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Expiration date and potency of Atripla
Dec 22, 2011

Dear Doctor,

Question:

What is the time window in which Atripla retains potency sufficient for the maintenance of already-established viral suppression, measuring from the time it was dispensed in the pharmacy and assuming that it has been kept in its original, sealed bottle until used?

Background:

I've had HIV for well over 20 years and have been on Atripla or its components since January 2005. Starting from a few months after initiating Atripla therapy, and continuing so far, my HIV has remained undetectable, and I haven't missed any doses. My most recent CD4 count (6 weeks ago) was 781.

I'm a US resident, but because my work sometimes involves long periods of time abroad (anywhere from 4 to 12 months at a time) in countries where Atripla is not generally available, and I would be moving around a lot without any way to safely receive international mailings, I've been obliged to gradually stockpile enough additional Atripla to have an uninterrupted supply on hand throughout these international stays. While I've been away I've have somebody else pick up my ongoing monthly prescribed bottle of Atripla in the US so I stay continuously ahead for the next time I go abroad.

The Problem:

The outcome is that, having returned two months ago from one year spent abroad, I'm now taking Atripla that is just over one year past the date the medication was received from the pharmacy (and, indeed, this situation has already been building up for several years, and I was taking Atripla throughout my most recent year abroad that was anywhere from 7 to 12 months past the date it had been received), and this disjuncture will be perpetuated as I continue to pick up each new monthly supply, unless I discard some of my oldest-stocked Atripla. I'm drawing the line at 13 months past the date of dispensation, out of fear that if the medication were any older I could be getting suboptimal therapy, but perhaps even this length of time is asking for trouble.

Strangely enough, while the pharmacy normally writes on the Atripla bottle that I should discard it one year from the date it was dispensed, in a few instances they actually wrote 18 months instead, hence my uncertainty. (Was that some sort of "rogue" pharmacist?) Am I putting my HIV regimen at risk with this schedule?

Thanks for your time, Worried...

Response from Dr. McGowan

Dear Worried,

Medication will often be dispensed well in advance of its' "expiration date" (usually stamped on the bottle), and it will retain potency long after that date. Most medications retain potency for many years after the expiration date, which is the date that the drug companies are willing to guarantee potency. Stroing meds in the refrigerator may help prolong their potency. There is a good webpage on this topic via Harvard University: http://www.health.harvard.edu/fhg/updates/update1103a.shtml.

You should use up your older meds first and rotate the newer ones in, or at least alternate them, that way you won't have older and older meds. I assume you are building up these supplies by getting your refills earlier each month. If it is from missed or intermittent dosing that WOULD be a BAD idea.

Best, Joe



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