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Sunday, November 21, 2010

Safe Disposal of Medicines

Disposal by Flushing of Certain Unused Medicines: What You Should Know


Medicines play an important role in treating certain conditions and diseases, but they must be taken with care. Unused portions of these medicines must be disposed of properly to avoid harm. Almost all medicines can be thrown away in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a container.
However, certain medicines may be especially harmful and, in some cases, fatal in a single dose if they are used by someone other than the person the medicine was prescribed for. For this reason, a few medicines have special disposal directions that indicate they should be flushed down the sink or toilet after the medicine is no longer needed. If you dispose of these medicines down the sink or toilet, they cannot be accidently used by children, pets, or anybody else.   
You may have also received disposal directions for these medicines when you picked up your prescription. If your medicine is on this list, and you did not receive information on disposal with your prescription, you can find directions on how to dispose of the medicines at DailyMed [http://dailymed.nlm.nih.gov/dailymed/about.cfm]. After you search on the drug name, the disposal information for these medicines can be found in one of the following sections of the prescribing information: 
  • Information for Patients and Caregivers
  • Patient Information
  • Patient Counseling Information
  • Safety and Handling Instructions
  • Medication Guide
It is important to note that disposal by flushing is not recommended for the vast majority of medicines. Unused or expired medicines that do not have flushing directions in the label can be disposed of safely in the household trash by:
  1. Mixing them with something that will hide the medicine or make it unappealing, such as kitty litter or used coffee grounds.
  2. Placing the mixture in a container such as a sealed plastic bag.
  3. Throwing the container in your household trash.
Below is some additional information about the disposal of medicine that is no longer needed. If you have additional questions about disposing of your medicine, please contact us at 1-888-INFO-FDA (1-888-463-6332). 

Frequently Asked Questions

Why do the medications on the list have flushing directions for disposal?
The medicines on this list (below) of medicines recommended for disposal by flushing are safe and effective when used as prescribed, but they could be especially harmful to a child, pet, or anyone else if taken accidentally. Some of the possible harmful effects include breathing difficulties or heart problems, possibly leading to death. For these reasons, FDA advises that flushing these medicines down the sink or toilet is currently the best way to immediately and permanently remove the risk of harm from the home.
FDA continues to work with and encourage the manufacturers of these medicines to develop alternative, safe disposal systems.

How should you dispose of medicines not found on the list?
Do not flush all medicines down the toilet. The FDA recommends that most medicines be disposed of in the household trash after mixing them with some unpalatable substance (e.g., coffee grounds) and sealing them in a container.  Unused portions of medicines must be disposed of properly to avoid harm. 
Drug take-back programs for disposal can be another good way to remove unwanted or expired medicines from the home and reduce the chance that someone may accidentally take the medicine. Contact your city or county government's household trash and recycling service to see if there is a take-back program in your community and if there are any rules about which medicines can be taken back. You can also talk to your pharmacist to see if he or she knows of other medicine disposal programs in your area. 

Does flushing the medicines on the list down the toilet or sink drain pose a risk to human health and the environment?
We are aware of recent reports that have noted trace amounts of medicines in the water system. 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.
Disposal of these select, few medicines by flushing contributes only a small fraction of the total amount medicine found in the water. FDA believes that any potential risk to people and the environment from flushing this small, select list of medicines is outweighed by the real possibility of life-threatening risks from accidental ingestion of these medicines.


This list from FDA tells you what unused or expired medicines you should flush down the sink or toilet to help prevent danger to people and pets in the home. Flushing these medicines will get rid of them right away and help keep your family and pets safe.
FDA continually evaluates medicines for safety risks and will update the list as needed.

