Expired Medications

• What does Expiration Date mean?
• Potency & Efficacy
• Safety & Toxicity
• Liquid medications
• Drugs that should never be used past their expiration date

by eMedExpert staff
Medical references reviewed: August, 2018

Many medications are very expensive and people hate to waste them. To avoid a costly visit to the doctor for a new prescription, many people have to consume expired drugs.

Physicians and pharmaceutical companies, because of legal restrictions and liability concerns, will not sanction such use and may not even comment on the safety or effectiveness of using their products beyond the date on the label.

1 What Does Expiration Date Mean?

The expiration date, required by law in the United States, beginning in 1979, indicated the date the manufacturer guarantees the full potency and safety of the drug. At the time of the medication expiry date, the drug must be at least 90% of the original potency under proper storage conditions.

The expiration date does not indicate a point when a medication loses potency and is no longer effective or becomes harmful.

In general, drugs expiration date is 2-5 years from production date. FDA regulations do not require manufacturers to determine actual long-term drug potency and stability. For example, if a company chooses a three year expiration date, it does not have to test beyond that for prolonged effectiveness.

2 Potency & Efficacy

In fact, medication's potency gradually decreases starting from the moment of its manufacture. This process is not in anyway spontaneous after the expiry date.

Expired drugs have not necessarily lost their potency and efficacy. The expiration date is only an assurance that the labeled potency will last at least until that date. Ongoing research[3] shows that stored under optimal conditions, many drugs retain 90% of their potency for at least five years after the labeled expiration date, and sometimes longer. Even 10 years after the expiration date many pharmaceuticals retain a significant amount of their original potency[4].

The best evidence of acceptable potency of the medications beyond their expiration date is provided by the Shelf Life Extension Program (SLEP) undertaken by the FDA for the Department of Defense[4]. The aim of the SLEP program was to reduce medication costs for the military. SLEP has found that 88% of 122 different drugs stored under ideal conditions should have their expiration dates extended more than 1 year, with an average extension of 66 months, and a maximum extension of 278 months.

Recently researchers investigated samples of 8 medications that had expired 28 to 40 years earlier and contained 15 different active ingredients in all[3]. The active ingredients tested for were: aspirin, amphetamine, phenacetin, methaqualone, codeine, butalbital, caffeine, phenobarbital, meprobamate, pentobarbital, secobarbital, hydrocodone, chlorpheniramine, and acetaminophen. The results showed that 11 (79%) of the 14 drug compounds were always present in concentrations of at least 90% of the amount indicated on the drug label, which is generally recognized as the minimum acceptable potency.

3Safety & Toxicity

Contrary to common belief, there is little scientific evidence that expired drugs are toxic. There are virtually no reports of toxicity from degradation products of outdated drugs.

According to The Medical Letter (2015) the only report of human toxicity that may have been caused by chemical or physical degradation of a pharmaceutical product is renal tubular damage that was associated with use of degraded tetracycline (GW Frimpter et al, JAMA 1963; 184:111). Since then, tetracycline products have been changed to eliminate the problem [2]. The lack of other reports of toxicity from expired medication is reassuring, however expired medication toxicity is not a well-researched field.

4 Liquid Medications

Drugs in liquid form (solutions, suspensions) are not as stable as solid dosage forms (tablet, powder, capsule).

Drugs prepared by addition of a solvent before dispensing or administration (such as suspensions of antibiotics for oral use or lyophilized drugs in vials for parenteral use) tend to be relatively unstable in the liquid state. Suspensions are especially susceptible to freezing.

With ophthalmic drugs, the limiting factor may not be the stability of the drug, but the continued ability of the preservative to inhibit microbial growth.

Injectable medications, which have become cloudy or discolored or show signs of precipitation should not be used.

