Tuesday, May 31, 2011

Death by Internet Searching

The hot flashes I experienced from chemo a few years ago, and continued anti-hormonal therapy, caused me to develop rosacea. It may have eventually erupted on its own, but I primarily fault my cancer treatment for bringing it on.

I am probably predisposed to the condition.....it tends to hit fair-skinned women in their 30's with Celtic ancestry.  That's me.

There is no cure for rosacea; it's a chronic condition that is managed, sometimes going into "remission" and then flaring up.

One of the treatments for rosacea consists of taking Doxycycline, an antibiotic, for about a month or two depending on how quickly symptoms subside.  Doctors aren't quite sure why the antibiotic works for rosacea, because rosacea isn't exactly an infection.

Anyway, now that I've bored everyone with my medical conditions, the point is that I had some Doxycycline in my medicine cabinet from the previous time I had taken it a couple of years ago. My rosacea was acting up and I decided to just take it because I didn't have time to get to the dermatologist and just figured they were going to tell me to take Doxycycline anyway.

I noticed it was expired, but then recalled a pharmacologist I once knew saying that most medicines are still effective way past the expiration date. I figured the worst thing that could happen would be that I would take it and it wouldn't work in which case I would have to go to the doctor anyway.


A curious mind is an infernal thing.  It never knows when to stop.  It's always asking "Why?".  It's always wondering how things work.  It's like a five-year-old child pestering their parent with a thousand questions a day, unsatisfied, always wanting more, more, more.  More answers.  More explanations.  More understanding of generally obscure, not-very-useful facts.

Unfortunately, I have one of those question-generating-machines in my skull driving me to look things up. Curious about why medicines expire, or what could happen from taking expired medicines I used some free time to look it up.

This is what I found:

Store doxycycline at room temperature away from moisture and heat. Throw away any unused medicine after the expiration date on the label has passed. Using expired doxycycline can cause damage to your kidneys.

What??? Kidney Damage???

In a panic, I tried to find more information.

Everywhere I looked on general, medical, non-obscure sites I found this dire warning about doxycycline and the words "renal failure" used in conjunction with expired doxycycline and tetracycline antibiotics.

OK.  I had taken 3 days worth.   How much trouble was I really in?  Should I let my husband know so that he could start planning my funeral?  How quickly was I going to die?  What symptoms should I look for?

So off I went through the inter-webs trying to find out more information, more details, more understanding of why this stuff is so bad for kidneys.

And what did I find?

Nothing really.

The first clue came from the wiki article on doxycycline.

In the case of doxycycline, the absence of an hydroxyl group in C-6 prevents the formation of the nephrotoxic compound.

Oh. OK.  So maybe I wasn't going to die after all.

Now I was very curious.  Which was it...Deadly Toxin, or Meh?

Eventually I came across the topic in this forum which seems to be associated with Rutgers University.

The forum administrator, while trying to answer a poster with the same question I had:

I tried to find the data behind the statement that "expired doxycycline can cause a dangerous syndrome resulting in damage to the kidneys" (Source (http://www.drugs.com/doxycycline.html)). I was unable to find a published study on the subject although there are many outrageous warnings of the dangers of expired tetracycline or doxycycline all over internet. Let me continue looking but this is making me very suspicious.

I followed the thread which I won't entirely repost.  He listed some information and basically said that there have been no studies about expired doxycycline and the information he was able to find was based on some case studies over 40 years old.

He finished the conversation with:

I was quite surprised to find all these strong warnings all over internet, including statements that taking expired tetracycline and doxycycline can kill people. That is one of the problems with internet. All these people are posting and reposting information without critically evaluating it. Even reputable sites are reposting the information. 

It turns out that tetracylines can degrade into a toxic substance, but so far there haven't been any concrete, documented examples of expired-doxycycline-caused renal failure. 


I hate when I mentally bump up against this. It always shakes me up a little when I come across these situations.....situations in which normally reputable people and organizations turn out to not know what the hell they are talking about.

Received wisdom from a perceived, authoritative source can become so powerful that no one questions it.  When we have a source that we have previously experienced as being smart, knowledgeable and useful, it is easy to assume that it will always be so.

It's uncomfortable when we realize it's not.

Anyway....turns out that I probably won't die... at least not from expired doxycycline.....but at the same time I don't think that I will take any more of it.

You know...just in case.



JS Allen said...

