Is It Safe to Use Expired Medications?

Some medications retain their effectiveness even after 40 years.

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First and foremost: it is generally recommended to dispose of medications past their expiration date. The U.S. Food and Drug Administration (FDA), for instance, strongly advises this, and there are several important reasons why.

Over time, some medications may become breeding grounds for bacteria. Others lose their potency, rendering them ineffective and allowing illnesses to worsen. Some can even chemically change and become toxic.

These FDA warnings are logical. However, the issue of expired medications is more nuanced than it appears. Here's why.

Why Expired Medications Aren't Necessarily Harmful

Let's start by understanding what an expiration date actually means. It is the timeframe during which the pharmaceutical company guarantees the safety and effectiveness of the medication. However, determining this period is often imprecise.

Generally, when a medication is produced, its chemical composition and active ingredient concentration are recorded, and then it’s stored on shelves. After one year, its composition is tested again to assess effectiveness. This process repeats annually.

The catch is this: suppose a medication has been on the shelf for three years. It cannot be sold without a stated expiration date. But pharmaceutical companies have little incentive to delay sales. Thus, they assign an expiration date based on tested periods—often three years—and release the product to pharmacies.

In reality, the medication might remain effective well beyond three years, but manufacturers typically do not verify this.

Lee Cantrell

Director of the San Diego Division at the California Poison Control Center.

Pharmaceutical companies are the only entities with the resources to conduct long-term studies on medication effectiveness. However, they lack any financial motivation to do so.

On the other hand, organizations with a financial interest in studying true expiration dates do exist. One example is the U.S. Department of Defense. In 1986, in collaboration with the FDA, it launched the Shelf-Life Extension Program (SLEP) to reduce costs associated with replenishing emergency stockpiles.

This program has yielded valuable results. For instance, in 2006, SLEP tested 122 medications stored under ideal conditions and extended the expiration dates of most by approximately four years.

Which Expired Medications Are Unsafe and Which Might Be Used in Emergencies

Despite the above findings, it is still best to heed FDA recommendations and regularly update your medicine cabinet. This may not be the most economical choice, but it is the safest.

Barbara Stark Baxter

MD, College of Physicians and Surgeons, Columbia University, New York.

The expiration date marks when responsibility for a medication’s safety and effectiveness shifts from the manufacturer to the consumer.

But what if you have a headache and only expired paracetamol is available? Or worse, someone nearby is experiencing a severe allergic reaction, such as angioedema, and you have an expired epinephrine auto-injector? Should you use it? Let’s explore.

Medications That Should Never Be Used After Expiration

While clinical studies confirming dangers of expired medications are limited, experts at Drugs.com recommend against using the following after their expiration date:

1. Insulin: Used to control blood sugar in diabetes, insulin can chemically degrade and become ineffective.
2. Oral Nitroglycerin: Commonly used for angina, it loses potency quickly after opening.
3. Biological Products: Including vaccines, blood products, immunoglobulins, and toxoids, these degrade rapidly.
4. Tetracycline Antibiotics: Some evidence suggests expired tetracyclines may produce toxic byproducts; better to avoid.
5. Antibiotic Suspensions: Likely to become ineffective after expiration.
6. Eye Drops, Nasal Sprays, and Other Preservative-Containing Solutions: Preservatives break down over time, risking bacterial growth.
7. Injectable Medications: Never use if the solution looks cloudy, discolored, or contains sediment.
8. Compounded Medications: Custom-mixed drugs are unpredictable past their prescribed expiration.
9. Any Medication That Appears Damaged: Crumbling tablets, foul smells, cloudy solutions, or dried creams should never be used.

Expired Medications That Might Be Used in Emergencies

The list of potentially safe expired medications is surprisingly extensive. A 2012 study analyzed eight drugs containing 15 active ingredients that had expired 28 to 40 years earlier.

Lee Cantrell

We found some medications retained full potency even 40 years after their manufacture date.

There are likely many more such long-lasting drugs. Here are some with scientific data supporting their extended efficacy:

1. Paracetamol: Retains about 99% effectiveness even after many years. However, if the first dose fails, do not take more.
2. Aspirin: Loses 99% effectiveness after 10 years, but may still provide relief if only 1-2 years expired and no alternatives are available. Spoiled aspirin smells like vinegar and should be discarded.
3. Codeine: A prescription cough suppressant that maintains over 90% potency long past expiration.
4. Antihistamines (e.g., Loratadine): Studies show loratadine withstands heat and sunlight, retaining about 99% potency, indicating it remains effective well beyond expiration.
5. Epinephrine Auto-Injectors (EpiPens): Though expensive, expired EpiPens have been shown to retain about 84% effectiveness up to 4 years after expiration. While not ideal, in emergencies, using an expired EpiPen is better than none.

It’s crucial to emphasize: experimenting with expired medications should only be considered when the medication is not vital to your survival. If you value your health, regularly replenish your medicine supplies.

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