Angela M Sexton, PharmD – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Sat, 30 Dec 2017 16:30:10 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.1 Drug Disposal – to Flush or Not to Flush? http://brainblogger.com/2011/06/23/drug-disposal-to-flush-or-not-to-flush/ http://brainblogger.com/2011/06/23/drug-disposal-to-flush-or-not-to-flush/#comments Thu, 23 Jun 2011 12:00:49 +0000 http://brainblogger.com/?p=6657 Richard Asher, considered one of the preeminent medical thinkers of the 20th century, said, “If you give a man a pill there are only two things he can do with it: he can swallow it or he can throw it away.” As the production and use of medications increases worldwide, it has become clear that a solution to the problem of consumer drug disposal is essential. In the past, many consumers have been told to flush unused or expired medications; however, concerns regarding accumulation of active pharmaceutical ingredients (APIs) in the water supply and the unknown environmental impact have increased the awareness for proper disposal methods. Furthermore, imprudent disposal may increase the risk of accidental poisoning and drug misuse.

This problem of unwanted drug disposal has created quite a dilemma for patients who need an acceptable and safe alternative to flushing unused medications. According to the National Community Pharmacists Association (NCPA), “Consumer surveys demonstrate that local pharmacies are the most convenient locations where consumers seek to return unused for expired medicines.”

The United States Food and Drug Administration (FDA) has established guidelines for the disposal of unused medicines. They recommend that take-back programs for disposal are the best and primary way consumers should use when discarding expired, unwanted, or unused medicines. When no take-back program is locally available to the consumer, the FDA provides specific guidelines for disposal of medicines in household trash, which include mixing the medication with a substance such as cat litter or used coffee grounds, placing the mixture in a container or sealed plastic bag, and disposing the container in the household trash.

The FDA has published a list outlining specific medications that, due to their especially harmful effects when used by someone other than the patient for whom the medication was prescribed, should be disposed of by flushing when they can not be disposed of via a take-back program. This again poses the concerns over risk of such substances to human health and the environment. The FDA states that, “The majority of medicines found in the water system are a result of the body’s natural routes of drug elimination (in urine or feces). Scientists, to date, have found no evidence of harmful effects to human health from medicines in the environment.” The FDA contends that the few medications disposed of by flushing contribute a small fraction to the overall total amount of drugs found in the water supply and propose that the health and environment risk associated with this method of disposal is exceeded by the possible life-threatening risks from accidental ingestion of these medications.

Apparently drug take-back efforts are having a positive effect and serving as a useful method of unwanted drug collection. The latest national drug take-back day was organized by the Drug Enforcement Administration (DEA) and held on April 30, 2011. According to the DEA, the collection at over 5300 sites brought in 188 tons of unused prescription medicine from the public. The drugs collected by authorities were incinerated.

References

Controlled substance disposal a natural for community pharmacies. Drug Topics E-News, 2011.

Disposal of unused medicines: what you should know. FDA, 2011.

Daughton CG. Drugs and the environment: stewardship & sustainability. National Exposure Research Laboratory, Environmental Sciences Division, US EPA, Las Vegas, Nevada, report NERL-LV-ESD 10/081, EPA/600/R-10/106. 2010 Sept 12.
 

Taylor R. Towards better prescribing. Journal of the Royal College of General Practicioners. 1978 May;28:263-270.

Frolund, F. (1978). Better prescribing. BMJ, 2 (6139), 741-741 DOI: 10.1136/bmj.2.6139.741

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Pass the Salt – Risks Linked to Low Salt Diet? http://brainblogger.com/2011/05/15/pass-the-salt-risks-associated-with-low-salt-intake/ http://brainblogger.com/2011/05/15/pass-the-salt-risks-associated-with-low-salt-intake/#comments Sun, 15 May 2011 12:00:14 +0000 http://brainblogger.com/?p=6488 In light of the fact that approximately 90% of all Americans will develop high blood pressure during their lifetime, the American Heart Association recommends a daily intake of no more than 1,500 milligrams of sodium to reduce the risk of high blood pressure, heart attacks, stroke, and kidney disease. However, results published in the Journal of the American Medical Association (JAMA) from a recent European study coordinated in Belgium have challenged the notion that a reduced sodium (salt) consumption lowers the risk of heart attacks, congestive heart failure, and stroke.

In a prospective, population-based cohort study, researchers tested urinary sodium excretion in 3,681 people without cardiovascular disease (CVD) (average age 40) for approximately 8 year to assess whether 24-hour urinary sodium excretion predicts blood pressure and health outcomes. According to JAMA, the study concluded that “systolic blood pressure, but not diastolic pressure, changes over time aligned with change in sodium excretion, but this association did not translate into a higher risk of hypertension or CVD complications. Lower sodium excretion was associated with higher CVD mortality.” The study results revealed that the systolic blood pressure was slightly lower in those who excreted less sodium, but, surprisingly, those with lower sodium excretion had an increased risk of cardiovascular death. The study results were consistent in participants younger and older than 60 years.

According to Dr. Jan Staessen, a professor of medicine at the University of Leuven in Belgium and one of the study authors, the study does not promote a reduction of salt consumption for everyone and states that, “Lower sodium intake is recommended for people with high blood pressure and people with heart failure, but recommending it to the population as a whole, I wouldn’t do without proving it’s completely safe.” He acknowledges a limitation of the study and states that while the study may apply to Americans of white European descent, it might less applicable to the black population since they are believed to be more salt sensitive.

Staessen explains, “If one lowers sodium intake to lower blood pressure, this change in sodium activates several systems (including the renin-angiotensin aldosterone system) that conserve sodium, and those systems are implicated in disease processes such as damaging the arterial wall and kidneys.”

The study results have been met with criticism from medical experts and other studies have also concluded that sodium reduction results in decreased cardiovascular disease risk in the general population. Ralph Sacco, president of the American Heart Association and chairman of neurology at the University of Miami said, “We have based our recommendations on the many scientific studies which show a strong relationship between reduced sodium consumption and a lower risk of heart attacks, congestive heart failure and stroke.” He contends, “There are good randomized, controlled studies – the gold standard of scientific studies – that show a lower sodium diet has a meaningful effect on blood pressure.”

According to the Centers for Disease Control and Prevention (CDC), the Dietary Guidelines for Americans 2005 recommends that specific groups, including individuals with hypertension, all middle-aged and older adults, and all blacks should limit intake to 1,500 mg/day of sodium. These specific groups include approximately 70% of the adult population in the United States. The recommended limit for all other adults is less than 2,300 mg/day of sodium. Processed and restaurant foods are the largest source of dietary sodium intake (77%) in the United States, while table salt and cooking accounts for 10%.

References

Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovský J, Kawecka-Jaszcz K, Nikitin Y, Staessen JA, & European Project on Genes in Hypertension (EPOGH) Investigators (2011). Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA : the journal of the American Medical Association, 305 (17), 1777-85 PMID: 21540421

Morrison AC, & Ness RB (2011). Sodium intake and cardiovascular disease. Annual review of public health, 32, 71-90 PMID: 21219163

Centers for Disease Control and Prevention (CDC) (2010). Sodium intake among adults – United States, 2005-2006. MMWR. Morbidity and mortality weekly report, 59 (24), 746-9 PMID: 20577156

Krzesinski JM (2009). [Sodium and arterial hypertension –one hundred years of controversies]. Bulletin et memoires de l’Academie royale de medecine de Belgique, 164 (3-4) PMID: 20120089

Mattes RD, & Donnelly D (1991). Relative contributions of dietary sodium sources. Journal of the American College of Nutrition, 10 (4), 383-93 PMID: 1910064

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