Beware expired medication!

What does ‘expired’ mean?

When it comes to taking medication, there are two terms you need to understand: expiration date and use-by date.

Expiration date

This is the deadline by which the manufacturer is able to guarantee that a drug maintains its potency, purity and physical characteristics. In general, the expiration date is 2 to 3 years after the date of production. However, this doesn’t mean that it’s no longer effective or unsafe after this time.

Use-by date

This is a hard deadline after which a drug should not be consumed because it was opened, handled or stored in a container different from the manufacturer's original packaging. So, what happens beyond either of these dates? Well, the manufacturer no longer guarantees that the drug is safe and effective. Moreover, some ingredients may become dangerous over time.

Concrete example

Let’s consider amoxicillin, an antibiotic that is available in powder form. Obviously, an expiration date is printed on the bottle. This is the manufacturer's expiration date and is one year from now. This means that the undisturbed powder in the bottle will retain its efficacy for one year. However, upon reconstituting it with water, the antibiotic has a use-by date. In this case, it’s 14 days (when stored in a refrigerator). This means that it must be consumed within 14 days.

Always check the prescription drug’s expiration date appearing on the label provided by the pharmacy.

By the way, the manufacturer’s expiration date is not always a hard deadline (e.g. in the event of a shortage). This is the case for certain nitroglycerin sprays that are used to treat angina.

Effects of expired medication

Is taking expired medication risky? It all depends on the type of medication, the dosage and the disease it’s being used to treat.

Loss of efficacy

It stands to reason that, over time, medication loses its efficacy. In the case of a painkiller, it might not dull the pain as much as it should. The same applies to acetaminophen or ibuprofen pills used to treat headaches. They might take longer to dull the pain. Thankfully, in these cases, there are no serious issues, health-wise. However, deteriorated efficacy could have a far more serious impact on a patient who takes allergy medication, for instance. This is why there are two categories of drugs.

Narrow therapeutic index drugs

According to the Ordre des pharmaciens du Québec, these are: &Drugs for which relatively small differences in dose or concentration result in therapeutic failure and/or serious adverse reactions that may be persistent, irreversible, reversible in the long term or even life-threatening.

For example, warfarin is a drug used to prevent blood clots. Administering too much of it can lead to hemorrhaging. Conversely, administering too little can cause stroke or venous thromboembolism. Since the efficacy of its active ingredients may diminish after the expiration date, taking this drug could have serious consequences.

Emergency drugs

This is medication that is required to meet an instant therapeutic need. Such drugs must be administered as promptly as possible because the person’s life is at risk.

For example, epinephrine, the active ingredient in Epipen® auto-injectors. When given intramuscularly, it decreases the body’s reaction (i.e. anaphylactic shock) to an allergen, that could otherwise cause death. In this case, a lack of efficacy could be fatal. However, when all you have on you is an expired Epipen®, then it’s probably worth using anyway—better to have partial efficacy than none at all.

Avoid contaminating the drinking water

Environmental impacts are not something that immediately come to mind when disposing of expired medication, but they exist. When active pharmaceutical ingredients end up in the water supply, the health risks may be low for humans, but high for animals. For example, the feminization of male fish has been linked to potent estrogenic hormones in the water.

Using responsibly

What does using medication responsibly mean and what are the consequences of misuse?

Wastage

Remember! By letting expired medication collect dust in your medicine cabinet, you’re wasting the active ingredients used in their production and unduly burdening our medicinal resources.

Accidental consumption/poisoning

Although it’s written on the bottle, we'll repeat it here: keep medication out of the reach of children and pets. By failing to do so, you’re needlessly endangering them, especially when the medication is expired.

Overdosing

Some drugs are considered controlled substances, meaning they have a higher potential for abuse.

These include narcotic painkillers (codeine, morphine and oxycodone) and drugs such as methylphenidate and barbiturates. Don't leave them lying around. This will prevent misuse, abuse and accidental or deliberate overdose.

Avoiding the bathroom / ideal storage conditions

Do you store your medication in the bathroom? This is actually a bad idea. Variations in heat, light and humidity create conditions conducive to the proliferation of bacteria and fungi. They also affect the medication’s properties and active ingredients.

So store them in a cool dry place, at a room temperature between 15°C and 25°C (or in the refrigerator at 2°C to 8°C).

Disposing of expired medication

Expired medication must never be tossed in the garbage. This could contaminate the soil or poison the wildlife. And don't flush it down the toilet either! This will pollute the rivers.

The solution? Drop them off at your local pharmacy where they will be disposed of in an environmentally friendly way. If possible, keep them in their original bottle, or in a container that will prevent direct handling by third parties.

Now you know the risks of expired medication and how to properly dispose of it. To carefully manage your medication, follow these 10 commandments (an amusing help guide). In the meantime, you might want to schedule a medicine cabinet clean-out this weekend!