Organised by therapeutic class. Doses are for otherwise-healthy adults unless noted. Paediatric doses are weight-based approximations — verify against current formulary when available. All shelf-life figures are estimates; see Section 2 for SLEP data.
| Drug (generic) | Class | Primary indication | Adult dose | Paediatric dose | Route | Frequency | Contraindications | Key interactions | Storage | Shelf life (labelled) | Extended shelf life est. |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Paracetamol | Analgesic/antipyretic | Mild–moderate pain, fever | 500–1000 mg | 15 mg/kg | PO/PR/IV | Q4–6 h (max 4 g/day) | Severe hepatic impairment | Warfarin (enhanced effect) | Room temp | 3–5 yr | 10–15 yr |
| Ibuprofen | NSAID analgesic | Mild–moderate pain, inflammation, fever | 400 mg | 5–10 mg/kg | PO | Q6–8 h with food | PUD, renal impairment, NSAID allergy, pregnancy (3rd trimester) | ACE inhibitors, warfarin, lithium | Room temp | 3 yr | 8–10 yr |
| Aspirin | NSAID/antiplatelet | Pain, fever, anti-platelet | 300–600 mg (pain); 75–100 mg (antiplatelet) | Avoid <16 yr (Reye’s risk) | PO | Q4–6 h (pain); daily (antiplatelet) | Children <16 yr, active bleeding, PUD | Warfarin, NSAIDs, methotrexate | Room temp, protect from moisture | 3 yr | 8–12 yr |
| Morphine | Opioid analgesic | Severe pain | 5–10 mg | 0.1–0.2 mg/kg | PO/SC/IV | Q4 h | Respiratory depression, head injury, MAOIs within 14 days | CNS depressants, benzodiazepines, MAOIs | Room temp; controlled substance | 2–3 yr | 5–8 yr |
| Codeine | Opioid analgesic | Moderate pain, cough suppression | 30–60 mg | 0.5–1 mg/kg (>12 yr only) | PO | Q4–6 h | Ultra-rapid CYP2D6 metabolisers (toxicity risk), children post-tonsillectomy | MAOIs, CNS depressants | Room temp; controlled substance | 3–5 yr | 8–10 yr |
| Tramadol | Opioid analgesic (weak) | Moderate–severe pain | 50–100 mg | 1–2 mg/kg (>12 yr) | PO | Q6 h (max 400 mg/day) | Seizure disorder, MAOIs, serotonin syndrome risk | SSRIs (serotonin syndrome), MAOIs, warfarin | Room temp | 3 yr | 8 yr |
| Amoxicillin | Aminopenicillin antibiotic | RTI, UTI, skin infections, H. pylori | 250–500 mg | 25 mg/kg/day div Q8 h | PO | Q8 h | Penicillin allergy | Warfarin, methotrexate, allopurinol | Room temp (tabs); refrigerate (susp) | 2–3 yr (tabs); 7 days (reconstituted susp) | 10–12 yr (tabs) |
| Flucloxacillin | Penicillinase-resistant penicillin | Staphylococcal skin/soft tissue infection | 250–500 mg | 12.5–25 mg/kg Q6 h | PO | Q6 h, 30 min before food | Penicillin allergy, hepatic dysfunction (caution) | Warfarin (reduced effect) | Room temp | 2–3 yr | 8–10 yr |
| Metronidazole | Nitroimidazole antibiotic | Anaerobic infections, C. diff, parasites | 400 mg | 7.5 mg/kg Q8 h | PO/IV | Q8 h | First trimester pregnancy, alcohol use (disulfiram-like reaction) | Warfarin, alcohol, lithium | Room temp, protect from light | 3–5 yr | 10–15 yr |
| Doxycycline | Tetracycline antibiotic | RTI, malaria prophylaxis, STIs, Lyme disease | 100 mg | Avoid <8 yr; 2.2 mg/kg Q12 h (>8 yr) | PO | Q12–24 h with food | Children <8 yr, pregnancy, severe hepatic impairment | Antacids/dairy (absorption), warfarin, retinoids | Room temp, protect from light/moisture | 2–3 yr | 8–12 yr |
| Trimethoprim | Diaminopyrimidine antibiotic | Uncomplicated UTI, prophylaxis | 300 mg daily or 150 mg Q12 h | 4 mg/kg Q12 h | PO | Q12 h or daily | First trimester pregnancy, folate deficiency, severe renal impairment | Warfarin, methotrexate, ACE inhibitors (hyperkalemia) | Room temp | 3–5 yr | 10–12 yr |
