How Long Do My Meds Last? A Look at Metronidazole

Consumer notice: A note on expiration dates. This article discusses published research on drug stability, including the FDA and Department of Defense Shelf Life Extension Program (SLEP). SLEP applies to federal stockpiles held under controlled, monitored storage and tested lot by lot. It does not apply to medications stored at home, and its findings do not extend the expiration date of any medication you own. FDA’s guidance to consumers is that expired medications should not be used. Jase Medical follows the manufacturer’s printed expiration date on every medication we dispense. Replace medications when they expire, and dispose of the expired supply following FDA’s disposal guidance.

Metronidazole is in a class of medications called nitroimidazole antimicrobials. It was initially developed at Rhone-Poulenc labs in France in 1959 to treat Trichomonas vaginalis, a parasitic infection. In 1962, it was discovered to be effective against both Trichomonas vaginalis  and bacterial gingivitis (bacteria). By the 1970s metronidazole was used for treatment of infections caused by gram-negative anaerobes such as bacteroides or gram-positive anaerobes such as clostridia. It is now widely used as a prophylaxis following bowel surgery to prevent infection. Metronidazole does not treat viruses or yeast infections- only bacterial and parasitic infections.

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Storage

Store metronidazole capped, in a cool, dry, dark location away from sunlight; UV exposure degrades it more than heat or cold. Replace it at the labeled expiration date.

Metronidazole is listed in the World Health Organization Model List of Essential Medications for the newly released 2023 edition:

FIRST CHOICE (From WHO 2023 list)

  • Difficile infection
  • Complicated intraabdominal infections (mild to moderate)
  • Complicated intrabdominal infections (severe)
  • Necrotizing fasciitis
  • Surgical prophylaxis
  • Trichomoniasis

SECOND CHOICE (From WHO 2023 list)

  • Complicated intraabdominal infections (mild to moderate)

Other uses include

  • Bacterial vaginosis
  • Tetanus infection if no other better options are present.

How to take

Take metronidazole with food to avoid stomach upset. DO NOT consume alcohol or products containing propylene glycol  for 3 days after last metronidazole dose.  Do NOT take if you have taken disulfiram (Antabuse) within past 2 weeks.

Side Effects

Mild side effects include (can mostly be alleviated by taking with food)

  • Vomiting nausea, diarrhea
  • Stomach cramps
  • Constipation
  • Loss of appetite
  • Headache
  • Metallic taste in mouth
  • Mouth or tongue irritation

Discontinue and contact your primary care provider if you experience the following

  • Numbness, pain, burning, or tingling in your hands or feet
  • Seizures
  • Hives, peeling or blistering of skin
  • Problems with coordination,
  • Difficulty speaking, confusion, or agitation
  • Signs of infection such as sore throat, fever, or stuffy nose
  • Tarry stools

Consult with your care provider before taking if you are taking any of the following:

  • Let your care provider know if you are taking any of the following: anticoagulants (‘blood thinners’) such as warfarin (Coumadin, Jantoven), busulfan (Busulfex, Myleran), cimetidine (Tagamet HB), lithium (Lithobid), phenobarbital, and phenytoin (Dilantin, Phenytek)

Make your care provider aware if you currently have (or history of)

  • Pregnant or breastfeeding. Metronidazole has a pregnancy category B rating -Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. A substantial amount of metronidazole does pass into breast milk and can be passed to infant. There is some evidence that metronidazole can cause diarrhea and thrush in breastfed infants,, but studies are inconclusive. If metronidazole must be given, avoid breastfeeding foe 12-24 hours after dose.
  • Allergy to metronidazole, secnidazole (Solosec), tinidazole (Tindamax), any other medications, or any of the ingredients in metronidazole preparations.
  • Have history of Crohn’s disease, or blood, kidney, or liver disease.

Closing notice: When a medication reaches its expiration date, replace it. Dispose of the expired supply following FDA’s guidance on expired medicines.

- Brooke Lounsbury, RN

Medical Content Writer

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How Long Do My Meds Last? A Look at Ciprofloxacin

Consumer notice: A note on expiration dates. This article discusses published research on drug stability, including the FDA and Department of Defense Shelf Life Extension Program (SLEP). SLEP applies to federal stockpiles held under controlled, monitored storage and tested lot by lot. It does not apply to medications stored at home, and its findings do not extend the expiration date of any medication you own. FDA’s guidance to consumers is that expired medications should not be used. Jase Medical follows the manufacturer’s printed expiration date on every medication we dispense. Replace medications when they expire, and dispose of the expired supply following FDA’s disposal guidance.

Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic, it is used to treat many different types of bacterial infections, and is used to treat biological warfare agent inhalation  Anthrax as a post exposure prophylaxis.

Storage

Store ciprofloxacin capped, in a cool, dry, dark location away from sunlight. Replace it at the labeled expiration date.

Ciprofloxacin is listed in the World Health Organization Model List of Medications for the newly released 2023 edition:

FIRST CHOICE (From WHO 2023 list)

  • Acute invasive bacterial diarrhea /dysentery
  • Enteric fever
  • Low-risk febrile neutropenia
  • Pyelonephritis or prostatitis (mild to moderate)

SECOND CHOICE (From WHO 2023 list)

  • Cholera
  • Complicated intraabdominal infections (mild to moderate)

In addition, ciprofloxacin can be used to treat:

  • Anthrax exposure
  • Tularemia
  • Urinary tract infection

How to Take

Take ciprofloxacin dose 2 hours before or 6 hours after taking other medicines. It may be taken with or without food. Drink plenty of liquids when taking ciprofloxacin.

Side Effects

Fluoroquinolones carry black box warning

Fluoroquinolones (FQ) have been associated with increased tendon ruptures. A tendon rupture is a partial or complete tear of a tendon.

A large study reviewing retroactive patient records was conducted between 2007 and 2016 with over a million subjects from the senior population age 65 and older. This study reviewed the use of FQ against other antibiotics and even similar drugs in the FQ class to assess tendon rupture occurrence.  Only one of the FQ antibiotics displayed a significant tendency to tendon rupture- between a 16% (rotator cuff) and fourfold risk (Achilles tendon). That antibiotic was levofloxacin. Neither ciprofloxacin-one of the antibiotics found in the Jase case- or moxifloxacin- which were part of the study- was found to increase tendon rupture.

For more information, please read this post: Does Ciprofloxacin (Cipro) cause tendon rupture?

What To Avoid

  • Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice.
  • Avoid antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others).
  • Vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.
  • Ciprofloxacin can cause sun sensitivity. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Consult with your care provider before taking if you are taking any of the following:

For a more complete list of drugs that may interact with ciprofloxacin check out this site.

Make your care provider aware if you currently have (or history of)

  • Low levels of potassium in blood
  • Muscle weakness, myasthenia gravis
  • Any history of heart disease
  • Aneurysm
  • Diabetes or low blood sugar
  • You or family history of long QT syndrome
  • Brain tumor, head injury or seizures
  • Liver or kidney disease
  • Nerve problems
  • If pregnant or breastfeeding consult your primary care provider for guidance. There is evidence that ciprofloxacin can affect the fetus and enter breast milk. Ciprofloxacin carries US FDA pregnancy category C (Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks).

Common ciprofloxacin side effects may include:

  • Nausea, vomiting, diarrhea, stomach pain
  • Headache
  • Abnormal liver function tests

Seek medical attention if you experience:

  • Signs of an allergic reaction to ciprofloxacin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction
  • Low blood sugar – hunger, irritability, nausea, fast heart rate, or feeling shaky
  • Nerve damage symptoms – numbness, crawling, pins and needles or tingling, burning pain in your hands, arms, legs, or feet
  • Serious mood or behavior changes – nervousness, agitation, hallucinations, memory problems, thoughts of suicide
  • Bloody or black, tarry stools

Discontinue and seek immediate medical attention if you experience:

  • Severe pain in your chest, stomach, or back (a rare but serious side effect of ciprofloxacin) which may damage the aorta, leading to bleeding or death
  • Fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out)
  • Muscle weakness
  • Breathing problems
  • Little or no urination
  • Jaundice (yellowing of the skin or eyes)
  • Increased pressure inside the skull – severe headaches, ringing in your ears, vision problems, pain behind your eyes.

Closing notice: When a medication reaches its expiration date, replace it. Dispose of the expired supply following FDA’s guidance on expired medicines.

- Brooke Lounsbury, RN

Medical Content Writer

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After School and Home Alone – Do Your Children Know What to do in an Emergency?

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As summer winds down and focus on starting a new school year is right around the corner, many parents and children are getting ready- adjusting bedtimes, school lunches, transportation to and from school, and in some instances, starting a new school. Along with this, many children will spend some time at home alone after school.

