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Hi Laurie!

Quick question. We occasionally treat severe iliopsoas strains via phonophoresis with LidoDex gel. The gel comes from a compounding pharmacy and is typically labeled with a discard by date of about 3 months from purchase. I really hate to waste the gel as it seems we either have multiple patients who need it or none. Can you give me any input as to whether the gel goes “bad” and is inactive after the date or does it become less effective? We contacted the compounding pharmacy and for obvious reasons they couldn’t give us any rationale, but said to discard according to the date on the bottle. What are your thoughts on this?

Thank you,
H.

Hi H,

Interesting question. My questions back, are: “Is it a true strain?” “Do you need to be doing phonphoresis?”

But if yes, then MY FEELING would be that the gel is ‘good’ for longer than the posted date on the bottle.
(And I’m going to post this onto the Forum as well, b/c I’d be more than open to others knowledge & opinions on this.)

Here’s the rationale for my ‘Feeling’ on the subject:
1) I remember back to my university pharmacology course, where we were told that the best before dates were just a time where there was no reduction in the drug’s half life… but that the medications would still be effective, useful, but may not provide the same strength or length of effectiveness. (So for a heart medication, that’s a problem, but for a pain med… not so bad!)
2) Just this fall I finally used up my ‘expired in 2004’ Tylenol… and it was still effective.
3) One can question just how effective phonophoresis is at all. Are you actually having a ‘direct’ effect? Within 24 hours the drug is systemic anyways. Is the effectiveness due to the ultrasound as compared to the LidoDex addition anyways?
4) I know that US nutraceutical companies are forced to put expiry dates on products shipped to Canada. We’ve had companies share with us that their expiry dates are arbitrary. When tested, their products was still just as effective. Now, I know that a ‘drug’ and a ‘nutraceutical’ are different things, but I have always questioned expiry dated (except on milk… THAT I believe!).

However, the other thing that you would have to consider would be liability issues should a client find out you were using expired product. Being that you’re from a great big litigious country… I think that that would have to factor into your decision making unfortunately! And it makes me feel the need to say: I am not a pharmacist. Check with your pharmacist before using any expired products!



Cheers,

Laurie

Not to directly answer your question, but still coming from the perspective of someone who used to phonophorese (is that a word?) with dex/lido, but stopped...

Given that chronic issues are more likely to be tendonopathy than tendonitis, and that increased vacularity and perfusion is required for healing, there is a strong argument to be made that using anti-inflammatories (with their associated vasoconstrictive effects) on these conditions will slow healing, even if they do reduce pain. Therefore, are they a good idea to use at all?

David Lane

Yep David, there IS that!!!

Thanks for chiming in!

Laurie