Vial Safety: The 28-Day Rule

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What you don't know about your medication vials could be putting your health at risk. In this eye-opening discussion, healthcare providers Kelli White and Nicole Baldwin tackle a critical but often overlooked aspect of medication safety that affects anyone using injectable treatments like GLP-1s, insulin, or B12.

The pair unveils the crucial distinction between the expiration date printed on your medication vial and what happens once you puncture it with a needle. Despite what many patients believe, that first puncture starts a 28-day countdown—regardless of the printed expiration date. Beyond this window, you face increasing risks of infection and decreased medication effectiveness that could seriously impact your treatment outcomes.

Through clear examples and personal clinical experiences, Kelli and Nicole explain why pharmacies and providers insist on specific dispensing practices that might seem inconvenient but are actually protecting your health. They share alarming scenarios they've witnessed firsthand when patients unknowingly used degraded medications, including dangerous blood sugar swings with insulin and painful muscle abscesses from contaminated injections. Their practical advice includes simple habits like marking your vials with puncture dates and understanding why your provider might prescribe multiple smaller vials instead of one large one.

Whether you're using semaglutide for weight management, insulin for diabetes, or other injectable medications, this conversation delivers essential knowledge that could prevent serious complications. Share this episode with friends and family members who use injectable medications—it might be the most important 13 minutes they spend on their health this week.

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Episode Transcript

kelli (00:00):
Hey guys, welcome back, Another episode of tattoos and
telehealth.
I'm Kelly White with ChariHealth, and this is my great
colleague and friend, NicoleBaldwin, and we are going to
chat for just a little bit aboutsomething that's kind of near
and dear to us.
But first, our lawyers and allthe peeps in the background that
we absolutely adore Shout outto all of our people in the

(00:20):
background that make thispossible make us say that this
podcast and this littleconversation absolutely does not
constitute a patient providerrelationship and that none of
this is to be considered medicaladvice.
We're just two gals chatting itup, having a conversation about
some things that we see dailyin our practice that we want to
pass on to everyone else.
So, having said all of that, wewant to visit for just a little

(00:45):
bit about your vials, yourvials of medication that you
have in your refrigerator.
So we prescribe a lot ofcompounded GLP-1 medication,
which, as everyone right nowknows, Tirzepatide and
semaglutide mostly.
There are some others, butthose are the two that we see

(01:05):
the most.
And what we mean by your vialit's the little glass bottle
that you get, or syringes thatyou get from the pharmacy when
you see your provider and theyprescribe your GLP-1 medication,
whether it's for weight loss,for diabetes, whatever the
situation may be.

(01:26):
We want to chat with you aboutthat expiration date.
So there's a couple of thingsright, Nicole.
So there's a best use date andthere is a vile expiration date.
So what is the difference?
Why does it matter?
What do we need to know aboutthat?
Who cares, Like I?
I mean, I assume it's not thesame.
As you go buy a jug of milk andit's you know best use date on

(01:48):
the jug of milk, Does that meanthat it's going to grow mold
Like?
What do I need to know?

Nicole (01:52):
Yeah, so what is commonly in the medical world
called the bud date is thebeyond use date and everything
that comes from the grocerystore and it comes from the
pharmacy just the same, the FDAsays it's got to have an
expiration date.
It has to, and so everythinghas an expiration date
regardless.
Medications are no different,especially those in the vials.

(02:13):
The importance of the vial isthat the beyond use date or
expiration date on that is, howlong it's good without being
punctured is how long it's goodwithout being punctured.
That's the big thing there.
And once you puncture itwhether it's insulin, whether
it's B12, whether it's GLP-1, Idon't care what it is once you

(02:35):
puncture it it is only good for28 days, regardless of the bud
date.
If it says, if it says on there, used by or whatever, 10 years
from now, once you puncture itthe clock starts ticking.
Once it's punctured.

kelli (02:54):
Does that mean they pop the top or they actually stick a
needle in it?
Stick a needle in it.

Nicole (02:59):
Gotcha, once it's punctured it is exposed to
potential contamination fromneedles, syringes, the
environment and bacteria andother pathogens can grow inside
the vial and over time thatincreases the risk for
infections, especially whenadministered subcutaneously or

(03:19):
intramuscularly, however you'reinjecting it.
So some pharmacies will say, ohwell, we have a beyond use date
of um, we, we.
We have a beyond use date of,you know, six months.
Okay, great, that's great.
But if it's a multi-use vial,there should not be doses beyond
28 days, because once you pokeit, it's only good for 28 days.

