Expired Medications: Dangerous or Just Less Effective?

Most people pay close attention to the use-by dates on foods like canned goods, meat and milk. They know that eating spoiled food can be harmful and watch carefully for signs that it has gone bad.

But what about medications? Are expiration dates really important? University Hospitals pharmacist, James Reissig, PharmD, MS, BCPS responds to frequently asked questions about over-the-counter and prescription medications and why it’s important to pay attention to the expiration dates.

Is it dangerous to take expired medications?

“Very few medications become toxic when they are past their expiration date,” says Reissig. “Most simply lose effectiveness over time due to changes in chemical composition. However, in some situations, taking expired medications can have serious health consequences. For example, taking sub-potent antibiotics might not fully treat an infection, leading to more serious illness and possible antibiotic resistance.”

In addition, any medication that requires a precise dosage to treat a specific disease or condition should never be used beyond the expiration date. Examples include:

• Anticoagulants & antiplatelets (blood thinners)
• Epinephrine pens
• Inhalers (especially rescue inhalers)
• Insulin
• Nitroglycerine tablets
• Seizure medications
• Thyroid medications

Taking these medications at less than full potency could lead to potentially dangerous health complications so it is always advisable to replace them before the expiration date. In an emergency situation, it may be better to take or use sub-potent medicines like an epinephrine pen or rescue inhaler versus nothing at all, but the medication should be replaced as soon as possible.

When did the FDA begin requiring expiration dates on medications?

The Expiration Dating Law was passed in 1979, requiring that all medications, both OTC and prescription, have an expiration date printed or stamped on the bottle or packaging. The manufacturer then guarantees the stability and effectiveness of the medication if taken prior to the expiration date provided.

How is the expiration date determined?

“In an ideal world, manufacturers would perform studies that show how long a medication is stable and remains effective when it is stored in various environmental conditions. However, if manufacturers actually had to do this, it could take decades for new medications to get approved. Therefore, most manufacturers provide very conservative estimates of the timeframe within which the medication will be safe and provide the intended benefit,” says Reissig.

For some medications, stability decreases once the original packaging is opened. Therefore, when the pharmacist fills a prescription by separating a portion of pills from the original bottle, he or she may indicate an expiration date that occurs sooner than the one provided by the manufacturer.

How should medications be stored?

Unless instructed by the pharmacist to store medications in a particular way – in the refrigerator, for example – medications should be stored in a dark, temperature- and humidity-controlled location. Extreme heat or cold, light and high levels of humidity can cause some medications to lose stability and thus reduce their effectiveness. “Many people store medications in their bathroom which is probably the worst place due to the frequent changes in humidity,” says Reissig.

And, of course, medications should always be stored where curious children or pets cannot accidentally get into them.

Are expired OTC medications like ibuprofen and acetaminophen safe to take?

The vast majority of over-the-counter medications retain stability and potency well beyond the listed expiration date. When used for minor aches and pains or allergies, it is fine to use an over-the-counter medicine that expired a couple months ago until you can replace it. For those taking a physician-recommended daily aspirin for heart health, the expired pills should be replaced as soon as possible. Again, this is a case where it is probably better to take potentially sub-potent expired medicine versus nothing until the expired medication can be replaced.

What is the safest way to dispose of expired medications?

The Environmental Protection Agency and the local water and sewer districts ask that medications not be flushed down the toilet or sink as many can cause issues in the sewers and water treatment facilities. Additionally, water treatment facilities cannot filter out medications from our drinking water.

Expired medications can be disposed of in the regular trash if precautions are taken to ensure that children or pets cannot gain access to it. However, the best option is to participate in one of the periodic medication take-back events. “A Google search of “FDA drug disposal” will take you to the FDA webpage that provides guidance on medication disposal as well as finding medication disposal locations,” advises Reissig.

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University Hospitals has pharmacy locations across the region, staffed by licensed pharmacists who can answer medication-related questions. We also have several permanent year-round medication disposal kiosks for the convenience and safety of our patients and the community.