| Ciprofloxacin | Fluoroquinolone antibiotic | UTI, gastroenteritis, respiratory/bone infections | 250–750 mg | Caution in children; 10–15 mg/kg Q12 h if essential | PO/IV | Q12 h | Children (cartilage risk), pregnancy, myasthenia gravis | Antacids (absorption), warfarin, theophylline, NSAIDs (seizure risk) | Room temp | 3 yr | 8–10 yr |
| Cephalexin | First-generation cephalosporin | Skin, soft tissue, UTI, RTI | 250–500 mg | 12.5–25 mg/kg Q6 h | PO | Q6 h | Cephalosporin/severe penicillin allergy | Warfarin (enhanced) | Room temp | 2–3 yr | 8–10 yr |
| Erythromycin | Macrolide antibiotic | RTI, whooping cough, atypical pneumonia, penicillin allergy alternative | 250–500 mg | 12.5 mg/kg Q6 h | PO | Q6 h | Hepatic impairment, QT prolongation, concurrent QT-prolonging drugs | Statins (myopathy risk), warfarin, digoxin, theophylline | Room temp, protect from moisture | 2–3 yr | 6–8 yr |
| Gentamicin | Aminoglycoside antibiotic | Severe gram-negative infections (IV/IM only) | 5–7 mg/kg once daily (renal-adjusted) | 7.5 mg/kg once daily | IV/IM | Once daily | Renal impairment (major caution), auditory/vestibular impairment | Loop diuretics (nephrotoxicity/ototoxicity), other nephrotoxins | Room temp (powder); refrigerate (solution) | 2–3 yr | 5 yr (powder only) |
| Enalapril | ACE inhibitor | Hypertension, heart failure | 5–20 mg | 0.08–0.6 mg/kg/day | PO | Q12–24 h | Bilateral renal artery stenosis, pregnancy, angioedema history, hyperkalaemia | Potassium-sparing diuretics, NSAIDs, lithium | Room temp | 3–5 yr | 10–12 yr |
| Metoprolol | Beta-1 selective blocker | Hypertension, angina, arrhythmia, heart failure | 25–100 mg | 0.2–0.4 mg/kg Q12 h (>1 yr) | PO | Q12–24 h | Cardiogenic shock, severe bradycardia, uncontrolled asthma, AV block | Verapamil/diltiazem, clonidine, adrenaline | Room temp | 3–5 yr | 10–15 yr |
| Amlodipine | Dihydropyridine calcium channel blocker | Hypertension, angina | 5–10 mg | 2.5–5 mg (>6 yr) | PO | Once daily | Cardiogenic shock, severe aortic stenosis | Simvastatin >20 mg (myopathy), cyclosporine | Room temp | 3–5 yr | 10–15 yr |
| Simvastatin | HMG-CoA reductase inhibitor (statin) | Hypercholesterolaemia, CVD prevention | 20–40 mg | Not for children <10 yr; 10–20 mg (>10 yr) | PO | Nightly | Active hepatic disease, pregnancy, breastfeeding | Amlodipine, erythromycin, amiodarone (myopathy risk) | Room temp | 3–5 yr | 10–12 yr |
| GTN (glyceryl trinitrate) | Nitrate vasodilator | Acute angina, heart failure | 0.3–0.6 mg sublingual | Not established for children | SL/topical | PRN (acute); Q6–8 h (patch) | Hypotension, phosphodiesterase inhibitor use, severe anaemia | Phosphodiesterase inhibitors (severe hypotension), antihypertensives | Cool, protect from light; tablets in original glass bottle | 2–3 yr | Very limited extension — light/heat degrades rapidly; replace on expiry |
| Frusemide (Furosemide) | Loop diuretic | Oedema, heart failure, hypertension | 20–80 mg | 0.5–2 mg/kg Q6–12 h | PO/IV/IM | Q6–24 h | Anuria, severe electrolyte depletion, sulfonamide allergy | Gentamicin (nephrotoxicity/ototoxicity), NSAIDs, lithium | Room temp, protect from light | 2–3 yr | 6–8 yr |