(03:42):
Otherwise, on day 29, you'rereally increasing your risk for
infection, cellulitis and thingslike that.
Any medication, includinginsulin biologics, can degrade
once the vial is open, so youshouldn't even really flip the
top.
I mean, you have to puncture it, but you know, especially once
you puncture it, it but it canlose its effectiveness, which

(04:05):
can compromise treatmentoutcomes, and you can go by the
beyond use state if it has notbeen punctured.
And I think patients think thatthey can just get a large dose
of insulin or a large vial ofb12 and they can use it till
it's gone, and that really is.
You really shouldn't do that.
You really shouldn't do that.
You really shouldn't do that.
You really should pay attentionto when you puncture it and

(04:27):
then you put with a marker youknow opened on or good until 28
days.
What are your thoughts on that,Kel?

kelli (04:35):
So you know, I think that it's a really I think it's a
common thing for people not tounderstand the difference
between the two.
You know, I think that wheneveryou see that beyond use date,
it's very easy to think thatit's as good as an expiration
date and it's as good as saying,well, it's going to be good

(04:57):
until this, no matter what.
And I think that's verymisleading.
I think that, and I thinkthat's very misleading.
I think that you know,pharmacies do the best that they
can in certain situations, butI really wish that we could even
see a you know puncture date onthe vials as well, or on the
packaging.
I think that would bebeneficial for patients if we
could see you know a beyond usedate, that's.

(05:18):
You know, that's certainlyhelpful, so we know how long the
vial itself is good.
But even if you know, underthat, if it could say puncture
date, you know, letting someoneknow puncture date 28 days, just
as a reminder, always as areminder 28 days, puncture date,
28 days on every vial that goesout, you know my concern.

(05:39):
There is not only their riskfor infection but, as you
mentioned just a second ago,those medications start to
degrade, meaning they break down, so they become less effective.
So let's say, we're givinginsulin to our diabetics and
we're asking them to dose thisbased on their blood glucose

(05:59):
readings and for some reasonthey're dosing themselves, but
their glucose never goes downand it's not responding
appropriately.
It continues to climb,continues to climb.
They're dosing insulin,continues to climb, they're
dosing more insulin.
And you know, one of two thingscan happen they either go into
what we call a DKA, which iswhere they're just an extremely

(06:20):
high, high glucose, becausetheir insulin was less effective
, it had broken down, it was tooold, it wasn't doing its job
which I have actually seenhappen or, heaven forbid, they
run out of that insulin.
They pop a brand new vial andgo okay, I'm going to double it,
it's not working, I'm going todo 12 units this time.
And they overdose on insulin.

(06:40):
And now we're in the oppositeproblem, because this is a fresh
vial, it's brand new, it'sready to go, it's full potency,
and they doubled it because theyweren't seeing the
effectiveness.
And now we have the oppositeproblem and they're hypoglycemic
.
And so we flip-flop thescenario, which can be
detrimental.
It can be very, veryproblematic.

(07:01):
So I think it's very importantthat we talk about and make sure
that everyone understandsthere's a puncture date on these
vials for lots of reasons, notjust the risk of cellulitis, but
just the risk of thatmedication not being effective
and what that can do to dosing.
I think that can be detrimentaland that goes for all

(07:23):
medications, right?
So you know, I've seentestosterone come in those
medications.
Sometimes men and women willget their own testosterone vials
and keep that, and that's anintramuscular injection.
Have you ever seen an abscessof a muscle?
Ooh, it it not pretty, it'spainful.

(07:45):
So if you get an infection thatabscesses itself off in your
muscle, oh, friends.
So I mean, there's a lot of,there's a lot of medications
that we, you know, puncture, usethe medication, keep in our
refrigerator.

