Expired medicines: safety, effectiveness, and disposal
Most medicines, whether prescription, over-the-counter (OTC), or complementary, are stamped with expiry dates: the final date at which the manufacturer can guarantee its full potency and effectiveness.
But what happens to a medicine after that date? Is it still safe to use? And, if it isn’t, can you just throw it in the bin?
This is what the experts say: The truth about expiry dates according to Harvard Health Publications (2015), a study conducted by the US Food and Drug Administration (FDA) found that almost 90% of more than 100 drugs were safe and effective as many as 15 years after the expiry date. Additionally, a 2012 report by pharmacist and toxicologist, Lee Cantrell, also found that 12 out of 14 compounds that had been stored for more than 30 years were still as potent as they were at manufacture.
The stability of these substances suggests that many medicines may still be safe to use after their expiry date. Anderson (2014) cautions, however, that since their potency can be affected by their ingredients and storage conditions, it’s hard to say which products will last longer than others. Plus, the medicines in the FDA and other studies were unopened and stored in ideal conditions; something that isn’t the case at home.
In other words: while it may be likely that medicines are still potent after the expiry date, outside of controlled conditions, there’s no guaranteethat they are. And, for many medicines, illnesses, and patients, that remains a dangerous scenario.
Dangers of expired medicines: A medicine losing some of its potency isn’t necessarily a problem if you’re treating something minor, like a headache, Anderson (2014) says. But when you’re taking an antibiotic, even a slight loss of potency can impact on your recovery and contribute to antibiotic resistance; a very serious and growing problem across the world.
Further, if the medicine is being taken for a more serious illness, like a heart condition, epilepsy, or a threatening allergy, a loss of potency can be deadly. So, if you’re considering taking an expired medication, it’s important to consider these factors first.
The stability of different medicines: Some medicines fare better than others over time. According to Anderson (2014), solid drugs, like tablets and capsules, tend to retain the most potency, while medicines that are solution or suspension-based, or those that need to be refrigerated, retain less.
Medicines that she suggests you steer clear of after expiry include:
· Solution-based substances
· Injectable drugs, especially if they look cloudy or discoloured
· EpiPen autoinjectors
· Refrigerated liquid
· Eye drops
· Oral nitroglycerin (NTG)
· Biologicals or blood products
· Medicines that are powdery, crumbling, have a strong smell, or have dried up
In addition, any medicine that you need for a chronic or serious condition, or to treat children or the elderly, should always be a fresh batch.
Dangers of incorrect disposal: When throwing unused or expired medicines away, it’s important not to throw them in the bin or to flush them down the drain or toilet. This is because most medicines don’t occur naturally in the environment, explains Low (2011). Not in the format you’re taking them.
Because of this, says Stassen (2009), when medicines break down, their main ingredients affect the ecosystem, either being consumed by animals or seeping into the soil and contaminating the water.
She adds that medicines flushed down the toilet make their way to water treatment facilities that are not designed to screen or filter for these substances. For instance, in a 2002 geological study in the US, 80% of 139 surveyed streams contained measurable traces of prescription and non-prescription medicines, steroids and hormones. In the short-term, this affects the reproductive health of fish. Long-term, no-one knows.
Low (2011) also warns that it isn’t just the serious drugs you need to be concerned about. All medicines – prescription, OTC, complementary, or even skin-care products – have ingredients that can endanger animals, fish, soil, plants, and people. They must be properly discarded.
Safe medicine disposal in SA: There are a few safe ways to dispose of unused medicines; the safest of which is through your pharmacy. The best time to do this is during National Pharmacy Month held in September, when pharmacists all over South Africa assist in responsibly discarding unused and expired medicine. But most will accept expired medicine throughout the year.
Still not sure what to do with your expired medicine? Chat to your local pharmacist or healthcare professional. They’ll point you and your family in the right (and the safest) direction.