Sharon Horesh Bergquist, MD, a physician with the Emory Clinic in Atlanta. She is assistant professor of medicine at Emory University, Atlanta. EmoryHealthCare.org
We all have medications we needed for a one-time concern that end up being shoved in the back of the medicine cabinet: the drug for motion sickness bought for a cruise, the antidiarrheal bought after a meal at a questionable food vendor, the jumbo bottle of ibuprofen that was a great deal at Costco three years ago.
When you need them again, your relief at not having to run to the store may be tempered by disappointment when you realize that they expired while on standby.
Expired doesn’t mean spoiled
The good news is that, based on testing of government stockpiles of drugs stored for national security, many of those drugs are still likely safe and effective after the expiration date. When the U.S. Food and Drug Administration tested 122 expired medications for the Department of Defense, researchers found that almost 90 percent of them maintained their quality a full year after their expiration dates. In fact, the FDA found that the average expiration date could be extended by 5½ years.
An expiration date doesn’t mean that a drug goes bad, like perishable food. Rather it’s the date through which the pharmaceutical company guarantees the medication’s full potency. Because it’s expensive to repeatedly test a drug’s potency for many years, most manufacturers stop testing at one to five years and set the expiration date based on their testing time. The American Medical Association has pushed for extended expiration dates, and the FDA occasionally extends a drug’s expiration if there is a shortage of that medication, but no widespread changes have taken effect yet.
These drugs are safe
How long a drug remains safe and effective past an expiration date depends on many factors, including how it was stored. If kept in a cool, dry in a solid form, like tablets, could be taken for at least one year past the expiration date. That includes medications for cold and allergy symptoms and nonsteroidal antiinflammatory drugs.
While the FDA found that certain lots of drugs like the cold medicine guaifenesin or the antibiotic ciprofloxacin lasted more than 10 years, it’s important to note that in the study, the medications were stored in ideal circumstances, which can’t be replicated at home.
Throw these away
While solid-form medications generally hold up well, creams, liquids, and ointments do not. After cough syrups, nasal sprays, eye drops, and topical ointments expire, toss them to avoid bacterial contamination from expired preservatives, or changing composition from evaporation. Probiotics should also be replaced before they expire, as they contain living organisms.
Any medication that you use for a serious medical issue should also be replaced upon expiration. If a drug like nitroglycerin, albuterol, insulin, or an epinephrine pen undergoes even a small decrease in potency, it could be dangerous.
The way you store medications can affect their potency even if they’re not expired. Never store medications or diagnostic strips in the bathroom, where heat and humidity can affect their performance. Avoid extreme temperatures. Most medications can safely be stored from 58 to 86 degrees unless they require refrigeration. Those temperatures can easily be exceeded if you leave medications in your car while running errands on the way home from the pharmacy or if you pack them in a checked suitcase when flying.
When storing medications, take care not to mix them up. Eye drops and ear drops look very similar, so keep them separated or clearly marked. When in doubt, look for the word ophthalmic before putting anything into your eyes and otic before putting a medication in your ears. Keep pets’ medications clearly marked or stored in a separate location.
Mixing up ear and eye drops isn’t the only medical error you need to watch out for. Something as seemingly harmless as taking a prescription sleep aid while also taking an over-the-counter allergy medication can be dangerous since they can both cause sedation. Some herbs and dietary supplements can alter the effectiveness of prescriptions too. Every time you fill a new prescription or start taking a supplement, spend a few minutes with your pharmacist to ask the following questions:
Will this new medication interfere with my other medication(s)?
What should I do if I miss a dose?
What should I do if I accidentally take more than the recommended dose?
Are there any foods, drinks, other medications, or activities I should avoid while taking this medicine?
How long should I take it?
What are the possible side effects? What should I do if they occur?
Can I cut this pill? Some medications are specially coated to be long-acting or to protect the stomach.
Can I crush this pill to take with food instead of swallowing?
Make sure any physician you see, including specialists, has a complete list of all of your current medications and supplements along with dosages. Keep a written record of your prescriptions, or use your smartphone to take photos of the labels.