Rumor vs Truth
Your trusted source for facts... where we dissect the evidence behind risky rumors and reveal clinical truths.
This new podcast series from TRC Healthcare, the team behind Pharmacist’s Letter and Prescriber Insights products, is designed to help pharmacists, pharmacy technicians, prescribers, and even patients navigate some of the claims they might see about medication therapy.
Find the video version of this show on YouTube: https://www.youtube.com/@trc.healthcare
Rumor vs Truth
Expired Medications
In this episode, hosts Don Weinberger and Steve Small separate fact from fiction about expired medications.
How are med expiration dates chosen? Is it science or just a guess?
Can a medication that’s older than the FDA itself… still work?
Are meds no longer effective after they expire?
It’s time to uncover the truth behind meds that are past their prime!
They’ll share research and insights into some interesting claims including:
- Med expiration dates are chosen at random.
- Meds are no longer good after their expiration date.
- Meds can be toxic after their expiration date.
- Expiration dates on meds can be extended.
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TRC Healthcare Editor Hosts:
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD
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The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Chart: Oral Meds to Keep in Original Containers
- Tech Tutorial: Medication Disposal in the Hospital
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Don’t miss out! Subscribe to Pharmacist’s Letter today to stay ahead with trusted insights and tools. If you're a student, good news—students can access a free version of Pharmacist’s Letter.
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This transcript is automatically generated.
00:00:05 Narrator
Welcome to Rumor vs Truth, your trusted source for facts… where we dissect the evidence behind risky rumors and reveal clinical truths. Today we’ll dust off claims about expired medications.
00:00:21 Stephen Small
Welcome folks. And to start us off, Don, I heard you have a spicy story for us.
00:00:26 Don Weinberger
Yes, I do so.
00:00:30 Don Weinberger
Even just behind actually this topic we're talking about today, I was organizing my Spice cabinet probably about 10 years too late, but when I was looking through I found some not so great spices in there, found a jar of chili powder that expired in 2014.
00:00:46 Stephen Small
Oh.
00:00:48 Don Weinberger
Yeah. Yeah. And here's the thing. I've moved about three times since then, so this expired jar has made it through multiple moves with me. So it just wasn't diligent and kind of checking that.
00:01:00 Don Weinberger
So from away.
00:01:01 Stephen Small
Once you press it as well, yeah.
00:01:03 Don Weinberger
Yeah, yeah, it's. And I went to see, you know, maybe it was still usable for some reason. Maybe it's my, you know, my own parents, kind of.
00:01:11 Don Weinberger
Deal with me. They keep everything expired like parents normally do, but it came out in a giant block. So it's that spice I could say is no longer usable.
00:01:21 Stephen Small
But you haven't answered the question. Don, did you actually end up using it for your food? That's we're all.
00:01:26 Don Weinberger
Yeah, I did not.
00:01:27 Don Weinberger
That.
00:01:28 Don Weinberger
No, I definitely did not. I just my food.
00:01:30 Stephen Small
Goodness.
00:01:31 Don Weinberger
So went without spice that day.
00:01:33 Stephen Small
That's good. That's probably a good move down for our listeners here. I'm Steve, the pharmacy.
00:01:39 Don Weinberger
And I'm Don the pharmacist.
00:01:40 Stephen Small
And in this episode, as you can guess it, we're looking at claims about expiration dates and whether age is just a number when it comes to medications.
00:01:49 Don Weinberger
Questions about expirations are they feel as old as time. Yeah. And they're always popping up. You know, this is really no joke, either. So expired medication actually cost a pretty penny. You know, looking at some studies before this podcast. And I found that.
00:02:03 Don Weinberger
Expired meds. There was once, mostly actually, that expired meds costed one hospital over $200,000 just in one year alone. So you can actually can imagine you take that number across. How many pharmacies across the country you're looking at millions of dollars just alone on expired medications.
00:02:20 Stephen Small
Yeah. Talk about time is money, Don. My goodness. Yeah, yeah.
