Expired PrEP?

[HappyPozBoy]

Does expired PrEP still work? A friend of mine stopped taking PrEP as he wasnt having sex. He was still collecting the scripts and has a few months worth. I had a look and on some of the boxes they are past the expiry date. Curious if they'd still work and provide the same level of protection or not? 

[BBArchangel]

Throw out any unused Prep that’s older than six months. Until six months it should still be safe. 

[ErosWired]

Name a product that you would buy off the store shelf if you saw that it was past its expiration date.

….

still waiting

…

Exactly.

‘Expired’ in the case of medicine can generally be taken to mean ‘no longer fully effective’ at best, or potentially has begun to break down into other compounds. Using PrEP that is no longer fully effective means increasing your chance of contracting HIV, or of exposing the HIV virus to a weakened drug that may allow it to survive and build tolerance.

Play Russian roulette much? The longer the med is out of expiry, the more bullets you put in the revolver.

[barebackbro]

@HappyPozBoy, the PrEP doesn’t sound useful to you regardless. Am I missing something?

[Close2MyBro]

Most drugs have potency long after the due date. I had to switch my PREP regiment because I was having kidney problems with Truvada and the doctor asked me if I had any of it left if I could bring it in so they can donate it to health clinics. They can't legally sell it beyond the expiration date but they knew that it was till potent past its expiration date so they would donate it for health clinics to distribute for free to patients who could not afford the medications.

There have been numerous studies about the efficacy of expired medications and the majority of them have shelf lives way beyond their expiration date. They're not tested beyond a 3 year shelf life. He's one study example: [think before following links] https://www.npr.org/sections/health-shots/2017/07/18/537257884/that-drug-expiration-date-may-be-more-myth-than-fact

 

[cub84]

So yes, for tablet medications (i.e. solid pills like truvada) then many drugs will last notably beyond their expiration date, but over time their effectiveness reduces. The medication is a stable chemical compound that either requires a reaction with water to activate or disolve the outer coating of the tablet - background mositure in the air will eventually cause this reaction to occur, which is something to consider if the medication is contained in a bottle/jar rather than in self-contained "blister packs" where each pill is separately sealed. The stability of the medical compounds and their resistance to background mositure will partially determine the choice of packaging by the manufacturer. As already mentioned by others this is why free clinics, and those in developing countries, will often use medicines past their expiration date because they are still likely to be effective, but certainly aren't guaranteed to be as effective. There's also consumer/health protection rules and regulations, as well as corporate interests from pharma companies to stop you stockpiling. I'd wager that many folk have almost certainly grabbed a couple of out of date paracetamol/acetaminophen when they've had a headache and its still worked.

Liquid based medications (i.e. either a straight liquid in a bottle that you pour or liquid medications contained in a small swallowable capsules) are naturally more volatile compounds, and so can be much less stable long-term but again it depends on the compound itself and how its been stored - cough syrups are largely the same medications as in cold/flu tablets just in a liquid solution that's mainly sugar and will probably still work years later, whereas something like insulin has a very definite short-term window of effectiveness.

For both Truvada and Descovy the information published by Gilead ([think before following links] https://www.askgileadmedical.com, search the drug name and "stability") says that when either medication is provided in a bottle they include a "silica gel desicate" (think those "DO NOT EAT" sachets that you get in some packaging boxes). Descovy is also available in a blister pack, and again Gilead includes within each blister cavity some form of desicant, which will protect the medication against mositure. They also publish some information about in-house stability tests but these are largely testing extreme circumstances (e.g. high/low temperatures, different humidity conditions). These are also stability tests once the medications have been opened, not tests of the long-term stability of medication that has been kept unopened in its original packaging.

Not that anyone should be taking random medical advice from an unqualified random stranger on the internet...

[BootmanLA]

To add to what Close2MyBro wrote (and endorsing what cub84 noted): medications in sealed original bottles (just like blister packs) are more likely to retain potency than the typical supply put into a plastic amber prescription bottle. Historically speaking, pharmaceutical companies would produce bottles of 100 or 250 tablets or capsules for pharmacies to use to dispense prescriptions - especially for medications that moved quickly and which were dispensed in small quantities, like a 7-day supply or the like.

For longer-term maintenance drugs, like PrEP and HIV treatment, some companies have gone to supplying 30-tablet sealed bottles, so that the pharmacy can simply label the original bottle and dispense that instead of opening a larger container, counting out 30 pills, and putting them in the little amber bottles we're used to getting. (Some drugs are also dispensed in 90-day supplies the same way, though HIV drugs, because of cost, are typically done in smaller batches.)

If the medication is still in the manufacturer's packaging (as opposed to a pharmacy's), and it's still sealed, it's almost certainly good for some period after its official expiration date, particularly if it's been kept in a cool, dry environment. But there's no absolute certainty as to *how long* the medication is still good. 

If the medication is in a pharmacy-provided bottle, it's less certain. Something like a pain killer I'd consider safe longer than, say, an antibiotic. I'd put HIV medication - whether for prevention or treatment - in the latter category. Couple of months past the expiration? Probably not an issue at all. A year or two? More problematic.

[funpozbottom]

15 hours ago, ErosWired said:

Name a product that you would buy off the store shelf if you saw that it was past its expiration date.

