Advise against Valeant Pharmaceuticals. Costa Mesa, CA 92626.
September 2005.
storing medicines in bathroom cabinets. Showers 8. Prescribing information for Dilaudid. Abbott
and baths create heat and humidity that can cause Laboratories. North Chicago, IL 60065. June
some drugs to degraded rapidly.57 Recommend 2006.
cleaning out medicine cabinets at least once a year 9. Prescribing information for Dilaudid-HP. Abbott
to properly discard and replace outdated products, Laboratories. North Chicago, IL 60065. June
2006.
damaged containers, and old supplies.57 Advise 10. Prescribing information for Dolophine. Roxane
patients to check with local hazardous waste Laboratories. Columbus, OH 43216. October
management or pharmacies for pharmaceutical 2006.
take-back programs or to dispose of unwanted 11. Prescribing information for Duragesic. Janssen
Pharmaceutical Products, LP. Titusville, NJ 08560.
medications by following the new federal drug February 2005.
disposal guidelines. 12. Prescribing information for Estrogel. Solvay
Pharmaceuticals, Inc. Marietta, GA 30062. March
2004.
13. Prescribing information for Fentora. Cephalon, Inc.
Salt Lake City, UT 84116. March 2007.
14. Prescribing information for Ionsys. Ortho-McNeil.
Ranitan, NJ 08869. August 2006.
15. Prescribing information for Opana. Endo
Pharmaceuticals. Chadds Ford, PA 19317.
August 2006.
16. Prescribing information for Opana ER. Endo
Pharmaceuticals. Chadds Ford, PA 19317.
January 2007.
More. . .
Copyright 2007 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #230401: Page 8 of 9)
More. . .
Copyright 2007 by Therapeutic Research Center
Pharmacists Letter / Prescribers Letter ~ P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com
(Detail-Document #230401: Page 9 of 9)
46. Taylor JS, Lyon RC, Prasanna HR, Hussain AS. 54. McEvoy GK. Tetracyclines general statement. In:
Stability profiles of drug products extended beyond American Hospital Formulary Service Drug
labeled expiration dates. Poster Board AC-08 Information (online). 2007. American Society of
presented at 2002 FDA Science Forum. February Health-System Pharmacists. (Accessed March 19,
20-21, 2002. Washington, D.C. 2007).
http://www.cfsan.fda.gov/~frf/forum02/a109ac8.htm 55. Product information for EpiPen. Dey LP. Napa,
(Accessed July 11, 2006). CA 94558. December 2000.
47. Altschuler R. Do medicines really expire? 56. Product information for Twinject 3 mg. Verus
Medscape General Medicine. September 9, 2002. Pharmaceuticals, Inc. San Diego, CA 92130.
http://www.medscape.com/viewarticle/460159. March 2005.
(Accessed July 11, 2006). 57. Lewis C. Your medicine cabinet needs an annual
48. Gross JM. Fanconi Syndrome (adult type) checkup, too.
developing secondary to the ingestion of outdated http://www.fda.gov/fdac/features/2000/200_med.ht
tetracycline. Ann Intern Med 1963;58:523-8. ml. (Accessed July 11, 2006).
49. Frimpter GW, Timpanelli AE, Eisenmenger WJ, et 58. Dillon P, Rubenstein L. Managing pharmaceutical
al. Reversible Fanconi Syndrome caused by waste: best management practices for plastic
degraded tetracycline. JAMA 1963:184;111-3. medication containers from consumers.
50. Montoliu J, Carrera M, Darnell A, Revert L. Lactic http://www.nerc.org/adobe/PlasticMedicationContai
acidosis and Fanconis syndrome due to degraded nerBMP.pdf. (Accessed March 20, 2007).
tetracycline. Br Med J (Clin Res Ed) 59. Rubinstein L. Operating unwanted medication
1981;283:1576-7. collections a legal & safe approach.
51. Fulop M, Drakin A. Potassium-depletion syndrome http://www.nerc.org/adobe/setting.up.draftFINAL.pd
secondary to nephropathy apparently caused by f. (Accessed March 20, 2007).
outdated tetracycline. New Engl J Med 60. Product information for Tequin. Bristol-Myers
1965;272:986-9. Squibb Company. Princeton, NJ 08543. January
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caused by degraded tetracycline. Arch Intern Med
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53. Hemstreet BA. Antimicrobial-associated renal
tubular acidosis. Ann Pharmacother
2004;38:1031-8.
Cite this Detail-Document as follows: Proper disposal of expired or unwanted drugs. Pharmacists
Letter/Prescribers Letter 2007;23(4):230401.
Subscribers to Pharmacists Letter and Prescribers Letter can get Detail-Documents, like this one, on any
topic covered in any issue by going to www.pharmacistsletter.com or www.prescribersletter.com
Proper Disposal of Prescription Drugs
O ffi c e o f N a t i o n a l D r u g C o n t r o l P o l i c y February 2007
Federal Guidelines:
Take unused, unneeded, or expired prescription drugs out of their original
containers and throw them in the trash.
Flush prescription drugs down the The FDA advises that the following drugs be
toilet only if the label or accompanying flushed down the toilet instead of thrown in
patient information specifically instructs the trash:
doing so (see box). Actiq (fentanyl citrate)
Daytrana Transdermal Patch (methylphenidate)
Take advantage of community Duragesic Transdermal System (fentanyl)
pharmaceutical take-back programs OxyContin Tablets (oxycodone)
that allow the public to bring unused Avinza Capsules (morphine sulfate)
O ffi c e o f N a t i o n a l D r u g C o n t r o l P o l i c y
7 5 0 1 7 t h S t . N W, Wa s h i n g t o n , D. C . 2 0 5 0 3
p (202) 395-6618 f (202) 395-6730
w w w. Wh i te Ho u s e D ru g Po l i c y. g ov
Proper Disposal of Prescription Drugs
O ffi c e o f N a t i o n a l D r u g C o n t r o l P o l i c y February 2007
Ask your
pharmacist for a copy
Federal Guidelines: of this page!
Flush prescription drugs down the The FDA advises that the following drugs be
toilet only if the label or accompanying flushed down the toilet instead of thrown in
patient information specifically instructs the trash:
doing so (see box). Actiq (fentanyl citrate)
Daytrana Transdermal Patch (methylphenidate)
Take advantage of community Duragesic Transdermal System (fentanyl)
pharmaceutical take-back programs OxyContin Tablets (oxycodone)
that allow the public to bring unused Avinza Capsules (morphine sulfate)
O ffi c e o f N a t i o n a l D r u g C o n t r o l P o l i c y
7 5 0 1 7 t h S t . N W, Wa s h i n g t o n , D. C . 2 0 5 0 3
p (202) 395-6618 f (202) 395-6730
w w w. Wh i te Ho u s e D ru g Po l i c y. g ov