| Salbutamol (albuterol) | Short-acting beta-2 agonist | Acute asthma, bronchospasm | 100–200 mcg (inhaler); 2.5–5 mg (nebuliser) | 100 mcg (inhaler); 2.5 mg (nebuliser <5 yr) | Inhaled | PRN; Q4–6 h (regular) | Tachyarrhythmia (caution) | Beta blockers (antagonism), digoxin (hypokalaemia) | Room temp, protect from cold | 2–3 yr | 5–8 yr (MDI canister) |
| Prednisone | Systemic corticosteroid | Severe asthma, anaphylaxis, inflammatory conditions | 25–50 mg (acute); 5–20 mg (maintenance) | 1–2 mg/kg/day (max 40 mg) | PO | Daily or divided | Active systemic infection without antibiotic cover, live vaccines | NSAIDs (GI risk), antidiabetics, warfarin | Room temp | 3–5 yr | 10–15 yr |
| Beclomethasone | Inhaled corticosteroid | Asthma prophylaxis (not acute relief) | 100–400 mcg/day | 50–100 mcg twice daily | Inhaled | BD | Active respiratory infection (caution) | Ritonavir (increased corticosteroid levels) | Room temp, protect from cold | 2–3 yr | 5–8 yr (MDI canister) |
| Omeprazole | Proton pump inhibitor | PUD, GORD, H. pylori eradication | 20–40 mg | 0.7–3.3 mg/kg/day | PO | Daily (before food) | Concurrent clopidogrel (caution — reduces antiplatelet effect) | Clopidogrel, methotrexate, some antiretrovirals | Room temp, protect from moisture | 2–3 yr | 6–8 yr |
| Ondansetron | 5-HT3 antagonist antiemetic | Nausea, vomiting (especially post-op/chemo) | 4–8 mg | 0.1–0.15 mg/kg | PO/IV/IM | Q8 h | Congenital QT prolongation, apomorphine | QT-prolonging drugs (additive risk), tramadol (reduced effect) | Room temp | 3 yr | 8–10 yr |
| Loperamide | Opioid-receptor agonist (gut) | Acute/chronic diarrhoea | 4 mg initially, then 2 mg after each loose stool (max 16 mg/day) | Not for <2 yr; 0.08–0.24 mg/kg/day (2–12 yr) | PO | After each loose stool | Bloody diarrhoea, pseudomembranous colitis, children <2 yr | CNS depressants (additive sedation) | Room temp | 3–5 yr | 10–12 yr |
| Oral rehydration salts (ORS) | Electrolyte replacement | Dehydration from diarrhoea/vomiting | Per WHO/UNICEF formula: Na 75 mmol/L, Cl 65, Glucose 75, K 20, Citrate 10 | Same formula — volume based on deficit | PO | As tolerated | None (dilute if vomiting) | None significant | Room temp (powder, sealed) | 3–5 yr (powder) | 10+ yr (powder, sealed and dry) |
| Metformin | Biguanide antidiabetic | Type 2 diabetes | 500–1000 mg | 500 mg BD (>10 yr, off-label) | PO | BD–TDS with food | eGFR <30, IV contrast procedures, excessive alcohol | Alcohol (lactic acidosis risk), iodinated contrast | Room temp | 3–5 yr | 10–12 yr |
| Insulin (various) | Pancreatic hormone | Type 1 and 2 diabetes | Highly individualised; initiate at 0.2–0.4 units/kg/day | 0.5–1 unit/kg/day (Type 1) | SC/IV | Varies by formulation | Hypoglycaemia awareness loss | Beta blockers (mask hypoglycaemia), alcohol, salicylates | Refrigerate (2–8 °C) unopened; room temp up to 28 days once opened | 2–3 yr (unopened, refrigerated) | COLD CHAIN CRITICAL — potency declines rapidly above 30 °C; no meaningful SLEP extension possible without refrigeration |
| Levothyroxine | Thyroid hormone replacement | Hypothyroidism | 50–100 mcg (initiation); 75–200 mcg (maintenance) | 2–5 mcg/kg/day (newborn–child) | PO | Daily, 30 min before food | Untreated adrenal insufficiency, acute MI | Calcium/iron/antacids (absorption), warfarin, antidiabetics | Room temp, protect from light/moisture | 2–3 yr | 8–10 yr |