Apparently, you've never been low income and had to shop at the dollar store. That said, there is a big difference between picking up an expired tube of tooth paste versus buying something that could potentially save your life -- like garlic powder. When protecting against vampires, you want to make sure that stuff is fresh.  And having said that ...

 

19 hours ago, HappyPozBoy said:

Does expired PrEP still work? A friend of mine stopped taking PrEP as he wasnt having sex. He was still collecting the scripts and has a few months worth. I had a look and on some of the boxes they are past the expiry date. Curious if they'd still work and provide the same level of protection or not? 

The issue of drug expiration dates is confusing because there are both use-by and sell-by dates. For most dry medications sold in original packaging, the drug "expiration" date on the bottle is actually a "sell by" date. Drugs can legally be sold up to and including that exp. date. Once opened, most medications are supposed to be used within one year. So, if you were looking for an actual "expiration," it would be one year after the date on the package, or one year after it is opened, whichever comes first.

That raises the question of: What does "expiration" actually mean? 

The expiration date  is a rough estimate of how long a medication is guaranteed to maintain at least 90% of its original potency. Since there are a lot of things that could effect a drug's potency, this isn't exact. And, since drug companies don't want to be sued for selling ineffective meds, the date picked is usually well before a drug actually loses potency.

I read an article about a study done on a few bottles of old meds that had fallen behind a counter at a drug store and were found when the store was torn down. They were bottles that had been untouched for over 50 years. Even after that amount of time, they were all (if I remember correctly) over 70% potency, and would be at least somewhat effective. The point of that anecdote is that, if stored properly, it takes a long time for medications to lose potency.

That brings up the question of how effective PrEP would be if it had a lower potency.  There's no real way to tell. There are a lot of variables, like, how far past the use by / sell by dates, whether the bottle was opened, and how it was stored, but my personal opinion is that it would probably work fine if you took it daily. (I base that on studies showing that every other day  and 2-1-1 and other on demand strategies are as effective as a daily dose strategy. However, you shouldn't base your health decisions on my opinion.) 

So, to round out my opinion, I'd say, toss any open bottles that have been sitting around for more than a year.  Unopened meds should still be good but should be used up quickly. You could improve effectiveness by restarting the prescription and alternating lots. 

If all that's too much of a hassle to deal with, tell your friend to get a new prescription and consider donating any unopened packages of meds to a charity that sends them to areas in need.

[TaKinGDeePanal]

15 hours ago, barebackbro said:

@HappyPozBoy, the PrEP doesn’t sound useful to you regardless. Am I missing something?

It could be that his friend is not a member of this site - and he is asking on his behalf.

[cuckie]

On 12/27/2023 at 9:24 PM, HappyPozBoy said:

Does expired PrEP still work? A friend of mine stopped taking PrEP as he wasnt having sex. He was still collecting the scripts and has a few months worth. I had a look and on some of the boxes they are past the expiry date. Curious if they'd still work and provide the same level of protection or not? 

Most likely. The expiration date is the point the product is calculated to be 80% effective. (FDA method) there's some things with arbitrary dates as FDA requires an expiration. 

Generally theres a ton of life left in meds, Mexico clinics and missions get a ton of our expired meds and they work just fine. That's not the same for everything (obviously)  and changes if a package is opened and there's environmental exposure. same with thermal cycling. 

[HappyPozBoy]

On 12/29/2023 at 4:59 AM, TaKinGDeePanal said:

It could be that his friend is not a member of this site - and he is asking on his behalf.

it was hence why i said. people must have missed it lol. 

[miticax]

hi folks

I take prep on rare occasion, and I'm still left with a few pills from a bottle that expired oct 2023.

I read somewhere maybe even here that anyway once you open the bottle those are good for 1 year anyhow, so I'm just looking for a confirmation that those pills are good to throw away.

this was ricovir-em which worked out fine for me, now I have to resupply. would you recommend anything better or stick with this?

happy breeding!

Edited February 13 by miticax

[viking8x6]

4 hours ago, miticax said:

I'm still left with a few pills from a bottle that expired oct 2023

If it still has the dessicant pack inside and hasn't been exposed to extreme temperatures, they should be OK to use.

You might want to consider switching to Emtricitabine/tenofovir alafenamide if it's available where you are (easier on the kidneys). Or there's the bimonthly injection (cabotegravir).

[JamesL100]

If pills are issued with a year or more on them, the efficacy won't suddenly drop shortly after 'expiry date'. The pharmaco's err on the side of safety.
(Same with long-dated dried goods. Unlike, say, a bottle of milk stating good for a week which you wouldn't drink much past its expiration.)

[inmyass262]

My understanding pertaining to Truvada is humidity is the environmental factor that degrades it the most when stored at room temperatures. When the 30 day supply bottle is opened they recommend not to use it after 6 weeks. 6 months for unopened bottles that still have the seal intact. This is strange because the expiration date is almost 2 years out on my most recent bottles of generic Truvada. Either way, humidity and temperature are the enemy and if you use it on demand it might not hurt to change the desiccant out each time you remove the pills for 2+1+1 dosing especially if it might be a while in between hookups.