UKC

I’m off on a trip soon and may (hopefully not) need some altitude drugs. I’ve have just had a dig around in my 1st aid box, I found a load of dexamethasone and Diamox tablets as well as some liquid dexamethasone – all of which went out of date in 2007 – does anyone have any idea if these will still be effective?
Thanks
Tom

In reply to ebdon:

There is a reason for the "use by date" on drugs.

OK you might get away with a month or two past the date, but 8 years........!?

In reply to Trangia:

Im sure I remember reading somewhere that the us army did some tests on out of date drugs and many where fine for years (but I might have made this up) i was just wondering if any one had had any medical knowledge on this

In reply to ebdon:

Sell them to a Caver

In reply to aultguish:

Someone told me that the problem with out of date stuff was not that it became dangerous or toxic but that it may simply become less effective. I know that less effective could lead to dangers !

Note:- I have no medical training!!!!!!

In reply to ebdon:

Personally I would risk a few months but not several years.

In reply to marsbar:

Dexamethasone and acetazolamide are really cheap, so you would be better off getting a new supply via a private prescription from your GP (if you're in the UK)

In reply to ebdon:

Drugs generally denature, the rate at which this happens being published very rarely. I'd replace (at very little cost).

Lowly MRCVS, using dex on a daily basis.

In reply to Martin not maisie:

Good advice, cheers

In reply to ebdon:

After a visit to my GP today apparently they won’t prescribe me anything due to ‘potential liability issues' it would seem they are happy to let me die a slow lingering death rather than risk any possible litigation, hmmmmm.....
so alas might have no choice but to rely on the old ones.

In reply to ebdon:

After asking me a few questions and doing a blood test my gp was happy to give me a private prescription for Diamox.

In reply to mypyrex:
Good for you! I don't suppose you have any left over?
I got the impression this was a the first time theyd had such a request apparently they may have considered acetazolomide if I had medical training (which sort of defied the point) but there's no way theyd give me Dexamethasone

In reply to ebdon:

After printing out stuff found online (and showing this to my Doctor) about the use of Acetazolamide (Diamox) as an preventative measure for Altitude sickness I secured a private prescription for this drug. The trouble is that it is not registered for that purpose in the UK (I believe it is a recognised usage in the US). I agree that Dexamethazone or Nifedipene are likely to be impossible to acquire through a GP as they are potent steroid based drugs with more chance of ill effects that could lead to medical professionals getting anxious about being sued. Go armed with some information and try another GP if your own is unresponsive, with a little determination Diamox should be available. If that doesn't work it is quite often available over the counter at pharmacies in country (I have seen it for sale in Kathmandu and La Paz for example).

In reply to ebdon:

Nifedipine is a calcium channel antagonist not a steroid. Little bit more serious from a toxicity point of view.

In reply to The Ivanator:

Cheers I did go armed with jagged globes excellent medical procedures but to no avail might see how much going private will cost

In reply to ebdon:
Have you tried a NHS travel clinic? The one in Edinburgh does 12 doses for a tenner.

Al

In reply to ebdon:

A sensible itinerary and good hydration are the best assurances of avoiding Altitude related problems, although where rapid height gain can't be avoided Diamox has its uses. As I understand it Dexamethazone and Nifedipene are more often used to try and stabilise a casualty for evacuation than as preventative measures.
I'm not a chemist, so am sure the description of Nifedipene above is correct. I have carried all these drugs when leading students in High Altitude ventures abroad (up to just over 6000m) but fortunately have never had cause to administer anything more serious than Diamox.

In reply to The Ivanator:
I totally agree I don't what this stuff for use as a prophylactic (which frankly I regard as cheating) its for emergency use if we are traped high due to weather etc and can't descend. Ive always carried diamox, dex and nifepenadrin on big trips but fortunately have never had to use them

In reply to ebdon:

Unfortunately not

I think it was the first time my gp had had such a request; in fact I think it was the first time he'd come across anyone going to high altitude. I did a lot of googling and passed a lot of info on to him for which he was grateful. I got the impression that he was very interested in high altitude medical matters and had not had to deal with it before. Hopefully we both helped each other.

