Mail order drugs, those left in hot cars lose potency

You can go to jail if you leave your child or animals in a hot car.

You can go to your grave if you leave your medications there.

With 110-degree-plus heat enveloping Las Vegas, it's time -- actually well past time, according to pharmacists -- for people to understand that medications lose their potency in excessive heat.

"If, for example, you're taking blood pressure medicine for hypertension and it's exposed to high temperatures for some length of time, you're at risk for stroke because it's not going to work as well as it's supposed to," said Iain Buxton, a professor of pharmacology at the University of Nevada School of Medicine.

Nearly 145,000 people die of stroke each year in the United States. No statistics are kept on how many died because their blood pressure medicine had been compromised by either high heat or extreme cold.

Buxton said the message that should be heard loud and clear from the public is this: After you pick up your prescription at the drugstore, either carry it with you into a climate-controlled environment or take it right into your air conditioned home.

"You certainly can't expect a liquid antibiotic that you get for a child to be effective for him after it's been in excessive heat for hours," he said.

Mail order drugs, which represent nearly 20 percent of retail prescription drug sales in the United States, are also a real cause for concern, Buxton said.

The truth is, he said, that prescriptions that "spend more than a couple of hours at high temperature are at risk for adulteration. ... It's a much better plan to pick up your drugs at the pharmacy in Las Vegas."

If you do have to have mail order drugs, Buxton suggests that something be worked out with a neighbor.

"You just can't risk having them sit outside all day," he said.

Buxton said if you have left medications in the car for even two hours in the high heat, take them back to the pharmacy. Your insurance company might not pick up the additional expense, but it's better to pay extra money than to pay with your life, he said.

If medications have been in your mailbox all day, Buxton suggests you call your mail order pharmacy "to work something out."

Amy Peak, a clinical pharmacist and director of Drug Information Services at Butler University in Indiana, said studies have shown that during extreme heat, temperatures can hit as high as 158 degrees inside mailboxes and reach 163 degrees in cars.

Yet, Peak said, the nonprofit United States Pharmacopeia Convention Inc., which sets standards to ensure the quality of medications that are enforced by the Food and Drug Administration, recommends that all medications be protected from excessive heat, which is defined as 104 degrees. But she said only a few medications are ever studied at temperatures above 86 degrees.

U.S. Pharmacopeia recommends that most drugs be stored at "controlled room temperature," an average of approximately 77 degrees, with "brief deviations" allowed up to 86 degrees.

Shipping trucks, warehouses, pharmacies and shipping docks are subject to controlled temperature standards set by U.S. Pharmacopeia Convention. They are allowed two-hour deviation periods in temperature as the drugs are transferred from one location to another.

Studies have shown, Peak said, that Albuterol inhalers used by those who suffer from asthma can burst at temperatures above 120 degrees. Concentrated ephinephrine, used to help those in cardiac arrest, lost 64 percent of its original potency when exposed to cyclical heating. Lorazepam, an anti-anxiety medication, decreased in effectiveness 75 percent.

Peak also said excessive heat will alter insulin, making it less effective and far more dangerous for diabetics. Also, she said extreme heat might make the volume of insulin inside the vials expand, possibly causing the vials to break.

Thyroid hormones exposed to excessive heat will be altered and result in inconsistent doses, she said.

If medications must be delivered by mail during high heat, she said, then try to have it done overnight with either the patient or a friend available to pick them up immediately.

Peak said to keep medications in the climate-controlled passenger compartment, not in the trunk.

Robbie Jacobs, a Walgreens pharmacist and market director, said studies continually show that medications exposed to high heat "break down and may not work at all."

Though Walgreens offers mail order prescriptions, he said it's better for people to go to a pharmacy.

"The major reason that people go mail order is to get a 90-day supply, and that's offered now at pharmacies," he said.

Paul Oesterman, a pharmacist with the Roseman University of Health Sciences in Henderson, said mail order pharmacies do try to keep some of their drugs cool through packaging, including ice packs. "They know there is liability involved," he said.

But Buxton said mail order pharmacies do little to package the majority of their drugs to withstand high heat. And he said pharmacists letting drugs go through the mail to destinations where there is high heat could end up in trouble because they know they're not supposed to put people in harm's way.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.