Liquid suspension medications are vulnerable to contamination from bacteria and fungus.
Life-saving medications should never be taken past their expiration date, except one.
April 28th is National Prescription Drug Take-Back Day.
At one time or another, many of us have been tempted to reach for a bottle of expired medication to help alleviate a head cold, migraine or infection. But, is it safe? Will it work? What are the risks? Sarah Pace, MD, MPH, a board-certified internal medicine physician at Mission Heritage Medical Group, helps us understand the risks of taking expired medications, why expired medications may not be effective and when we should avoid them all together.
Q. Taking expired medication in pill form will not yield the maximum benefits, but are there other specific health concerns with doing this in some cases? What about liquid suspension medications?
A. Most expired pills and tablets are not harmful to your health as long as they are stored in a cool, dry place. Expired gel capsules must be used with a great deal of caution because they are sensitive to heat and humidity. Before ingesting any medication, you should examine the pills and bottles to make sure they are not broken, open, sticky or discolored.
Liquid medications should not be used past their expiration date. These medications can be dangerous because they provide a welcome environment for bacteria and fungus to grow. If you use expired, potentially contaminated, liquid medications, especially on sensitive tissues like your eyes, you can very likely cause an infection.
Liquid medications often have more specific storage requirements and instructions than pills or tablets. Nitroglycerine, for example, is extremely sensitive to heat and sunlight, so it is stored in a dark colored bottle. Certain chemotherapy drugs must be stored in the refrigerator, inside glass bottles. Insulin is another liquid medication that must be stored in the refrigerator. For medications like nitroglycerine (used for people with heart issues) and albuterol (used for people with lung issues), you simply do not want to gamble with the medication not working effectively.
Q. Medication toxicity from degradation of outdated drugs is not a well-researched field. In your experience are there certain prescription or over-the-counter (OTC) medications that should never be taken after the expiration date? If so, why?
A. People have a tendency to stockpile antibiotics, which usually means they did not take all of the prescribed medication the last time they were sick—but that is an entirely different issue! Expired antibiotics typically lose some of their potency, which means it is unlikely they will be able to completely kill the bacteria that is causing your infection.
If you are tempted to use leftover or expired antibiotics for a new infection, they are not likely to help. In fact, they may not be appropriate for the type of infection you have. When you take the incorrect antibiotic, it actually helps bacteria develop a resistance to the medication. This means the next time you need the antibiotic, it may not work when you need it the most. If you’re struggling with an illness or infection, it is important to talk to your doctor to ensure you get the right antibiotic for your illness.
There are certain medications that should never be taken past their expiration date, like birth control pills. Even the slightest variation in the hormone levels can allow for ovulation to occur. Insulin, too, should never be taken past its expiration date because it can lose its effectiveness (insulin often expires 30-60 days after the vial or pen is opened, be sure to confirm expiration guidelines with your pharmacy). Unfortunately, it is not uncommon for me to see people in the emergency room with diabetic ketoacidosis (a condition in which there isn’t enough insulin in the body) because they were using expired insulin.
Thyroid medications are also sensitive to expiration dates, so older medications may not be able to effectively stabilize your thyroid-stimulating hormone (TSH).
Anti-platelet medications (blood thinners) are often prescribed after you have had a heart stent, a valve placed or a blood clot. This or any medication that helps control a potentially life-threatening condition like epilepsy, asthma, diabetes, or heart failure should be taken with great care and attention because using old, expired, discolored, or broken medications can be fatal.
Q. With the rising costs of prescription drugs, some people may be tempted to take expired medications already in their medicine cabinet. What advice could you offer to people in those situations?
A. Autoinjection epinephrine, which is prescribed for the treatment of anaphylaxis or acute allergic reaction with facial and throat swelling, is one of the most expensive medications we prescribe. While we certainly recommended replacing all expired medications, we recognize that can be cost prohibitive for a lot of Americans. So, if a person has a severe allergic reaction and their only option is expired epinephrine, it is preferred over no medication at all.
Epinephrine solutions that are within 24 months of their expiration date typically have at least 90 percent of the label dose; solutions within 50 months of their expiration date still have as much as 88 percent. In the specific case of anaphylaxis—which is a life-threatening emergency—administering expired epinephrine if that is your only choice, is better than just waiting for emergency medical services (EMS) to arrive.
Depending on your chronic medical condition it is an important responsibility to ensure life-saving medications such as aspirin, nitroglycerine, epinephrine, albuterol (rescue) inhaler, or naltrexone are kept up to date. The easiest way to accomplish this is to have these medications auto-renew at your pharmacy.
Q. What is the difference between shelf life and expired medications?
A. Shelf life relates to the drug’s quality. For example, the medication may still be safe to use but the quality or effectiveness is not guaranteed. Expiration implies that the medication could not only be ineffective but harmful as well.
Q. How can people properly dispose of expired medications?
A. Pain medications should always be disposed of either at a police department or events like National Prescription Drug Take-Back Day.
Medications with needles should always be properly discarded in a ‘sharps’ container. These containers are often accepted by pharmacies and sometimes the drug manufacturer will provide free postage.
Is it time to do a little spring-cleaning in your medicine cabinet? April 28th is National Prescription Drug Take-Back Day; DEA-authorized collectors safely and securely collect and dispose of prescription medications containing controlled substances and other medicines. In your community, authorized collection sites may include retail pharmacies, hospital or clinic pharmacies, and law enforcement locations. Find a take-back location near you.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.