En español | There's certainly controversy about expiration dates on food, but as upsetting to your stomach as it can be to eat items that are no longer fresh, taking expired medications can be more complicated and, in certain cases, have far greater consequences.
"If the drug is an over-the-counter product for minor aches and pains, you may not get 100 percent of the benefits if the expiration date has passed, but it's not dangerous," explains Rabia Atayee, an associate clinical professor of pharmacy at the University of California, San Diego.
However, for people taking medications for chronic or life-threatening illnesses — such as heart conditions, seizures, COPD or severe allergies — a drug that's not completely effective can be downright dangerous, she says.
Here are some answers to common questions that may help you stay out of harm's way when it comes to ingesting and discarding expired medications.
1. "I have some five-year-old antibiotics I want to take on my vacation in case I get sick. Are they still good?"
They won't make you sick, but they may not be strong enough to fight off infection, which can be harmful. Over time, antibiotics stored at home can lose up to 50 percent or more of their strength, meaning they may not be able to halt a potentially life-threatening bug that's invading your system.
Plus, if you're taking leftover antibiotics from a past illness, you won't have a complete dose to knock out all the bacteria. As Amy Tiemeier, associate professor of pharmacy practice at St. Louis College of Pharmacy, points out, not taking a full dose allows the most drug-resistant bacteria to remain in your body. You then risk getting the same infection again and needing a stronger drug to knock it out, which could mean more side effects and pricier antibiotics.
2. "Are there any medications that I should never, ever use beyond their expiration dates?"
Yes, absolutely. Oral nitroglycerin (NTG), a medication used for angina (chest pain), may lose its potency quickly once the bottle is opened and should never be taken after the expiration date. Similarly, insulin, used to control blood sugar in those with diabetes, may stop working after its expiration date. Other drugs you need to be sure are full strength include anticonvulsants, warfarin, digoxin, thyroid preparations and oral contraceptives (see full list here).
Another must-toss once the expiration date has passed: inhalers. "They will lose potency after their expiration date," Tiemeier says. "If you're having an acute respiratory attack and your inhaler doesn't work, it could be a dangerous situation." Ditto for EpiPens; the epinephrine in auto-injectors loses its potency. As with inhalers, EpiPens are used in life-threatening situations like anaphylaxis, so using an expired one is a major health threat.
Lastly, using ophthalmic (eye) drops past their expiration date could be dangerous because of the high risk for bacterial growth. You could risk losing your vision from contaminated drops, Tiemeier says.
3. "Is a drug's expiration date the same thing as the 'use-by' date I see on my prescription vials?"
No. The expiration date is the one legally required to be on the original large container the pharmacist receives for dispensing drugs. The "discard after" or "do not use after" date on bottles or packages given to patients is often for a shorter time — generally a year after dispensing — because of safety reasons once the drug is no longer being stored at the pharmacy. Some states even require pharmacists to add this date. Drugs such as nitroglycerin and insulin have even briefer "use by" windows: nitroglycerin's is typically six months; insulin's is 28 days from the first use, says Atayee.
4. "I keep all my medications on the kitchen counter so I remember to take them, rather than in my medicine chest. Are they safe there?"
It depends. Heat and humidity can affect a drug's potency, and a small kitchen gets hot quickly when the stove or oven is being used. Ironically, the medicine cabinet in your bathroom isn't ideal for storing drugs either, particularly if the space lacks proper ventilation and gets hot and humid. "Meds need to be kept in a dry, cool place," says Atayee, who suggests using a storage box with a lid. Also important: Don't store medication in your car's glove compartment. It may seem convenient, but the temperature extremes can affect the drug's strength.
5. "How can I safely dispose of expired medications?"
While your first instinct may be to crush and flush them, doing so can contaminate drinking water. And when it comes to controlled substances, like narcotic painkillers, you don't want to leave any around: More than half of those who abuse drugs such as painkillers, tranquilizers and stimulants get them from a family member or friend without that person's knowledge, according to the 2011 National Survey on Drug Use and Health. Atayee suggests taking controlled substances to the sheriff's department. The U.S. Drug Enforcement Administration coordinates a nationwide drug "take-back" day in September, when communities, pharmacies and law enforcement groups pay to dispose of expired medications until a permanent statewide program is in place.
If your community doesn't offer a take-back program, you can always crush the meds and put them into empty bottles of liquid bleach, or in used cat litter, to prevent them from getting into the wrong hands, Atayee suggests.
6. "How often should I clean out my medications?"
If you want meds that you know will be potent, aim for every six months. Time this purge to coincide with other safety habits you do at home at the half-year mark, such as checking the batteries in your fire alarm. "Think of it as a whole-house safety check," Atayee says.
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