Vial Safety: The 28-Day Rule

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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Chapters

• 0:00 Introduction and Medical Disclaimer
• 0:40 Understanding Medication Vials and Expiration
• 2:12 The 28-Day Rule After Puncturing
• 4:38 Risks of Using Expired Medications
• 9:44 Preservatives Impact on Medication Shelf Life
• 10:42 Provider Responsibility and Patient Education

Transcript

kelli: 0:00

Hey guys, welcome back, Another episode of tattoos and telehealth. I'm Kelly White with Chari Health, and this is my great colleague and friend, Nicole Baldwin, and we are going to chat for just a little bit about something that's kind of near and dear to us. But first, our lawyers and all the peeps in the background that we absolutely adore Shout out to all of our people in the background that make this possible make us say that this podcast and this little conversation absolutely does not constitute a patient provider relationship and that none of this is to be considered medical advice. We're just two gals chatting it up, having a conversation about some things that we see daily in our practice that we want to pass on to everyone else. So, having said all of that, we want to visit for just a little bit about your vials, your vials of medication that you have in your refrigerator. So we prescribe a lot of compounded GLP-1 medication, which, as everyone right now knows, Tirzepatide and semaglutide mostly. There are some others, but those are the two that we see the most. And what we mean by your vial it's the little glass bottle that you get, or syringes that you get from the pharmacy when you see your provider and they prescribe your GLP-1 medication, whether it's for weight loss, for diabetes, whatever the situation may be.

kelli: 1:26

We want to chat with you about that expiration date. So there's a couple of things right, Nicole. So there's a best use date and there is a vile expiration date. So what is the difference? Why does it matter? What do we need to know about that? Who cares, Like I? I mean, I assume it's not the same. As you go buy a jug of milk and it's you know best use date on the jug of milk, Does that mean that it's going to grow mold Like? What do I need to know?

Nicole: 1:52

Yeah, so what is commonly in the medical world called the bud date is the beyond use date and everything that comes from the grocery store and it comes from the pharmacy just the same, the FDA says it's got to have an expiration date. It has to, and so everything has an expiration date regardless. Medications are no different, especially those in the vials. The importance of the vial is that the beyond use date or expiration date on that is, how long it's good without being punctured is how long it's good without being punctured. That's the big thing there. And once you puncture it whether it's insulin, whether it's B12, whether it's GLP-1, I don't care what it is once you puncture it it is only good for 28 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 it the clock starts ticking. Once it's punctured.

kelli: 2:54

Does that mean they pop the top or they actually stick a needle in it? Stick a needle in it.

Nicole: 2:59

Gotcha, once it's punctured it is exposed to potential contamination from needles, syringes, the environment and bacteria and other pathogens can grow inside the vial and over time that increases the risk for infections, especially when administered subcutaneously or intramuscularly, however you're injecting it. So some pharmacies will say, oh well, 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 poke it, it's only good for 28 days. Otherwise, on day 29, you're really increasing your risk for infection, cellulitis and things like that.

Nicole: 3:51

Any medication, including insulin biologics, can degrade once the vial is open, so you shouldn't even really flip the top. I mean, you have to puncture it, but you know, especially once you puncture it, it but it can lose its effectiveness, which can compromise treatment outcomes, and you can go by the beyond use state if it has not been punctured. And I think patients think that they can just get a large dose of insulin or a large vial of b12 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 attention to when you puncture it and then you put with a marker you know opened on or good until 28 days. What are your thoughts on that, Kel?

kelli: 4:35

So you know, I think that it's a really I think it's a common thing for people not to understand the difference between the two. You know, I think that whenever you see that beyond use date, it's very easy to think that it's as good as an expiration date and it's as good as saying, well, it's going to be good until this, no matter what. And I think that's very misleading. I think that, and I think that's very misleading. I think that you know, pharmacies do the best that they can in certain situations, but I really wish that we could even see a you know puncture date on the vials as well, or on the packaging. I think that would be beneficial for patients if we could see you know a beyond use date, that's. You know, that's certainly helpful, so we know how long the vial itself is good. But even if you know, under that, if it could say puncture date, you know, letting someone know puncture date 28 days, just as a reminder, always as a reminder 28 days, puncture date, 28 days on every vial that goes out, you know my concern. There is not only their risk for infection but, as you mentioned just a second ago, those medications start to degrade, meaning they break down, so they become less effective.

