Food Allergy Support

So what do you have?


I'm curious-- and I also have a method to my madness-- I appreciate anyone weighing in on this one. 

I'm seeing how many stashed, ideally stored (or nearly so) epipens our community might have on hand, and how many of the OLDEST of them. 

Nobody has ever really done a study of how long the epinephrine actually lasts under reasonably good storage conditions.  All anyone really knows is that they seem to still be in the therapeutic range for about 24 months past expiry, by and large.

Beyond that, though, it's not clear what the timeline of degradation actually IS.


I know some people who have the ability to publish this.  Not kidding.

ugh, I usually have a slew, but when I switched to Auvi I ditched them. Then when I got epi replacements, I decided to test fire all my Auvis (they were all just fine btw  :rant:).

But I have a set that expires in January and 2 sets that expire in February. Stocked up when I hit my out of pocket max about a year/year and a half ago.

With the legalities of epi's changing hands and going through the mail and the uncontrolled (i.e. unverifiable) storage conditions...are you polling to gauge just how far past expiration your friend should test based on how long people tend to save their epi's? This sounds like a very helpful but unfortunately lengthy study to do.

Ummm, do you want them, to test?  I am embarrassed to post how old some are.  I just have not been to the town hall to drop them in the sharps box.  Let's just say, if they were needed for study, and I could legally deliver them, I would be happy to be rid of them!! 

Yes, this is EXACTLY what I am wondering, Becca-- I have, being a chemist, a lot of contacts that COULD quite readily do this study.  And I can tell them how, using the USP HPLC-UV method.  I also happen to know a couple of undergraduates in stats/actuarial science, and an allergist with ties to Sinai.  So this really, really could happen. 

If you DO have old autoinjectors-- PLEASE keep them a bit longer.

The last such study was published a very very long time ago, and frankly, the numbers were far too small to say much. 

http://www.ncbi.nlm.nih.gov/pubmed/10808186?dopt=Abstract (http://www.ncbi.nlm.nih.gov/pubmed/10808186?dopt=Abstract)


My fond hope is that we can show that at least for a year or two, parents COULD have a bit more peace of mind re: expired sets as "home" sets, or for backup places other than schools.  The expense issue is SO severe now that parents are going to be making those choices anyway-- they might as well know what kind of risk it is.


For the record, I still have DD's very first set-- from 2000.  I also have at least a few of the other pre-2004 sets.  I've got a stash of them, frankly.  At least two dozen.  Probably more like three.  They range from about 2003 through expiry earlier this year.  I'm not sure that we've ever had one stay at super high temperatures for anything more than a few hours (in a hot car a couple of times).

I'm also guessing that other parents who are super-compliant have stashes.  My allergist could probably elicit those, and maybe enlist other professional contacts to do so.   

This is DEFINITELY publication-worthy.  I'm not especially territorial of the idea, either-- I just want SOMEONE to do it-- soon.

I have 2012, 2014, 2015 that we will use to train and practice with.  Some could definitely have been exposed to heat, but not sure.

Since I keep forgetting to dispose of the used ones that we've practiced with I have some that date prior to 2012.

I used to keep them specifically for practice, to offer to nurses at school, and the transportation department for it.  After saving a bunch, they no longer wanted them, so I just had them.  I would honestly be happy to be rid of them now.  They are taking up space.  I don't particularly like having gobs of meds around that are not essential.  Though, I have considered that they could provide handy self defense in a pinch!

I would not know which ones may have been damaged due to heat or freezing, but a few have-not many. 

Ugh! I wish you'd asked three weeks ago. I cleaned out the medicine closet and dumped an entire bag. I think it had every expired epi pen we've ever owned that wasn't used (either for real or for training). I know there were some in the old flimsy, yellow plastic tubes in there.

Yeah-- and honestly, I think that it might be just as well to include "general daily use and storage" in the hands of end-users, anyway.

Because real life ISN'T "ideal."

So for clinicians and parents-- while yeah-- "replace them at expiry" is still the going advice-- the reality is that some people CAN'T. 

Is it truly better to try to train a babysitter to use a vial and syringe?  Or to hand her a 2yo epipen?


I'm also recalling that expiry USED TO BE 24 months, back in the day.  Er... Dey.  ;) 

So did Mylan change the expiry in 2010 when they retooled the device?

I'd LOVE to know that.  I'd love to know the justification, too.  If there even was one.  I begin to suspect that there wasn't-- that it might have been profit motive, which would be the lever that lawmakers need with Mylan, since straight-up price gouging isn't technically illegal in the US.  But that kind of market/demand MANIPULATION definitely IS.


If someone can, say... SHOW that there is statistically NO break in the concentration curve between the devices at the time when the expiration was shortened... well then.

I only keep the last set of expired ones (four at a time, usually) as extreme worst case scenario spares.  Then they get returned to the pharmacy for disposal. I don't bother to test them on oranges since I know all-too-well how they work in real life and have four trainers that work just as well.

When they replaced my Allerject I got 18 months on my new EpiPen, much to my delight.  Perhaps the expiry dates haven't changed so much as the processing, handling, and storage times?

I am very curious about this study too.  Very.  Not because I cannot afford replacements, but because I would love to have spares that were truly viable should they be needed. I can think of too many uses for expired yet viable EpiPens - not all would be legally sanctioned, but helpful to those in need or for use as stock Epi in places that wouldn't otherwise have any. 

DH was cleaning out cabinets yesterday and said he found epis from 2012. He put them in the basement for the apocalypse. I'd be willing to donate them to science.