| Diazepam | Benzodiazepine | Anxiety, alcohol withdrawal, seizures, muscle spasm | 2–10 mg | 0.12–0.8 mg/kg/day div Q6–8 h | PO/IV/PR | Q6–12 h | Respiratory depression, sleep apnoea, severe hepatic impairment | Alcohol, opioids, other CNS depressants (profound sedation) | Room temp, protect from light; controlled substance | 5 yr | 10–15 yr |
| Amitriptyline | Tricyclic antidepressant | Depression, neuropathic pain, migraine prophylaxis | 10–150 mg (titrate) | Not for <12 yr; 25–50 mg (>12 yr) | PO | Nightly (sedating) | Recent MI, arrhythmias, closed-angle glaucoma, MAOIs within 14 days | MAOIs (hypertensive crisis), SSRIs (serotonin syndrome), QT-prolonging drugs | Room temp | 3–5 yr | 10–12 yr |
| Haloperidol | Typical antipsychotic (D2 antagonist) | Psychosis, acute agitation, delirium | 0.5–5 mg | 0.025–0.05 mg/kg/day (>3 yr) | PO/IM/IV | Q8–12 h | CNS depression, Parkinson’s disease, QT prolongation | QT-prolonging drugs, lithium (NMS risk), CNS depressants | Room temp, protect from light | 3–5 yr | 10–15 yr |
| Adrenaline (epinephrine) | Catecholamine / vasopressor | Anaphylaxis, cardiac arrest | 0.3–0.5 mg IM (anaphylaxis); 1 mg IV (arrest) | 0.01 mg/kg IM (anaphylaxis) | IM/IV | Q5–15 min PRN | None absolute in life-threatening emergency | MAOIs (exaggerated pressor response), beta blockers (paradoxical hypertension) | Protect from light; autoinjectors at room temp (not below 15 °C or above 25 °C) | 18 months–3 yr | Some SLEP data suggests 2–4 yr beyond expiry in pre-filled devices stored correctly; verify colour — discard if brown or precipitated |
| Atropine | Muscarinic antagonist | Bradycardia, organophosphate poisoning | 0.5–1 mg IV (bradycardia); 2–4 mg (OP poisoning) | 0.02 mg/kg IV (min 0.1 mg) | IV/IM | Q5 min PRN | Angle-closure glaucoma (relative), urinary retention | Antihistamines, antipsychotics (additive anticholinergic) | Room temp | 3–5 yr | 8–12 yr |
| Naloxone | Opioid antagonist | Opioid overdose reversal | 0.4–2 mg IV/IM/SC (repeat Q2–3 min up to 10 mg) | 0.01 mg/kg IV (repeat PRN) | IV/IM/SC/IN | Q2–3 min PRN | None absolute in opioid emergency | Opioids (precipitates withdrawal), buprenorphine (partial reversal) | Room temp, protect from light | 2–3 yr | 5–8 yr |
| Chlorphenamine (chlorpheniramine) | First-generation antihistamine | Allergic reactions, anaphylaxis adjunct | 4 mg | 0.1 mg/kg Q6 h (1–12 yr) | PO/IV | Q4–6 h | Angle-closure glaucoma, BPH (urinary retention risk) | CNS depressants, MAOIs | Room temp | 3–5 yr | 10–12 yr |
| Hydrocortisone cream 1% | Topical corticosteroid | Mild eczema, contact dermatitis, insect bites | Apply thin layer | Apply thin layer (short-term) | Topical | BD–TDS | Infected skin without antimicrobial, rosacea, periorbital (caution) | None significant (topical) | Room temp | 2–3 yr | 5–8 yr |
| Silver sulfadiazine cream 1% | Topical antimicrobial | Burns, skin infections | Apply to clean wound 2–5 mm thick | Apply to clean wound | Topical | Daily–BD | Sulfonamide allergy, near-term pregnancy, neonates | Enzymatic wound debriders (may be inactivated) | Room temp, protect from light | 2–3 yr | 5–7 yr |
| Oral contraceptive (levonorgestrel/EE) | Combined hormonal contraceptive | Contraception, menstrual regulation | Standard 21/7 cycle | Not applicable | PO | Daily | Thromboembolic history, migraine with aura, oestrogen-dependent cancer, smokers >35 yr | Rifampicin (reduced efficacy), some anticonvulsants, St John’s Wort | Room temp, protect from moisture | 3–5 yr | 8–10 yr |