00:02:25 Don Weinberger
Right. All right. So with that, let's go ahead and get to the fun. We have our first claim here.
00:02:31 Don Weinberger
And the claim is met. Expiration dates are more of a guess than a science, and I kind of see this claim is actually coming from people in practice normally. See these medications consistently have either two or three-year expiration date from today, so they think OK or manufacture just putting these numbers up there or just something a little more scientific.
00:02:53 Don Weinberger
To it. And so the answer is there's definitely something more scientific to it. So FDA regulations require that these drug applicants provide stability data test.
00:03:03 Don Weinberger
On certain medications and they put these medications in the regular rolls, so they put room temperature conditions and elevated temperature, lower temperature, different humidity conditions as well. And they kind of test the product after certain periods of time.
00:03:19 Don Weinberger
Set intervals and they test for these impurities. That kind of come up with decorated medications, and when they find a certain points in that condition, whether it's room temperature or high humidity, normal humidity, whatever it may be.
00:03:35 Don Weinberger
If the impurity within the medication is above a certain level, that's the particular point where they set that expiration date for that medication. So so two to three years tends to be kind of the average for it. Five years tends to be the maximum that they give certain medications.
00:03:53 Don Weinberger
And it is definitely not an arbitrary kind of thing. So looking back at the claim.
00:03:59 Don Weinberger
Met expiration dates are more aghast than science. The verdict is.
00:04:08 Don Weinberger
It's a rumor, as I'd say, that there's.
00:04:11 Don Weinberger
Pretty huge rigamarole that these manufacturers go through to test that stability of those medications before they put an expiration date on.
00:04:19 Stephen Small
The product? Yeah, that's quite a gauntlet for those meds done. And are there ever meds that don't have expiration dates? Does that ever happen?
00:04:27 Don Weinberger
Yeah, actually there is. And to the bane of you know, when you.
00:04:30
Hopefully.
00:04:32 Don Weinberger
When you try to compound certain medications and you find that some don't have an expiration, what do you do? So one example that it was seen with investigational drugs and the reason why that is is because.
00:04:42 Stephen Small
Else.
00:04:43 Don Weinberger
They're investigating the use of that drug while the company's doing.
00:04:48 Don Weinberger
That expiration testing on that medication, so it's kind of going in tandem with it, but usually there's some kind of beyond you state that's attached to that protocol or to that investigational medication. So makes you look at protocols to see what type expiration you should be putting on there and some OC's actually don't have it either like I said.
00:05:08 Don Weinberger
Earlier, you know, with the bane of compounding like certain ointments and you know, creams may have an expiration date on them.
00:05:15 Don Weinberger
It's that you don't have to do it.
00:05:18 Don Weinberger
Because if it's been shown to be good after three years, then manufacturers don't really have to stamp that expiration on that particular product.
00:05:26 Stephen Small
Interesting. Hmm. Well, the good news, folks, is that by and large, we don't have scientists throwing darts at DART boards for this definitely dates.
00:05:33 Stephen Small
To.
00:05:35 Stephen Small
But then the question does become dawn with this next claim, meds are no longer good after their expiration date, yes.
00:05:40 Stephen Small
Or no? And what I was able to find is technically almost everything does have an expiration date, especially if you want to get philosophical about it. Right. And it does depend on the drug, inactive ingredients, how they're made and also pretty importantly, how we're storing them. I know of some meds where you have to keep them in the manufacture bottle. You can't take them out because there's such Divas you got to protect them from light.
00:06:01 Stephen Small
Or moisture, and they're just so sensitive to the environment.
00:06:05 Stephen Small
Is able to find a really cool study from 2019 that looked at antique or like relic meds. Really old meds to test test their potency for example. I found one where they mentioned a 53 year old furosemide injection vial. So a diuretic and still had 99% of its original potency. So I was actually pretty impressed by that.
00:06:25 Stephen Small
But on the flip side, they had an amphetamine 5 milligram tablet that lost 56% of its strength after 28 to 40 years. So it depends on the drug here.
