Mail order drugs tainted by heat

Mail-order prescriptions exposed to excessive environmental heat, such as temperatures found in mailboxes and car interiors, may become significantly less effective for patients.

Formoterol, a common inhaled asthma medication, delivered less than half of its expected dosage and showed significant physical changes after being exposed to 150[degrees]F for four hours. "Inhaled medications are calculated to deliver a specific dosage for each use. Extreme temperatures can affect medications in just a few hours, causing them to deliver inaccurate dosages," asserts physician Gregory T. Chu, Carl T. Hayden Veterans Affairs Medical Center and Banner Good Samaritan Medical Center, Phoenix, Ariz. "For patients with respiratory conditions who rely on their medications to relieve acute breathing difficulties, inaccurate medication dosage can lead to serious medical consequences."

Researchers tested how heat affected powder-filled formoterol capsules and its effects on drug delivery. Formoterol capsules were heated in their original packaging for four hours at 150[degrees]F. similar to the temperature found in the inside of an Arizona mailbox. Capsules were removed from their packaging and dispensed into a filter tube using the inhalation technique and device provided by the manufacturer. Weights of the filter tube pre-and post-dispensation were obtained to calculate simulated drug delivery. Results showed that filter weights of heated medications were less than half of those unexposed to heat, showing that a significantly less amount of the drug had been dispensed after it had been heated. In addition, capsules exposed to heat were grossly distorted in appearance and showed visible clumping.

The mail order sector represents an estimated 17% of retail prescription drug sales in the U.S., totaling more than $35,000,000,000 in sales. "Mail-order prescriptions have become increasingly popular among patients in the last few years. However, many patients do not realize that most medications have storage requirements regarding exposure to excessive temperatures," says study co-author Richard A. Robbins. "We strongly advise that patients avoid exposing medications to the extreme heat found in mailboxes and car interiors and inspect all mail-order medications prior to consumption."

According to researchers, asthma medications and other prescriptions delivered in the extreme-heat states of the Southwest are not the only medications that necessitate monitoring. Any situation that exposes a drug, particularly those with gelatin capsules or containing powder, to excessive temperatures may put a patient at risk for consuming altered medication.

"With the increasing popularity of ordering medications by mail, retailers who fill prescriptions must place additional focus on the proper packaging and shipping requirements for at-risk medications," concludes Paul A. Kvale, president of the American College of Chest Physicians. "It also is important for patients to review manufacturer storage directions to ensure that medications are not exposed to extreme temperatures, either inside or outside the home."

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