Check any container of over-the-counter medicine, and you\u2019ll see its expiration date. Prescription medicines have similar lifetimes, and we\u2019re told to discard old medications rather than hold on to them. Most of them lose their effectiveness over time, and some can even become toxic. We\u2019re discouraged from disposing of them in our wastewater because they can find their way into other organisms, sometimes with deleterious effects. <\/p>\n
We can replace them relatively easily on Earth, but not on a space mission beyond Low Earth Orbit.<\/p>\n
<\/p>\n A round trip to Mars takes about three years. A lot can happen in that time. Important medical supplies, including medicines, might not remain as effective for that long. <\/p>\n That could create problems for astronauts who make the journey.<\/p>\n New research in Nature\u2019s npj Microgravity examines the lifetimes of medicines and how they could affect astronauts on long-duration space missions. It\u2019s titled \u201cExpiration analysis of the International Space Station formulary for exploration mission planning,\u201d and the senior author is Daniel Buckland. Buckland is from the Department of Emergency Medicine\u00a0at the Duke University School of Medicine and is an aerospace medicine researcher. The lead author is Thomas Diaz, a pharmacy resident at The Johns Hopkins Hospital.<\/p>\n Getting sick in space isn\u2019t rare. Canadian astronaut Chris Hadfield talked about the problem in 2013. \u201cWhen we first get to space, we feel sick. Your body is really confused. And so, you know, you\u2019re dizzy, your lunch is floating around in your belly \u2019cause you\u2019re floating, and what you see doesn\u2019t match what you feel.\u201d NASA calls it \u2018space adaptation syndrome,\u2019 and motion sickness and anti-nausea medications can help.<\/p>\n Research also shows that astronauts\u2019 immune systems are weakened in space. Weaker immune systems raise the risk of infections. Humans carry latent viruses that can become active when immune systems are weakened, and the entire problem is amplified on longer missions. <\/p>\n When used properly and early enough, common medications can prevent relatively simple afflictions, such as a minor infection, from growing into more dangerous problems. Expired medications can create a problem because their effectiveness is often diminished over time. <\/p>\n \u201cEffective medications will be required to maintain human health for long-duration space operations,\u201d the authors write in their paper. \u201cPrevious studies have explored the stability and potency of several of the medications used on the International Space Station (ISS).\u201d<\/p>\n However, this is the first time researchers have compared medications used in space with drug expiration dates in four different international drug registries. <\/p>\n Lead author Thomas Diaz got the idea for this work and then contacted Buckland.<\/p>\n \u201cTom reached out with the idea, knowing my work on risk mitigation for extended spaceflight,\u201d said Buckland. \u201cHe was concerned that not enough research addressed the problem of medication longevity on a Mars mission.\u201d<\/p>\n NASA doesn\u2019t reveal what medicines it stores on the ISS. For this research, Diaz used a Freedom of Information Act Request to get the list of medicines. The researchers assumed that the formulary would be the same or at least similar for a Mars mission. <\/p>\n The ISS carries 111 medications, divided among five different colour-coded kits. Each kit holds medicines pertinent to its designated use. <\/p>\n Some medications are duplicated in multiple kits, and two of them are diluents for other medications. <\/p>\n The ISS\u2019s formulary, a list of drugs stocked on the station, contains 106 medications, excluding multiples and diluents. The most common issues that need to be addressed with medicines are motion sickness, allergies, minor pains, and infections. The list of medicines includes antibiotics, sleep aids, pain relievers, and allergy medicines. The drugs are chosen because they are effective in microgravity environments and because they have longer shelf lives than similar medications. <\/p>\n The research shows that over half of the medicines stocked on the ISS would expire on a Mars mission before astronauts returned to Earth. <\/p>\n \u201cOf the 106 medications in the ISS formulary, shelf-life data was found in at least 1 of the registries for 91 (86%) medications,\u201d the authors write in their research. \u201cOf these 91 medications, 54 have an estimated terrestrial shelf-life of less than or equal to 36 months when stored in their original packaging. 14 will expire in less than 24 months.\u201d<\/p>\n \u201cIt doesn\u2019t necessarily mean the medicines won\u2019t work, but in the same way you shouldn\u2019t take expired medications you have lying around at home, space exploration agencies will need to plan on expired medications being less effective,\u201d said Buckland.<\/p>\n On Earth, different medications become less effective at different rates after expiration. However, the effects of space flight on their effectiveness are largely unknown. Space is a harsh environment, and radiation could have a pronounced effect on medications. Increasing the amount of each medication carried on a Mars mission could help deal with the problem, but it\u2019s a rather clumsy solution.<\/p>\n \u201cHopefully, this work can guide the selection of appropriate medications or inform strategies to mitigate the risks associated with expired medications on long-duration missions,\u201d Buckland said.??<\/p>\n \u201cPrior experience and research show astronauts do get ill on the ISS, but there is real-time communication with the ground and a well-stocked pharmacy that is regularly resupplied, which prevents small injuries or minor illnesses from turning into issues that affect the mission,\u201d he said.??<\/p>\n In their conclusion, the researchers note that pharmaceutical drugs will be the cornerstone of astronaut health on long missions. They also point out a gap in data regarding the shelf lives of the drugs in the ISS\u2019s formulary. For example, 14% of the medicines in the formulary lack expiration data. \u201cIt is imperative to know and understand these pharmacologic parameters in order to supply a safe and effective astropharmacy,\u201d they write.<\/p>\n If medicines become unstable sooner on long space missions, it\u2019s a problem that needs to be addressed. <\/p>\n \u201cUltimately, those responsible for the health of spaceflight crews will have to find ways to extend the expiration of medications to the complete mission duration or accept the elevated risk associated with administration of an expired medication,\u201d they conclude.<\/p>\n\n
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