About 3.5 million American children between the ages of 5 and 12 spend time at home alone after school. The average amount of time isn’t much—only about an hour a day, according to a U-M study presented in Chicago at the Society for Research on Adolescence biennial meeting. This number represents about 26 percent of American children who spend time after school alone, including time spent getting from one place to another (from school to home, for example) on their own.

Many children are ready to be home alone for an hour or so; however, a lot can depend on the maturity and ability level of the individual child.

In addition, each living situation is unique. Families living in apartments and condominiums have a different lifestyle and circumstances than their suburban and rural counterparts. Even geographic locations-where you live-playa large part in readying your child to stay home alone.

No matter what age your children are, or type of housing, there are still many situations in common that you can ready your child for, ensuring their safety while home.

Assess your children’s age and ability

Ability doesn’t necessarily come with age. A lot depends upon your child’s temperament, emotional maturity, and physical ability. For instance, children with special needs- whether physical, mental or emotional-should be factored into how much time they can be home alone. For example, a 9-year-old child on the autism spectrum may not be able to stay at home alone, whereas a 9- year-old without special needs could be left alone for a short period of time.

Geographical location

Do you live in an area that has extreme heat or cold spells? Do you live in a flood zone? Do you live in a hurricane or tornado-prone area? If so, does your child know what to do if these situations arise? What if you cannot get home because of an adverse weather event? Does your child know what to do?

Weather events are the most likely emergency- assess the most likely weather that your children could encounter, during a severe weather event, the power may go out, phones may not work, and heat and air conditioning may also not be working. In addition, if there is severe weather and you can’t get home to your children in the usual time frame, would your children know what to do? Knowing what to do is important if cell phone service goes down and there’s no way to communicate with each other.

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Home-alone emergency supplies

  • Basic first aid kit with basic supplies. Instruct your children how to use it in case of a minor emergency and when they should be calling 911. Laminate a card to keep in the first aid kit with these instructions.
  • Two flashlights with extra batteries
  • Bottled water
  • Prepackaged snacks
  • Portable radio with extra batteries with the emergency services bands
  • Portable cellphone battery chargers for each cell phone in the home. Test periodically and ensure they have a charge. Keep an additional cable with them for easy access.
  • Extra blankets and cold weather gear- and a small tent that can be set up in the bedroom or living room to contain heat in case you aren’t able to get home in a timely fashion

In case of evacuation

  • Evacuation should not be taken lightly. Most of the time, your child is safer in their home than in the great outdoors. Fires, power outages that affect heating, and even door-to-door evacuation orders are reasons your child needs to be prepared. Luckily, having to evacuate is not very likely. But it is always better to be prepared than to have regrets.
  • Put together a go-bag for each child in the home. Have the child put the bag on and ensure it isn’t too heavy and fits their frame. In the bag, place a laminated card with their name, address, medications, allergies, parents’ names, and phone numbers.
  • Two bottles of water for each go bag
  • Two or more prepackaged snacks-Lara bars are a great nutritious snack
  • Child’s medication for at least three days in clearly labeled bottles
  • A change of clothing-socks, pants, underwear, shirt, hat, gloves, and coat/sweater, depending on your climate.
  • Headlamps and extra batteries (headlamps free hands for tasks)
  • Reflective tape on the go bag, or purchase reflective tape and apply it to the backpack for visibility
  • Laminated map of the immediate area that you live in
  • Rechargeable hand warmers (with recharging cables) if you live in a cold weather area
  • Phone and portable recharger with cable

Put together a plan and practice.

  • Post on the refrigerator or a conspicuous place emergency phone numbers, relatives, trusted friends, and neighbors that your children can contact or go to in the event they need to leave home. Make the people on this list aware that your children will contact them in an emergency.
  • Pull out the first aid kit, go through all the items in the kit, and practice using them—role play. Purchase extra gauze and bandages for your children to use and practice with. As you go through scenarios, advise them to treat only minor cuts and injuries. Give examples of a minor injury and when they should call 911 or seek a trusted adult if phone service or power is out. Ideally, take your child to a local first aid course.
  • Have your children operate the portable radio. Have them remove and replace the batteries, and demonstrate they know how to find the emergency station(s) for information about local weather events.
  • Practice removing and replacing flashlight batteries. Make sure they know how to operate them.
  • Review and rehearse what your child would do if phone service were unavailable. For example, not to panic, and if able to safely make it to a trusted neighbor’s home.
  • If your child has misplaced or lost their key, have an alternate area to access a key, not just under a mat or a rock near the house. These would be obvious places for intruders to gain access to your home by finding that key.

