Published: 5 September 2014


Medicine Storage - An Uncontained Issue?

Prescriber Update 35(3): 36-37
September 2014

Key Messages

  • Some medicines cannot be repacked and must be stored in the original container until it is time for the patient to take them. If in doubt, refer to the medicine data sheet.
  • Heat, air, light and moisture may impact the effectiveness and safety of a medicine. The original container is designed to protect the medicine from these elements.
  • Medicines such as solid dose cytotoxic preparations, finasteride and chlorpromazine always require special handling precautions.
  • Unless a medicine requires refrigeration, all medicines should be stored in a cool, dry place, out of the sight and reach of children.

Many medicines are repackaged into monitored dosage systems ("blister packs") or plastic compartmentalised containers ("pill boxes") to aid medication adherence and safe administration, particularly in residential care facilities. However, healthcare professionals are reminded that removing some medicines from original packaging to repack them into another dosage system may adversely affect the characteristics of the medicine. Repacking medicines can impact the medicine's effectiveness and safety.

The Centre for Adverse Reactions Monitoring (CARM) recently received a report from a patient who experienced haematuria after he began repacking dabigatran (Pradaxa) into a weekly pill box. These symptoms resolved once he stopped repacking dabigatran and kept the capsules in the original container. Dabigatran capsules absorb moisture from surroundings if removed from the original packaging. Moisture absorption may increase the bioavailability of the dabigatran dose, which can in turn increase the risk of adverse effects.

This case highlights that not all medicines are suitable for repacking. In general, the original container protects the medicine from heat, air, light and/or moisture. Exposure to these elements may affect the stability of the formulation and/or the active ingredient, which can alter the effectiveness and safety of the medicine.

The table below gives examples of medicines that should be kept in original packaging (this is not an exhaustive list):

Effervescent, dispersible, buccal, sublingual tablets (eg, Ondansetron orodispersible tablets, Rizatriptan orodispersible tablets, Prochlorperazine buccal tablets) The foil packaging or tightly closed glass/plastic container protects the product from moisture absorption and thereby prevents product degradation.
Use dry hands to prevent the medicine from dissolving prior to administration.
Dabigatran capsules The original container protects these capsules from moisture absorption. Once the original container is opened, the contents must be used within four months.
Glyceryl trinitrate tablets The glass amber bottle protects these tablets from both moisture absorption and light. Once opened, the contents need to be discarded within three months.
Nifedipine tablets The foil packaging protects these tablets from both light and humidity.
Cabergoline tablets The desiccant in the cap of the bottle should not be removed because it protects the tablets from excess moisture absorption (hygroscopic product).
Sodium valproate tablets These tablets must be kept in protective foil until taken. This protects the tablet from excess moisture absorption (hygroscopic product).
Levodopa + benserazide dispersible tablets
The packaging protects the tablets from moisture absorption. These tablets should be taken within half an hour of dissolving the tablet due to sedimentation issues.
Ciclosporin capsules The ethanol (required for solubility of ciclosporin) vaporises out of the soft capsule when removed from the foil packaging.

Some medicines also have special handling requirements. Healthcare professionals who consider repacking or administering medicines need to be aware of these for their own safety. Some examples of medicines that have special handling requirements include:

  • solid dose cytotoxic preparations such as methotrexate should not be handled, particularly by women if they are or may potentially be pregnant
  • women should not handle crushed or broken finasteride tablets (5α-reductase inhibitor), as this may cause birth defects
  • women must avoid contact with broken dutasteride capsules (5α-reductase inhibitor) due to absorption through the skin
  • chlorpromazine can cause dermatitis when handled.

It is important that medicines are stored in a cool, dry place, out of the reach and sight of children. If in doubt about the storage conditions of a medicine, refer to the appropriate data sheet ( or contact the manufacturer.

*Please note that this information is advisory only and it is at the discretion of the healthcare professional to determine if repacking medication is required for patient adherence and safety.

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