Warning about 'granny' pill boxes

Hey guys,

I've been all over the place with migraines and one change I made recently was to start putting my Topiramate (Topamax) into a granny pill box thingo which has a little box for each day of the month. Pretty much a week or so after I started doing that I started getting back to back migraines and was trying to figure out what the hell was going on.

Since the topamax had been a little helpful prior to that I was losing the plot (remember my first post here) and was considering decapitation.

Since then I've spoken to a pharmacist and I don't even know why I asked, but I told her I'd been taking the topamax out and putting it in the pill boxes and she freaked out. She said that as soon as I removed the pill from the airtight, and light-excluding environment of the foil, it begins to degrade. She said that under no circumstances should pills be removed from their foil for granny pill box storage. I HAD NO IDEA! I asked her about this thing we call a 'webster pack' where the pharmacist puts the pills in a foil thing with the days on it - and she said even those are not as reliably airtight as the manufacturer's packaging.

So just a warning to those of you who might also be taking your pills out a month ahead of time. I'm now just ramming the foil into the appropriate day - it doesn't fit and I can't close the lid - and when I take it I close the lid for that day. That's how I remember that I've taken it. The whole reason I had to get the pill box was I couldn't remember if I'd taken the drugs or not and I was skipping and double dosing.

Anyway...just thought I'd mention it. I'm much more stable even after a week being back on the drugs straight from the foil. They were definitely degrading if my stability is anything to judge by.

Cheers =)

Thank You, what a wonderful piece of advice! I never would have thought of that, or to ask that. My MIL is going to school to become a pharmacy tech and I will pass this on to her!

That is definitely worth knowing. Does it only apply to things that come in a foil pack? Or to other things as well? I also use those day of the week boxes for the same reason. So I can remember what all to take when, and can remember if I took them or not. I mostly have supplements (progesterone, vitamin D, iodide, omega3, magnesium), but also amitriptyline.

For those of you on Topomax, also be careful of potential for birth defects.

http://www.healthcentral.com/migraine/news-571298-98.html?ic=6018

Ooh a pharmacy tech. Your MIL will be a wealth of knowledge when she's through studying.

Pretty shocking huh. I'm kinda glad it wasn't just me who did it! I felt a bit dumb lol. You'd think there'd be a big warning on the pill box saying DO NOT REMOVE YOUR PILLS FROM THEIR PACKAGING. Yes the pharmacist said anything that comes in foil should not be removed until you're about to swallow it. She was really *serious* about it too. Quite stern. I definitely got the message

Thanks for the warning about the birth defects with topiramate - unfortunately from what I've been reading - people with epilepsy have to stay on it during pregnancy and fortunately often get away with it. It must be so hard for them because if they come off it they don't just get pain - they get serious brain damage. Not really an option. All the sandomigran, endep and imigran are also teratogens for pregnancy - lucky my husband's infertile eh. I don't have to worry about it anymore.

When I was living in Australia, the topamax came in foil packages. Here in the US, they come in pill bottles. There may be a difference in manufacturing, but who knows.

Oh wow...that's interesting. What kind of bottle is it? Was it dark?

I guess, bottom line, the granny pill box is not air tight or light proof. At least a bottle is going to be airtight if it has a proper screwtop lid. I wonder about the light though. The instructions on the topamax pack say keep away from light...very interesting.

It's orange-the standard US pill bottle. I have a feeling mine were dispensed from a bigger bottle. I'll ask the pharmacist the next time I go in.

Migrainegirl wrote:That is definitely worth knowing. Does it only apply to things that come in a foil pack? Or to other things as well? I also use those day of the week boxes for the same reason. So I can remember what all to take when, and can remember if I took them or not. I mostly have supplements (progesterone, vitamin D, iodide, omega3, magnesium), but also amitriptyline.

Wondering the same thing.

My Topamax always came in the regular pharmacy bottle, too, but I don't take that anymore.

My topamax came in a pharmacy bottle like anything else. Took it until it gave me kidney stones. Hope it works well for you though.

Ouch kidney stones! I've had those before and let's just say...I cried a river. I haven't had them from topamax tho (yet).

I just spoke to another pharmacist who suggested that different manufacturers will use different whatchamacallit 'filler' stuff to carry the drug in. She said maybe the USA pills have a coating that the Australian ones don't have? But she double checked and said there's a warning that the pills shouldn't be removed from their pack until they're being swallowed.

So still no definitive answer...but maybe a coating? Does it look like there's a coating on them? Mine are teeny tiny and not coated.

The one's I had here in the Midwest US were a capsule, so they were likely in a different formula than the Australian variety.

If you're taking Topamax and have had kidney stones in the past you may want to talk to your doctor to make sure it's safe. My neuro freaked out when she heard I had a stone and was on Topamax. She said anyone who's ever had a kidney stone shouldn't be on Topamax.
Just a heads up.

oh really Brenda? ...hmmm. They hurt like hell don't they. But I think I'm gonna take the risk. My neuro was through the public health system and worse than useless. Worst case scenario is that I get a kidney stone and then I'll come off them. But if I don't get one then I get the benefit. Nothing else seems to help. (not even sure if these are helping actually - I just keep say they are in the hope that they will!). Maybe I should give them another few months and maybe come off them and try sandomigran or something or other.

The topamax tablets in the US were a bit harder and shinier than the Australian ones, so they may be coated.

Ya know, the kidney stone hurt, but truly, it wasn't as bad as some of my migraines.

Former Big Pharma employee here. There are a ton of different formulations for prescription drugs, and if they are generic the differences can be dramatic. So, coatings may be different, and so can "fillers" (inert ingredients combined with the active pharmaceutical ingredient in the pill or capsule). PACKAGING is a huge issue and can change from manufacturer to manufacturer. The company just has to approve their formulation provides the same effect as the original (brand) drug. Even when they do that and start selling the (generic) drug, patients often find that the generic drug doesn't work as well as the brand, or works differently.
Also, each country has different regulations about what is allowed for coatings, fillers, packaging, etc. I was surprised when I picked up generic sumatriptan from CVS (in the US) that it was in a plain brown bottle with no dessicant. I was used to the brand Imitrex which comes in the peel-and-push blister pack, each tablet in a separate cavity (and darn hard to get to if you're getting a migraine). I have been meaning to ask the pharmacist about this, but so far I haven't had any problems with the generic (knock on wood). I also get generic sumatriptan via mail order and it comes in a flimsy plastic blister pack.
Also, most drugs are made overseas now, i.e. India or China (even if the company is headquartered in the U.S. or Japan). There are a lot of quality issues that the FDA doesn't have the funding or staff to even begin to address.
I tried Topamax and could not tolerate even a small dose; gave up after 3 awful weeks. I know it works really well for a lot of people; wish I was one!!! Good luck and best wishes

mamun_tech wrote:Thanks for taking the time to discuss this, I feel strongly about information and love learning more on this. If possible, as you gain expertise, it is extremely helpful for me. Would you mind updating your blog with more information?

If you're referring to my post, yes I am happy to share expertise from 24+ years in Big Pharma. I'm not a scientist, but I do know a fair amount about how the business works, for what it's worth.
If you're not referring to my posts, Happy Easter!!
In fact, Happy Easter to everyone!!

I should also say, this isn't MY blog, so content decisions and which posts are kept vs deleted - also not my decision. Which is good, because decision-making is not my strong point especially when I am hurtin' like I am today!