Nicole (07:58):
Um, that may or may not be, you know good, past that
certain time, yeah, there's eveneven if you I think it's on
like a bottle of ketchup, youcan store it at room temperature
for a long time.
But you also see, use withinseven days of opening or
whatever it is.
I don't it's longer than that,but I'm just saying there's so
many things in your refrigeratorthat say, use within seven days

(08:21):
of opening or use within 28days of opening or whatever.
Like even even a bottle of soda, it can sit at room temperature
probably forever.
I mean, I don't know, there's a, I'm sure there's a date on it,
but once you open it, it'll, itgoes flat eventually.
It's not good.
It's even if, even if you, ifyou open it and then you put the
lid on it is sitting out, itwill still get.
It will still go flat once youopen it.

(08:42):
But the expiration date is, youknow, 10 years from now.
Right, but once you mess withit it starts to degrade.
The same concept withmedications that you're
injecting.
So you don't just have.
You know you drink a flat sodaand you know, whatever you're
injecting this in here, you knowin, you're injecting it into
your body and so you really haveto be careful with that.

(09:04):
And that's a lot of the reasonwhy there's not large vials of
things, that we can't just sendyou a large vial and say, you
know, have at it.
You know, I remember working atthe hospital and if we opened a
multi use insulin we had towrite with a marker 20, you know
the 28 day mark.
So, yep, I mean, it's just,it's just what's what's safest

(09:26):
and you don't want to riskinfection and injecting things,
and you know.

kelli (09:31):
So that brings up the next thing you know some of
these medications, you know I doa lot of IV therapy for archery
when we go to archerytournaments and so I do a lot of
IV therapy at those archerytournaments and some vials are
preservative free, meaning theyhave a lower shelf life and a

(09:52):
lower best use date, and thenthose with preservatives may
have a longer shelf life, lowerbest use date, and then those
with preservatives may have alonger shelf life or best use
date.
So those things matter, whetheror not what you're getting has
preservatives or doesn't havepreservatives.
And so you know, guys, I thinkwhat we're getting to here is
ask the questions, ask thequestions about what you're
getting.
Does it have preservatives?

(10:14):
What is the best use date?
What is the?
You know, what can you expectafter you open it?
What can you expect after youpuncture it?
You know all of those questionsare very, very important, but
then as providers, our job is tospend that time educating our
patients.
Once you puncture that vial,you've got 28 days.

(10:34):
Once you puncture that vial,you've got 28 days.
Period into story, 28 days.
And then, as your provider, ourjob is to be sure that you have
another vial coming before that28 days.
If this is a continuous regimen, you know if we have you on
insulin for your diabetes, wewant to be sure you don't run
out.
So our job is to make sure thatafter you know, before that 28
days runs up, that you've gotanother vial, whether the one

(10:58):
you have is empty or not,because that one's done.

Nicole (10:59):
Yep, absolutely Absolutely.
And you know the bud date, thebeyond use date is think of the
expiration date.
But just like anything else,once you open it, once you
puncture it, the clock startsticking.
It's to where it's just, it'sjust not, it's just not good
anymore.
And you know, I get a lot ofpatients that want more than one

(11:20):
month and I'm like, okay, but Ihave to send you multiple vials
, right?
So if you want multiple months,you've got to have, let's say,
you want three months, you gotto have three vials and the one
you open and then you use it,and then the one you open and
then you use it, and then thethird one you open and then you
use it.
And that's why it comes thatway.
That's why we don't justprescribe haphazardly these

(11:44):
large doses, because why getsomething and be wasteful if you
can't safely use it after 28days?
We don't want you using it.
It's a safety thing.
It's not that we're beingrotten or trying to be difficult
, it is what it is, so for sure.
Yeah, so I think, I think wedrove our our point home today.

(12:07):
Just please understand why wedose things, why providers dose
things.
The way that we dose things,there's always your safety in
mind.
You know we shouldn't send youa larger volume because it's
just as cheap or whatever it hasto do with that beyond use date
.
And then the puncture date alsois the most important.

(12:29):
So pay attention, ask yourquestions.
If you want to talk furtherabout this, you can reach me at
wwwHamiltonTelehealthcom, andfor Kelli, you can reach her at
ChariHealthcom C-H-A-R-I Healthdot com.
All right.
If you guys have any questions,let us know.
We'll be happy to explainthings further.

(12:50):
If you have any questions orjust need some medical care
online, we can certainly helpyou.
Have a good day.

kelli (12:57):
Bye guys.