ISMP Safe Medicine May/June 2008, Volume 6, Number 3. ©2008 ISMP

Brand name medicines appear in green; generic medicines appear in red.

Camphor and seizures in children

Medicines that are no longer used, needed, or expired should be discarded in a manner that protects your family, pets, community, and environment. Consumers were once told to flush old medicines down the toilet. However, recent studies show that medicines disposed in sewer and septic systems might later be found in very small amounts in the environment. So the rule of thumb today is: DO NOT FLUSH medicines. A few exceptions exist. The US Food and Drug Administration (FDA) has identified thirteen prescription medicines that should be flushed. These medicines are listed in Table 1.

According to the federal government (www.whitehousedrugpolicy.gov/drugfact/factsht/proper_disposal.html), medicines should be disposed in the following manner:
 

• Take unused, unneeded, or expired medicines out of their original containers and throw them in the trash. But first mix prescription medicines with an undesirable substance, such as used coffee grounds or kitty litter, and put them in sealed, plain containers, such as empty cans or sealable bags. This will help prevent children and pets from accidentally getting into the medicine in the trash. It will also discourage adults from removing the medicine from the trash for abuse. 
• Flush prescription medicines down the toilet only if the label or accompanying patient information specifically instructs you to do so (such as those listed in Table 1).         
• Some communities have take-back or waste disposal programs that allow you to bring unused drugs to a central location for safe disposal. Ask your pharmacist whether these programs are available in your community.
• Some medicines have specific instructions for safe disposal, such as folding patches with the sticky medicine side together before disposal. So always read the instructions on your medicine and talk to your pharmacist if you have questions.

For additional information about proper medicine disposal, visit: www.smarxtdisposal.net/.

Table 1. FDA advises flushing these prescription medicines instead of disposing of them in the trash. This includes both brand and generic versions of the medicines.

Actiq (fentanyl)
Daytrana Patch (methylphenidate)
Duragesic Patch (fentanyl)
OxyContin Tablets (oxycodone)
Avinza Capsules (morphine)
Baraclude Tablets (entecavir)
Reyataz Capsules (atazanavir)
Tequin Tablets (gatifloxacin)
Zerit Oral Solution (stavudine)
Meperidine Tablets
Percocet (oxycodone and acetaminophen)
Xyrem (sodium oxybate)
Fentora (fentanyl buccal tablet)