Heatwave puts medicine efficacy at risk

Medical experts have expressed concerns that the ongoing heatwave sweeping through the country for the past week could reduce the efficacy of many essential medicines, as most pharmacies in the country do not have adequate cooling systems to preserve them.

They say maintaining the cold chain is very important to ensure the efficacy of medicines. Blood products, vaccines, and various types of kits should be stored at 4°C to 8°C. Besides, many medicines need to be kept at temperatures between 25°C and 30°C.

However, temperatures have been fluctuating between 39°C and 42°C in recent days across the country. The Directorate General of Health Services (DGHS) has started formulating guidelines to address heatwave following the deaths of two persons reportedly from heatstroke in Pabna and Chuadanga yesterday.

The situation has worsened as many areas, including the capital, are facing long hours of load shedding.

As a result, it has been challenging for pharmacies to preserve medicines at the required lower temperatures, experts say.

Professor Dr Sayedur Rahman, chairman of the Department of Pharmacology at Bangabandhu Sheikh Mujib Medical University, told The Business Standard that out of around two lakh pharmacies in the country, one lakh pharmacies do not have air conditioning. Therefore, the efficacy of medicines decreases when the temperature exceeds 35 degrees.

"Due to the increase in temperature, there is a greater risk for the medicines that need to be kept in the refrigerator. They will lose their effectiveness. They are mostly valuable and life-saving medicines," he said.

Many areas are facing long hours of load shedding. As a result, the risk of spoilage of the medicines kept in the refrigerator is increasing, he added.

He said people should be aware of maintaining the efficacy of medicines at home. "Patients with chronic diseases who have medicines at home should keep them in a relatively low temperature and where there is airflow for the next week," he said.

Stakeholders say stability studies are conducted by subjecting medicines to temperatures of 40 degrees Celsius and humidity levels of up to 75% before they are introduced to the market. This process determines the extent of stability loss of the medicine under these conditions, enabling the establishment of an expiration date.

Dr ASM Ansarul Islam, vice president of the Bangladesh Society for Pharmaceutical Professionals, said, "If the temperature exceeds 40 degrees for 15-20 days, the product will encounter two types of problems: the color of syrups will fade, and the capsules' shade will soften. Prolonged exposure to heat will decrease the efficacy of products."

He also said drug companies deliver medicines in refrigerated covered vans, but once they arrive at the store, it becomes the responsibility of the pharmacy to control the temperature. However, most pharmacies do not do so.

"Model pharmacies have air conditioners and refrigerators, but the number of model pharmacies is very few. The Directorate General of Drug Administration is responsible for monitoring whether drug shops are maintaining the temperature," he said.

Consumers should also be aware. Medicines should be purchased from shops equipped with fans, air conditioners, and refrigerators, he added.

According to the Directorate General of Drug Administration, there are around two lakh pharmacies in the country, of which about 800 are model pharmacies. Medicines are sold in many tin-shed shops across the country, including Dhaka, which lack air conditioners or refrigerators. 

The cold chain of medicines in those stores is not properly maintained even during normal times, and experts believe that the situation is more dire during the heatwave.

ABM Faroque, professor of the Pharmaceutical Technology Department at the University of Dhaka, said medicines expire before their expiration dates in summer. "We have repeatedly emphasised that pharmacies should have air conditioners. Otherwise, the quality of the medicine is being compromised even without the knowledge of the pharmacy owners," he said.

However, Ashraf Hossain, deputy director of the Directorate General of Drug Administration, said there would be no effect on the medicine during the ongoing heatwave. "We advise pharmacies to keep medicine at 30 degrees, but usually, medicine stability studies are conducted at 40 degrees. So, 2-5 days of a heatwave will not pose much of a problem."

"In the current heatwave, there are still no issues with the quality of medicines as most pharmacies have air conditioners and fans. The temperature drops even when the fan is running. We have not encountered any issues regarding this in our monitoring so far," he said.

DGHS formulating guidelines to address heatwave

Due to the intense heat, patients are suffering from various diseases including fever, diarrhea, pneumonia, and heat stroke.

Professor Dr Meerjady Sabrina Flora, Additional Director General of the Directorate General of Health Services (Planning and Development), told TBS that medical guidelines have been prepared to deal with heatstroke and are being distributed to doctors nationwide.

"Doctors will undergo training in this regard," she said.

"Additionally, we are running a campaign to raise awareness about heatstroke. It is important to stay indoors and drink plenty of water to avoid heatwave-related illnesses," she added.