Can medicines that live in the fridge go in a pill organiser?

Medicines that need to be kept cold should not go into a pill organiser or a dosage system: they stay in the fridge, in their box, with a separate reminder.

No, medicines kept in the fridge should not go into a weekly pill organiser. If the box says to store them between 2 and 8 °C, they must stay in the fridge in their original packaging, and they are organised with a reminder separate from the other tablets.

This question comes up a lot when an older person takes tablets alongside insulin, eye drops or a vaccine. In this article we explain how to tell which medicines need to be kept cold, which others are best left in their packaging and how to set up a system that works.

Can fridge medicines go in a pill organiser?

No. A medicine that must be kept cold loses its guarantees if it spends days at room temperature in an organiser. The Spanish Medicines Agency (AEMPS) points out that medicines labelled for storage between 2 and 8 °C must always be kept in the fridge.

That is why the good practice guide for dosage systems from the Spanish General Council of Pharmacists lists «medicines that need to maintain the cold chain» among those that cannot be packed into these devices. The same applies to a pill organiser at home: if the pharmacy would not put them in a weekly blister pack, you should not either.

Besides, many fridge medicines are not tablets at all: they are insulins, vaccines, some eye drops or injections, which would not fit in an organiser anyway.

How do I know if a medicine should go in the fridge?

The box tells you and so, always, does the leaflet. According to the Madrid regional government, medicines stored between 2 and 8 °C carry a specific symbol on the box, and the AEMPS stresses reading the leaflet, which always includes storage instructions.

• Keep them in the fridge, but not in the door and not pushed against the back, where they could freeze.
• Do not put them in the freezer: the Spanish General Council of Pharmacists stresses this especially for insulins.
• Keep them in their original box, with the leaflet, and write the opening date on it where relevant.
• When travelling, use a cool bag with ice packs that do not touch the medicine directly.

One detail to watch: some fridge medicines change storage conditions once started. For example, many insulin pens are kept in the fridge before use and, once in use, outside it for a limited time. That period varies from product to product, so always check its leaflet or ask at the pharmacy.

Which other medicines are best left in their packaging?

Not only fridge medicines. Some medicines stored at room temperature should also stay in their blister or original pack because moisture or light affects them, or because their form does not allow handling. The General Council dosage system guide lists several forms that cannot be repackaged.

If you are unsure about a particular medicine, ask your pharmacy before taking it out of the blister. To review how to prepare the rest, see our guide on how to organise a weekly pill organiser.

How do you organise doses when some are in the organiser and some in the fridge?

The key is a single medication list in two parts: what is in the organiser and what is taken separately, showing for each item the time and where it is kept. That way nobody forgets what they cannot see.

1. Make a complete list of all medication, including what is not in the organiser.
2. Mark which medicines are in the fridge and what time they are due.
3. Put a visible reminder on the fridge door, for example a note with the insulin time.
4. If the dose coincides with the organiser, tie both to the same routine (breakfast, for example) so that neither is forgotten.
5. Check expiry dates and opened boxes every week.

If the fridge breaks down or there is a long power cut, do not use or throw away the medicine without checking with your pharmacy first: some medicines tolerate time out of the fridge and others do not, and it helps to know what temperature was reached.

A practical example: Rosa, insulin and seven tablets

Let us take the case of Rosa, 79, who lives with her husband and takes seven medicines as tablets, plus insulin and eye drops that are kept in the fridge. Her daughter fills the organiser on Sundays and has thought about putting the eye drops in a little bag next to the morning tablets.

• At the pharmacy they explain that the eye drops and unopened insulin pens must stay in the fridge.
• Her daughter sticks a sheet on the fridge with two columns, «Organiser» and «Fridge», with the time of each dose.
• The insulin pen in use is kept as its leaflet says, always in the same place.
• Every Sunday, when she fills the organiser, she also checks the opening date of the eye drops.

With this system, Rosa does not depend on remembering what she cannot see, and any relative who helps her knows exactly what is due and where it is.

How can IMA Health help?

At IMA Health we coordinate with a specialised pharmacy so that medication is prepared by day and time in a personalised dosage system, delivered to the home and followed up personally. Medicines that cannot go in the blister pack, such as fridge medicines, are identified separately so that the person and their family know what is taken outside the system. You can see how it works in our home medication service or read more about what a dosage system is.

Sources

• Spanish General Council of Pharmacists: good practice in community pharmacy, preparation and provision of personalised dosage systems (2018, in Spanish)
• AEMPS (Spanish Medicines Agency): how to store medicines in summer (in Spanish)
• Madrid regional government: medicines and heat (in Spanish)
• Spanish General Council of Pharmacists: how to store medicines properly at home (in Spanish)
• CIMA (AEMPS): package leaflet for Pradaxa 110 mg hard capsules (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.