Do Medications Really Expire?

[cave76]

http://www.medscape.com/viewarticle/460159


Medscape Psychopharmacology Today

Do Medications Really Expire?

from Medscape General Medicine™


[cave note: a notable exception, which this author didn't talk about, are the tetracyclines. doxy, mino etc. Those are NOT safe to use after the expiration date.)

As far as the other information in this article, I've heard this so many times from reputable sources that I tend to believe it. I under NO circumstances advise this. My disclaimer.]

[NellyP]

Cave,

They do mention cyclines:

"Second, medical authorities uniformly say it is safe to take drugs past their expiration date -- no matter how "expired" the drugs purportedly are. Except for possibly the rarest of exceptions, you won't get hurt and you certainly won't get killed. A contested example of a rare exception is a case of renal tubular damage purportedly caused by expired tetracycline (reported by G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient."

Nelly

[Martian]

I knew expired tetracycline (or all tetracycines?) are thought to be bad, but now I wonder: is that based only on that one report? (by G. W. Frimpter and colleagues in JAMA, 1963;184:111).

[NellyP]

I knew expired tetracycline (or all tetracycines?) are thought to be bad, but now I wonder: is that based only on that one report? (by G. W. Frimpter and colleagues in JAMA, 1963;184:111).

Could well be you know the way things are!

People (myself included) think stuff they read/hear from reputable sources are reliable and based on hard evidence, and often it just isn't. The internet has accelarated the "urban myth" phenomenon. But if we can be bothered we can also research these claims more readily. If anybody would like to research the reliability of the "cyclines go bad" info I'd gladly read it

Nelly

[cave76]

f anybody would like to research the reliability of the "cyclines go bad" info I'd gladly read it

Me too.

Smilie removed by cave

[Claudia]

Damn. Just the other day I cleaned out the medicine cabinet, tossed out some expensive antibiotics and a big unopened bottle of Benadryl that was a few weeks past its labeled expiration date.

[Joe Ham]

From the link:

A contested example of a rare exception is a case of renal tubular damage purportedly caused by expired tetracycline (reported by G. W. Frimpter and colleagues in JAMA, 1963;184:111). This outcome (disputed by other scientists) was supposedly caused by a chemical transformation of the active ingredient.

Unfortunately that article does not seem to be available on-line but a related link brought up this:

"Old"and degraded tetracyclines have previously been demonstrated to have direct toxic effects on the renal proximal tubule, but because of changes in manufacturing techniques this is no longer a real problem.
Tetracyclines in Renal Insufficiency... 1978, PDF

More from the linked article:

Third, studies show that expired drugs may lose some of their potency over time, from as little as 5% or less to 50% or more (though usually much less than the latter).

How significant is this degradation given that generics are allowed to range in potency from 75% to 125% of the labeled potency?

Joel Davis, however, a former FDA expiration-date compliance chief, said that with a handful of exceptions -- notably nitroglycerin, insulin, and some liquid antibiotics -- most drugs are probably as durable as those the agency has tested for the military. "Most drugs degrade very slowly," he said. "In all likelihood, you can take a product you have at home and keep it for many years, especially if it's in the refrigerator."

Somewhat off topic:
Nitroglycerin (Nitro) is used for temporary relief of angina symptoms. It is considered a "fragile" drug in that it is sensitive to heat (keep in refrigerator), light (comes in a dark colored bottle) and moisture (number of bottle openings and shake out only one at a time, do not touch the others because of skin moisture).

Nitro will tell you when it is loosing its punch. It looses its "bite". That usually happens near the end of the bottle. When I notice it I just take two.

Country remedy: Some gunpowders contain nitroglycerin. They are called "double base" powders and can contain up to 25% nitroglycerin. The other "base" is nitrocellulose and is biologically inactive. "Old timers" have been doing this ever since smokeless powder was invented -- dosed for effect. It doesn't taste very good but better than a heart attack. And it's cheap.

Another thought; the local pharmacist says that all 'dispensed' (counted out) drugs can have no more than a one year expiration date on the consumer package even if the bulk pack has a much longer date. So it might be a good idea to ask the pharmacist what date is on the bulk package and make a note of it.

[cave76]

Another thought; the local pharmacist says that all 'dispensed' (counted out) drugs can have no more than a one year expiration date on the consumer package even if the bulk pack has a much longer date. So it might be a good idea to ask the pharmacist what date is on the bulk package and make a note of it.

CYA? (the pharmacy, I mean)

[Joe Ham]

CYA? (the pharmacy, I mean)

Yeah, maybe. He implied that it was a regulation that was implemented because the pharmacy had no control over how the customer would handle the drug.
Stored on a window sill?, top of the fridge?, dashboard of a car?

It may be a state regulation, maybe national, I don't know.
But the take away message of this thread is clear: keep your meds out of a reactive environment. Keep them like mushrooms, cool, dry and in the dark. (But don't feed them BS.)

[cave76]

I think that's the most important reason for an expiration date to be on a drug------- there's no control over how the idjit customer will handle it.

In the past, when this subject came up somewhere else-----there was also the question of how the middle man (warehouse, wholesaler, delivery people like UPS etc) handled a shipment of drugs. Like probiotics that are meant to be kept cool. Sitting on the dock of the warehouse in 100 degree weather?

Oh, well.