In reply to ebdon:

I found my GP practice had a policy of not prescribing Dex and Nifedipine even though they were sympathetic to my reasons for wanting them, litigation concerns I presume.
They would give me diamox but that's preventative and can mask the symptoms of odema anyway and its not much use when the sh*t hits the fan.

I emailed somebody at the BMC who gave me a list of doctors who are members of Medex
http://www.medex.org.uk/
I emailed the nearest GP on their list and he gave me an appointment and prescribed me the drugs and gave me run down on when to use them etc. His view was that whilst they are powerful drugs with potentially serious side effects, if you need them and haven't got them you'll die anyway!
Good luck.

In reply to pec:

Diamox (Acetazolamide) does not mask the symptoms of altitude sickness. It is a pretty safe drug if taken as instructed. Dexamethasone can, and is a potent steroid and it should not be used without clear instruction from a medical professional (whether direct or preemptive advice).

Diamox speeds the natural acclimation process and improves sleep at altitude, although may well not be necessary with a sensible ascent profile. It can be taken at a higher dose to help with severe AMS (and potentially in HAPE and HACE, along with nifedipine and dex respectively), but in combination with descent. It absolutely does not mask any form of mountain sickness; in fact it should be strongly considered in these circumstances, with descent being the next step if no improvement.

I suspect most Drs with independent prescribing rights on the list would have a liberal policy towards prescribing Diamox, but would want a bit more information before supplying nifedipine and dex (probably a few questions and a chat).

Cardi
Dip Mtn Med

In reply to Cardi:
Perhaps my information is out of date but I have certainly read that diamox can mask symtoms of altitude illness, not just random stuff I've found on the net but in books.

In reply to pec:

Whilst the jury is out on whether it is worth taking prophylactically, there is absolutely no evidence that it masks AMS. I am still highly suspicious that what you have read relates to Dexamethasone.

The mechanism of action of Diamox has been extensively studied in physiology journals, and the side effects are well documented. Altitude textbooks, journal reviews and consensus among the UK mountain medicine community share the view that it does not mask AMS and in general agree that it has a role in treatment of altitude illness.

The tingly fingers and toes would be my personal reason for not taking it routinely.

In reply to ebdon:

My Diamox supply was bought in 1992 in Pakistan.

I last used it in the Margarita Hut in 2013. Was absolutely fine. I was up and plodding around at 4500m without any symptoms whatsoever (apart from the tingles) while my 5 roommates all rolled over, felt sick and went back to sleep with headaches.

I'd risk your old supply.

But I'm not a medic - just a user!

In reply to ebdon:

Short answer: Return them to you local pharmacy so they can be appropriately disposed of and buy some more privately if your GP won't prescribe them. (not of www.buyanydrugs.com).

Pharmaceutical shelf lives are limited based on proven stability windows, which are extended as much as possible, based on the drug meeting its specification. Sometime shelf life is limited by factors that affect the active pharmaceutical ingredients rate or extent of release. i.e. how much dose you end up getting. Usually this means you get less dose over a longer period, but for modified/extended release tablets it could mean you get the full dose quicker and potentially end up over dosing. Most commonly though it's degradation of the active ingredient. Sometimes the products of this degradation are perfectly harmless, others, they're perfectly toxic/mutagentic/carinogenic/tetrogenic/genotoxic/just plain nasty.

In reply to Cardi
You're obviouisly more up to date than me, it could have been up to 15 years ago when I read that and what I read could have been written some time before that and clearly medical opinion changes. It may not even have been a widely held opinion at the time, just that there was "some indication that it could mask symptoms" or something along those lines.
If I remember rightly the mechanism was something like by taking it to speed acclimatisation, people felt more acclimatised than they actually were because they weren't getting all the normal symptoms and so would push on upwards faster than they really should and then when the symtoms caught up they were higher than they were really ready to be and so could get caught out.