It's flu season, and the only bottle of cough syrup in your cabinet is one that expired in 2012. Is it safe to take, or should you brave the cold to get a fresh supply at the pharmacy? In general, expired drugs aren't likely to kill you, but there are some things you should know. Image via Bildagentur Zoonar GmbH (Shutterstock).
You should talk to your doctor if you have a question about a specific medication, of course. And we certainly aren't going to recommend taking something that says on its package you should not take it. But you may be happy to know old pills don't "go bad" in the same way food does. They can, however, become less effective over time.
There was one case of people getting sick from expired antibiotics, back in the 1960s. Three patients developed a kidney disease, and recovered. Aside from that, expired medications haven't been linked to any dangerous conditions.
Instead, these medications go bad in more subtle ways. The active ingredient might break down slowly over time, so that a drug that's past its expiration date might not be 100 per cent effective. The US Food and Drug Administration describes the time before the expiration date as the time you can expect the drug to retain its identity, strength, quality and purity.
A drug might still be good after that date, though. If the manufacturer wants to guarantee the drug will be good for two years, they only have to test whether it will last two years, and they're done. They aren't required to test what happens to the drug after that date.
Many (But Not All) Drugs Are Still Good After Their Expiration Date
If you're curious about the drugs in your stockpile, though, you're in good company: the US government keeps drugs around for emergencies, and would rather not replace them if they haven't actually gone bad. So the FDA has a shelf life extension program, where the Department of Defence or the Centres for Disease Control and Prevention can request that extra testing.
A report published in the Journal of Clinical Pharmacology in 2006 found that 88 per cent of the tested drug lots were good for at least a year past their expiration date, with an average extension of five years. Some lasted far longer. One lot of the antibiotic ciprofloxacin, the drug of choice for treating anthrax, was still good nearly 12 years past date. Several lots of potassium iodide granules, part of the treatment for people exposed to radiation, were still good after 18 years.
Here's the problem, though. You can't be sure that your bottle of your favourite drug is going to still be good. The authors of the report concluded that "many drug products can be extended past the original expiration date, but this additional stability period is highly variable". If storage conditions aren't perfect, the drug probably won't last as long. And some drugs may just be more stable than others.
Sadly, there's no way to know if that bottle of pills in the back of your medicine cabinet is one of the super-stable ones or if it's already started to lose its effectiveness.
Don't Take Chances With Lifesaving Drugs
If your Panadol or cold medicine is a little less effective than when it was brand new, that's not the end of the world; you'll just ache or sniffle a little more. But if you're depending on something like an Epi-Pen to save your life, you would want one with full strength drugs.
The epinephrine in Epi-Pens is, in fact, a drug that gets significantly less effective after its expiration date. While you're sitting here thinking about it, you should replace the expired one you already have. But if you were to have a sudden allergic reaction, any Epi-Pen is better than none.
eMedExpert suggests you should replace drugs that lose their strength very quickly or that depend on a very specific potency to work. Here are some examples:
- Anticonvulsants like phenytoin, carbamazepine, lamotrigine and oxcarbazepine
- Dilantin, phenobarbital
- Procan SR
- Thyroid preparations like levothyroxine sodium
- Oral contraceptives
- Epinephrine (like the Epi-Pen)
- Eye drops
These make sense, because you need your birth control or your insulin for an important reason. A less-effective dose of these kind of defeats the point.
Don't Stockpile Drugs Without a Good Reason
In some cases, it makes sense to have a stash of drugs. You have allergy medication because from time to time you encounter a cat or a tree full of pollen. But for other drugs, especially prescription ones, you may want to ask yourself why you have leftovers.
If you have leftover antibiotics, for example, you probably didn't take them as prescribed. Next time you get an antibiotic prescription, try setting reminders with an app like Dosecast or just a simple repeating calendar reminder so you won't forget to take your pills.
The same goes for opioid painkillers. Trying to conserve them actually makes you more likely to get dependent on them. And definitely don't save your leftovers for a rainy day. Using a powerful painkiller for something minor like a headache puts you at risk of addiction.
That said, it's reasonable to want to keep extra medication on hand in a serious survival kit or just for convenience when you're away from a pharmacy. You'll have to use your own judgment to decide if you're comfortable taking a chance on expired drugs.
So, take stock of that medicine cabinet. Expired allergy meds just mean you need to make a trip to the pharmacy... eventually. Expired lifesaving drugs should be replaced ASAP. And then bring any unwanted drugs to the pharmacy or look for a medication take-back day in your community — no need to keep it around.