I have a couple of Prograf questions for you transplant veterans...

[kellyt]

1)  Do you keep your Prograf and Cellcept in your fridge?  A friend of mine said their pharmacist friend told her fiance to keep these two meds in the fridge for longer lasting "freshness", I guess.  I was never told this.

2)  Due to raising and lowering my Prograf doses over the last two years, and the fact that they discontinued my Cellcept for quite a few months when I was having the lymphocele problem, I have acquired a surplus - more of the Cellcept than Prograf.  I've been keeping ahead of the year expiration on both meds, but tonight found that I'm no longer ahead. 
Hopefully this makes sense to you guys...  Sorry if I'm confusing y'all.

Anyway, I found tonight that I have March and April 2010 for my Cellcept and April 2010 for my Prograf that I have not taken.  I hate to throw them away, but technically they are over the year for expiration.  So I started tonight with my May 2010 dose of my Cellcept and the August 2010 for my Prograf.  Both of these are my oldest bottles for these two meds.  Next month I'll take June 2010 for Cellcept and Sept 2010 for my Prograf, etc, etc.  Believe it or not I have a system, but apparently I got off somewhere.

Question #2 is...Would you throw away the March and April or just take them??  Maybe mix them in with the good meds...?

Thanks

[Sax-O-Trix]

I am a newby to transplant, but have read alot about both of these drugs as I take Cellcept and Prograf almost killed me.  Both Prograf and Cellcept are to be stored at room tempature (77 degrees F).   I have also read that you are NOT to store either of these meds in the fridge.   

I would not mess around with either of these meds as they are pretty toxic, lol.  If they are expired, get rid of them, it's not worth the chance that they are not effective anymore.  If they are not expired, continue your system of catching them up to date.  Just my 

[Chris]

1.) I never been told that either. I keep mine in my room in my drawer. I was told not to keep them in the bathroom though. I won't keep mine in the fridge though, some food can smell bad and I do not want my meds smelling or tasting worse!
 
2.) I have surplus also of CellCept, Myfortic, Ranitide, Nexium. Prograf I wish because if it falls on the floor, I throw it out due to possible cat hair. A town north of me has their fire station collect old prescription for proper disposal and I want to do that, but it is only on weekends in the mornings at an earlyhour which is when I usually am asleep. I tried to see if the transplant center could use them, but they can't take them.

[kellyt]

I think I agree with you on the expired ones.  I just wanted someone to tell me to throw them out.  They are so expensive!!  Don't tell my insurance company!! 
Thanks for your two pennies.   

[monrein]

I don't keep mine in the fridge.  I'd ask a pharmacist about the expiration date and keep everything crossed that you don't have to throw them out since I know they
re super expensive.  I understood exactly what you meant about the meds getting out of whack because of dose adjustments but I usually calculate things out and try to get less of the others to keep things somewhat even...I get 3 months at a time of meds so sometimes I ask for only two months worth of one or sometimes I have to call early for a month or two supply of one that I'm short on.

I wouldn't decide the risk of the out of date meds on my own...too  big a gamble.  Let us know what happens. Ok.

[wj13us]

I'm a transplant veteran but so much so I don't take either of those drugs (they weren't invented when I got my transplant).

However I do work in the pharmaceutical industry (if you can't beat them join them) so I can give some insight.

When new drugs are developed one of the attributes that need to be determined is shelf life.  Per FDA guidelines an medication is no longer acceptable when the amount of active pharmaceutical ingredient reaches 85% of the label claim.  So if there is 100 mg of drug in a tablet when that number goes down to 85 mg it is no longer good.  Drugs do loose potency over time.

Therefore pharmaceutical companies are required to perform stability tests on new drugs to determine shelf life.  Some drugs will degrade quickly at room temperature.  Refrigeration usually slows the process but keeping a drug cold throughout the supply chain is a pain in the neck and expensive.  So room temperature storage is ideal.  And in the early development stages sometimes changes in the formulation are made to improve stability to allow room temperature storage.  Usually a pharmaceutical company is looking for at least 3 years at room temperature and average humidity conditions.

One of the other advantages to cold storage is lack of humidity.  Tablets are formulated to dissolve in the stomach, a water environment.  Therefore the tablets are made to react (dissolve) in water.  So in a humid environment some of this reaction can take place in the bottle interfering with its ability to perform in the body once taken.  That's why, as mentioned above, its not a good idea to keep you medications in the bathroom.  I'm sure you have read on labels a 100 times "Keep in a cool dry place."  Also keep in mind that while cold slows down the degradation process heat and humidity speed it up.

Bottom line keeping you medications in the refrigerator not a bad idea (will slow the deterioration) but if its not called for not necessary.  But keeping them in a cool, dry place and out of the bathroom a good idea.

Bill

PS Would I take a medication past its expiration date...NO!

[Jie]

The labels for both of my Prograf and Myfortic indicate to store them in room temperature. It is ok to store outside of room temperature for a short time, but not for long time. Unless the medicines are automatically filled, we should not re-fill them if we have enough.

[kellyt]

Thank you!  Thank you!  Thank you!  I can always count on you guys!

[lawphi]

Prograf has gone generic.  Talk to your nephrologist.

I like to keep a stash in case of a natural disaster. 

[Chris]

I'd ask your transplant center doctors first. Thoughts very on switching to generic depending how long you have had a transplant. Mine will not want me to go on generic because I am to far along and that the generic wasn't tested on transplant paitents, just regular people. Ohe of the fears I was told is the absorbtion rate of the med compared to Prograf. On top of that, they are larger and I am running out of room in my weekly pill boxes. You may also have to do additional testing when switched to.

[kellyt]

I was told Day 1  NO GENERIC.

[Chris]

I forgot who posted it awhile back, but this letter from their transplant center explained their view on generics before my center sent me one almost a year later. I think it may have been you kelly.

[Sax-O-Trix]

I strarted out from day one on generics for both Prograf (Tacrolimus - the one I ended up with TPP/HUS from) and Cellcept (Mycophenolate) and then added Gengraf (Cyclosporine Modified) when they took the Tarco away.  I am willing to bet the generic scripts had something to do with my insurance company...  I do know that I am to make sure that I make sure I get the same manufacturer of the generics, not to accept a switch unless the Nephrologist prescribes a change.

@Lawphi - good idea to have a stash in case of a natural disaster.  I hadn't thought about that...  Right now is the time for me to start to get a month or so ahead because they switched my dosage so many times during the first month that I am "ahead" on Cyclosporine and Cellcept.  Thanks for that tip!