EXPIRED - to be or not to be
Let's talk expired medications!
Do they really expire?
Are they still going to work?
Will they poison me?
How can I tell?
Expiration dates are determined by the drug manufacture at the time of application to the FDA. They are required to provide stability testing data with a proposed expiration date and storage conditions when they submit an application for FDA approval of their drug. Things tested for are strength, quality and purity throughout the proposed shelf-life.
Beyond use dates are also set by compounding pharmacies on the prescriptions they make in their labs. They use guidance of USP 797 and USP 795 for sterile and non-sterile compounding. They do not have grand stability studies on each and every custom compound that's prepared and sold so general guidance is used.
What that means to you, the consumer, is that the expiration date is IMPORTANT.
Lower strength than intended: If the drug was not stored according to the labeled conditions and if it has degraded, then it might not provide the patient with the intended benefit because of the lower strength. It may still give partial benefit but that also can create problems, like with antibiotics, lower peak levels may not kill the bacteria and create a resistance loop that is harmful to everyone. With blood thinners, adequate thinning may not be achieved. Once Nitroglycerin is opened it begins to degrade due to heat and light becoming less effective.
Higher concentration than intended: Creams and ointments are medications that are mixed into a cream, lotion or ointment "bases". As time goes on and the base evaporates, the cream can actually get MORE potent, ie. stronger.
Harbor bacterial growth: Medicated eye drops and liquid antibiotics are particularly sensitive to this. Using the medications may make things worse and cause secondary issues.
Toxic compounds when the medication degrades: These compounds could cause consumers to experience unintended side effects. One example is Tetracycline. As it degrades, byproducts such as epi-anhydrotetracycline or anhydrotetracycline can lead to serious illness, like Fanconi Syndrome. Taking the expired medication could be like taking a poison.
In general, expirations do matter but it isn't just cut and dry about what happens at this magical date that is set. Tablets are more stable than liquids and the day after an expiration date doesn't just make it unfit...it makes it less fit and less predictable. If you have unused antibiotics - get rid of them, I won't nag you on the past...ie. you needed to have taken the full course at the time of infection, my guess is you already knew that. If you have liquids for your kiddos, toss them when the date comes up, like for real. Get rid of them. If you have over the counter cough and cold tabs well that's up to you, don't you want the most effective treatments possible. Get them out of the house and go to the local pharmacy and get the right product for you for this illness....last time may not be the same as this time. Give yourself the best shot.
By: Becky Stillo, PharmD