Why you shouldn’t take expired medication and what’s the ONE medication we recommend you keep past its expiry date?
We’ve all done it. You’ve got a headache, you’ve rummaged around your medicine cabinet and found something that’s been there for months (or years!), but before you pop that expired medication read on.
In this blog we explain the difference between BEST BEFORE, USE BY, DISCARD AFTER and EXPIRY DATES and explore the reasons some medications have shorter expiry dates than you would expect.
Firstly, what about food?
On food products you will often see BEST BEFORE dates. These dates refer to the quality of the product, not its safety. Food may no longer be at its freshest or best and may be beginning to lose its flavour, texture or nutrients. It doesn’t necessarily mean that the food is no longer safe to eat. Foods with a BEST BEFORE date can be legally sold after that date. Many of you will have seen and grabbed the grocery bargains that are heavily marked down once this date is reached.
USE BY dates on food are different. These foods must be eaten before this time for health or safety reasons. Foods can’t legally be sold if their USE BY date has passed and should be avoided.
Ok. Got it. So, what about my expired medicines?
Most medications, last for years and years. A study by the American Military showed many medications were still as effective 15 years after manufacture, with some 80-90% potent after 30 years.
What this doesn’t consider is storage conditions. Yes, we mean those musty mouldy bathroom cabinets, those hotter than hell car glove boxes and now we have climate change to worry about.
What we have is a safety issue and a need for consistency trumping long expiry dates. Once a medication leaves the controlled environment of a manufacturer or pharmacy, the temperature variations, exposure to light, air, water and bacterial contamination pose too many variables for companies to risk guaranteeing the safety and effectiveness of their product.
To this end an arbitrary expiry date of 5 years from manufacture has been chosen as suitable for all long-term stable medications.
Two parameters must be considered with medication – potency and safety.
- With regards to potency, the expiry date is calculated to be when the loss of active drug is less than 10% of the medications stated strength.
- Safety must be considered by weighing up the risks. When do the adverse effects or risks start to outweigh the benefits?
That’s all good and well, but what expired medication shouldn’t I take?
We strongly recommend you don’t take or use the following medications or groups of medications beyond their expiry date.
- Antibiotics. Most antibiotics have a shorter shelf life than the five-year maximum and often struggle to get to two years. There are some reports of toxic effects which have occurred with patients taking old antibiotics and with infections it is better to get a new infection checked to make sure you are treating the infection with the right antibiotic and not just any antibiotic.
- Reconstituted medications. Some medications have had water added by the pharmacy. These often include antibiotic mixtures for children. The clue here is if they are so unstable that the pharmacy must add water at the very end of the manufacture process, they aren’t going to be last long. Pharmacists will add a DISCARD AFTER date to the label, based on days AFTER it reconstituted. They can become contaminated with bacteria or may lose their effectiveness after the DISCARD DATE, so out they go. The discard date in these cases overrides the manufacturer’s expiry date.
- Eye drops, eye ointments and some ear drops. Although, these products contain preservatives to reduce bacterial growth, they keep concentrations low to minimise eye irritation. With these products the exposure to air and the possibility of introducing bacteria into the bottle through accidental touching of the infected eyes or lids mean the risk of using them after their expiry is much higher. These medications will often have DISCARD DATES added by the pharmacist based on time from when they are opened. Again, the DISCARD DATE trumps the manufacturer’s expiry date.
- Nasal sprays. A bit like eye drops, nasal sprays are used where levels of resident bacteria are high and regular use opens the door to contamination with bacteria getting into the liquid inside the spray.
- Products containing ASPIRIN. Aspirin is highly unstable when exposed to air, hence they are usually wrapped in foil. Taken out of the foil the tablets rapidly degrade to acetic acid and begin to smell like vinegar. Great for your salad dressing but not so effective for your headache. Those of you still cutting aspirin tablets in half to help thin the blood, take note. That second half should be thrown away.
- Tablets for Angina or Chest Pain. These medications need to be carried with patients so that if they develop chest pain, the medication can be used in an emergency. The problem is they degrade quickly in the heat and even body temperature (think pockets of your clothing) is not really a suitable storage environment. Don’t rely on these past their USE BY date which will have been added by the dispensing pharmacy. Read the label on the bottle and mark your calendar, so that you don’t run short of these vital medications.
- Refrigerated items. There are also many other drugs with short use by dates, that can be stored in the refrigerator at the pharmacy long term but once home have a much shorter expiry date when stored below 25 degrees as a concession to your convenience. If you want to prolong the expiry of these medications, then you can do this by popping them straight back into the fridge when you get home from the pharmacy. These include common medications such as hormone patches, thyroid tablets and even insulin which can all be safely used out of the fridge. Check each individual medication for specified dates that relate to non-refrigerated expiry dates, or ask the pharmacist if you are unsure.
So, what’s the ONE expired medication you should keep?
Shortages and an inconsistent supply have plagued the whole of Australia for the last couple of years for the life-saving adrenaline filled pen.
- The safest way is to always renew your Epipen when it expires. Keep a note or reminder to replace your Epipen whether it’s on an old school calendar or on a phone app. Put this date in as soon as you pick up new pens from the pharmacy. Epipens have an Expiry Date that is barely 12 months from the date of manufacture and let’s be honest, they are expensive, but worth it if you need to use them.
- In times of shortage, an expired pen is still better than no pen when it comes to saving a life, so keep them on hand until you get a chance to replace it with a fresh batch. Depending on the emergency, one pen also may not be enough, or may be used incorrectly, so in a panic situation, it is handy to have a backup even if it is expired. Please check to see that the liquid is still clear and colourless before you use it.
If you have any questions, about taking any expired medication, please contact our Dunsborough pharmacists before you take the dose. We are happy to help you with guidance and the best storage conditions for your medications, just ask. No question is a silly one, and it’s better to make informed decisions specific to your situation.
Check our video on Flu Vaccine. Till our next blog. Be Wise Be Well.