I do not know about your medicine cabinet, but
mine is a jumble of mostly expired drugs: the muscle relaxants I got when I
threw out my back a few years ago; the anti-nausea medicine I never took during
my stomach woes last summer; the Xanax to occasionally help me cope with the
dizzying state of the world.
اضافة اعلان
I have often
wondered what I should do with these expired medicines — whether and how I
should get rid of them, if they are unsafe to use or whether some might still
work perfectly well. I dug into the research and reached out to three eminent
pharmacists, one of whom has studied expired medicines, to gain some insight.
With guidance from
the US Food and Drug Administration (FDA), manufacturers set drug expiration
dates based on tests they have conducted to determine how long the medication
will remain safe and effective.
An expiration date
“represents a promise that the medication is good at least that long, if
properly stored”, explained Dan Sheridan, a medication safety pharmacist at
OhioHealth Marion General Hospital. Many expiration dates are set between one
and five years after the drug is made.
For many
prescription drugs, however, what you see on your bottle is not an expiration
date but a “beyond use” date. (On my prescriptions, this date appears after the
words “Discard by”.) The beyond use date is typically sooner than the
medication’s original expiration date, explained James Stevenson, a pharmacist
at the University of Michigan College of Pharmacy and the chief clinical
officer at the health care technology company Omnicell. That is because a
pharmacist often has to handle, mix with other ingredients and move a medicine
into a new container in order to give it to you, and doing so reduces the
amount of time it will be usable, he said.
For some drugs, the
beyond use date is just a few days or weeks after the medicine is dispensed.
“A powdered
antibiotic suspension may be good on the pharmacy shelf for two years, but for
only 14 days once the pharmacy adds water and dispenses it to the patient,”
Sheridan explained.
Although expiration
and beyond use dates provide useful information — you can feel confident your
medicine will work for at least that long if it has been properly stored —
drugs do not necessarily become dangerous or less potent once that date has
passed, said Lee Cantrell, a clinical pharmacist with the School of Pharmacy at
the University of California, San Francisco.
In a small 2012
study, Cantrell and three colleagues tested eight drugs, containing 14 widely
differing active ingredients, which had been sitting unopened in a pharmacy
closet with expiration dates that had passed between 28 and 40 years earlier.
They found that 86 percent of the drugs’ ingredients were still present in the
concentrations they were supposed to be. The findings suggest that some
medications, like acetaminophen and the opioid painkiller hydrocodone, retain
their potency “for a long, long time”, he said.
Cantrell pointed
out, though, that he and his colleagues did not actually test the drugs in
people.
“I cannot say that
it is OK to take expired medication,” he said.
The FDA also recommends against taking expired
drugs. However, he has been working at the California Poison Control Center in
San Diego for nearly 30 years, and said people called the center regularly
after realizing they had taken expired medicines, worried about what would
happen. To his knowledge, nothing bad ever has, he said.
Cantrell’s study is
one of just a few published studies that have evaluated the chemistry of
expired medicines. In a study published in 2006, researchers with the FDA and
the pharmaceutical company Sandoz tested 122 drug products and found that 88
percent were still safe to use an average of 5.5 years past their expiration
date.
In fact, the FDA
sometimes tests expired drugs needed for public health emergencies and extends
their expiration dates if they are found to work and be safe.
When considering
whether to take an expired drug, use your common sense. It is safer to take an
expired drug to treat a health nuisance — like ibuprofen to aid a headache or allergy
medicine to treat mild hay fever — than it is to take one to treat a serious
medical condition, Cantrell said.
Antibiotics belong
to one class of drugs that you should not use past the expiration date,
Stevenson said. If you take an antibiotic that is not as strong as it should
be, “that could actually be harmful”, he said, because the drug might not
effectively fight your infection. Research from the 1960s also linked expired
tetracycline to kidney problems, perhaps because the antibiotic produces dangerous
chemicals when it breaks down, but it is unclear if current formulations pose
this risk.
Sheridan also
cautioned against using expired eye drops — they can become contaminated with
microorganisms; and expired nitroglycerin, as the explosive that is also used
to treat chest pain in people with heart disease loses its potency over time.
The American Diabetes Association does not recommend using insulin past its
expiration date, either.
Most drugs can be
discarded in the trash, but the FDA recommends that you mix them with coffee
grounds, dirt, or cat litter so they are less appealing to children or pets who
might consider eating them, and that they should be sealed in a bag or
container. Some drugs that have abuse potential, including those containing
opioids, should not be thrown away.
According to the FDA, these drugs can be flushed down the
toilet, but the Environmental Protection Agency warns that doing so can cause
drugs to contaminate drinking water, rivers, and lakes, since many water
treatment plants are not equipped to remove medicines. Sheridan instead
recommended dropping drugs into secure medication disposal boxes found at
pharmacies. Also, the Drug Enforcement Administration partners with local
governments to collect drugs on designated “National Prescription Drug Take
Back Day” events.
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