It’s late, and someone in your house has a headache, stuffy nose, or – oh no, was that a snoring sound? You rifle through your home medicine stash, silently pumping your fist in the air when a bottle of Tylenol or Pepto-Bismol finds your hand.
Only then will you notice the expiration date: it was last month, last year, last decade. You realize that you don’t really know what that means—whether the drug you’re holding is dangerous or merely ineffective, and whether you want to do more harm by using it or withholding it.
what now
For many, drug expiration dates are a source of fear and doubt. Whether it’s an over-the-counter fever reducer or a complex prescription heart medication, knowing how to assess the risks of taking it — or not taking it — can save you a lot of worry. Here’s what you need to know about how drugs age.
Expiration dates are somewhat arbitrary
The US Food and Drug Administration has begun requiring only drug manufacturers to write expiration dates on drugs. 1979. However, they did not tell companies how to come up with those dates. Most companies have not chosen the expensive task of systematically testing each drug during development to determine the exact age at which it began to degrade. Instead, most simply chose dates a few years later, tested the drug’s potency at that time, and if it was still as good as new, called the expiration date.
That is, drug expiration dates aren’t as much “best before” dates as they are “best before” dates. For most drugs, these dates are set approximately three years after the date of manufacture, says Lee CantrellA pharmacist and toxicologist who directs operations at the San Diego Division of the California Poison Control System.
However, many drugs retain much of their potency for more than three years. In 2012, Cantrell and several colleagues tested a variety of medications (including acetaminophen, the sedative phenobarbital, and the opioid hydrocodone) that were decades past their expiration dates, and found that 86 percent of them still had intentional concentration their active ingredients. A few years later, a group of German researchers conducted one Similar studies with similar results.
One of the German researchers, Ulrich HolzgrabeA pharmaceutical chemist at the University of Würzburg, told me that these findings suggest that drug companies should set expiration dates more strictly. “After licensing a drug, companies should store the drugs for another 10 years” and conduct annual analyzes for stability.
There’s an obvious disincentive for manufacturers, Cantrell says: Proving that some products have a much longer shelf life than we think means less frequent restocking, which will reduce sales. Some manufacturers may actually have done research proving their products last well past their expiration dates — but “there’s no way they’re going to release that data — it’s not in their interest,” Cantrell says.
Replacing drugs that are still effective is wasteful and expensive. In an effort to make better use of their drug supply, federal agencies that stockpile drugs — such as the military or the Department of Veterans Affairs — Ask the FDA In the 1980s to extend the official shelf life of several drugs. The company has developed Shelf-life extension program To do just that with batch-testing on the verge of expiration.
Still, this extension only happens on one On a case-by-case basis — and only for pharmacies run by government institutions. Although the expiration date does not accurately represent the actual lifespan of a drug, the system we have in place right now does not account for it.
Medicines change with age, but not in the way you fear
Part of the problem with drug expiration dates is that it’s hard to tell with the naked eye whether most drugs are past their prime. “A drug is not a yogurt or a piece of meat or a strawberry,” says Holzgrabe. Yet experts are of the opinion that such invisible changes are possible and unlikely with the drug after a certain period of time.
For starters, pharmaceuticals generally don’t become toxic with age. “I’m not aware of any drugs that become toxic past their expiration date,” Cantrell says. This means you usually don’t have to worry about an expired medication making you sick. However, because some medicines lose potency over time, expired medicines may cause some harm by not working as you expect.
It is difficult to tell with the naked eye whether most drugs are past their prime. “A drug is not yogurt or meatloaf or strawberries.”
Over time, the integrity of the inactive ingredients of some drugs may also change. These are drug additives that get the drug’s active ingredients where they need to go or make them palatable to the consumer. For example, a skin cream used for eczema may separate or change in texture over time, or a suppository containing fever medicine may melt. Conversely, liquid formulations can slowly thicken as the water and alcohols in them evaporate. This means a shot from that old bottle of NyQuil could be stronger than theoretically supposed.
Sometimes, time can make a drug delivery system ineffective, making it impossible for you to access the actual drug inside it. It’s the same idea that renders an old can of hairspray unusable even though there’s still plenty of product left inside: Medicines that rely on propellants — like the itch-control sprays or albuterol rescue inhalers used to control asthma symptoms — often become useless when their containers is very old.
It’s not just the years that change the potency of our medicines: the way they’re stored can also have an effect. Exposure to sunlight, heat, and moisture all degrade drugs more quickly. These exposures can facilitate microbial overgrowth, even on unexpired medications. Although this risk is more related to unsafe drug storage than the age of the drug, it is worth being aware of. This is especially true for drugs that are intended to sterilize, e.g eye dropsBecause contamination can cause permanent eye damage to those using these products.
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To keep medications from losing their potency prematurely and reducing their chances of becoming infected with germs, Holzgrabe recommends storing them in the bedroom — not the bathroom or kitchen, where they’re more likely to be exposed to heat and humidity.
The safest method is to keep only expired medications in your home — especially when it comes to critical, life-saving medications like antibiotics, blood thinners, EpiPens, asthma rescue inhalers, insulin, and the like. The FDA advises consumers to regularly take stock of what they have on hand Throw away expired medication. Provides recommendations for organizations How to dispose of safely Different types of drugs.
That said, if you find yourself in an emergency situation where you only have an expired version of a life-saving drug and you can’t immediately get a new supply, use the drug you have — as long as it’s not too late to get it to the sick person. urgent care “If somebody calls me and asks me and says, ‘This is what I’ve got and I’m having trouble breathing and all,’ I’ll say, ‘Use it,'” Cantrell said.
The truth is, experts say they often use expired over-the-counter medications at home in unnecessary situations — for example, if they have a child with a cold. However, this is not something they can recommend to others; Drugs need more rigorous testing before such broadly applicable recommendations can be made.
Although medicines may have a longer shelf life than on packaging, it should not be up to the consumer to guess which ones may still be effective. Instead, manufacturers should conduct studies to determine its actual expiration date by storing quantities of each newly licensed drug and checking its stability on an annual basis, Holzgrab said. Tighter regulation of the pharmaceutical industry would help, he says: “The law needs to change so we don’t throw away so many drugs that are still OK.”