MedicineActive Ingredient
Actiq, oral transmucosal lozenge *Fentanyl Citrate
Avinza, capsules (extended release)Morphine Sulfate
Daytrana, transdermal patch systemMethylphenidate
Demerol, tablets *Meperidine Hydrochloride
Demerol, oral solution *Meperidine Hydrochloride
Diastat/Diastat AcuDial, rectal gelDiazepam
Dilaudid, tablets *Hydromorphone Hydrochloride
Dilaudid, oral liquid *Hydromorphone Hydrochloride
Dolophine Hydrochloride, tablets *Methadone Hydrochloride
Duragesic, patch (extended release) *Fentanyl
Embeda, capsules (extended release)Morphine Sulfate; Naltrexone Hydrochloride
Exalgo, tablets (extended release)Hydromorphone Hydrochloride
Fentora, tablets (buccal)Fentanyl Citrate
Kadian, capsules (extended release)Morphine Sulfate
Methadone Hydrochloride, oral solution *Methadone Hydrochloride
Methadose, tablets *Methadone Hydrochloride
Morphine Sulfate, tablets (immediate release) *Morphine Sulfate
Morphine Sulfate, oral solution *Morphine Sulfate
MS Contin, tablets (extended release) *Morphine Sulfate
Onsolis, soluble film (buccal)Fentanyl Citrate
Opana, tablets (immediate release)Oxymorphone Hydrochloride
Opana ER, tablets (extended release)Oxymorphone Hydrochloride
Oramorph SR, tablets (sustained release)Morphine Sulfate
Oxycontin, tablets (extended release) *Oxycodone Hydrochloride
Percocet, tablets *Acetaminophen; Oxycodone Hydrochloride
Percodan, tablets *Aspirin; Oxycodone Hydrochloride
Xyrem, oral solutionSodium Oxybate

*These medicines have generic versions available or are only available in generic formulations.
List revised: March 2010

For specific drug product labeling information, go to DailyMed [[http://dailymed.nlm.nih.gov/dailymed/about.cfm]] or Drugs@FDA [http://www.accessdata.fda.gov/scripts/cder/drugsatfda/].

New FDA Web Page Lists Disposal Instructions for Select Medicines

The U.S. Food and Drug Administration today launched a Web page [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm] for consumers with information on how to dispose of certain drugs, including several high-potency opioids and other selected controlled substances. These medicines have the potential to be harmful, even deadly, in a single dose if taken by someone other than the intended person. 
The FDA recommends that these medicines be disposed of by flushing down the sink or toilet. The goal is to keep them away from children and others who could be harmed by taking them accidentally.
Medicines not listed should be thrown away in the household trash after mixing them with some unpalatable substance, such as coffee grounds, and sealing them in a bag or other container. Another option is to dispose of them through drug take back programs, if federal and state law permit.
“The safe disposal of medicines from the home after they are no longer needed is an important concern for the FDA,” said Douglas Throckmorton, M.D., deputy center director of FDA’s Center for Drug Evaluation and Research.
All medicines listed have disposal instructions in their professional prescribing information; however, this information is targeted to health care professionals. The Web page provides clear instructions for consumers on whether a medicine should be flushed or disposed of in the trash.
Throckmorton also said, “The FDA is working with other groups to improve the use of several drug disposal methods, including drug take back programs. However, for some potent medicines that can cause harm or death if inadvertently taken by family members, the FDA currently recommends flushing them down the sink or toilet to immediately and permanently remove them from the home. Simple precautions like these can reduce the likelihood of accidental and potentially dangerous exposure to unused medicines.”
The FDA worked with the White House Office of National Drug Control Policy (ONDCP) to develop the first consumer guidance for proper disposal of prescription drugs. The ONDCP federal guidelines were first issued in February 2007.

Microsoft Word - RxDisposalGuidelines_20091015.doc
Federal Guidelines for Microsoft Word - RxDisposalGuidelines_20091015.docProper Disposal of Prescription Drugs:

Do not flush prescription drugs down the toilet or drain unless the label or accompanying patient information specifically instructs you to do so. For information on drugs that should be flushed visit the FDA’s website.

To dispose of prescription drugs not labeled to be flushed, you may be able to take advantage of community drug takeback programs or other programs, such as household hazardous waste collection events, that collect drugs at a central location for proper disposal. Call your city or county government’s household trash and recycling service and ask if a drug takeback program is available in your community.

If a drug takeback or collection program is not available:
  • Take your prescription drugs out of their original containers.
  • Mix drugs with an undesirable substance, such as cat litter or used coffee grounds.
  • Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag.
  • Conceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off.
  • Place the sealed container with the mixture, and the empty drug containers, in the trash.
References: www.WhiteHouseDrugPolicy.gov


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