| Ferrous sulfate | Iron supplement | Iron-deficiency anaemia | 200 mg (65 mg elemental iron) TDS | 3–6 mg/kg/day elemental iron div BD–TDS | PO | BD–TDS | Haemochromatosis, non-iron-deficiency anaemia | Tetracyclines, quinolones, antacids, levothyroxine (absorption reduced) | Room temp, protect from moisture | 3–5 yr | 10+ yr |
| Folic acid | B-vitamin supplement | Folate deficiency, neural tube defect prevention, haemolytic anaemia | 0.4–5 mg | 0.1–1 mg/day (age-dependent) | PO | Daily | Untreated B12 deficiency (may mask) | Phenytoin/methotrexate (folate antagonists) | Room temp, protect from moisture | 3–5 yr | 10+ yr |
Shelf Life Extension Data
Based on the US Shelf Life Extension Program (SLEP), a joint FDA/Department of Defense programme that has tested >1,100 products since 1986. Core finding: most solid oral dosage forms retain >90% potency for 5–15 years beyond labelled expiry when stored cool and dry. Liquids, biologics, and eye drops degrade faster and should not be extended without testing.
| Drug / Drug class | Labelled expiry (typical) | Typical SLEP extension | Conditions required | Degradation risks | Notes |
|---|---|---|---|---|---|
| Most solid oral tablets and capsules | 2–5 yr from manufacture | +5 to +15 yr | <25 °C, <60% RH, original sealed packaging | Hydrolysis, oxidation if moisture ingress | SLEP extended 88% of tested lots |
| Paracetamol tablets | 3–5 yr | +10–15 yr | Room temp, dry, sealed | Minimal if stored correctly | Among most stable solids |
| Tetracyclines (doxycycline) | 2–3 yr | +8–12 yr | Cool, dry, protect light | Older data on degradation to epitetracycline (nephrotoxic) not confirmed in modern formulations | Current formulations appear safe beyond expiry |
| Aspirin tablets | 3 yr | +8–12 yr | Dry storage critical | Hydrolysis to acetic acid + salicylic acid (detectable by vinegar smell) | Discard if vinegar odour present |
| Ciprofloxacin tablets | 3 yr | +8–10 yr | Room temp, dry | Minimal | Well-studied under SLEP |
| Metronidazole tablets | 3–5 yr | +10–15 yr | Room temp, dry | Minimal | Very stable |
| Diazepam tablets | 5 yr | +10–15 yr | Room temp, dry | Minimal | Controlled substance — assess before SLEP use |
| Amoxicillin capsules/tablets | 2–3 yr | +8–12 yr | Room temp, dry | Hydrolysis accelerated by moisture | Reconstituted suspension: 7–14 days only — no extension |
| Adrenaline (epinephrine) injections | 18 months–3 yr | +2–4 yr (limited data) | Cool, dark, protect from oxidation | Oxidation to brown/pink discolouration — renders inactive | Discard any discoloured solution; autoinjectors less studied |
| Insulin | 2–3 yr (refrigerated) | None reliable | Cold chain (2–8 °C) mandatory | Protein aggregation, loss of bioactivity above 30 °C | Critical: potency drops sharply after cold chain failure |
| Eye drops / ophthalmic solutions | 1–2 yr | Not recommended | N/A | Preservative degradation, contamination risk | Discard at expiry — risk of eye infection |
| Liquid oral antibiotics (reconstituted) | 7–14 days (reconstituted) | None | N/A | Rapid hydrolysis | Store in powder form — reconstitute only when needed |
| GTN tablets/spray | 2–3 yr | Very limited — not recommended | Original glass container, below 25 °C | Volatilisation; potency loss rapid once opened | Replace at or before labelled expiry |
| Biological products (vaccines, most proteins) | Variable | None | N/A | Protein denaturation | Cold chain mandatory; no meaningful SLEP extension |