5 Drugs That Should Never Be Used Past Their Expiration Date

Certain medications have a narrow therapeutic index and little decreases in the pharmacological activity can result in serious consequences for patients. Observing the expiration date is obligatory for the following medications:

• Anticonvulsants - narrow therapeutic index
• Dilantin, phenobarbital - very quickly lose potency
• Nitroglycerin - very quickly lose potency
• Warfarin - narrow therapeutic index
• Procan SR (sustained release procainamide) - powerful antiarrhythmic agent
• Theophylline - very quickly lose potency
• Digoxin - narrow therapeutic index
• Thyroid hormone preparations
• Paraldehyde
• Oral contraceptives
• Epinephrine - very quickly lose potency
• Insulin - very quickly lose potency
• Eye drops - eyes are particularly sensitive to any bacteria that might grow in a solution once a preservative degrades.
• Long-expired antibiotics (e.g. amoxicillin, azithromycin, cephalexin, doxycycline) can contribute to increased antibiotic resistance and treatment failure [5].

6 Storage Conditions

Factors that negatively affect drug stability:

• light (especially sunlight)
• oxygen
• moisture
• extreme temperatures

Proper storage is very important for preservation of medicines. Medications react to the environment around them and breakdown over a period of time.

7 Factors to Consider in Deciding Whether to Use an Expired Medicine

• Dosage formulation -- liquids are generally unstable.
• Package-type, container closure system.
• Storage conditions. Medications do retain their effectiveness longer if they are kept unopened.
• Length of time between initial manufacture and final use.
• Appearance of medication. Do not use if: tablets are brittle or breaking apart; tablets or capsules have loss of sheen; tablets or capsules are soft; emulsions or suspensions remain separate despite shaking; injectables appear discolored or a precipitate has formed. With aspirin, it's easy to tell if it's "going bad": the stronger aspirin tablets smells, the less effective it is. Never take medicine that seems suspicious in some other way.

8 Can You Take Expired Medications?

The wisdom suggests that if your life does depend on an outdated drug, and you must have 100% of the original strength, it is wise to follow the cliché "better safe than sorry".

If your life does not depend on an expired drug -- such as you have headache, common cold, or constipation -- you may take the medication and see what happens.
It can be:

• Pain or fever relievers, e.g. ibuprofen (Advil®), naproxen (Aleve®), acetaminophen (Tylenol®), tramadol (Ultram®).
• Antihistamines for allergy symptoms, e.g. diphenhydramine (Benadryl®), loratadine (Claritin®), cetirizine (Zyrtec®).
• Cough medications, e.g. guaifenesin (Mucinex®), dextromethorphan (Robitussin®).
• Ear drops. There is evidence that ear drops containing gentamicin or ciprofloxacin (e.g. Ciprodex®) don't lose their efficacy over at least 4 months from opening [7].

Medical authorities uniformly say it is safe to take drugs past their expiration date -- no matter how "expired" the drugs presumably are. Except for possibly the rarest of exceptions, you won't get hurt and the old drug certainly won't turn into a poison.

References

• 1. Lyon RC, Taylor JS, Porter DA, Prasanna HR, Hussain AS. Stability profiles of drug products extended beyond labeled expiration dates. J Pharm Sci. 2006 Jul;95(7):1549-60. PubMed
• 2. Drugs past their expiration date. Med Lett Drugs Ther. 2015 Dec 7;57(1483):164-5. The Medical Letter
• 3. Lee Cantrell. Stability of Active Ingredients in Long-Expired Prescription Medications. Arch Intern Med. 2012;172(21):1685-1687
• 4. American Medical Association. "Pharmaceutical Expiration Dates." Report 1 of the Council on Scientific Affairs (A-01). July 25, 2001. Accessed November 18, 2011.
• 5. Ogunshe A, Adinmonyema P. Evaluation of bacteriostatic potency of expired oral paediatric antibiotics and implications on infant health. Pan Afr Med J. 2014 Dec 15;19:378. PubMed
• 6. Binkhathlan Z, Badran MM, Alomrani A, et al. Reutilization of Tacrolimus Extracted from Expired Prograf® Capsules. AAPS PharmSciTech. 2016 Aug;17(4):978-87. PubMed
• 7. Clark MP, Pangilinan L, Wang A, Doyle P, Westerberg BD. The shelf life of antimicrobial ear drops. Laryngoscope. 2010 Mar;120(3):565-9.

Last updated: July 23, 2018
Created: October, 2013