Medication UseWhat does the expiration date on a medication mean?

There may actually be two separate expiration dates on a prescription medicine. If it was left in the original packaging, there will be a stamped date from the manufacturer. Often, there’s a separate date printed by the pharmacist on the label, which may say “use by” or discard after.” These two dates may be different.
 
The manufacturer’s date means that the medicine is guaranteed to maintain its potency until at least that date, as long as it’s stored properly and left in its original container. Many medicines will in fact keep their potency longer than that date. The U.S. government stockpiles medications for emergencies, including antibiotics and pain medicine and many other pills, and their data shows that most medicines stay strong from 1 to 15 years past that manufacturer’s date.
 
Pharmacists add the “use by date,” often 1 year after purchase. This is to remind people not to hoard medications. They should be used as instructed, and any leftovers discarded.
 
It’s always important to store medicines in a cool, dry, dark place. Talk to your doctor about the possibility of using some medicines past their expiration date. For non-critical medicines, that may be reasonable.
 
Liquid medications that are mixed by the pharmacist, including most liquid antibiotics, have a short shelf life. These are stored and shipped as powders, and only mixed into liquid right when they’re dispensed. The “use by” date on these will be only a few weeks, and even with ideal storage these products will not keep their potency much past that date.
 
 
Can using expired medicines be unsafe?
Older, expired medicines can start to gradually lose their potency-they may not work as well or as strongly as fresh medicine. In general, liquids lose their potency the quickest, and pills last the longest (creams and ointments are in between.) Depending on what you’re using the medicine for, a small drop in potency may not matter much.
 
There has been some concern that old medicines can become toxic. Cases in the 1960s implicated an antibiotic, tetracycline, as turning into a substance poisonous to the kidneys if past its expiration date. That form of tetracycline is no longer available.
 
Medicines that are used for injection (like insulin, or epinephrine for allergic reactions) should not be used if the liquid looks cloudy or discolored or has particles floating around in it. Besides, it really is important for critical medications like these to have their full potency-injected medicines really need to be replaced if expired.
 
Some liquid antibiotics, like amoxicillin or Augmentin, are supposed to be kept in the refrigerator. What if I leave them out overnight?
Several studies have looked at how these liquids keep their potency at room temperature. Though refrigerated storage is best, we know that Augmentin and amoxicillin will keep almost all of their potency if left at ordinary room temperature for up to five days. Note that any heat beyond that (like a hot car) will destroy these medicines quickly. Ask your doctor or pharmacist for instructions if you leave any refrigerated medication out for more than a few hours.
 
 
What should I do with old, expired medication?
Most medicines are best discarded by mixing them into something unpalatable-something like kitty litter or coffee grounds-and tossing them into the trash. The FDA recommends that potential drugs of abuse (pain medicines) be flushed down the toilet to ensure they’re not used.
 
 
Why shouldn’t I hold onto old prescription medications in case I need them again?
Holding onto old medications isn’t always a good idea. For example, the next time you’re tempted to use a prescription, you may not have the same diagnosis. Not all ear pain is swimmer’s ear, for instance, and not all round rashes are ringworm. The wrong medicine may delay the correct diagnosis and treatment-and may make your condition worse.
 
Some medicines can become more dangerous with more lasting side effects if used too often. Oral steroids fall into this category. Used judiciously and rarely, under a doctor’s supervision, they’re unlikely to cause lasting harm. But medicines like these shouldn’t be used indiscriminately.
 
It’s especially important not to hoard and try antibiotics. Using the wrong antibiotic for the wrong reason at the wrong time is a perfect way to encourage bacteria to become resistant. Antibiotics should always be used the way they’re prescribed, for the full course, never leaving any left over.
 
There is also, unfortunately, the potential for abuse. Prescription medicine abuse is a huge problem among both adolescents and adults-and often, those medicines come right from their homes, or their neighbors’ homes. Though pain medicines and sleeping pills are most commonly abused, any prescription pill can be a target for a curious teen. It’s best to dispose of them safely, and get them out of your home.
 
There are times when some medicines really can be saved for “as needed” use-for chronic health issues, or problems that recur. Your doctor should make clear which medicines are for you to hold onto to use next time.
 
Do herbal remedies and supplements expire?
Any biologically active substance is going to degrade over time. Unfortunately, since supplements are not regulated, you really don’t have any guarantee of potency regardless of any stamped expiration date. One recent study looking at the chemical composition of common herbal products found that 30% of samples from the market had exactly none-0%- of the ingredient claimed on the label. And these were fresh, unexpired product.
 
It’s probably best to store herbs and supplements in a dark, cool place, as you would medications, and discard them after the expiration date printed on the package.
 
 
Are generics as good as brand-name prescription products?
The FDA ensures that generic (or “off-brand”) products contain the same amount of the same active ingredients as the brand-name version. In almost all cases, generics are equivalent and should be chosen-they can save you a lot of money.
 
There is some concern especially about generic versions of time-release medications. Though these must have the same active ingredients, the time-release delivery technology may not be identical to the brand, which means that medication might not be delivered the same way. I usually advise my patients to try them out, but if they notice a difference with time-release products then we can go back to the brand-name version.
 
Other than choosing generics, what other ways are there to save money on prescription medications? 
Look for medications that are on a lower tier on your insurance plan’s formulary. Often, there are multiple medications that are very similar, and a low-tier product may be just as suitable as a more expensive choice. Keep in mind that your physician may not know which medications are on which tier and probably doesn’t know which insurance you have. It’s best to bring a copy of your formulary with you. Sometimes, your pharmacist may be able to recommend substitutions.
 
Many drug companies offer “patient assistance programs” for low-income or under-insured patients. A great “clearing house” website that contains links to these programs is at www.needymeds.org. Needymeds is a non-profit run by the publisher of this newsletter. At that Needymeds site you can also download and print a drug discount card that may be able to save you quite a bit of money, especially on brand-name products. Needymeds.org does not collect private information and is not part of any sort of marketing program.
 
Why are some medicines prescription and others over-the-counter (OTC)?
When a company wishes to sell a medication, it asks the FDA for permission to sell it as a prescription or OTC. The company makes that decision based on their marketing strategy. It has nothing really to do with safety or strength of their product. The FDA doesn’t decide how a medicine is sold-they just give permission to the company to sell it the way the company wants to.
 
In some cases, medicines first come out as prescription, and are later re-marketed as OTC. In those cases the company has to go back to the FDA for permission to start selling its product OTC-and sometimes it keeps selling a version by prescription, too.

For example, the common allergy medicine Claritin came out as prescription originally; now it’s only sold as OTC. Meanwhile, though Prevacid (an ulcer and reflux medicine) is now sold OTC, there is still a prescription version available. The prescription and OTC versions of medicines may or may not be sold at the same dosing strength. It can be very confusing!
 
In some cases, OTC medicines are clearly less safe than prescription products. For instance, OTC Afrin nose spray, while effective for nasal congestion, is addictive and can cause nasal erosions with long-term use. Meanwhile, most of the steroid allergy nasal sprays (which are much safer) are only available with a prescription (though this summer, one version, Nasacort, became OTC).
 
Whether a medicine is by prescription or OTC, they can all have side effects. Any medicine should be taken as directed.

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From issue: 29/11-12