Is it ever safe to take expired meds?

Published on Monday, August 1, 2022

By: Gary Pettus, gpettus@umc.edu

Drugs which can, among other things, help you breathe easier, give you a new beginning or improve your vision may have taken their last breath, met their end or become a sight worse.

It’s a pharmacy fact: There comes a time when we have to let go, and that time is the expiration date.

If you’ve ever wondered whether expired drugs are ever safe, how to dispose of them, and what’s the difference among the labels “expired” “discard by” and “beyond use,” experts at the University of Mississippi Medical Center can offer guidance.

“It’s never safe to recommend taking medications after the expiration date,” said Steven Dancer, assistant director of pharmacy services at UMMC’s Jackson Medical Mall Pharmacy.

“Expired medical products can be less effective and pose a risk to the patient due to changes in chemical composition of the medication over time.  Once the expiration date has passed, there is no guarantee that the medication is safe and effective.” 

Weighing in as well are Dr. Bridgett Chisolm, assistant professor of pharmacy practice, and pharmacy manager, and her colleague, Thomas Pressley, clinical pharmacy specialist. Even if a medication should retain 90 percent potency after a certain time period, Chisolm said, using them “makes them more dangerous to the patient, who isn’t receiving the full dose.

“That could lead the prescriber to increase the dose (as it ‘isn’t working well enough’), causing the patient to receive a much higher dose than they did with the expired medication. It would be best to get a new prescription so everyone can be on the same page.”

Before going any further, let’s come to terms, according to the experts’ knowledge:

• Expiration Date – The date by which a manufacturer can no longer guarantee the strength or safety of a product. “A product that expires, for example, in December 2023, means that product is guaranteed until that date – as long as it’s unopened,” Dancer said. For the sake of effectiveness and, possibly, your life, it’s particularly important not to use expired antibiotics, insulin and nitroglycerin, Pressley and Dancer said.
• Beyond Use Date – Used for prescription products, this is the date by which a compounded medication (mixed in the pharmacy on a patient-to-patient basis) is no longer guaranteed safe and effective. “At UMMC we follow 797 United States Pharmacopeia recommendations to guide our BUD selection for our aseptically compounded medications [those prepared to ensure they’re free from contamination by micro-organisms],” Pressley said. “With the recent updates to our compounding clean room at UMMC, we are able to admix some medications and give them a BUD of nine days under refrigerated storage conditions.”
• Discard by Date – Used for prescription and over-the-counter products, this is the date by which a medication should be disposed of once it has been removed from the manufacturer’s original packaging. That is typically one year from the date the prescription is dispensed to the patient, although it can be much sooner than that, Pressley said. This date is given to ensure that, under reasonable storage conditions, the medication will retain its original, intended potency.

As you sort through your supply of moldering medicine and decaying drugs, other questions may occur to you involving such matters as:

• Storage – Use a cool, dry place away from light, such as a dresser drawer, closet shelf, or kitchen cabinet, Dancer said. “Storing medication improperly (as in a damp bathroom cabinet) can cause medicine to be less effective before reaching the expiration date. Store medication away from the sink or hot appliances in kitchen areas. All medication, prescription and over-the-counter, should be stored to prevent children from having access, to prevent accidental poisoning.” It’s important to keep a medication in its original container, Chisolm said. “However, if the bottle contains a cotton ball, take it out. Cotton pulls moisture into the bottle.”
• Expired eye drops – Never use them, Chisolm said. Some include preservatives to keep them sterile, but sterility degrades after the expiration date, causing decreased potency and increased risk of microbial invasion. Inhalers and topical drugs can also decompose over time, Dancer said.
• Disposal (in the trash) – “The rule of thumb today is: Pour the medication in a sealable plastic bag and add a small amount of water to dissolve tablets/capsules,” Dancer said. “Add any material that mixes with the medication, such as kitty litter, saw dust or coffee grounds. Seal the bag and place in the trash.” Chisolm recommends marking out all personal information on containers before trashing them. “All medicines, except those on the FDA flush list, can be thrown into your household trash,” Dancer said. “These include prescription and over-the-counter medicine."
• Disposal (in the toilet) – The FDA flush list includes medicines that are high on the list for misuse/abuse potential, can be life-threatening if taken inappropriately, and can be especially harmful to children and pets, not to mention adults, Dancer said. Do not flush your medicine unless it is on the flush list, he said. “Opioids make up the majority of the flush list,” Chisolm said. The best option, Dancer said, is a drug take-back location (see below).
• Drug take-back programs, drop-off boxes, mail back programs, etc.: “Some pharmacies and police stations offer on-site medicine drop-off boxes,” Dancer said. “You can find the nearest drop-off location on the Drug Enforcement Administration's website. The DEA sponsors National Prescription Drug Take Back Day to provide a safe way to dispose of unneeded medication. The next Take Back Day is Oct. 29.” Chisolm recommends these sites as well: com and consumermedsafety.org.
• Inhalers – “If punctured or placed in a fire incinerator, they could be dangerous,” Chisolm said. “In the hospital, these products are placed in a special hazardous disposal bin. In the community, the best and safest way to dispose of inhalers is to drop them off at a take-back location. The package instructions in each inhaler box contain handling instructions that are specific for that medication.”
  
  

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