LOL, I also take Doxycyclene intermittently to keep my skin clear, and hadn't heard about the renal failure risk. My most recent hypochondriac freakout about doxycyclene was when I thought I had melanoma (turns out I don't). Are you sure you're worrying enough about the melanoma risk inherent in doxycyclene? :-) I was also recently wondering if I should stop asking for nitrous oxide at the dentist, "just in case", since it can cause spinal column degeneration.

Sabio Lantz said...

I use to work in Dermatology and we gave out Doxy like candy.
Essentially all drugs are either excreted by the kidneys or the liver. When we prescribe we choose are suppose to keep this in mind.

Heck, Motrin (ibuprofen), Naprosyn and the other NSAIDS really damage the kidneys too.

Tylenol damages the liver.

How is that for a bright note.

Now, on another note. I eat Paleo (see Mark's Daily Apple as one page). It is essentially very low-carb with calories coming from fat and protein. I have done this for 2 years. Within 6 months after starting, my rosacea traits cleared up, my blood-pressure issue cleared and GERD was gone. Med free for two years.

But stories like mine are a dime-a-dozen using lots of different health-nuts weird diets. But I thought I'd share.

I wonder if the gluten in wheat is the enemy of many of us -- slowly , insidiously and chronically.

Hi terri

terri said...


Great. I'm supposed to have my wisdom teeth out sometime this summer under nitrous oxide. Now not only will I be on dialysis from taking expired anti-biotics, but my spine is going to shrivel up!



I've never looked into the diet angle. My largest rosacea "trigger" is actually exercise....which really sucks. My face turns bright red anytime I work out vigorously...which is a big no-no for controlling rosacea.

But...I have worked too hard to be able to consistently run a few miles several times a week to suddenly stop. Plus part of my dedication to running was for cancer recurrence prevention. WIth the type of cancer I had, a direct link has been shown between regular, consistent, long-term exercise and better recurrence stats.

It sucks that doing something that's good for the rest of me aggravates my face.

Maybe I should take up swimming instead.maybe it would "cool down" my face!! ;-)

Retriever said...

My family totally ignore the warnings about expired meds. Partly because some of the meds people have taken fall into the $500 a month variety, and if I were ever laid off and lost health insurance, I would rue the day I threw out a particular medicine someone got switched off (we get them for 3 months at a time mail order under our plan).

We believe strongly that given the high price of medicine, it's wasteful to throw it out. So we keep it in case someone else in the family gets prescribed it. Or in case I am short of cash at the beginning of the year when having to make it to our $6000 dollar deductible. I'm a strong believer that meds that work for one family member are likely to work for another.

Also, we are a family that does not believe in taking more medicine than necessary when prescribed merely for comfort. So, for example, we will meticulously finish antibiotics for an infection (to lower chances of resistant infections) but if given painkillers after surgery or codeine cough syrup, we will take as little as possible. That way, we can cache some up at our place up north (15 miles from a hospital and no doctors of ours) and have some way to ease pain or an injury in an emergency. Also, once every 3 three years or so, I get bronchitis badly enough to need cough syrup for a couple of nights, but don't want to bother going to the doctor just for palliative prescriptions. We tend to throw stuff out when it's over 6 or 7 years old, tho.

Keeping extra meds is a big help lately as we have a new prescription plan mail order that sometimes takes two weeks to deliver, and we've scrambled sometimes to give the kid their medicine from old pills fortunately saved. Or upping doses by adding from old pills when the mail order people take forever to send it.

We also have terrible problems with our local CVS and Walgreens which often don't stock meds and make one wait a couple of days.

Not to sound anxious or paranoid, but if we didn't keep extras on hand, my family members would often have to go off their maintenance meds (with dangerous effects) because of the unreliable and delayed supplies by local pharmacies and the mail order. And I don't like racing to the doctor when I know what I need.

If I die of expired medicine, my family won't sue anyone....

Sabio Lantz said...

Concerning Expired Meds:
I worked as the medical officer for the American Consolate in China (Chengdu). We had our own pharmacy to take care of consulate staff and the Peace Corp volunteers in the area. My pharmacy was stocked to the brim with hugely expired meds. They worked like a charm!

Assistant Village Idiot said...

Danger alert. My son thinks the "Anonymous" posting about my comments on Instapundit on Thomas Ball's suicide by self-immolation is the same guy we had last year in that brutally long comments thread. I figured I'd better give you and Retriever a heads-up.

terri said...


I was blessedly unaware of the incident to which you refer! ;-)

I looked it up and am glad that I haven't entered any internet frays with the likes of Anonymous again.

I can't help but marvel at how vile and insane certain segments of the blogosphere are.