Before you take any medicine from a delivery that sat out in the sun, read the storage instructions on its label, then check with the pharmacy that filled it, the prescriber's office or the manufacturer whether it can still be used, and hold each dose until one of them has answered. If the box holds a medicine you cannot safely miss a dose of, ring the prescriber's office now, before that dose is due, and ask whether to take it while a replacement comes.
What a few hours of heat can do to a medicine
Heat, air, light and moisture may damage your medicines, and even the heat and moisture from a shower, bath and sink may damage medicines kept in a bathroom cabinet, which can then become less potent or go bad before the expiration date. Pills and capsules are easily damaged by heat and moisture. For the same reason, a car's glove compartment is no place for medicines, because they can get too hot, cold or wet there.
If a medicine may have been exposed to excessive heat, consider replacing it. That advice, like the warning about bathroom cabinets, comes with no temperature and no number of hours, so the time the box spent on your step cannot settle the question, and the pharmacy's answer can.
Some damage can be seen, and a medicine with any of these signs is not to be taken:
- a change in its color, texture or smell, even if it has not expired
- pills that stick together, are harder or softer than normal, or are cracked or chipped
A medicine that looks normal can still have lost strength, because temperature-sensitive medicines may lose potency when they are not stored at the recommended temperature, and the pharmacy that filled it can tell you whether yours is one of them.
Medicines that need a refrigerator, in the box or at home
A medicine that should be kept cold and arrived warm goes through the same steps as the rest of the box: its label first, then the pharmacy, the prescriber's office or the manufacturer. A weekly weight injection that needs refrigeration is stricter: if it arrived warm or without enough cold packs, it should not be used, even if it has been in the refrigerator since, so set it aside and ask the pharmacy that sent it what to do with it (see Check a vial or pen that doesn't match your prescription).
A refrigerator that lost power at home has a rule of its own, and it turns on how long the power was off. When the power is out for a day or more, throw away any medication that should be refrigerated, unless the drug's label says otherwise, so read the label before anything goes in the bin, and where it says otherwise, follow it instead. Some drugs need refrigeration to keep their strength, including many liquid drugs, so check the label of anything liquid even if you do not remember it being a cold one. If the power was off for less than a day, check the medicine's storage instructions, if available, or ask a pharmacist, the prescriber or the manufacturer whether it can still be used.
One exception covers a refrigerated medicine someone's life depends on: when a replacement is not readily available, use it only until a new supply is available. Replace every refrigerated medicine as soon as you can. If a medicine you depend on to stay alive was in a refrigerator that lost power, keep it rather than throwing it away, and ring the prescriber's office about a new supply before the next dose is due.
What to do with the box in front of you, in order
- Look at each medicine first for a change in color, texture or smell, or for pills that have stuck together, cracked or chipped, or turned harder or softer than normal. One that shows any of these stays untaken, whatever the temperature on the step turns out to have been.
- Read the storage instructions on each label. If one says to keep the medicine refrigerated, put it in the refrigerator now and follow the medicine's labeled storage instructions from here on, keeping it in its original container. Keep anything that does not need the cold somewhere cool and dry, such as a dresser drawer or a kitchen cabinet away from the stove, sink and any hot appliances.
- Before the next dose is due, ring the pharmacy that filled it, or the prescriber's office, and ask whether it can still be used. Tell them what the medicine is, what its label says about storage, roughly how long the box sat out and whether the cold pack had gone soft. Your pharmacist can also go through any specific storage instructions with you, and the manufacturer is the third place to ask.
- Before you throw anything out, ask the prescriber's office for a new prescription. If the answer is that the medicine cannot be used, replace it with a new supply as soon as possible, and bring the old one to your pharmacist, or mix it with something that ruins it, such as coffee grounds or kitty litter, and seal the mixture in a plastic bag before it goes in the trash (see Getting rid of a used needle, leftover vials and the box with your name on it).
If someone has already taken a dose from it
If you have already taken some, say so when you ask the pharmacy or the prescriber's office about the box. Damaged medicines may make you sick. If you think a dose from the box has made you sick, call the Poison Help line, 1-800-222-1222, which reaches your local poison control center. It takes any question about poisoning at any hour of any day, free and in confidence, and the call does not have to be an emergency.
If anyone who took it has trouble breathing, passes out or faints, or has a seizure, go to an emergency department or call 911. Call 911 for the emergency team to come to you if breathing has stopped or is severely short, or if a seizure lasts more than a minute or the person does not wake quickly from it. If you do go to the hospital, take the container with you, if possible.
Reporting a delivery that arrived warm
Report the warm delivery even if nobody got sick, first to the pharmacy that filled it, since with drugs a pharmacist is often the first to recognize a product quality problem, and then to FDA. Problems with product quality may occur during manufacturing, shipping or storage, and a medicine whose stability is in doubt after hours in the heat is a quality problem worth reporting. To report it to FDA, use MedWatch, FDA's medical product safety reporting program for health professionals, patients and consumers, through its online form or by calling 1-888-463-6332 and pressing 2. A serious reaction to a dose can be reported there too (see Reporting a side effect that has not gone away).
If your prescription came through NicoCares, a state-licensed pharmacy partner prepared it and shipped it to you, so that partner is the pharmacy that filled it. Ask your care team, in the Spruce Health messages where they reach you, how to contact the partner and whether the medicine can still be used. If a dose from the box has made you unwell, phone Poison Help, or 911 for trouble breathing, fainting or a seizure, rather than waiting on a message.
