After the Storm: A Pharmacist's Guide to Medication Safety During Power Outages and Flooding

The Insulin and Refrigerated Medication Crisis

The most urgent post storm medication safety issue for most patients is the loss of refrigeration for temperature sensitive medications.

Insulin is the most common and most critical refrigerated medication. The rules for insulin storage after power loss are specific and worth knowing in advance:

Unopened insulin, still sealed in original packaging, never punctured, can be stored at room temperature below 77 degrees Fahrenheit for the manufacturer specified period, which is typically 28 days for most insulin formulations. If the temperature in your home after a storm is below 77 degrees, unlikely in a Mississippi summer, sealed insulin can remain at room temperature and still be used through its beyond use date.

If the temperature exceeds 77 degrees Fahrenheit, which it will rapidly in an unventilated Mississippi home after a summer storm, unopened insulin should be transferred to a cooler with ice as quickly as possible.

Opened insulin, a vial that has been punctured or a pen that has been used, has a separate in use beyond use date that is typically 28 days from first use, and also should not be exposed to temperatures above 77 degrees. Keep opened insulin in a cooler with ice when power is out and ambient temperature is high.

Signs that insulin has been damaged by heat: cloudiness in normally clear insulin, clumping or crystallization, unusual color changes, or unusual particles. Insulin that shows any of these signs should not be used, it may not provide adequate glucose control and could be unsafe.

Other refrigerated medications that require the same attention: some liquid antibiotics, certain eye drops and eye medications, some biologics and injectable medications, and some suppositories. Check the storage requirements on the label for any refrigerated medication you take.

Medications Damaged by Flooding

If your medications were exposed to floodwater, even briefly, they should not be used.

Floodwater after a Gulf Coast storm is contaminated with sewage, agricultural runoff, industrial chemicals, and biological hazards. Any medication that has been submerged in or splashed by floodwater has been exposed to this contamination regardless of whether the container appears intact.

Do not attempt to dry out and use medications that were flooded. Do not use medications whose containers were compromised by water even if the medication itself appears visually unchanged. The contamination is not always visible.

Contact your pharmacy for emergency replacement fills of medications lost to flooding. As discussed in our hurricane prescription access post, Mississippi emergency regulations allow pharmacists to dispense emergency supplies of maintenance medications when the original supply has been lost due to a declared disaster.

Document medication losses for insurance purposes, most homeowner and renter insurance policies cover medication losses under disaster conditions. Your pharmacy can provide documentation of what was lost and its value.

Heat Exposure and Medication Degradation

Beyond insulin and refrigerated medications, heat exposure above recommended storage temperatures accelerates the degradation of many medications that are typically stored at room temperature.

The recommended storage temperature for most oral medications is 59 to 77 degrees Fahrenheit, cool, dry, room temperature. In an unventilated Mississippi home after a summer storm, interior temperatures can reach 90 to 100 degrees Fahrenheit within hours of power loss.

Medications most sensitive to heat exposure:

Nitroglycerin tablets are among the most heat sensitive common medications. Even brief exposure to high temperatures can significantly reduce potency. Nitroglycerin exposed to post storm heat conditions should be replaced before it is used for angina management, the consequences of using ineffective nitroglycerin during an acute cardiac event are potentially fatal.

Liquid medications, liquid antibiotics, liquid cough products, liquid antihistamines, degrade faster than solid oral forms and are more sensitive to temperature extremes. Any liquid medication that has been in an unventilated hot environment for extended periods should be treated with suspicion.

Suppositories are designed to melt at body temperature and will become unusable at elevated room temperatures. Store them in a cooler with ice if power is out during high heat conditions.

Eye drops exposed to heat may experience changes in pH and preservative effectiveness. Follow the manufacturer’s storage guidance for specific ophthalmic products.

Inhalers, particularly metered dose inhalers for asthma and COPD, should not be stored in extreme heat. The propellant pressure and drug delivery mechanism can be affected by high temperatures. Keep rescue inhalers in a pocket or cooler rather than leaving them in a hot car or hot room.

Water Supply Contamination and Oral Medications

After major flooding, municipal water supplies are sometimes under boil water advisories, meaning the water is contaminated and unsafe for drinking without boiling first.

Taking oral medications with contaminated water is a documented post disaster risk. Use bottled water or boiled and cooled water to take all oral medications when a boil water advisory is in effect. Do not use tap water from a compromised municipal supply for medication administration even if the water appears clear.

This applies to medications taken with water, medications that need to be dissolved in water before taking, medications administered through feeding tubes, and medications prepared by caregivers for children or elderly patients.

Stress and Chronic Condition Management After a Storm

Hurricane recovery is physically and emotionally exhausting. The stress response, sustained elevation of cortisol, disrupted sleep, physical exertion from cleanup, changed eating patterns, disrupted medication schedules, directly affects the management of chronic conditions.

Blood pressure typically rises during periods of psychological and physical stress. Patients with hypertension should be particularly attentive to medication adherence during storm recovery and should check their blood pressure more frequently if they have a home cuff available.

Blood sugar is significantly affected by stress, physical exertion, disrupted eating patterns, and missed medications. Diabetic patients should monitor blood glucose more frequently than usual during storm recovery and should be alert for symptoms of both hypoglycemia, shakiness, sweating, confusion, and hyperglycemia, excessive thirst, frequent urination, fatigue.

Psychiatric medications, antidepressants, anxiolytics, antipsychotics, mood stabilizers, should be maintained on their normal schedule as consistently as possible during storm recovery, even in chaotic circumstances. The psychological stress of storm recovery is exactly the condition these medications exist to help manage. Missing doses during a period of elevated stress risk is doubly problematic.

Pain medications, including both prescription pain medications and OTC pain relievers, are commonly used more heavily during storm recovery because of physical labor, injury, and stress. Be attentive to acetaminophen accumulation if you are using multiple products simultaneously, as we discussed in our acetaminophen overdose post.

The Post Storm Medication Inventory

As soon as it is safe to do so after a storm, conduct a complete medication inventory. For each medication ask:

Was it exposed to floodwater? If yes, discard and replace. Was it exposed to temperatures above 77 degrees Fahrenheit for extended periods? If yes, assess based on the specific medication and replace if there is any doubt. Is the container intact and undamaged? If no, discard and replace. Is the medication visually unchanged, same color, same clarity, no unusual particles? If no, discard and replace.

When in doubt, discard and replace. The cost of replacing a medication is always less than the cost of the adverse health outcome from using a damaged one.

Getting Replacement Medications After a Storm

Contact Fairview Pharmacy as soon as phone lines and internet connectivity are restored. We maintain a disaster response protocol that includes emergency dispensing capabilities, generator backup for critical pharmacy operations, and established relationships with emergency supply distributors specific to Gulf Coast storm scenarios.

We have done this before. We know how to help patients rebuild their medication supplies after a storm. Please call us first, before going to an emergency shelter or driving to an out of area pharmacy, so we can tell you what we have available and what the fastest path to getting your medications is.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.