Guest Article: Using Expired Medications – Antibiotics and Antiviral Medications – Part 1, by Cynthia J. Koelker, MD

My first guest post on generated an abundance of questions and concerns.  Among the most popular was that of using medications beyond their expiration date.  Are they safe?  Are they effective? 

It’s easy enough for me to say I think it’s safe, but is there any science to support my opinion?  I spent the week looking into the facts, and found some fascinating information.
To start with, just what is a drug expiration date?  In short, the date (required since 1979) does not indicate when a drug goes bad, but rather a date through which the drug is guaranteed to be good.  Compare this to what you might find on a can of beans:  the “best if used by” date.  
How are these dates determined?  In two ways. 

The first is by real-time testing.  Medications are stored under manufacturer-recommended conditions (which does not mean in your hot, humid bathroom over the toilet).  At given intervals the medications are tested for appearance, drug content, and stability.  Nowhere could I find that they are tested for safety specifically, but if the drug itself is present in acceptable amounts, it seems reasonable to conclude it is still safe. 

Secondly, drugs are tested under high-temperature stress conditions to simulate longer time periods.  Logically, if a drug is only two years old, five years of stability testing is unlikely to have been performed.  However, if a medication remains stable for a specified time period under adverse conditions, one may presume it likely stable and therefore safe for much longer periods.

Expiration dates are only found on the original packaging and apply to unopened meds that have been stored as directed.  This is in contrast to the date on your actual prescription bottle, a “do not use beyond” date.  Pharmacists commonly purchase pills in bottles of 1,000 then dispense them into smaller containers, generally with a shorter expiration date.  The latest this will be is a year beyond the original prescription date.  Although the original bottle may have a date 2-3 years in the future, your own bottle will be dated for 1 year or less from purchase, due to uncertainty about actual storage conditions and patient use.   
One tip on stocking up, then, is to request your prescriptions in the original packaging, typically bottles of 100 (usually not 90, as insurance often prefers, though there are exceptions).  Your doctor will not necessarily know this information, but you can look it up in a PDR to save time.  A used Physicians Desk Reference (PDR) can be purchased on Amazon for under $5.  Generic drugs are not in the PDR.  You will have to ask the pharmacist for information regarding your own prescription.  

The primary source of information regarding the prolonged stability of medications comes from the Shelf Life Extension Program (SLEP) database.  Rather than discard millions of dollars worth of expired drugs stockpiled for emergency use, the government tested representative lots for extended stability.  These stockpiled drugs are aimed at emergency use for injuries and infections rather than chronic diseases such as diabetes, heart disease, and asthma.  The most useful data for the layman is related to drugs to combat bacterial and viral infections.

In 2009 as a result of the H1N1 scare, two anti-viral (anti-influenza) drugs were granted an Emergency Use Authorization (which has since expired).  Relenza was granted approval for up to one year after the original expiration date, whereas Tamiflu products were approved for up to an additional 5 years.  Tamiflu is easier to use, has fewer side-effects, and comes in blister-packs of 10.  A full dose is one 75-mg tablet twice daily for 5 days, to be started within the first day or two of true influenza infection (which is not always known, a discussion for another day). 

Several antibiotics tested for extended use were found to be safe as well, for an additional one to several years.  At this time I am unsure whether the tested drugs were brand-name or generic, but I am looking into the question and will address the specifics in Part 2 of this article.

Interested in a free teleconference on the use of expired medications?  Sign up here.  I’ll discuss more info that I’ll be including in my upcoming book, Armageddon Medicine.

About The Author: Cynthia J. Koelker, MD is the author of the book 101 Ways to Save Money on Health Care explains how to treat over 30 common medical conditions economically, and includes dozens of sections on treating yourself. Available for under $10 online, the book offers practical advice on treating: respiratory infections, pink eye, sore throats, nausea, diarrhea, heartburn, urinary infections, allergies, arthritis, acne, hemorrhoids, dermatitis, skin infection, lacerations, lice, carpal tunnel syndrome, warts, mental illness, asthma, COPD, depression, diabetes, enlarged prostate, high blood pressure, high cholesterol, and much more.

Dr. Koelker has recently started a new medical blog on surviving TEOTWAWKI, She welcomes your questions, comments, and critiques.

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