Understanding Drug Expiration Dates: Key Facts and What You Need to Know

The SLEP Study: When the Military Uncovered a Hidden Truth About Medication Stability

The best evidence suggesting that some drugs can last past their expiration date comes from an unlikely source: the U.S. military. In the 1980s, they faced a budgeting dilemma: what to do with a billion-dollar stockpile of medications nearing or past their expiration dates!

Enter the Shelf Life Extension Program (SLEP), a joint effort by the FDA and the Department of Defense. They wanted to know if those drugs were really useless or if they could save their billion-dollar investment. What they discovered was quite encouraging: the stability data indicated that approximately 88% of the tested drug lots could have their expiration dates extended for an average of 66 months, that’s 5 ½ years! Even more notable was that 12% of those same drug lots remained stable for at least an additional four years. This demonstrated that, for a significant portion of the tested medications, the original expiration dates were considerably conservative. It’s worth noting that this study included common medications such as amoxicillin, ciprofloxacin, diphenhydramine, and morphine sulfate injection, all of which maintained their integrity throughout the assessment period.

Please note that these findings are subject to appropriate storage conditions and the specific medications tested and may not apply to all medications.

Cantrell L, Suchard JR, Wu A, Gerona RR. Stability of active ingredients in long-expired prescription medications. Arch Intern Med. 2012 Nov 26;172(21):1685-7. doi: 10.1001/archinternmed.2012.4501. PMID: 23045150.

Red Flags: When To Toss Expired Medications Without Question

This doesn’t mean you can take anything years after it’s expired. Some medications are a hard “no” after that date due to safety concerns. Here’s when to be extra careful:

• Birth control pills: Small hormone changes can lead to ovulation, risking an unintended pregnancy. Not worth the risk!
• Insulin: Absolutely critical for diabetics. Expired insulin can lose effectiveness quickly, leading to dangerously high blood sugar levels (diabetic ketoacidosis).
• Thyroid medications: Inconsistent hormone levels can lead to serious health issues.
• Blood thinners: Expired blood thinners lose potency, raising the risk of dangerous clotting events like strokes or heart attacks.
• Medications for chronic, life-threatening conditions (epilepsy, asthma, heart failure): Don’t mess around with these. Ineffectiveness can be harmful, even fatal.

The Trouble with Liquids: Why They’re More Vulnerable

Liquid medications are more vulnerable to contamination after their expiration date. Bacteria and other harmful pathogens can thrive, especially in:

• Eye drops: Expired drops can easily cause eye infections.
• Oral liquid antibiotics: These medications can become contaminated, which may cause further illness or prevent proper treatment.
• Other liquid medications (antacids, some antibiotics): They may also break down quickly and lose effectiveness.

The One Medication You Should Never Take Expired

There’s one exception to the general rule that expired medications may still be safe: Tetracycline. This antibiotic is known to be harmful when expired. In rare cases, expired tetracycline has caused Fanconi syndrome, a serious kidney condition that interferes with the body’s ability to absorb essential electrolytes. Do not use expired tetracycline.

Your Quick Reference Guide to Expired Medications

Here’s a handy guide to help you decide what to do with those questionable medications:

Medication	What It Treats	Risk Level After Expiration	What Happens After Expiration	Recommendation
Tetracycline	Bacterial infections	HIGH	Can degrade into toxic compounds that cause Fanconi syndrome (kidney damage)	Never use when expired
Nitroglycerin	Chest pain and heart attacks	HIGH	Highly sensitive to heat/moisture, breaks down, may fail to relieve chest pain	Replace immediately after expiration
Insulin	Diabetes	HIGH	Degrades rapidly, reducing effectiveness, leading to high blood sugar	Always use fresh; replace upon expiration
Epinephrine (EpiPen)	Severe allergic reactions	MEDIUM-HIGH	Loses potency over time, but still better than nothing in an emergency	Replace promptly; can use expired in absolute emergency ONLY; call 911 after
Oral Liquid Antibiotics	Bacterial infections	HIGH	Risks contamination, worsening infections	Discard after expiration
Eye Drops	Eye conditions	HIGH	Can become contaminated, leading to eye infections (conjunctivitis)	Discard 1-3 months after opening, regardless of expiration date
Birth Control Pills	Pregnancy prevention	MEDIUM-HIGH	Effectiveness decreases, which can lead to unplanned pregnancies or irregular bleeding	Never use expired
Blood Thinners (Warfarin, Aspirin)	Preventing blood clots	HIGH	Decreased potency can lead to dangerous clotting events like strokes or heart attacks	Replace upon expiration
Thyroid Medications	Thyroid disorders	MEDIUM-HIGH	May not effectively stabilize hormone levels, leading to symptoms and complications	Replace upon expiration
Pain Relievers (Acetaminophen, Ibuprofen)	Pain, inflammation	LOW	Gradual loss of potency, but generally safe	Effective up to 1-2 years after expiration if properly stored
Antihistamines	Allergies	LOW	Gradual loss of potency, but generally safe	Effective up to 1-2 years after expiration if properly stored
Amoxicillin (dry tablets)	Bacterial infections	LOW	Minimal degradation when properly stored	May remain effective for years after expiration
Diazepam (Valium)	Anxiety, muscle spasms	MEDIUM	Gradual loss of potency	Replace within 1 year of expiration
Albuterol Inhalers	Asthma, COPD	MEDIUM-HIGH	May deliver less medication than needed in an emergency	Replace upon expiration
Nitroglycerin Patches	Angina prevention	HIGH	Rapid degradation of active ingredient	Replace upon expiration

The “Better Than Nothing” Exception: Emergency Scenarios

In some emergency situations, expired medications might be better than nothing:

• Epinephrine (EpiPens): If faced with a severe allergic reaction, an expired EpiPen is better than no medication. Potency does decrease, up to 88% of the labeled dose may remain up to 50 months after its expiration. Always call 911 or seek emergency care immediately after using an expired EpiPen, and tell medical staff it was expired.

“How Long Is Too Long Expired?” Key Questions to Ask

So, when should you be worried about an expired medication? Consider these factors:

• How long has it been expired? Weeks? Probably less of a concern. Months? Time to replace it.
• How was it stored? Heat and humidity accelerate spoilage. Medications stored in a bathroom or a hot car may degrade more quickly.
• Was the container properly sealed? Medications must be stored in airtight containers.

The Importance of Proper Storage

Storing medications correctly is crucial for their effectiveness. Never store medications in a bathroom, as the heat and humidity can break them down. Keep your medications in a cool, dry cupboard — and avoid leaving them in the car or any other place where temperature fluctuations are common. Some medications, like insulin and liquid augmentin, have specific temperature requirements, so always follow the storage instructions on the label.

Pro Tip: Medicine Cabinet Checklist

While you’re cleaning out your medicine cabinet, here are some essential items to check or restock:

• Bandages (various sizes), gauze pads, and adhesive tape for minor injuries
• Thermometers (avoid mercury-based ones)
• Alcohol wipes, hydrogen peroxide, and antibiotic ointment for disinfecting and protecting wounds
• Antacids, antihistamines, and decongestants for common ailments
• Pain relievers like acetaminophen, ibuprofen, and aspirin (note: avoid giving aspirin to children or teens under 19)
• Antiseptic wipes for disinfecting hands