Backup plans Kids should know where a key is hidden in case they’ve lost theirs, where to go in the neighborhood if they need help, and who to call if there’s a problem and they can’t be reached.

- Brooke Lounsbury, RN

Medical Content Writer

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Jase Founder Dr. Rowland Deploys with Aerial Recovery Group to Lahaina

When Dr. Shawn Rowland heard of the fire in Lahaina, and thousands were displaced, he wanted to offer his home on nearby Oahu for a displaced family or two to stay. He had no idea that he would be a part of the rescue and recovery efforts of a global outreach group called Aerial Recovery Group. Dr. Rowland had contacted their chief medical officer, Aaron Asay, physician assistant and friend that had lived on Maui, to offer his home for a displaced family or two.

Aaron had planned to be out of the country on assignment and would not be available to deploy to Lahaina. He asked his friend if he could be their physician for the group going to Lahaina, which Dr. Rowland readily accepted, and within two hours, a team had activated and organized. Once in Lahaina, the group connected with the Maui chief of police, who had locked down the city to prevent looters and onlookers that could prevent EMS and recovery workers from performing their jobs.

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Drone mapping and real-time satellite imagery helped put together a scenario of the extent of the fire and where people might be that needed help. At that point, there was no electricity, communications, or cell phone service. Initially, they treated acute injuries such as broken bones, smoke inhalation, and minor injuries to those who stayed behind in the town. Many people remained in the Lahaina area because they could not return if they left.

 That evening, Dr. Rowland heard about a man who could not leave his home because he had an infected foot. In the pitch dark, with no electricity, they made their way through the neighborhoods and up the dirt road, where they encountered many people sitting along the sides of the road who greeted them. “At first, I thought these were people that were housing others in their homes who had been displaced by the fire and were just sitting outside talking and visiting,” he said, “however, once we took care of the man with the infected foot and came back down, we were told that these were some of the people who had lost everything, including family members and all their possessions. I still get emotional talking about it.”

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As one of the first independent disaster response teams, Dr. Rowlands’ role quickly became that of resource allocation and coordination. Volunteers from the community – from physicians to nurses, medics, firefighters, and volunteers poured into the area and needed guidance on where to go and what to do. At the same time, relief was coming in from harbors, planes, and local groups. As Dr. Roland put it, “It was organized chaos.” They needed to quickly establish an infrastructure that could distribute and set up tents and supplies in each designated area and for medical teams to go door to door in the immediate area to see if anyone needed medical care.

Over the coming days, as supplies, tents, and distribution centers were set up, Dr. Rowland noticed that the most pressing need was for people’s medications. They needed their blood pressure medicines, diabetic supplies, antidepressants, and other drugs. It made him more aware of why Jase Daily (having a year’s supply of your prescription medication) existed. As founder and CEO of Jase Medical, he went over as a volunteer and came back, knowing that the mission of Jase Medical was to help people prepare in the event of any emergency or natural disaster.

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When asked what people could do to help or donate, Dr. Rowland said that, for now, all their physical needs were being met. It will take months, if not years, for these people to be back in a home environment.

He suggests, in addition to charities, such as the Red Cross, that gift cards through a reputable source that can get directly to the people would be the best way to help them with their personal, everyday needs. He also advises exercising caution when donating. Opportunistic scammers come out and take advantage of others in times like these.

He reports that there was plenty of food, water, clothing, diapers, and other essential supplies for the time being. There will be an ongoing need for a long time, however.

Dr. Rowland plans to return in the coming weeks, and we will keep you posted.

To learn more about the Aerial Response Recovery group and their missions, please visit their website.

“Aerial Recovery trains and deploys Humanitarian Special Operators to effectively respond to natural disasters and man-made disasters and combat sex trafficking. Made up of Veterans and First Responders, Aerial tackles some of the most difficult rescue and response missions globally.”

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Postscript

As of this writing,

  • Ninety-nine people were reported dead. The death toll is expected to climb by 10-20 more daily.
  • Names of those deceased and identified to start being released today (Tuesday, August 15)
  • According to Maui Police Chief John Pelletier, only 25 percent of Lahaina has been searched. They expect to complete the recovery process by the weekend.
  • According to Hawaii Electric, 80 percent of power has been restored.
  • Even though the power has mostly been restored, many families have no way to communicate with loved ones. Many people lost phones in the fire while fleeing for their lives, according to Governor Josh Green
  • This has been the largest loss of life to a fire in over a hundred years of US history.

