In Orofacial Pain and Oral Medicine, many chronic conditions need permanent storage of medications since patients need to take the medicines for months, even for years. The prescription is usually granted once every 8 to 12 weeks when the patient is seen in a follow-up visit. Therefore, for weeks, even months, a patient needs to store the medication and keep it in the right place to conserve the effectiveness and durability of the medication. Some examples of these medications with the associated diagnosis are listed in Table 1.
Table 1: Some of the diagnoses in OFP and OM that could require long-term pharmacotherapy.
| Diagnosis | Medication | Frequent Dosage Forms |
| Trigeminal neuropathy | Gabapentin | Tablets/Capsules/Solution |
| Trigeminal neuralgia | Carbamazepine | Tablets/Capsules |
| TMJ Arthralgia | Nabumetone | Tablets |
| Oral Lichen Planus | Dexamethasone | Solution |
| Mucous Membrane Pemphigoid | Clobetasol | Cream/Gel/Ointment |
Note: The medication column shows examples of possible medications that can be prescribed for some of these conditions. It does not correspond to the absolute or unique medication used for the diagnosis.
Part of the prescriber’s responsibility should be to educate the patient on how to store medication and how vital this component is, almost as crucial as how to take the medication. Below are some essential recommendations for where to store medicines since the environment in which drugs are stored can affect their potency, durability, and safety.
Altitude and Humidity
– Altitude: At high altitudes, there are lower atmospheric pressures and, often, temperature fluctuations. This can cause medications to degrade faster if not stored properly. Following storage instructions specific to the medication type is essential, especially in locations with significant altitude variations.
– Humidity: The amount of moisture in the air and the humidity can severely impact medications, especially those in tablet or powder form. Moisture can cause drugs to break down chemically, leading to reduced effectiveness or even harm if the breakdown products are toxic. Unfortunately, many people store their medications in bathrooms, among the most humid places in the home. This is not the recommended location for most medications, as the hot and moist conditions can accelerate decomposition, rendering the drugs less effective or unsafe to use.
Heat and Sunlight Exposure
– Heat: Heat is a significant factor that can affect drug stability. Medications stored in warm environments, such as near stoves, ovens, or even in cars, can become less potent. High temperatures can break down the chemical compounds in drugs, particularly those that are temperature sensitive. For example, insulin, certain antibiotics, and biological medications must be stored at controlled temperatures. Even drugs that don’t specifically require refrigeration should be kept away from high temperatures.
– Sunlight Exposure: Sunlight can negatively affect medications, particularly if stored in transparent containers. Ultraviolet (UV) rays from sunlight can break down the active ingredients in many medications, causing them to lose effectiveness over time. Direct sunlight exposure can also cause changes in the chemical composition of certain drugs, potentially making them harmful. Keeping medications in a dark, cool place away from direct light is best.
The Right Place for Drug Storage
– Cool and Dry environment: The best place to store most medications is in a cool, dry environment, such as a kitchen cabinet away from heat sources, a drawer in a climate-controlled room, or any other location with a stable temperature and low humidity. Avoid storing medications in areas exposed to moisture or temperature fluctuations, like the bathroom or near a window.
– Refrigeration Requirements: Some medications require refrigeration. For example, some insulin medications (e.g., Humulin, Lantus) must be stored in the fridge, and some must not be refrigerated 24 hours a day. Always read the label or ask the pharmacist about the specific storage needs. If refrigeration is required, ensure it’s not placed in the refrigerator door, where temperature fluctuations are typical.
For instance, the recommendation for storing dexamethasone oral solution is to keep it in a closed container at room temperature, away from heat, moisture, and direct light. The box will include the store temperature in Celsius and Fahrenheit, and the recommendation is DO NOT FREEZE.
If Medications Don’t Seem to Work, check the environment of storage first
If the medication is not working as expected, one of the first steps is to check where and how the medication has been stored. If a drug has been kept in a hot, humid environment for a long time, it might have lost its potency. Always ask patients about their medication storage habits if they report ineffective medications.
Also, always check the expiration date and look for any visible signs of degradation, such as changes in color, texture, or smell. When in doubt, consult a pharmacist or healthcare provider to determine if the medication is still safe to use.
Conclusion
Proper medication storage is not just a matter of regulation but a critical aspect of ensuring that the drugs are effective and safe. Always store medications in a cool, dry place away from sunlight, and check for specific storage requirements such as refrigeration.
Remember to check with the patient before prescribing any medication, how to store a particular medication, and explain the signs of a possible unsafe medication. Consult with the prescriber, provider, or pharmacist if in doubt.
References
• Pietsch, Urs et al. Stability of Drugs Stored in Helicopters for Use by Emergency Medical Services: A Prospective Observational Study. Annals of Emergency Medicine, Volume 80, Issue 4, 364 – 370
• Sarah R. Williams, David A. Nix, Ketan H. Patel, Drug Storage and Stability, Volume , Issue , 07/2007, Pages , ISSN 978-0-323-03228-5,
• https://www.epa.gov/household-medication-disposal/safe-storage-medicines-home
• Funk OG, Yung R, Arrighi S, Lee S. Medication Storage Appropriateness in US Households. Innov Pharm. 2021 May 5;12(2):10.24926/iip.v12i2.3822. doi: 10.24926/iip.v12i2.3822. PMID: 34345509; PMCID: PMC8326694.
• https://www.cdc.gov/wtc/prescriptionsafety.html
• Vlieland ND, van den Bemt BJF, Bekker CL, Bouvy ML, Egberts TCG, Gardarsdottir H. Older Patients’ Compliance with Drug Storage Recommendations. Drugs & Aging. 2018;35(3):233–241. doi: 10.1007/s40266-018-0524-8.
• Guide to good storage practices for pharmaceuticals. World Health Organization. 2003. [Jul 20;2020 ]
