Do You Take Expired Medications.Lots of people do. Here’s what you need to know.
Oct. 27, 2006 – Last week Debi Loarie was straightening her medicine cabinet when she noticed a 2003 expiration date on some Sudafed. She decided to check everything in her Highland Park, Ill., home. “I would say 70 percent of the medicine I had in my cabinet was expired, she says. Nobody looks. I had stuff from 2001, 1996. ” She tossed it all. Why do you want to take a chance, she says. When you are really sick, and you want to feel better, you need that to work.
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Loarie is not alone in holding onto expired medications. This month a survey of more than 1,000 adults by the pharmacy chain Medicine Shoppe found that 65 percent of Americans said they took expired medication. Unlike Loarie, more than half of them said they took them knowingly.
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So, does the expiration date matter? Experts say it depends on the individual drug and on storage conditions. Over time, medications do lose some of their strength. Usually, the worst thing that could happen is it won’t be as potent as you expect it to be, says Dr. Edward Langston, a pharmacist and family physician in Lafayette, Ind., and chair-elect of the American Medical Association Board of Trustees.
But it can be a more serious problem. Some drugs such as the epinephrine used to treat anaphylactic shock by people allergic to bee stings and certain foods lose effectiveness faster than others. When you are having a potentially fatal reaction, that’s not the time you want to find out the drug isn’t as potent as it should be, says pharmacist Michael Negrete, vice president of professional affairs for the California Pharmacists Association. Store Epi-Pens at a consistent temperature, and promptly replace expired ones.
Storage is important for all drugs. Medications break down more quickly in unstable environments. Incredibly, the bathroom, where, according to the survey, 49 percent of Americans store their medications, is a poor choice because of fluctuating temperatures and humidity. (The kitchen, where 29 percent keep their drugs, is a problem for the same reasons.) “Drugs degrade more rapidly in such conditions, says Negrete. It’s also important to remember that medicine often comes in colored vials to keep out light, which can degrade some drugs. A bedroom, where the temperature is consistent and where medications can be kept out of humidity and sunlight is a better option
In general, expiration dates are shorter on injected medications and longer on oral ones. Anything that comes in a solution form has the potential to degrade very rapidly, says Todd Cecil, vice president of standards development for the United States Pharmacopeia (USP), the standard-setting authority for prescription and over-the-counter drugs and dietary supplements. When items are in solution, theres a lot more ability for changes in a molecule to happen vs. in a solid form.â Some products, like aspirin, may last for years past their expiration dates. As aspirin ages, it may become more acidic, smell like vinegar and upset the stomach more, says Langston. If it has a peculiar odor about it, there must be some decomposition.
Many drugs are fine long after their expiration date. An FDA study of 122 drug products including Cipro and amoxicillin (both antiobiotics) for the U.S. Department of Defense, published in July 2006, found that 88 percent were OK up to five years after their original expiration date. (The drugs that did not always remain stable included the antibiotic penicillin G procaine powder and the antimalarial mefloquine HC1 tablets.) Despite the FDA’s findings, most experts say it’s not worth it for the rest of us to take a chance on expired medications. For one thing, the military stores its medications in their original, unopened containers, under rigorously controlled conditions, not in humid bathroom cabinets. My recommendation is, if it’s expired, it’s expired. You are not going to get the effects you intended, says pharmacist Bill Bailey, director of specialized care centers for Medicine Shoppe. The medicine may not work as you intended or have the effects you intended. Not surprisingly, drugs are more likely to last longer when they are sealed. Once you open a bottle up, you begin to have air in there, humidity, in some cases different temperatures and sunlight, says Bailey.
The FDA requires manufacturers to submit expiration dates based on real-time stability data when they apply for new drug approval. These dates are usually about two years after manufacture, says Langston, but drug makers can submit data and petition for a longer date later, using so-called accelerated stability studies and actual real-time stability data. The longest shelf life is five years. Stability testing is usually conducted at 77 degrees, but manufacturers may do accelerated testing at up to 104 degrees. They run that through their computer models and make a reasonable estimate, says Langston. These tests aren’t intended to be accurate to the day. It’s a lot of science, and a little bit of art, says Langston.
To get rid of expired drugs, check with your local pharmacy, city and county to see if they dispose of medications. If not, remove labels with personal information and then put medicine in the trash in a childproof container. Be careful, particularly with dangerous drugs. There are people who rummage through old garbage, says Langston. There are reasons medications are prescription drugs.
What does the government recommend? There is no clear guidance at the federal level, says Negrete. In fact, government agencies, along with manufacturers and groups like the American Pharmacists Association (APhA), are looking into the disposal issue now. It is so difficult, says Rogene Waite, a spokeswoman for the U.S. Drug Enforcement Administration. Anything you can come up with is going to have an opposite side. There is not going to be any easy answer The best answer we have right now is: people are working on it, and stay tuned. The East Bay Municipal Utility District in Oakland, Calif., is working with the Drug Enforcement Administration to set up a pilot project to allow medicine disposal at pharmacies and other locations. The U.S. Environmental Protection Agency has no regulations about disposal. There’s just the agency encouraging consumers to be environmentally smart, says EPA spokeswoman Enesta Jones. Currently, the EPA is evaluating proposals submitted through Sept. 29 for the disposal of unwanted and unused medications
The bottom line: clean out the medicine cabinet. Besides getting rid of drugs that may not be at their full strength, you could get some unexpected benefits. Once she got rid of two dozen old bottles, Loarie realized she had more cabinet space. And she felt so good about her efforts that she decided to tackle the expired food in her kitchen, too.
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Sources:The News week