Practical rule: If a solid oral tablet is dry, unbroken, and not discoloured, stored below 25 °C in original packaging, it is likely still clinically effective well past the printed date. Liquid formulations, biologics, and unstable molecules (GTN, adrenaline solutions, insulin) must be treated as expired at the label date unless SLEP-tested.
Drug Interactions Matrix
Critical interactions between medicines listed in Section 1. Severity ratings: Critical (avoid combination or requires specialist management), Major (significant risk; use with caution and monitoring), Moderate (monitor; adjust dose if needed).
| Drug A | Drug B | Interaction type | Severity | Clinical effect |
|---|---|---|---|---|
| Warfarin | Aspirin / NSAIDs | Pharmacodynamic | Critical | Greatly increased bleeding risk — dual anticoagulant/antiplatelet effect |
| Warfarin | Metronidazole | Pharmacokinetic (CYP2C9 inhibition) | Critical | Metronidazole inhibits warfarin metabolism — INR rises sharply |
| Warfarin | Erythromycin | Pharmacokinetic (CYP3A4 inhibition) | Major | Increased warfarin effect; monitor INR closely |
| MAOIs | Tramadol / opioids | Pharmacodynamic | Critical | Serotonin syndrome and/or hypertensive crisis — potentially fatal |
| MAOIs | Amitriptyline | Pharmacodynamic | Critical | Hypertensive crisis, serotonin syndrome — do not combine |
| MAOIs | Adrenaline (epinephrine) | Pharmacodynamic | Critical | Severe hypertensive crisis |
| Opioids (morphine, codeine) | Benzodiazepines (diazepam) | Pharmacodynamic | Critical | Synergistic respiratory depression — a leading cause of overdose death |
| Amlodipine | Simvastatin >20 mg | Pharmacokinetic (CYP3A4 inhibition) | Major | Elevated simvastatin levels — rhabdomyolysis risk; limit simvastatin to 20 mg |
| Erythromycin | Simvastatin | Pharmacokinetic (CYP3A4 inhibition) | Major | Elevated statin levels — myopathy/rhabdomyolysis |
| Ciprofloxacin | Antacids / dairy / iron | Chelation (absorption) | Major | Reduced ciprofloxacin absorption by up to 90% — separate by 2+ hours |
| Doxycycline | Antacids / dairy / iron | Chelation (absorption) | Major | Markedly reduced tetracycline absorption |
| Levothyroxine | Calcium / iron / antacids | Reduced absorption | Moderate–Major | Separate by at least 4 hours |
| Gentamicin | Frusemide | Pharmacodynamic | Major | Additive nephrotoxicity and ototoxicity |
| ACE inhibitors (enalapril) | Potassium-sparing diuretics | Pharmacodynamic | Major | Hyperkalaemia — can cause fatal arrhythmia |
| ACE inhibitors (enalapril) | NSAIDs | Pharmacodynamic | Major | Reduced antihypertensive effect; acute kidney injury risk |
| GTN | Phosphodiesterase inhibitors (sildenafil) | Pharmacodynamic | Critical | Profound hypotension — potentially fatal |
| Beta blockers (metoprolol) | Adrenaline | Pharmacodynamic | Major | Paradoxical hypertension (beta blockade unmasks alpha effect) |
| Beta blockers (metoprolol) | Verapamil / diltiazem | Pharmacodynamic | Major | Severe bradycardia/AV block |
| Clopidogrel | Omeprazole | Pharmacokinetic (CYP2C19) | Moderate | Reduced antiplatelet effect of clopidogrel |
| SSRIs | Tramadol | Pharmacodynamic | Major | Serotonin syndrome risk; also reduced tramadol analgesia |
| Ondansetron | QT-prolonging drugs (haloperidol, erythromycin, ciprofloxacin) | Pharmacodynamic | Major | Additive QT prolongation — risk of torsades de pointes |
