Expired Drugs: Reading Between the Lines

Part 2 of a 3-part series on product ‘expiration’ dates

You have a headache, so you reach for the bottle of aspirin—but it expired last month. The date on your decongestant reads six months ago. You have a few alprazolam (e.g., Xanax) for flight anxiety, but you had to cancel your trip last year, and now the pills are expired. Can these expired drugs still help you, and are they safe?

Most likely, the answer to both questions is yes. But that doesn’t mean you should ignore those dates.

It helps to understand what an expiration date on a medication really means. The U.S. Food and Drug Administration (FDA) requires drug manufacturers to print an expiration date on all prescription and over-the-counter products. This date reflects lab testing and indicates how long the medication is thought to be both safe and effective. Most medications are considered to still meet these conditions for one to three years after manufacture, although some can be good up to five years.

When a pharmacist repackages a prescription medication, the new packaging will often carry an automatic one-year expiration date, even though the medication is likely still beneficial long after that time.

So why don’t manufacturers push for longer, more accurate expiration dates? It’s simple: Drugs that expire quickly increase sales by making you think you need to buy a new supply sooner.

Do drugs really go bad so quickly?

There’s certainly reason to think medications still have value even after their expiration date. Interestingly, the U.S. government maintains a Strategic National Stockpile—a massive collection of medicines and medical supplies that could be needed during a public health emergency or bioterrorism attack (including antibiotics, antivirals, and vaccines). Because it is so expensive and logistically difficult to constantly replace drugs that have expired, the FDA is working together with manufacturers to extend the shelf life of the drugs in the stockpile for as long as possible—often much longer than the expiration date you’d see on a commercially sold product. But as you’d expect, these supplies are stored under the most optimal conditions and remain unopened until (hopefully never) needed.

And it’s important to remember that an expiration date assumes a medication is being stored under similarly optimal conditions. Once a package is opened and the contents are exposed to light, humidity, heat, and changing temperatures (does this sound like your bathroom medicine cabinet?), a medication can degrade more quickly. Medications will stay at their peak potency the longest if they’re stored in a cool, dry place like a dresser drawer, a kitchen cabinet away from the stove, or a non-bathroom closet. A good tip: Throw away the  cotton ball that comes in the bottle (which is there to keep the pills from moving around), as it can attract moisture that spreads to the pills. (The little silica packets that may come in the bottle are fine to leave in there—they help keep products dry. Just make sure to keep them unopened and out of the reach of children, as they can be dangerous if eaten.)

Some medications do degrade more quickly than others and shouldn’t be relied upon after their expiration date—including essential medications like nitroglycerin, insulin, EpiPens, and liquid antibiotics. All liquid medications and those that require refrigeration are among the fastest to lose their potency.

Prescription drugs shouldn’t be left over

An important question may be: Why do you have leftover prescription drugs in the first place? Most medications are prescribed for one of two reasons—either an acute illness (when you’ll likely be instructed to finish all pills in the bottle) or a chronic condition (and you’ll be expected to take the medication as scheduled and get a refill when it’s finished). Neither situation should result in leftover medication.

For other medications, like an inhaler for a respiratory infection or antibiotic drops for pinkeye, don’t keep them past their expiration date. And certainly don’t use them for a second infection (in you or a family member) without getting advice from your doctor. What works for one infection—or person—may not be appropriate for another.

To take or to toss—what is the final answer?

Most  expired drugs are unlikely to make you sick, although a few—particularly liquid medications like eyedrops—do have a risk of bacterial growth that could cause infection or illness. The more likely danger comes from expired medications not being potent enough to address the condition you’re trying to treat. An expired product could have a change in chemical composition that makes it less strong, meaning you’re only getting a partial benefit. Antibiotics that are past their prime, for instance, may not fully treat an infection, leaving you vulnerable to a more serious infection.

Over-the-counter medications like pain relievers, cold remedies, sleeping pills, and topical medications are likely fine to use after their expiration date has passed, as even a slightly less potent version can still help.

On the flip side, a medication can go bad even before its expiration date has passed. Don’t take any medicine that has changed in color, texture, or smell. And don’t take any pills that are stuck together, harder or softer than usual, or have become powdery, cracked, or chipped.