Set aside a box whose expiration date has passed, even when the pills inside look exactly as they did on the day you put it away. You will find that date printed on the label or stamped onto the bottle or carton, sometimes after the letters EXP. Once it has passed, there is no guarantee that the medicine will be safe and effective, and that holds for a box that has sat untouched for months as much as for one you used every day.
What does the date on the carton actually cover?
The date on the carton marks how long the medicine is known to keep its strength, quality and purity, on one condition: that it has been stored the way its label says. If the box was not kept that way, the date no longer describes the medicine inside it.
For a medicine FDA approved, the date and the storage conditions come from the same testing. A company asking FDA to approve a drug has to submit stability testing data together with a proposed expiration date and storage conditions, and FDA verifies that the proposed date is supported by appropriate studies the company has conducted. That testing is designed to give confidence that the medicine will meet its standards for its whole shelf life. An over-the-counter medicine sold without its own FDA approval still gets its date and storage conditions from its manufacturer's stability testing.
So where the box spent its months matters. A bathroom cabinet exposes medicines to heat and moisture from the shower, bath and sink, which may damage them, and medicines can become less potent, or go bad, before their expiration date. Pills and capsules are easily damaged by heat and moisture.
Are medicines really fine for years past their dates?
The medicines whose dates are extended after FDA's own testing are certain drugs held in federal stockpiles, and a box kept at home is not one of them. Under the Shelf-Life Extension Program, FDA tests products kept in those stockpiles in environmentally controlled locations. The stockpiles hold drugs that might be needed to prevent or treat disease in a public health emergency, and the labeled shelf life of some of them can be extended after periodic stability testing by FDA.
Boxes kept at home may each have been stored differently since they were sold, which makes it difficult to test for a later date that would hold for all of them after long storage. The right conditions depend on the drug, and may include temperature, humidity and exposure to light.
A manufacturer can also extend the date on its own product, but it does so on its own testing and acceptable data, under a protocol approved in the drug's application to FDA. To help ease drug shortages, FDA has also approved extensions of expiration dates when data supporting the extension are available. None of that testing involved your own box or how it was kept. If you have heard that dates on some medicines were extended, go by the date printed on the box in your cupboard: if your medicine has expired, do not use it.
What can go wrong if you take it anyway
A medicine that has degraded might not give the benefit intended, because its strength is lower than intended, and it may also yield toxic compounds that could cause unintended side effects. People with serious and life-threatening diseases may be particularly vulnerable to those risks from drugs that have not been stored properly.
A weaker tablet raises the question of whether to take more of it to make up the difference. That is a question about your dose: ask your prescriber's office.
Certain expired medicines are at risk of bacterial growth, and an antibiotic that has lost strength can fail to treat an infection, leading to more serious illness and to antibiotic resistance. If the old box is a leftover antibiotic you were thinking of starting for a new infection, phone your own doctor's office about the new infection instead.
A medicine can also be unfit to take before its date. Damaged medicines may make you sick, and a medicine that has changed color, texture or smell is one not to take, even if it has not expired. The same goes for pills that stick together, are harder or softer than normal, or are cracked or chipped. Put a box like that with the expired ones for disposal.
If you have already swallowed a tablet from the old box and want to know whether it matters, call Poison Help at 1-800-222-1222, which takes questions as well as poisoning emergencies and is free, confidential and open 24 hours a day, every day of the year.
Getting a new supply and clearing out the old box
Call your prescriber's office for a new prescription before you throw out the old medicine, and tell them the box expired while you were not taking it. Keep the box until then, since its label names the medicine and its strength. Once the new prescription is written, clear the old box out in this order:
- Read the box and any leaflet with it for disposal instructions specific to that medicine, and follow them if there are any.
- Take it to a drug take-back location or send it in a prepaid drug mail-back envelope, which are the preferred ways to get rid of expired medicine. There are many take-back locations in retail, hospital and clinic pharmacies and in law enforcement facilities, with kiosks or drop boxes, and you can find one by typing "drug disposal near me" into Google Maps.
- If neither is available, check whether the medicine is on FDA's flush list. A medicine on that list may be flushed down the toilet. Any other one goes in the household trash, mixed first with something that ruins it, such as coffee grounds or kitty litter, and sealed in a plastic bag (see Getting rid of a used needle, leftover vials and the box with your name on it).
Until the old box has left the house, keep it out of reach and out of sight of children, in a cabinet with a child latch or lock. Old medicines that are not disposed of safely can injure children and pets who take them by mistake, and in 2020 there were an estimated 36,564 emergency department visits among children aged 5 years and under for unsupervised medication exposures.
If a child may have swallowed medicine from the box and is not breathing, call 911. If the child is breathing, call Poison Help at 1-800-222-1222 right away, without waiting for signs of poisoning, and keep the box beside you while you talk, because the label has important information and the expert will ask what product was involved.
When you get the new supply, read its label for storage instructions first: certain medicines need to be stored in the refrigerator and others cannot be exposed to high temperatures. For most medicines, a cool, dry place such as a dresser drawer, a closet shelf or a kitchen cabinet away from hot appliances and the sink suits them better than a damp bathroom cabinet. Leave the medicine in the container it came in, take the cotton ball out of the bottle, since it pulls moisture in, and ask the pharmacist at the pharmacy that filled it about any storage instructions of its own.
If the box in the cupboard came from a prescription written through NicoCares, ask your care team for a replacement in Spruce Health, which hosts your secure messages with them, and ask them there how the new supply should be stored. Whether a replacement is clinically appropriate is decided by a physician holding a license in your state. NicoCares gives no time by which a Spruce message is answered, so a child who may have swallowed from the old box needs a phone call, never a message: 911 if the child is not breathing, and Poison Help at 1-800-222-1222 if the child is breathing.
