MD Insights: Dr. Yost on Expired Medications

You’ve accidentally taken expired medicine- it happens to the best of us. Here’s and MD’s perspective on what to do next:

What should I do if I accidentally take expired meds? Will it really hurt me? What does the expiration date mean? These are questions I’ve heard many times from patients over the years, and even from my friends and family. We open the bathroom cabinet or the kitchen drawer with a headache or a runny nose, take the first thing we find and only then do we realize— this bottle of Ibuprofen expired months ago! First things first, don’t panic. Let’s walk through your next steps if you ever find yourself in this situation.

First, it will be helpful to know what the expiration date actually means. For many drugs, the “expiration date” simply signifies the date at which the manufacturer can still guarantee the full potency and safety of the drug. In a study on drug expiration dates conducted by the FDA in the late 90s, the Food and Drug Administration found that 90% of more than 100 drugs, both prescription and over-the-counter, were harmless to use at their original recommended dosages even years after the expiration date.

Of that figure, the drugs that fall into the 10% are the most important to know. Below, I walk you through what your next steps should be based on what kind of medication you took. We’ll start with medications you never want to take past the expiration date and progress to the ones that shouldn’t cause too much worrying. As a reminder, you should always notify your healthcare provider if you have taken or plan to take medication past the expiration date.

You’ve accidentally taken a drug past its expiration date. What’s next?

If the drug falls into the following categories, you should consult a doctor immediately. They will be able to check for adverse effects, and re-prescribe you a renewed prescription as needed.

Drugs for serious conditions where full potency should be guaranteed (ex: heart rhythm medication)
Any drug that is delayed release or sustained release. Many of these will say “XR”, “ER” etc.
Drugs that have shown signs of physical decay in drug expiry studies:
- Liquid antibiotics
- Insulin
- Nitroglycerin
Eye drops, as they can become contaminated with microorganisms
Any drug used for emergency situations such as Epi-pens
Any drug that causes sedation or is used as a sleep aid

What if the drug doesn’t fall into any of those categories?

Many times when we find ourselves in this predicament, the culprit is one of the common over-the-counter drugs we all keep around the house “just in case”. This includes drugs like acetaminophen, ibuprofen and Benadryl. The main threat these medications pose past expiration is loss of potency. “Loss of potency” of medications is a very slow and even-paced process that starts the day after they’re manufactured. Because of this, expiration dates don’t mark a spontaneous moment where the drugs go from “good” to “bad,” as we are used to seeing with goods like avocados or berries, that can make the transition from one day to the next.

These dates do mark the earliest time where a drug may begin to lose its full effectiveness, or the earliest time when physical decay begins to set in. For most drugs outside the above categories, however, a loss of “full potency” does not make them dangerous, or even ineffective.

So, what’s next? If you’ve taken a drug like ibuprofen or Benadryl past its expiration date, do you need to visit a doctor?

The FDA recommends that you always notify your healthcare provider when you’ve taken a drug past its expiration date. In the end, however, it is up to your discretion. Just remember that here, the nuance matters. Is the drug only a couple months past the expiration, or has it been 5 years? Did you follow the recommended dosage, or did you take more? If you would rather not have to worry or question, there’s nothing wrong with consulting a doctor just in case. But for those of you who would rather avoid a doctor’s visit if you can, you’ll probably be okay as long as none of the above conditions apply.

There’s a lot more to unpack on this topic, so keep reading if you would like to learn more about optimal drug storage or how to safely dispose of your medications when it is time to throw them out.

Optimal Drug Storage

Where and how you’re storing your medications can have big effects on the drug’s safety, effectiveness and shelf life. The more important the medication is, the more important it’s stored safely and responsibly.

Here are some basic guidelines to follow when deciding where and how to store your medications:

Follow the instructions! Either on your medication’s packaging or in the patient information leaflet, there will be instructions on proper storage. Some medications have specific storing instructions, so ultimately, this is the best place to go to ensure your drugs are optimally stored.
Use the original packaging. As best you can, leave medications in their original packaging with the label intact. That packaging was specifically designed to store that drug, and the label makes sure you always keep all the pertinent information about the drug on hand.
Store them at room temperature. Most medication should be stored between 68°F and 77°F, although as before, it’s best to check the medication’s specific instructions to make sure. Avoid as much as possible exposing medications to extreme hot or cold, as these temperature fluctuations can degrade their potency.
Store in a dry place. Exposure to moisture can affect the stability of medications, so it’s best to store away from any sources of water. This means storing your medication in a kitchen drawer next to the sink or in the bathroom cabinet next to the shower is not advised. Especially as both of those areas of the house also tend to experience fluctuations in temperature.
Keep them away from light. Some medications are sensitive to light, especially direct natural sunlight. Keep these medications in a dark drawer, cabinet or container.
Keep your loved ones safe by storing out of reach of pets and children. Use child-lock containers for your medications if you have kids in the house, and make sure to store them where a curious pet can’t find and open them.

These are the basic principles of safe drug storage! Now, what happens when your medications expire? Below I outline the best ways to ensure you’re keeping your family and community safe through safe and responsible drug disposal.

Safe Drug Disposal

Although it may seem as simple as throwing something away, drug disposal has farther reaching consequences than we oftentimes imagine. How we dispose of our medications can either help prevent or help facilitate things like accidental poisonings, drug abuse, and environmental contamination. Let’s go through the basic principles of safe and responsible drug disposal:

The first safety rule starts before drugs even expire: always keep medications away from those they weren’t intended for. This can look like storing them safely and securely in your home, away from the eyes and hands of your children and pets. It can also look like kindly refusing when a friend or family member asked to use prescription medicine that wasn’t prescribed to them.

Second, check for drug take back programs in your area. Drug take back programs provide safe disposal for expired or unused drugs and are oftentimes offered by pharmacies or local law enforcement. If you can find one near you, you can simply drop off your unused or expired medications, and you won’t even have to worry about disposing of them yourself.

Now, if you find yourself with expired medications and your community doesn’t have a drug take back program, here are some general guidelines to keep your neighbors and your environment safe.

Most medications should not be flushed down the toilet or poured down the drain. These methods of disposal can contaminate water sources and harm the environment. Instead, do the following:
Remove any personal information from the packaging to protect your privacy.
Place the medications in a secure container or a sealable plastic bag.
Then, mix in an undesirable substance like cat litter, dirt or coffee grounds. This will deter other people or animals from ingesting them after disposal.
After sealing securely, the bag or container can then be placed in a household trash bag.

For some controlled substances (oftentimes opioids, stimulants, depressants, and anabolic steroids can fall into this category), this method may not be sufficient, so make sure to follow FDA guidelines for medications that fall into that category.

MD Insights

Dr. James Yost, Chief Medical Officer at CRH Healthcare

An Emory alum with 30 years of healthcare experience and 17 years as a practicing physician, Dr. Yost cares deeply about the patient experience, inside and outside our centers. Starting this year, Dr. Yost will be answering our patients’ most common questions through MD Insights, with practical and trustworthy advice.

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