Should You Ignore the Expiration Date for Drugs?
According to a study published in October in the Archives of Internal Medicine, a cache of eight medications between 28 and 40 years expired was found in original unopened containers. Even after decades of storage, 80 percent of the capsules’ active ingredients maintained at least 90 percent of the labeled amounts.
By industry standard, a level of 90 percent drug activity present in a medication meets acceptable potency guidelines for retail sale.
More on expired medications in The Dallas Morning News.
Expiration dates are often arbitrary. Manufacturers don’t necessarily conduct tests to establish the expiration date that is tacked on to drugs. Liquids tend to spoil much sooner than solids. Drugs in a mild, dry climate tend to last longer than those in wet or excessively hot climates. However, for most people who find an over-the-counter drug in their medicine cabinet that’s a dozen years old, ignore the expiration date.
The same is true for other consumer products. Daily products tend to have conservative expiration dates. I’ve even heard of dry aging beef in your own refrigerator for a week to enhance the flavor.
I’ve had to answer this question many times. Many people are very mindful of expiration dates, fearing the second that it passes there exists some danger in using the product.
Had some expired Half & Half this morning. Good stuff.
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The same can be said about most of the food we eat. Apparently, according to one my professor, land fills through America are littered with “edible” food products. They aren’t expired because all the preservatives in them.
“If, in time, drug companies are able to extend expiration dates, as the Archives of Internal Medicine report suggests, significant health care dollars could be saved.”
Perhaps, but you’d need quite a lot of research to get better expiration dates.
Extending the expiration dates on many medicines would really equal some serious savings in many households.
Of course, let’s not forget that it is not in the best interests of pharmaceutical companies to extend these dates. Why would they do such a thing? Besides, how much and how often we consume a product has a significant bearing on pricing. If something will be “in service” longer and is likely to reduce purchasing volume over time, you’d be assured that prices would go up to offset the loss of revenue.
Yoon’s right. Conservative expiration dates decreases liability and increases sales.
Why would anyone take expired medication?
With 24/7 pharmacies open 365 days a year. . . there is no need to have “extra” expired medicine on hand for the future or to extend a prescription by not taking it exactly as prescribed. Buy smaller quantities with # refills instead of larger prescriptions. Check the expiration date when you pick up your prescriptions. Expiration dates are much more accurate than they were decades ago.
Are you in the 99+% of patients who use expired medications and “get away” with it? Or are you in the <1% who has now obfuscated an emerging illness, or ruined accurate microbial cultures and sensitivities, or taken an expired epi-pen and now won't make it to the ER in time?
Would you write the same responses that expiration dates are anything but legitimate, if we, as physicians, administered expired medications to you in our offices? Would any State Medical Board or hospital allow physicians and nurses to ignore expiration dates?
I just treated two children from Rio de Janiero with severe asthma. At first it was impossible to know what was really going on. . .not because of the limitations of Brazilian Portuguese machine translation. Theses girls were taking anything and everything suggested by local doctors out of professional desperation, including over-the-counter oral prednisone /steroids with questionable expiration dates.
Some patients presume expired medications will probably work – or at worst expired medications won't do anything. Physicians never make that presumption because we only see when things go horribly wrong.
Of all the variables that physicians must consider in making correct diagnostic and therapeutic decisions – the actual potency and correct dosage of a medication that is on board can only be evaluated when compared to what we know from the pharmacology literature and our extensive clinical experience – which is based on patients who are taking non-expired medication.
When patients should take non-expired medication AFTER the period the FDA approval recommends?
There are prescriptions that absolutely should be used even after the formal FDA recommendations would state otherwise. A classic example was RhoGam in the early years. The window for administration of non-expired vaccine had nothing to do with its real effectiveness. A mom who is Rh negative with a new Rh positive baby receives RhoGAM. If a mistake is made and the date by which the RhoGAM is supposed to be administered is passed, it should still be given anyway. The FDA recommendations for when to administer RhoGAM were based on the physician researchers having to leave Sing Sing prison in New York, for prison security reasons, not any legitimate medical or scientific reasons.
This is an old saw. We have a similar problem today. I recently had a new immune deficient patient who was just infected with HPV. She was told by her gynecologist that it was now "too late" for her to get the vaccination series. I sat her down and explained that in my "opinion" with no EBM studies to back me up, she should get vaccinated anyway. She did. It is her life and her money. The last thing that she needs is to read a study 10 years from now showing that giving the vaccine, right after initial infection, had some positive impact modifying her immune response and the course of her HPV's clinical history. . . leaving her only with regrets.
Happy New Year!
Dorothy Calabrese, M.D.
Allergy & Immunology San Clemente, CA