Ever been in this situation? You have a cold and when you look in your medicine cabinet, you discover your cold medicine expired three years ago. Do you take it or throw it out? Let’s talk about expired medications, their safety and which ones should not be kept past their expiration dates.
I find patients with old white rescue inhalers in their purses. What’s the big deal? The white ones are the generic albuterol inhalers made prior to 2008 before the CFC propellants were taken off the market for ozone concerns. That’s some old (and likely ineffective) albuterol!
For physicians wanting unbiased, reliable and timely drug prescribing information, The Medical Letter is a valuable publication published by a nonprofit organization. It has helped me optimize my prescribing behavior with cost and effectiveness in mind. For example, a past article explained that the surface of the eye can barely hold one drop of liquid medicine and anything extra just runs down your face. I no longer prescribe “1-2 drops in each eye” because I know the second drop is wasted.
A December 2009 article in The Medical Letter titled Drugs Past Their Expiration Date examined safety and effectiveness, citing data from the Department of Defense/FDA Shelf Life Extension Program. The purpose of the program was to save money on military stockpiles of medications if they could be used safely and effectively well past their expiration dates. They found that 88% of over 3,000 lots of 122 different drug products remained stable for an average of 66 months past their original expiration date if they were unopened and in their original containers. The article also stated there were no reports of human toxicity from current drug formulations used after their expiration date. A longer usable lifespan is therefore suggested, at least when it comes to tablets or dry, powder medications.
This is not generally the case with liquids. While all medicines are more likely to degrade with extremes of temperature or humidity, solutions and suspensions (liquids) are usually more susceptible to this degradation. Dr. Estelle Simons, a well-known allergist, did a study on out of date EpiPens and showed a significant decrease in epinephrine content with greater time past the expiration date. There is no room for error when it comes to Epipens. They are needed in cases of life threatening anaphylaxis. Delayed administration and under-dosing have been associated with increased risk of dying. It is imperative to keep your EpiPen up to date. Since most rescue asthma inhalers are “aqueous,” they too should be kept up to date.
So in summary, drug companies and doctors are limited by liability and legal restrictions when it comes to following the expiration dates of medications. It is always best practice to keep medications in date. However, data exists to suggest dry tablet or powder forms of medications might have a longer shelf life. That is not the case with liquids. You should always renew your water based rescue inhalers and EpiPens once their expiration date is reached.
It’s time to clean out your medicine cabinet. (Click here to learn more about safely disposing drugs in the Louisville-area.) It may feel as if you just bought that bottle of Nyquil, but there’s a good chance it expired 2 years ago!
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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.