00:06:36 Stephen Small
And also what's interesting is that the US government actually does expiration date extensions based on stability studies, specifically for stockpiled meds we keep for emergencies.
00:06:48 Stephen Small
And when they tested some of those meds, they found out that many could be extended three to four fold for their expiration dates. And that's quite a bit. But again, there were exceptions like albuterol, inhalers. They couldn't give an extension because of their questionable results. But on the flip side, coding tablets had an expiration date that was extended by over seven years.
00:07:09 Stephen Small
And what's more, it depends on the lot and batches even of the same met. For example, cephalexin capsules and antibiotic. Certain lots were extended by 20 months, whereas others were extended by over 100 months, depending on which one you're talking about. So not all meds are made alike, and overall the authors said that solid dosage forms tend to be more stable.
00:07:30 Stephen Small
An injectable meds and that makes sense to me, right? Injectable meds are more complex. They have a lot more ingredients like buffers. And you got to keep those things sterile. So when it comes to this claim, whether medications are no longer good after their expiration date, the verdict is.
00:07:50 Stephen Small
True, but with conditions like we saw. Although many meds are likely still usable after their expiration date, that degradation we saw is way too variable even for the same Med to know for sure. And I would say that is not worth the risk, especially if we're talking about meds, Don that rely on exact dosing. I'm thinking things like.
00:08:08 Stephen Small
Anti seizure meds or insulin, right?
00:08:12 Don Weinberger
Yeah, definitely. And you know, Steve, you didn't mention relics, so I'm really curious, since you were doing the research, what was the oldest relic Med that you found?
00:08:20 Stephen Small
So get this. They had a vial of epinephrine injection from 1934, and it actually had 70% of its potency still intact. And just to keep in mind, folks, the FDA wasn't established.
00:08:32 Stephen Small
Until 1938, so that is 1 old vial of epinephrine, and even though it was 70%, I probably still want to. I wouldn't.
00:08:39 Stephen Small
Want to use that?
00:08:41 Don Weinberger
No, no, no, definitely not. Yeah, it's interesting. Yeah, so.
00:08:47 Don Weinberger
Let's go ahead.
00:08:48 Don Weinberger
And move on to our next claim here. And the claim actually, is certain medications can become toxic after the expiration date, and it's a good segue from your.
00:08:57 Don Weinberger
Topic Steve, because.
00:08:58 Don Weinberger
Yeah, definitely a patient may ask going off what you said. OK, well, it's no, it's no longer good. Yes or no.
00:09:07 Don Weinberger
Is it gonna hurt me if I take this medication?
00:09:10 Stephen Small
At this point.
00:09:10 Don Weinberger
I can deal with the five percent, 10% lack of potency, but am I going to get hurt from this?
00:09:15 Don Weinberger
M.
00:09:16 Don Weinberger
For solid form, but some medications, this isn't really true about being harmful. We did mention our last tetracycline podcast, that there was that classic case of tetracycline causing the Fanconi syndrome, which is that, you know, kidney disease. But that doesn't really apply today because tetracycline has been reformulated.
00:09:36 Don Weinberger
So that's pretty much true of solid medications. They're not really toxic. Again, we don't recommend taking expired medications, but toxicity is not really seen there when it comes to liquid medications or medications that preservatives.
00:09:49 Don Weinberger
That could become a different story. You know, this is.
00:09:54 Don Weinberger
You know, a review of preservatives, what's their design design is to actually prevent that microbial growth that happens in medications. But when you're looking at where these medications go when the preservative actually no longer, you know, works to prevent that microbial growth and become an issue. So there were some cases actually showing.
00:10:14 Don Weinberger
Where eye drops were used past their expiration date and it was causing eye irritation redness.
00:10:21 Don Weinberger
In those particular cases, because of the there was bacterial growth actually in that eye drop because they were expired. Another, I'm thinking another case as well where.
00:10:31 Don Weinberger
In, you know, thinking of hospital examples of.
