The question: Is it ever safe to use expired medications?
The answer: We've all come across that bottle in the farthest corner of the medicine cabinet. You haven't needed it for a while, but then you do, for whatever reason, and you realize it's expired. But does medicine actually go bad? And what's the risk?
It's twofold, explains Jeff McClusky, pharmacy supervisor at a speciality clinic in the Harris Health System in Texas and an American Pharmacists Association (APhA) spokesperson. Expiration dates, he tells The Huffington Post, guard against potential spoilage of medication ingredients as well as potential losses in potency.
An expired medication may not have an adverse effect, but it's a big risk. A dip in potency of your over-the-counter pain reliever wouldn't typically be a big deal, but consider a more serious ailment: Heart or diabetes medication, for example, is critical to managing disease. A dose at lower potency could cause "a negative effect almost immediately," he says.
Compensating for the lowered potency brings about risks of its own, says Jennifer Adams, PharmD, EdD, a spokesperson for the APhA and the senior director of strategic academic partnerships at the American Association of Colleges of Pharmacy. If an expired medication is now only 90 percent effective, some patients might just assume it's safe to take two pills instead of one, or three instead of two, she says. "You aren't really sure in terms of how much you're going to be getting, and you could potentially be getting too much ... That's when it can be very dangerous."
The U.S. Food and Drug Administration (FDA) requires that an active ingredient in a medication must be present in 90 to 110 percent of the amount indicated on a drug's label. Tablets and capsules have the longest shelf life, according to McClusky, who says on pharmacy shelves many are good for as long as five years. Liquids and injected medications like insulin last much shorter time periods, with some antibiotics losing potency in as little as 10 to 14 days. Drug manufacturers revisit their own products frequently after leaving them to age in storage facilities to prove how long a particular medication remains effective.
Lee Cantrell, PharmD, the director of the San Diego division of the California Poison Control System and a professor at University of California San Francisco and San Diego, led a study of the potency of various expired prescription meds. The findings, published in the Archives of Internal Medicine in 2012, were promising: "By and large," Cantrell tells The Huffington Post, "the majority of the contents the active ingredients retained their stated potency."
However, the study wasn't designed to measure safety or efficacy of these expired medications, and, he cautions, didn't examine fillers or other binding agents in the pills. "They may be perfectly fine," he says, "but no one has done that study yet."
It's not completely unheard of to adjust expiration dates, he points out. The federal Shelf Life Extension Program, a joint venture between the Department of Defense and the FDA, aims to extend the use of certain stockpiled medications in certain storage conditions to help allay the costs of replacing such stored quantities. "The powers that be have extended and continue to extend the expiration dates on multiple types of medications, [so] there's some precedent that medications are still good beyond their expiration dates," says Cantrell. "That's probably the most robust data set we have suggesting that's the case."
Since neither drug manufacturers, healthcare professionals nor pharmacy experts can guarantee safety or efficacy of expired medications, you're "on your own" if you decide to still use one, says Cantrell. But your best bet is probably just to safely dispose of those pills. Not only is it potentially harmful for you to take them, but -- especially with more powerful narcotics -- you don't want others to have access to them.
The FDA has detailed guidelines for disposing of medications on its website. But Adams keeps a handy adage in mind: Zip it, inactivate it and trash it. Medications should be placed in a sealable bag and then inactivated, either by diluting it in water, mixing it with dirt or even tossing in some coffee grounds or kitty litter -- really! After sealing the bag, feel free to toss it in the trash. "A lot of people think you should just flush medications," she says, "but there are unintended consequences that happen because of that," including environmental concerns. The FDA maintains a list of flushable medications here. Some pharmacies may offer to take back unused medication and dispose of it for you.
In the meantime, you can make one very simple change to help prolong the shelf life of your medications: Stop storing them in the bathroom. "High humidity and high temperatures actually cause degradation of the medications quicker," says McClusky. Stop exposing your pills to your morning showers and stash them instead on a high kitchen shelf, where it's probably dryer and cooler, he says.
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