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    Should We Use Expired Drugs When Necessary?

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    Name:
    ++++SHOULD WE USE EXPIRED DRUGS ...
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    Final Accepted Manuscript
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    Author
    Iserson, Kenneth V.
    Affiliation
    Department of Emergency Medicine, The University of Arizona
    Issue Date
    2021-03-19
    Keywords
    drug expiry date
    drug safety and stability
    Food and Drug Administration
    informed consent
    patient welfare
    
    Metadata
    Show full item record
    Publisher
    Elsevier Inc.
    Citation
    Iserson, K. V. (2021). Should We Use Expired Drugs When Necessary?. The Journal of Emergency Medicine.
    Journal
    Journal of Emergency Medicine
    Rights
    © 2021 Elsevier Inc. All rights reserved.
    Collection Information
    This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.
    Abstract
    Background: Medication shortages commonly occur in resource-poor settings. The relatively short expiry dates on many medications exacerbate these shortages, often requiring clinicians to choose between providing needed medications to the patient and violating rules governing drug dispensing. Case Report: A patient presented to an emergency department in a resource-poor setting with an acute anterior myocardial infarction. Standard of care required using thrombolytics due to the unavailability of percutaneous coronary intervention. The only available thrombolytic, streptokinase, was 2 weeks past its labeled expiration date. The physicians faced the ethical dilemma of violating regulations and using the medication vs. failing to provide the patient with the best available therapy. Discussion: The physicians in this case needed to weigh their obligation to improve the patient's health against the professional danger to themselves, their colleagues, and their institution for violating a health care regulation. The information they needed to make this decision and to provide the patient with factual informed consent requires an understanding of the myths, regulations, and science surrounding drug expiry dates. Two myths about medications pervade both the professional and lay communities—that they are uniformly effective and that medications taken past their expiry dates may be ineffective or even harmful. Scientific studies have demonstrated that both are false. Conclusions: Ethically, physicians have a duty to place their patient's welfare above their own self-interest. In a time of increasing medication shortages around the globe, clinicians need to push rule makers to synchronize drug expiry dates with scientific findings. © 2021 Elsevier Inc.
    Note
    12 month embargo; first published online 19 March 2021
    ISSN
    0736-4679
    DOI
    10.1016/j.jemermed.2021.02.002
    Version
    Final accepted manuscript
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jemermed.2021.02.002
    Scopus Count
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    UA Faculty Publications

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