00:10:34 Don Weinberger
Medications where bacteria just love. So propofol is actually one of them, right where it's a lipid emulsion. Bacteria just love to be in there and and grow in there and that you're thinking about, well, if you're injecting these medications, you're bypassing the body's natural defense towards bacteria, and you're putting it right in the persons veins. So.
00:10:38 Stephen Small
Yeah, true.
00:10:55 Don Weinberger
That could definitely be an issue if you're injecting medications that have that microbial growth added to.
00:11:01 Don Weinberger
And this I'll to recap on that. It's also important why, you know in the hospital, pharmacy, whatever may be to put those beyond use dates and expiration dates on those medications. So people know not to use those particular medications after a certain time.
00:11:13 Stephen Small
Absolutely. That's key, yeah.
00:11:17 Don Weinberger
So looking back at the claim, certain meds can be toxic after expiration date, the verdict is.
00:11:25 Don Weinberger
True, with conditions like I said, solid forms not really shown to be toxic past expiration date, but the bets are off when it comes to liquid medications that have preservatives. You know that could be injected into.
00:11:39 Stephen Small
The body? Yeah. And don't that made me think of a recent news item, I believe.
00:11:43 Stephen Small
Benzoyl peroxide, the acne topical creams and.
00:11:47 Stephen Small
Those are currently a concern, right? Because expired versions of them might break down into carcinogenic benzene. And I believe they're even saying throw out any expired benzoyl peroxide. And perhaps if you had some that isn't expired, make sure you keep that according to their storage conditions. So kind of a current events example there.
00:12:04 Stephen Small
Serious stuff, but what? What do you do if you have a Med that isn't toxic after expires? Can those expiration dates ever be extended or is it just set in stone? That's our next claim. Can expiration date some meds ever be extended?
00:12:05 Don Weinberger
Good ad there.
00:12:21 Stephen Small
Technically, medications after their labeled expiration date do become unapproved drugs per FDA, which is a big no no out in the pharmacy world. But I was able to find a couple different rates that exist for different meds to have their extension for the expiration date, and it's usually reserved for emergency situations, and in fact we already talked about two of them.
00:12:41 Stephen Small
One was the route you mentioned where manufacturers can redo their testing and submit that testing to the FDA. But as you can guess, that takes a lot of paperwork and a lot of time, which probably most companies aren't willing to.
00:12:53 Stephen Small
And I also mentioned the US government program earlier where we test supplies and our national stockpiles to see if we can extend that dating. That's known as the shelf Life Extension program or sleep that tests that. And again that's only for stockpile or agency meds.
00:13:10 Stephen Small
The other two routes I found were interesting. The Secretary of Health and Human Services for the US and the FDA can issue an emergency use authorization to change expiration dates. We kind of saw that with.
00:13:20 Stephen Small
Right. And the FDA can also do the same for meds that are officially on shortages in case we need to do that. And then the last route I found pretty hilarious is that the FDA can simply choose not to enforce expiration dating rules. They didn't want to.
00:13:35
Hmm.
00:13:36
So.
00:13:36 Stephen Small
I don't think they take that route very much, but.
00:13:38 Stephen Small
It does exist.
00:13:39 Narrator
And Mel?
00:13:40 Stephen Small
It could also be a pretty bold move, but with that, this of claim that expiration dates on meds can be extended, the verdict is.
00:13:51 Stephen Small
True, but with conditions really. As we saw before, this only applies to critical meds. It's really unlikely to see this process done for chronic or non-emergency meds like statins or high blood pressure meds. And the FDA has a list of these medications on their website. But keep in mind folks, it's certain NDC's.
00:14:11 Stephen Small
The national Drug codes of certain meds.
00:14:14 Stephen Small
Not all of a certain Med is going to be approved for this, and it also even depends on a lot or batch numbers for a specific Med. So it's all over the place. And in addition, the FDA can also dictate additional requirements for things like new storage or labeling standards when they end up doing this. So there are stipulations to doing this as well.