When we moved here in 2012 I got rid of quite a lot of older Epis. That's the first time I actually saw yellow liquid.

And I do keep lightly expired Epis around for use as backup. I think that's what's in my desk right now. I will probably replace them later this fall or winter. 

CM - I found one old epi in a bag in my closet that expired Sept. 2012 (prescribed June 2011, so just over a year before expiry).  It's just starting to discolor.  It lived in my purse, so most likely kept at room temp except for waiting for the hot car to cool down.  Let me know if you want it.

Will there be a prize for the owner of the oldest epipens?  I am going to go dig them out now!

 :hiding:

We are *such* packrats around here.  Pure laziness on my part.   :misspeak:

It sounds as though you and I are both in the running, Becca. 

Lazy here too.  Our pharmacies don't take them back, and years passed before I found out there is a sharps box inside our town hall.  Now, I feel weird marching in there with gawdknowshowmany of them and jamming in the box.  I'd come up with a plan to drop 4 each week or two, but still not gotten to executing it. 

So, just dug them out of the closet.  Oldest is Sepember, '01!  Those would likely be her first ones, given her year of birth is 1999. Then, a gap of a few years.  Maybe gave some to nurses or preschool for practice.  I've practiced with a few too.

So, embarrassed to say, 80 pens.  A few were Ds's.  They way 10.8 pounds, according to dd. Ds calculated $40,000 at the price of $500 each, but actually, it is $500 per twin pack, no?  But, seriously, think of that expense at today's prices, over the life of a child until they can purchase their own. Fortunately for us, most of these were a modest copay compared to the last couple of years.  I have the choice to get 3 sets by mail for $30(it may have changed), or for $300 each twin pack at CVS.  Seriously.  So, I'll refill in October.  Lowest risk of extreme temps.

Saw this & thought you might be interested CM:


Tweeted by @Donteatmagnets
Julie Brown MD

QuoteEpigate came a few months too soon for our systematic review of epi stability stored in syringes. Scrambling to get it publication-ready.

------


We have a few recently expired (I think).

Thanks-- I might contact her if it looks like I can do this.  It'll be two weeks until I have a home base to figure that out. 

:) 

Geez.  We have big bag full (maybe 40?) . . . just couldn't figure out where to get rid of them and didn't use all for practice.

We have 50+ dating back many years.  We don't need that many for training and with two kids who carry them and have them at school, too, we have a LOT.

Oh man, I only have maybe 4 expired ones.  Why would you keep that many expired ones? 

Disposing of them can be a challenge . . . . we never felt we should put one into regular trash, even if used.

Don't pharmacies everywhere take back medications and sharps for disposal?

I recently brought a bag of old pills and liquids, both Rx and OTC along with epi-pens going back to about 2012. They were not accessible in an emergency.

I did recently discover that all 3 epi's we are carrying were expired.  :misspeak: And there were no refills on our scripts at the pharmacy. The day after I picked up new ones I found an unexpired one in the cupboard.

So currently I have 3 expired in 2015, 1 will expire in 2016, and 2 are good until 2017.

Quote from: spacecanada on August 31, 2016, 07:38:04 PM
Don't pharmacies everywhere take back medications and sharps for disposal?

Nope.  I called around, and none here would take them.  I only fairly recently, relative to how long we have been getting epipens, discovered that our Town Hall has a sharps disposal box. 

Forgive me for party-pooping, but in spotting a potential boo-boo... Can a controlled substance be transferred via USPS (or private delivery) even if expired?  Not to mention across state lines.

Actually, name, I questioned the same in my initial response.  I had mentioned, if I could legally get them to the right person, I would be happy to help, but not sure that I can.  There will also be much unknown about the storage of the expired pens, especially since expiry. 

Quote from: catelyn on August 31, 2016, 05:30:44 PM
Oh man, I only have maybe 4 expired ones.  Why would you keep that many expired ones?

I'm happy to be rid of them but pharmacies won't take them and just found out the expired drug round up for my county won't either.  What am I supposed to do with them?

My pharmacy takes them back so I stay on top of them and don't keep anything but the most recently expired set at home as a back up.

YKW, can you contact the pharmacy to ask what they suggest? Or check if you can drop them off at the hospital for disposal in a sharps bin?

Our allergist's office takes them and puts them in their sharpes container.

This is what I'm wondering-- if our allergist could 'collect' them-- or a friend in a chem dept or pharmacology school.

That way there is a transfer to someone official, chain of custody can be arranged, etc. 

also-- this is NOT a 'controlled' substance via a drug schedule, so there is also that. 

In other words, I need NO license/approval to purchase epinephrine from Fisher, Sigma or anyone else. 

There seems to be some research on this, but vague.

https://www.washingtonpost.com/news/wonk/wp/2016/09/27/why-epipens-expire-so-quickly/?postshare=1991474999508059&tid=ss_fb (https://www.washingtonpost.com/news/wonk/wp/2016/09/27/why-epipens-expire-so-quickly/?postshare=1991474999508059&tid=ss_fb)

Quote from: CMdeux on September 27, 2016, 08:07:42 PM
This is what I'm wondering-- if our allergist could 'collect' them-- or a friend in a chem dept or pharmacology school.

That way there is a transfer to someone official, chain of custody can be arranged, etc. 

also-- this is NOT a 'controlled' substance via a drug schedule, so there is also that. 

In other words, I need NO license/approval to purchase epinephrine from Fisher, Sigma or anyone else.

That I can do.  I can make it rain... expired EpiPens AND Auvi-q in both dose strengths.  Bags of 'em at controlled temps.

I used to take them to allergist office.  they put in sharps container