During lockdown where unnecessary movement is not allowed, health experts feel some people may be forced to use leftover medicines that were prescribed to them earlier. This, they say, is common practice where one has a headache, stomachache or any other illness that they think is not serious, and so they use leftover medicines they have. Dr Flandrie Habyarimana, Eastern & Southern Africa Region Representative at Commonwealth Pharmacists Association (CPA), says there are many reasons as to why people may develop this habit. Habyarimana, who also doubles as the president of Rwanda Community Pharmacists Union (RCPU), says people tend to stop taking medicines as soon as they feel better. The remaining dose, he says, is kept in their house because they actually plan to reuse it when they get sick again, or someone else in the family. Due to lockdown, he says, people may fear to go see a health professional, or have difficulty getting transport, among other things. Prosper Dusengeyezu, a public health officer at Rwanda Pharmaceutical Students’ Association (RPSA), says in some scenarios, in case of an illness that was cured using prescribed medicine from a practitioner and some was excess, they will take the same medicine in case they feel symptoms which appear to be similar to the ones they had suffered before. He notes that among other reasons, some medicines are left when a person didn’t finish the dose required. He says this is not right, although the medicine might have not expired, what they should put into consideration is that they are not getting the right dose as it’s supposed to be, which is dangerous. He says it’s not advisable for one to assume an illness just because they have similar symptoms as before, adding that consulting is the best way when it comes to treatment of any sickness. The ineffectiveness of leftover medicines Darius Uzabakiriho, a health system analysis specialist, Ministry of Health, says it is obvious that people tend to self-medicate for new illness with medicines previously prescribed for a different illness. He says it’s clear that we all store unused medicines or leftover medicines at home, but how often do we check the expiry dates or adhere proper storage conditions? First of all, he notes that leftover medicines present a risk of being ineffective and or unsafe due to damage caused by poor storage conditions, or having exceeded their shelf-life. “It is always advisable to check the expiry date on medicines before taking any,” he advises. Resistance and other risks Habyarimana says there are many consequences as long as the medicines are not kept properly. He notes that safety is not assured as long as the storage condition is not assured, adding that the medicines may be expired. “There is no guarantee that the medicines will be taken correctly. Remember that medicines are chemical products, taking them requires attention,” he says. He goes on to add that all of this can harm one’s health, as long as they are not sure about the dosage or the efficiencies of their medicines. In fact, he says, the continuation of this will increase drug-resistance and the aggravation of the diseases. Uzabakiriho highlights that many people tend not finish the dosage of antibiotics, and will certainly use them for minor illness such as sore throat and common cold, which are often caused by a viral infection. In this situation, the medic points out that the use of antibiotics confers drug-specific risks and increases the antimicrobial resistance. He adds that the resistance makes diseases such as pneumonia, tuberculosis, gonorrhea, to mention a few, incurable and threatens the ability to undertake surgeries. Health experts believe that using leftover medicines comes with risks such as incorrect self-diagnosis. Another risk, Uzabakiriho says, is failure to seek appropriate medical advice in time, and incorrect choice of therapy, among others. For the adverse cases, severe effects excessively prolonged use, and risk of dependence and abuse. “All medicines can cause unwanted side effects, ‘the dose makes the poison’,” he says. Examples of drugs that can become toxic once irrationally used, Uzabakiriho says, include over-the-counter analgesics such as ibuprofen. He notes that ibuprofen long term use is linked to ulcers, stomach bleeding, kidney problems, high blood pressure, and increased risk of heart attack or stroke. Other drugs are antibiotics such as ciprofloxacin and levofloxacin, commonly used for sinusitis and urinary tract infections. “These drugs are associated with potential risks for irreversible side effects like peripheral neuropathy,” he says. Dusengeyezu says opioids are also drugs that can become toxic if irrationally used, adding that these include codeine and morphine, which are associated with a risk for misuse and abuse. Medicine disposal Uzabakiriho says disposing medicines through waste management services may create a possibility that someone else could use them improperly. Also, he notes that throwing medicines into the toilet can cause drug pollution, but this might be justifiable for quickly disposing of a dangerous drug. However, Dusengeyezu says the best way to dispose of medicine is to return your unused medicines to community pharmacy, for proper disposal, including incineration. In any case, he says guidelines offered by both Rwanda Food and Drugs Authority and other competent authorities prevail. Storing of unused medicines Uzabakiriho says serious circumstances may cause a consumer to have unused drugs. He explains that in some scenarios, a consumer might find that their medication is ineffective and quit taking it. “The medicine might be effective, but the consumer might not adhere to the treatment and fail to take it, for whatever reason, and this can lead to storing of medicines at their place,” he says. Uzabakiriho says it takes effort to discard something, but no effort to leave it where it is “People tend to keep their medicines thinking they might be useful later on, which shouldn’t be the case,” he adds. Habyarimana cautions against using leftover medicines as long as you don’t know if the medicine you kept is normally indicated to the problem you have. “Remember to call your doctor or pharmacist to seek advice. Approach community health workers in case you have any problem, they can help you or advise you on what to do,” he says.
