[6 MIN READ] 

In this article:

• Drug expiration dates can be confusing. With a few exceptions, most medicines are actually safe to take well beyond their expiration date, but others can get contaminated and potentially become harmful.

• For many lifesaving prescription medications like epinephrine (EpiPens), taking less effective medication is better than taking nothing. However, patients should head to the emergency department immediately for severe allergic reactions, asthma attacks or chest pains.

• Learn more about how to safely store and organize medications to keep them safe for longer, and how to properly dispose of expired medications.

How bad is it to take expired medication?

Whether dealing with a cough, headache or sinus infection, many of us have been tempted to reach for a bottle of expired medicine to relieve our symptoms. But is it safe to take these expired medications? Will they work? What are the risks? Which ones should be avoided altogether?

“The FDA has actually found that 90% of medications are still safe to use up to 15 years after their expiration date as long as they are stored correctly,” says Sarah Pace, M.D., an internal medicine physician at Providence. “However, asking a pharmacist is the best way to check if your medication – especially lifesaving medication, gels or liquids – is still safe.”

Q. What is the difference between shelf life and expiration date? How can patients find these dates on medication labels?

A. The expiration date is the last day the manufacturer ensures the full potency and safety of the drug. A 1979 law requires this date to be printed on the medication packaging. The shelf life, however, refers to the quality or effectiveness of the medication over time. It is typically much longer than the expiration date as long as the medication is stored correctly and in the original container.

Q. How does medication formulation (e.g., pills, liquids) impact safety after expiration?

A. Most expired pills and tablets are not harmful to your health as long as they are stored in a cool, dry place, though they may lose some of their effectiveness. Gel capsules are sensitive to heat and humidity and may begin to break down if stored improperly, even before their expiration date. Before taking any gel, pill or tablet medication, you should examine the pills and bottles to make sure they are not broken, open, sticky or discolored.

Liquid medications are prone to infection-causing bacterial growth, which can be particularly dangerous for eye drops and lead to conjunctivitis. Patients should look for liquid medication with individual-use packaging and not use it past its expiration date.

Liquid medications often have more specific storage requirements and instructions than pills or tablets. Nitroglycerine, for example, is extremely sensitive to heat and sunlight and must be stored in a dark-colored bottle, and certain chemotherapy drugs must be stored in glass bottles in the refrigerator. It’s important to keep these drugs stored properly to make sure they work as effectively as possible.

Q. Are there any particularly dangerous medications people forget to throw away?

A. The most dangerous medications to keep in the home after you no longer have a use for them are medications with abuse or overdose potential. Keeping these medications out of the home is important for the safety of children and young adults. These medications include:

• Anxiety medications such as Xanax.
• Cough syrup with codeine.
• Opioid pain medicine.
• Phenergan, an anti-nausea medication.
• Sleeping medications such as Ambien.

Q. What are the dangers of taking expired drugs? What are the symptoms to look out for?

A. Taking degraded or melted capsules can cause irritation to the esophagus and stomach, leading to pain, ulcers and gastrointestinal bleeding. In the case of eye drops, patients can develop conjunctivitis, leading to itchy, red eyes, from expired liquid medication. Cough syrups and other liquid medications that have been contaminated with bacteria may cause GI upset like diarrhea and vomiting.

Q. With the rising costs of prescription drugs, some people may be tempted to take expired medications already in their medicine cabinet. What precautions should people take in these situations?

A. Auto-injection epinephrine is one of the most expensive medications providers prescribe. While we want patients to have access to up-to-date medications, we also recognize keeping medications current can be costly. Generally, epinephrine within 24 months of its expiration date has around 90% of its labeled dose. Within 50 months, that number is still around 88%.

In the case of medical emergencies like anaphylaxis (severe, life-threatening allergic reactions), asthma attack or angina (chest pain), while expired medications like epinephrine, albuterol and nitroglycerin may have lost some of their effectiveness, it is better to take these expired medications than nothing at all, but patients should immediately go to the emergency department because the medication’s benefits may not last very long.

The easiest way to stay up to date with these medications is to have them auto-refill at the pharmacy.

Q. In your experience are there certain prescription or over-the-counter (OTC) medications that should never be taken after the expiration date?

A. People tend to stockpile antibiotics, which usually means they did not take all of the prescribed medication the last time they were sick – an entirely different issue! Expired antibiotics typically lose some of their potency, which means it’s unlikely they’ll completely kill the bacteria that is causing your infection. Further, they may not be the right kind of antibiotic for the type of infection you have. When you take the incorrect antibiotic, it helps bacteria develop a resistance to the medication. That means the next time you need the antibiotic, it may not work when you need it the most. If you’re struggling with an illness or infection, it is important to talk to your doctor and get a new prescription for the right antibiotic for your illness.

Certain medications should never be taken past their expiration date:

• Birth control pills: Even the slightest variation in the hormone levels can allow for ovulation to occur.
• Insulin: Insulin loses its effectiveness quickly and often expires within 30-60 days of being opened. I see people in the emergency department with diabetic ketoacidosis (a condition in which there isn’t enough insulin in the body) because they were using expired insulin. Be sure to get specific guidance from your pharmacist for your prescribed insulin.
• Thyroid medications: Older medications may not be able to effectively stabilize thyroid-stimulating hormone (TSH).
• Anti-platelet medications: Blood thinners are often prescribed after a blood clot or placement or a heart stent or valve and can lose their effectiveness over time, which can be fatal.

Other medications that control potentially life-threatening conditions like epilepsy, asthma, diabetes or heart failure should be taken with great care and attention because using old, expired, discolored or broken medications can be harmful.

Q. What is the safest way to store medication, and how can proper storage increase shelf life?

A. Most medications should be stored in a dry, dark place. Never store medication, especially gel capsules, in the bathroom or the car. Instead, opt for dresser drawers, closet shelves or kitchen cabinets. If you have children in the home, make sure all medications are out of reach.

Medications that require refrigeration must have specific labeling. Make sure that you create a dedicated space in your refrigerator for those medications.  Some medicines like insulin pens and injectable weight loss medications need to be stored in the refrigerator before their first use but are typically okay to keep at room temperature for 30 days after. Speak with your pharmacist to learn the storage requirements for your specific medications. 

Q. How can patients track when their medications are set to expire?

A. People should keep medications in their original bottles and not combine or “marry” them. To track expiration dates or open dates, they can use a highlighter or sticker to mark the date, especially for infrequently used medications. I do recommend that my patients who take multiple medications use pill organizer boxes, but don’t suggest using more than a four-week organizer. Patients should read medication labels carefully before putting them in the organizer box to make sure that the medication will not expire before its use date.  

Q. How can people properly dispose of expired medications and where can they find additional resources?

A. People should always dispose of pain medications either at a police department or events like National Prescription Drug Take-Back Day. They should always discard medications with needles in ‘sharps’ containers, which are often accepted by pharmacies or drug manufacturers.

If it’s time to do a little cleaning out in your medicine cabinet, April 27 is National Prescription Drug Take-Back Day. On this day, DEA-authorized collectors safely and securely collect and dispose of prescriptions containing controlled substances and other unused medicines. In your community, authorized collection sites may include retail pharmacies, hospital or clinic pharmacies, and law enforcement locations. Find a take-back location near you.

Contributing caregiver

Sarah Pace, M.D., is an internal medicine physician at Providence.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.