This got me to thinking about what was in my medicine cabinet so I went to look -- lots of hair products, some face creams, a rainbow of nail polish, sun block, thermometers, deodorant etc. Ironically the only medication I actually keep in there is ibuprofen and acetaminophen. All my prescriptions are in my night stand because bathrooms are generally too warm and hot for proper storage. I have a huge bottle of each ... and both were expired.
Somewhere along the way I picked up the notion that medication expiration dates or beyond-use dates aren’t really that important. (Expiration dates? Beyond-use dates? These links define these in detail.) I shrugged, closed the cabinet, checked my hair in the mirror and went to watch television –- a MythBusters marathon. Sweet! So watching MythBusters after having just gone spelunking in my medicine cabinet, I wondered if my belief about medication expiration dates was myth or fact.
Always up for a good literature review, I started searching through journal databases. I expected to find tons of research on this subject. After all, expiration dates are stamped all over anything with an active ingredient. I was quite surprised to find very little. I did find a report of the American Medical Association (AMA) noting that the US Food and Drug Administration (FDA) and Pharmaceutical Research and Manufacturers of America (PhRMA) “were unaware of any comprehensive studies that addressed the clinical impact of pharmaceutical dates and no such studies were found in the peer reviewed scientific literature” (AMA, 2008). It would appear that has not changed since this was published.
What little I did find in the research journals all essentially referenced one long-term study conducted by the FDA at the request of the military. In 2000, Laurie P. Cohen in an article for the Wall Street Journal reported that between 1993 and 1998, the military had the FDA test more than 100 drugs –- both prescription and over-the-counter –- finding that 90% of these medications were safe and effective far past their original expiration date. In some cases, eight to fifteen years beyond their expiration dates. By 2008, the number of tested medications was up to 312.
As per Joel Davis, a former FDA expiration-date compliance chief, “most drugs are probably as durable as those the agency has tested for the military” (Altschuler in Kramer, 2003). Noted exceptions to this include nitroglycerin, insulin and some liquid antibiotics.
Considerable conversation and debate can be -- is being given to the pharmaceutical industry’s motivation for expiration dates and beyond-use dates. Clearly these companies profit every time someone tosses an old bottle and purchases a new one. And yet, the AMA endorses these dates so what is a consumer to do?
Dr. Richard Altschuler, in an article that has been endorsed and republished by Psychopharmacology Today and quoted by Harvard Medical School Family Health Guide, provides an excellent bit of advice,
"Wisdom dictates that if your life does depend on an expired drug, and you must have 100% or so of its original strength, you should probably toss it and get a refill, in accordance with the cliché, “better safe than sorry.” If your life does not depend on an expired drug –- such as that for headaches, hay fever, or menstrual cramps –- take it and see what happens" (Altschuler in Kramer, 2003).
Altschuler, R. (2002, September 9). Do medications really expire?
American Medical Association. "Report 1 of the Council on Scientific Affairs (A-01): Pharmaceutical expiration dates." Feb 2008.
Cohen, L.P. (2000, March 29). Drugs frequently potent past expiration. Wall Street Journal.
Family Health Guide. (2003, November). Drug expiration dates – do they mean anything? Harvard Health Publications.
Kramer, T.A.M. (2003, August 21). "Commentary: Do medications really expire?" Medscape Psycopharmacology Today.