- Brooke Lounsbury, RN

Medical Content Writer

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Are You Happy? 7 Tips to Happiness

“Folks are usually about as happy as they make their minds up to be.” – Abraham Lincoln

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“Happiness Happens Day” ,celebrated on August 8th of each year was founded by Pamela Gail Johnson. She started the Secret Society of Happy People in 1998, “to provide a missing voice for those who are happy and want to express it without having other people rain on their parade.”  It is a day dedicated to recognizing and promoting happiness in our lives and encouraging people to share their positive moments and emotions. On her website she goes on to say, “We spend so much time focusing on our “what’s wrong” moments that we ignore many of our happy moments, so our happiness became a secret — even to us.”

Words that can describe happiness are:

  • Joy- a feeling of great pleasure
  • Contentment-A sense of satisfaction and being at peace with what one has.
  • Bliss- extreme happiness and joy
  • Fulfillment– A sense of achievement and satisfaction derived from reaching goals and aspirations.
  • Harmony- A sense of balance and alignment that contributes to inner happiness.
  • Serenity-A state of calm and tranquility that brings a peaceful happiness.
  • Optimism- A positive outlook on life- a belief that all will work out for the best
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Happiness comes by focusing on the positive aspects of life, no matter how small or seemingly insignificant.

7 ways to nurture happiness in your own life

  1. Fulfilling relationships and strong emotional connections

Fulfilling and close relationships keeps loneliness and isolation away. We are wired for connection.

  1. Personal accomplishments- both great and small

Celebrate your personal accomplishments- no matter how small they are. Every great accomplishment is the result of placing one foot in front of the other (small accomplishments add up)

  1. Cultivate gratitude

Gratitude- the act of being grateful for both the tangible and intangible. Research has repeatedly shown the strong correlation between gratitude and happiness. One way to practice gratitude is to start a daily gratitude journal and list 5 things, no matter how small that you are grateful for.  Even the tea or coffee you are drinking while working on your journal is something to be grateful for. The journal can be as simple as a small notebook or pick up a gratitude journal that has daily affirmations and exercises to encourage you.

  1. Limit negative influences in your life– Influences, such as tv, social media and even consistently negative people can dampen and make achieving personal happiness difficult to attain and maintain. Everyone has a “bad day” or experience; however, when possible, guard your thoughts and eyes from unnecessary drama. The “what ifs” on the tv or social media do nothing but prey on the fight or flight center of your brain. Analyze relationships and how they affect you. When possible, limit those relationships that cause unnecessary distress in your life.
  2. Practice self-care- Self care can mean engaging in satisfying hobbies, time alone, lunch with a friend, a hot bath or anything that brings pleasure, and you look forward to doing. If you aren’t sure what to do, take time to really think about what brings you pleasure and satisfaction- and make time for it!
  3. Help others- Helping others or volunteering, builds relationships and strengthens bonds , leading to a feeling of fulfillment.
  4. Learn and practice resilience- Resilience is the ability to bounce back from setbacks and challenges. Cultivate resilience learning from failures and maintaining a positive outlook.

Being happy is linked to improved outlook of health

Studies have shown that being happy can have positive effects on physical and mental well-being.

Some ways in which happiness contributes to health:

  • Stress reduction- Happiness reduces stress. Chronic stress leads to increased cortisol levels. Chronically high cortisol levels can lower immune function, raise blood pressure, and contribute to raised blood glucose levels. Being happy counteracts the effects of stress.
  • Better lifestyle choices leading to longevity– When you are happy, you tend to eat better, are more motivated to exercise and connect with those in your life that you value. In fact, regular, consistent exercise produces mood enhancing endorphins.
  • There is a strong correlation between pain and emotions. Powerful pain-relieving endorphins- natural painkillers-are released while engaging in pleasurable activities. These endorphins reduce the perception of pain.
  • Happiness produces positive emotions– These emotions can promote resilience and help cope with the ups and downs of everyday life. Positive relationships are linked to improved mental health and overall cognitive function. In addition, problem solving abilities are enhanced when happy.
  • Happiness isn’t something that just “happens”. Personal responsibility and getting to know yourself- your genetics, overall health and personality, environment and abilities all play an important role in happiness. However, taking a proactive role in your personal happiness will yield a more fulfilled (and happy) life.

- Brooke Lounsbury, RN

Medical Content Writer

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