| Ferrous sulfate | Doxycycline / ciprofloxacin / levothyroxine | Chelation | Moderate–Major | Significantly reduces absorption of interacting drug |
| Metformin | Iodinated IV contrast | Pharmacodynamic | Major | Lactic acidosis risk — withhold 48 h before/after IV contrast |
| Lithium | NSAIDs | Reduced renal clearance | Major | Elevated lithium levels — toxicity (tremor, confusion, arrhythmia) |
Emergency Drug Doses — Quick Reference
For use when formulary access is unavailable. These are first-line doses; titrate to response and reassess. Paediatric doses shown in brackets where applicable.
| Emergency | Drug | Dose | Route | Repeat | Notes |
|---|---|---|---|---|---|
| Anaphylaxis | Adrenaline (epinephrine) 1:1000 | 0.5 mg adult [0.01 mg/kg child, max 0.5 mg] | IM (anterolateral thigh) | Q5–15 min | Lay patient flat; call for help; autoinjector acceptable |
| Anaphylaxis adjunct | Chlorphenamine | 10 mg IV/IM [0.1 mg/kg] | IV/IM | Once | Antihistamine alone is NOT adequate for anaphylaxis |
| Anaphylaxis adjunct | Hydrocortisone | 200 mg IV [4 mg/kg] | IV | Once | Slows late-phase response; not immediate effect |
| Cardiac arrest | Adrenaline (epinephrine) 1:10,000 | 1 mg IV [0.01 mg/kg] | IV/IO | Q3–5 min | Give after 2nd shock in shockable rhythms; asap in non-shockable |
| Cardiac arrest (bradyasystole) | Atropine | 1 mg IV [0.02 mg/kg, min 0.1 mg] | IV | Q3–5 min up to 3 mg | Limited evidence in asystole but low-risk to administer |
| Severe asthma | Salbutamol | 5 mg nebulised [2.5 mg <5 yr] | Nebulised | Q20 min x 3, then reassess | Back-to-back nebulisers acceptable in life-threatening attack |
| Severe asthma | Prednisone / prednisolone | 40–50 mg PO [1–2 mg/kg] | PO | Once daily x 3–5 days | If unable to swallow: hydrocortisone 200 mg IV |
| Severe asthma | Ipratropium (if available) | 500 mcg nebulised [250 mcg] | Nebulised | Q20 min x 3 | Additive bronchodilation; combine with salbutamol |
| Status epilepticus | Diazepam | 10 mg IV (2 mg/min) [0.2–0.3 mg/kg] | IV slow / PR | Repeat x1 at 5 min | PR route: 10 mg adult, 5 mg child — effective if no IV access |
| Opioid overdose | Naloxone | 0.4–2 mg IV/IM/SC [0.01 mg/kg] | IV/IM/SC/IN | Q2–3 min, up to 10 mg | Titrate to restore respirations, not full reversal (avoids acute withdrawal) |
| Severe pain | Morphine | 2.5–5 mg IV (titrate) [0.05–0.1 mg/kg] | IV slow / SC | Q5–10 min PRN | Assess pain, respiratory rate, sedation after each dose |
| Sepsis — empirical antibiotics | Amoxicillin + Metronidazole (if penicillin-tolerant) | Amoxicillin 1 g IV Q8 h + Metronidazole 500 mg IV Q8 h | IV | Ongoing | Source-dependant; adjust when culture results available |
| Sepsis (penicillin allergy) | Ciprofloxacin + Metronidazole | Ciprofloxacin 400 mg IV Q12 h + Metronidazole 500 mg IV Q8 h | IV | Ongoing | Confirm allergy type — anaphylaxis vs. rash |
| Hypoglycaemia (conscious) | Oral glucose / sugar | 15–20 g glucose PO | PO | Repeat Q15 min if <4 mmol/L | Juice, sugar, glucose gel — avoid if airway at risk |
| Hypoglycaemia (unconscious) | Glucagon (if available) | 1 mg SC/IM [0.5 mg <25 kg] | IM/SC | Once | If glucagon unavailable: 50% dextrose 25–50 mL IV |
Drug Storage Requirements
Correct storage is the primary determinant of extended shelf life. Temperature excursions are cumulative — a drug stored correctly for 10 years and then exposed to 35 °C for several weeks may still be viable, but monitoring is not possible without testing.