kelli: 5:52

So let's say, we're giving insulin to our diabetics and we're asking them to dose this based on their blood glucose readings and for some reason they're dosing themselves, but their glucose never goes down and 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 things can happen they either go into what we call a DKA, which is where they're just an extremely high, high glucose, because their insulin was less effective, it had broken down, it was too old, it wasn't doing its job which I have actually seen happen or, heaven forbid, they run out of that insulin. They pop a brand new vial and go okay, I'm going to double it, it's not working, I'm going to do 12 units this time. And they overdose on insulin. And now we're in the opposite problem, because this is a fresh vial, it's brand new, it's ready to go, it's full potency, and they doubled it because they weren't seeing the effectiveness. And now we have the opposite problem and they're hypoglycemic. And so we flip-flop the scenario, which can be detrimental. It can be very, very problematic.

kelli: 7:01

So I think it's very important that we talk about and make sure that everyone understands there's a puncture date on these vials for lots of reasons, not just the risk of cellulitis, but just the risk of that medication not being effective and what that can do to dosing. I think that can be detrimental and that goes for all medications, right? So you know, I've seen testosterone come in those medications. Sometimes men and women will get their own testosterone vials and keep that, and that's an intramuscular injection. Have you ever seen an abscess of a muscle? Ooh, it it not pretty, it's painful. So if you get an infection that abscesses 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, use the medication, keep in our refrigerator.

Nicole: 7:58

Um, that may or may not be, you know good, past that certain time, yeah, there's even even if you I think it's on like a bottle of ketchup, you can store it at room temperature for a long time. But you also see, use within seven 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 refrigerator that say, use within seven days of opening or use within 28 days 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, it goes flat eventually. It's not good. It's even if, even if you, if you open it and then you put the lid on it is sitting out, it will still get. It will still go flat once you open it. But the expiration date is, you know, 10 years from now. Right, but once you mess with it it starts to degrade.

Nicole: 8:50

The same concept with medications that you're injecting. So you don't just have. You know you drink a flat soda and you know, whatever you're injecting this in here, you know in, you're injecting it into your body and so you really have to be careful with that. And that's a lot of the reason why there's not large vials of things, that we can't just send you a large vial and say, you know, have at it. You know, I remember working at the hospital and if we opened a multi use insulin we had to write 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 and you don't want to risk infection and injecting things, and you know.

kelli: 9:31

So that brings up the next thing you know some of these medications, you know I do a lot of IV therapy for archery when we go to archery tournaments and so I do a lot of IV therapy at those archery tournaments and some vials are preservative free, meaning they have a lower shelf life and a lower best use date, and then those with preservatives may have a longer shelf life, lower best use date, and then those with preservatives may have a longer shelf life or best use date. So those things matter, whether or not what you're getting has preservatives or doesn't have preservatives. And so you know, guys, I think what we're getting to here is ask the questions, ask the questions about what you're getting. Does it have preservatives? What is the best use date? What is the? You know, what can you expect after you open it? What can you expect after you puncture it?

kelli: 10:22

You know all of those questions are very, very important, but then as providers, our job is to spend that time educating our patients. Once you puncture that vial, you've got 28 days. Once you puncture that vial, you've got 28 days. Period into story, 28 days. And then, as your provider, our job is to be sure that you have another vial coming before that 28 days. If this is a continuous regimen, you know if we have you on insulin for your diabetes, we want to be sure you don't run out. So our job is to make sure that after you know, before that 28 days runs up, that you've got another vial, whether the one you have is empty or not, because that one's done.

Nicole: 10:59

Yep, absolutely Absolutely. And you know the bud date, the beyond use date is think of the expiration date. But just like anything else, once you open it, once you puncture it, the clock starts ticking. It's to where it's just, it's just not, it's just not good anymore. And you know, I get a lot of patients that want more than one month and I'm like, okay, but I have 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 got to 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 the third one you open and then you use it. And that's why it comes that way.

Nicole: 11:40

That's why we don't just prescribe haphazardly these large doses, because why get something and be wasteful if you can't safely use it after 28 days? We don't want you using it. It's a safety thing. It's not that we're being rotten or trying to be difficult, it is what it is, so for sure. Yeah, so I think, I think we drove our our point home today. Just please understand why we dose things, why providers dose things. The way that we dose things, there's always your safety in mind. You know we shouldn't send you a larger volume because it's just as cheap or whatever it has to do with that beyond use date. And then the puncture date also is the most important. So pay attention, ask your questions. If you want to talk further about this, you can reach me at wwwHamiltonTelehealthcom, and for Kelli, you can reach her at ChariHealthcom C-H-A-R-I Health dot com.

Nicole: 12:46

All right. If you guys have any questions, let us know. We'll be happy to explain things further. If you have any questions or just need some medical care online, we can certainly help you. Have a good day.

kelli: 12:57

Bye guys.