00:14:35 Stephen Small
To keep that in mind.
00:14:38 Don Weinberger
Yeah. Thanks, Steve. And you know, looking back at our claims, it seems like expired medications risks outweigh their potential benefits. And it seems the clinical judgment is really important here. You know, so expired medications live on borrowed time, even though we say that they're past their prime.
00:14:55 Stephen Small
Right. It makes me think of the scenario here.
00:14:57 Stephen Small
If you and I are on like a desert island and all we have is an expired EpiPen and I go into anaphylaxis, are you not going to use it on me and just let me die? Like what?
00:15:06 Stephen Small
Would you do here?
00:15:08 Don Weinberger
I would use the 1934.
00:15:10 Don Weinberger
Relic epinephrine. Bill that you mentioned.
00:15:12 Stephen Small
Earlier and you know what? I wouldn't.
00:15:14 Stephen Small
Blame you for that.
00:15:15 Stephen Small
Yeah. And you can see the same thing for things like naloxone for opiate overdose. One more time on life threatening issues here. There are rare circumstances where maybe using experiment may make sense, but on the flip side, meds lying around do increase the risk of accidental or intentional overdose.
00:15:31 Stephen Small
Right. And probably now's a good time down to advocate for how to properly dispose of expired meds. One example I can think of is DA's drug take back days over April and October each year, and they also have year round drop off locations you can find on the web.
00:15:45 Stephen Small
Site.
00:15:47 Don Weinberger
And also you know some pharmacies do have those special disposal receptacles in there and they also have those mail back programs. So just ask.
00:15:54 Don Weinberger
Pharmacy staff.
00:15:55 Stephen Small
Or yeah, they're great resource and the FDA also has resources too. At fda.gov/drug disposal, they have tips on different meds. Not every Med is disposed the same way. So check that out.
00:16:07 Stephen Small
For different nuances there and our website also has a great technician tutorial entitled Medication Disposal in the hospital for All You hospital folks out there. We didn't forget you.
00:16:18 Don Weinberger
Thanks for mentioning that Tectura cause that's a great resource. Yep for sure. So couple more things here if you enjoy today's episode, don't forget to follow Ray interview rumor versus Truth where you get your podcasts, those ratings and reviews really help others find us.
00:16:33 Don Weinberger
You can also help our show grow by telling a friend about the awesome things you learned and where you fit.
00:16:39 Don Weinberger
With us, you know, believe or not, Steve, we're actually 4 episodes in and you know we are recovered juicy interactions, hangover remedies and tetracyclines in preview shows.
00:16:48 Stephen Small
And they're great episodes, friends. So Speaking of helpful things, we've packed our show notes with resources, including a link to pharmacist letter, pharmacy technicians letter and prescriber insights, where you'll find our upcoming.
00:16:59 Stephen Small
Article in our May 2025 issue on this topic. Plus we've linked our chart on meds that need to be stored in their original containers.
00:17:07 Don Weinberger
If you're not already a TRC healthcare subscriber, you're missing out on our industry-leading evidence based tools and continuing education. Head over to our tsar.com to learn more about our unbiased clinical resources.
00:17:19 Stephen Small
And we really want to hear from you. Got a rumor you'd like us to investigate?
00:17:24 Don Weinberger
Yeah, it's really super easy to reach us. Just text us right from the shows notes using the contact US link at the bottom of your TRC healthcare or letter homepage. You know you've got some burning and spicy questions for us. We can be demystified.
00:17:38 Stephen Small
Yep. And join us next time where we'll decipher what's the deal with dyes.
00:17:44 Don Weinberger
Thanks for listening to Rumor vs Truth – your trusted source for facts, where we dissect the evidence behind risky rumors and reveal clinical truths.
See you next time!
00:18:06 Narrator
Want to put faces to these voices? Catch the video version on YouTube - just search 'TRC Healthcare' or click the link in our show notes. While you're there, check out our other TRC podcasts like Medication Talk and Clinical Capsules.
