Handling Essential and Counterfeit Medicines
Essential Medicines Management
Medications must be stored, handled, and used according to product-specific recommendations, drawn up immediately before use, and discarded if beyond expiration dates or showing visible contamination. 1
Storage and Handling Requirements
Single patient use only for all medications and fluids - the practice of combining, multidosing syringes, or sharing vials between patients is unacceptable. 1
Clean glass ampule necks and rubber caps with 70% isopropanol (with or without chlorhexidine) and allow to dry before inserting a drawing-up needle, as exterior surfaces of injection vials are not sterile. 1
Draw up medications just before use to minimize contamination risk and maintain sterility. 1
Discard medications beyond use-by dates or with any breaches of sterile integrity. 1
Store medications per product-specific recommendations, particularly heat and moisture-labile antibiotics that can deteriorate in tropical conditions. 1
Emergency Drug Preparation
Label emergency drug syringes with medication name, concentration, date, time prepared, and preparer's name/initials. 1
Each provider should draw up their own emergency drugs for their shift to reduce contamination risk and drug errors. 1
Change emergency drugs at every shift transition. 1
Store prepared emergency medications in secured areas per local guidelines. 1
High-Risk Medications
Exercise special care when preparing propofol, which is 3.2 times more likely to be contaminated compared to other medications like ephedrine. 1
Recognize that propofol can support bacterial and fungal growth, promote endotoxin production, and maintain viral stability. 1
Counterfeit Medicines: Recognition and Prevention
Pharmacists and healthcare providers must purchase medications exclusively from known, reliable, licensed sources to prevent counterfeit drug distribution. 2
Prevalence and Impact
Counterfeit medicines account for approximately 1% of drugs in developed countries, rising to 10% globally and up to 50% in some developing countries. 3
In low- and middle-income countries, the median prevalence of counterfeit and substandard antibiotics is 28.5%, with 93% containing inadequate amounts of active ingredients. 1
Up to 50% of medicines available via the internet are counterfeit according to WHO estimates. 3
Counterfeit drugs can contain wrong ingredients, insufficient or excessive active ingredients, or no active ingredients at all. 3
Detection and Reporting Strategies
Examine products for suspicious appearance including packaging irregularities, unusual labeling, or physical inconsistencies. 2
Monitor counterfeit product alerts from regulatory authorities, manufacturers, and distributors regularly. 2
Confirm with distributors that products were purchased directly from manufacturers or other verified reliable sources. 2
Report suspicious medications immediately to the FDA, the distributor, and the manufacturer. 2
Consider counterfeits as a possible cause when patients experience unexpected adverse reactions or therapeutic failure. 3
Supply Chain Protection
Close gaps in the supply chain, especially for drugs in short supply which are particularly vulnerable to counterfeiting. 2
Use scanning technology in pharmacy practice as part of prescription verification processes. 2
Work collaboratively with the pharmaceutical industry, distributors, and FDA to strengthen supply chain integrity. 2
Avoid purchasing from unauthorized online pharmacies or unregulated sources. 2
Patient Education and Protection
Warn patients explicitly about the dangers of purchasing medications over the internet from unlicensed sources. 2
Educate patients to report any irregularities concerning their medications, unexpected side effects, or decreased therapeutic effect. 3
Instruct patients to obtain medications only from licensed pharmacies. 3
Inform patients that 16% of consumers who privately imported medicines through online pharmacies experienced adverse events. 4
Healthcare Professional Responsibilities
Educate yourself, coworkers, and patients continuously about counterfeit medication risks. 2
Stay vigilant as the most important players in campaigns against counterfeit medicines. 3
Recognize that counterfeit drugs have become increasingly sophisticated and difficult to detect over time. 3
Understand that the complete absence of quality control in counterfeit products makes them particularly dangerous, even when indistinguishable from genuine products. 5
Critical Pitfalls to Avoid
Never assume that branded medications are immune to counterfeiting - both branded and generic medicines have been counterfeited. 3
Do not ignore the possibility of counterfeits in developed countries, as they increasingly penetrate even well-regulated markets. 3, 6
Avoid complacency regarding supply chain verification, particularly during drug shortages when counterfeit risk increases. 2
Do not underestimate the health consequences - counterfeit medications can cause serious harm including allergic reactions and denial of life-saving treatments. 6, 5