| Storage category | Temperature range | Relative humidity | Examples | Key notes |
|---|---|---|---|---|
| Room temperature (controlled) | 15–25 °C (excursions to 30 °C briefly permitted) | <60% RH | Most tablets, capsules, topical creams; GTN (in original glass); autoinjectors | The default for most solid oral forms. Avoid bathroom storage (heat and humidity cycles). A cool internal cupboard is preferred over a medicine cabinet. |
| Cool / refrigerated | 2–8 °C | Not critical | Insulin (all types), biologics, reconstituted amoxicillin suspension, some vaccines | Do NOT freeze insulin — freezing destroys it. Monitor fridge temperature. Allow refrigerated drugs to reach room temp before injection where relevant. |
| Protect from light | Any — light protection is independent of temperature | Any | Metronidazole IV, adrenaline solutions, nifedipine, furosemide IV, silver sulfadiazine | Use original amber containers or foil wrapping. UV and visible light accelerate oxidative degradation. |
| Protect from moisture | Room temperature, desiccant recommended | <40% RH preferred | Aspirin, amoxicillin, ferrous sulfate, ORS powder, effervescent preparations | Store with silica gel packets in humid climates. Never refrigerate unless required — condensation on warm–cold cycles degrades moisture-sensitive drugs. |
| Controlled substance storage | As above per formulation, plus security requirements | As above | Morphine, codeine, tramadol, diazepam, haloperidol (varies by jurisdiction) | Locked storage mandated under NZ Medicines Act (and most jurisdictions). Inventory logging required. |
| Avoid freezing | >0 °C | Any | Insulin, some biologics, emulsion-based preparations | Freezing disrupts protein structure (insulin) and can crack vials or break emulsions. |
Sources
- NZ Formulary (NZF) — nzf.org.nz. Dosing, contraindications, and interaction data for New Zealand clinical practice.
- Medsafe — medsafe.govt.nz. New Zealand regulatory data sheets and product information.
- WHO Model List of Essential Medicines, 23rd edition (2023) — who.int/publications. Basis for drug selection.
- Shelf Life Extension Program (SLEP) — US FDA / Department of Defense. Cantrell FL et al. (2012) ‘Stability of Medications Stored Under Simulated Field Conditions,’ Ann Emerg Med 59(4):315-317. Segal DL (2003) SLEP summary data. The SLEP programme has tested over 1,100 products across multiple lots since 1986.
- Alnaim L (2009) — ‘Stability of Drugs Beyond Expiry Date,’ J Young Pharm 1(3):283-286.
- British National Formulary (BNF/BNFC) — bnf.nice.org.uk. Cross-reference for paediatric dosing and interactions.
This document is generated reference data for planning and triage use in resource-limited settings. It does not replace clinical judgement, a current formulary, or prescriber oversight where available. Doses and recommendations reflect evidence current to 2024; verify against the most recent edition of the NZ Formulary or equivalent national formulary when accessible.