What to do with expired medications

At some point in your life, you've probably found some expired medications in your cabinet. Or you may have stopped taking a prescription, but you've got leftover medication, and you're not sure what to safely do with it.

Soo, I'm here to help (with some evidence-based suggestions, OF COURSE.)

Do medications actually expire?

Based on my reading, it appears that manufacturer expiration dates are sometimes a little...sketchy.

Nothing magically happens to the medication the day after the expiration date, of course; that date is just when the manufacturer is willing to guarantee the medication's effectiveness.

It is in the manufacturer's best interest to err on the side of caution when it comes to expiration dates because then they are protected from litigation. Also, early expiration dates encourage consumers to buy more product.

There's another reason too: it's expensive to do further testing to figure out if expiration dates can be extended, and companies are loathe to spend money to do something that will cost them in multiple ways.

American has a Shelf Life Extension System (SLES) that's actually run by the Department of Defense, and their work involves testing medications to see if they are potent beyond their expiration dates, so that unnecessary medication waste can be avoided. They've found that many medications are still effective after their expiration dates (Arioua & Shaw, 2024).

This varies by medication, though; their work shows that tablets are the most likely to stay potent, while liquids are more likely to lose their potency (Gikonya et al., 2019).

Also, when considering the use of expired medications, not every case is equally important. For instance, if your over-the-counter ibuprofen has lost potency, then perhaps your headache will persist. That's not fun, but it's not a huge deal.

But if your expired insulin has lost potency, you could get really sick. If your antibiotic isn't potent, your infection could persist. If your paramedic's amiodarone doesn't work, you might not pull through!

Also, storage matters; medications that have been in a cool, dark place last longer than medications that have been in hot sunlight (Gikonyo et al., 2019).

Should you use expired over-the-counter medications?

I'm not gonna tell you what you should do, because I'm not trying to get sued. 😉

For me personally, it would depend on the product. If it's a low-stakes situation, I'd be willing to try a slightly expired medication, assuming that it had been stored in a cool, dry place.

If my Gas-X has lost a little potency, nothing terrible will happen, you know? And given that the DOD program has shown that something like 90% of drugs are good for years after their expiration dates (Gikonyo et al., 2019), it's not a very risky proposition anyway.

I'd also be willing to try, say, an anti-itch topical medication because it would be pretty obvious if it wasn't working. Ha.

I would be very loathe to use any kind of expired eyedrop though, because it's a liquid (less stable), and I would feel so nervous that I might hurt my eye or give myself an infection.

But again, I am not giving you advice on this topic. 😉

What about expired prescription medications?

I take a much harder stance here, mainly because if you keep prescription medications around for years and then you self-treat with them, you could hurt yourself.

What if this medication interacts poorly with one of your other medications? What if your health status has changed, and now the medication could harm you instead of helping you?

It is much safer to visit a doctor who can evaluate you and all of your medications and help design a treatment plan that is appropriate for right-now-you, not five-years-ago-you.

So, that issue is much less about expiration and more about appropriately diagnosing you and properly managing the big picture of your medications.

For this reason, it is safest to get rid of extra prescription medications once you no longer need them. This also reduces the risk of another household member accidentally taking them (which can happen especially with children or the elderly).

Also: always tell your health care provider about all medications and supplements you take. It'll help them safely care for you!

How to safely dispose of medications

The Environmental Protection Agency says you should not:

• throw them in the trash
• flush them down the toilet

Rather, you should take them to a drug drop-off location. My favorite option is CVS. They have a secure metal bin by their pharmacies, and you can simply drop your meds and walk away.

Police stations often have a similar setup, and hospitals do as well.

Walgreens offers free mail-in envelopes for drug disposal, and so does Med-Project USA.

If you do live somewhere without a drug drop-off, or somewhere without mail (?), the recommendations are to mix the medication with coffee grounds or kitty litter, place it in a sealed plastic container (like an empty sour cream container), and throw it in the trash.

The TL;DR (too long, didn't read)

• Many medications are good past their expiration date if they've been stored properly
• Expired OTC meds might lose potency
• Expired prescription meds should be disposed of; don't self-medicate. See a doctor!
• Don't flush or trash meds
• Do take them to a drop-off location or mail them in an approved envelope

A bonus point: exercise restraint when buying over-the-counter medications (don't buy multiples at the same time unless you're sure you can use them), and always check the date if you have multiple packages so you can use the soonest-to-expire package first.

What advice would you add to mine? And have you ever used a medication drop-off box?

References (just to be all official-like, in case you want to fact-check me)

Arioua, A., & Shaw, D. (2024). Use of Expired Drugs: Patients benefits versus industry interest. JMA journal, 7(1), 1–4. https://doi.org/10.31662/jmaj.2022-0209

Gikonyo, D., Gikonyo, A., Luvayo, D., & Ponoth, P. (2019). Drug expiry debate: the myth and the reality. African health sciences, 19(3), 2737–2739. https://doi.org/10.4314/ahs.v19i3.49