Are expired drugs still good to use? Check out the following excerpt from the Wilderness Medicine magazine article "Expired Drugs: Immortal or DOA?: by Nancy Pietroski, PharmD FAWM, WEMT, CTH. Read the full article here.

"The 'Strategic National Stockpile,' (SNS) overseen by the CDC, is a large supply of drugs and medical supplies used to protect American citizens in the event of a public health emergency like a terrorist attack, influenza outbreak, earthquake, etc.). If these medical countermeasures (MCMs) reach their expiration date before being used, they must be discarded, which can be very expensive. To help prevent the loss of potentially still potent medication, the FDA is involved in several expiration dating programs. The 'Shelf-Life Extension Program' (SLEP) was established in 1986 by the US Department of Defense to conduct extended stability studies on a number of drugs in federal stockpiles like the SNS. In 2006, a summary report was issued on 122 different drugs (>3000 lots). It was found that 88 percent of the lots were extended by at least a year past their original expiration date (the average extension was ~5.5 years). Top performers included ciprofloxacin tablets (yes, almost 12 years!), naloxone HCl, and potassium iodide (23 years!), with many year extensions for multiple drugs past their labeled expiry."

"The extended stability studies discussed above have been conducted on drugs in their original containers and stored according to the manufacturer’s recommendations. Storage at extremes of temperature (hot or cold), exposure to oxygen, moisture (high humidity), or exposure to light may affect the potency of drugs, and therefore the true potency may not be reflected in the expiration date."

"However, it is important to note that toxicity of expired medications is an area that is not well researched."

"Which Drugs Should Definitely Not Be Used Past Their Expiration Date?

Any drugs that become discolored, powdery, or are emitting an odor should not be used. Drugs that are injectable solutions should not be used if they appear cloudy or have precipitates. The table below lists some drugs that should not be used past their expiration date.

Any drugs that become discolored, powdery, or are emitting an odor should not be used. Drugs that are injectable solutions should not be used if they appear cloudy or have precipitates. The table below lists some drugs that should not be used past their expiration date.

Examples of Drugs That Should Not Be Used Past Their Expiration Date

Drug: Reason

• Antibiotics, suspensions: very quickly lose potency
• Anticonvulsants: narrow therapeutic index
• Digoxin: narrow therapeutic index
• Dilantin, phenobarbital: very quickly lose potency
• Insulin: very quickly lose potency
• Nitroglycerin: very quickly loses potency
• Ophthalmic drops: loses sterility once preservative degrades
• Oral contraceptives: very quickly lose potency
• Theophylline: very quickly lose potency
• Thyroid preparations: very quickly lose potency
• Warfarin: narrow therapeutic index

As for epinephrine, see the post in this Blog that is specifically about epinephrine.