What’s in Your Medicine Cabinet?

With the New Year, you may make resolutions to get organized. Don’t forget your medicine cabinets. Jeanie Jaramillo, Pharm.D., director of the Texas Panhandle Poison Center and assistant professor in the School of Pharmacy, said medications do have expiration dates.


“Expiration dates are estimated based on testing done by pharmaceutical manufacturers,” Jaramillo said. “The expiration date is the date after which the manufacturer no longer guarantees potency or effectiveness of the product. However, medications not stored in a cool, dry location may actually lose efficacy at an earlier date. For instance, if medications are stored in the bathroom medicine cabinet, they are subject to frequent fluctuations in temperature and humidity that occur when we bathe. This frequent change can result in a breakdown of the components of the medication prior to the expiration date.”


Many people ask if medications can be taken after their expiration date. Jaramillo shared two concerns with the post-expiration use of medications. Those concerns are, “Will the medication still work after expiration?” and “Is it dangerous to take the medication after expiration?” She said that in the 1960s, there were reports of kidney damage in patients who took the medication tetracycline (an antibiotic) after its expiration date. However, this formulation is no longer available and this has not been reported to occur with current formulations of the medication. Currently, there is no evidence of the development of toxic effects of medications occurring with use after the expiration date.


“On the other hand,” Jaramillo said, “There is no guarantee that the medication will continue to be effective after its expiration date. So, what can occur is that the patient does not receive the desired effect. For instance, if a patient is taking a medication to control their blood pressure, and they continue to take the medication past its expiration date, their blood pressure may not adequately be controlled. Although there are studies indicating that many medications retain potency after expiration, there is not an easy way for consumers to know which medications will be good and which will not. Therefore, the best policy at this time is to not rely on expired medications.”


The very old and the very young are most susceptible to illness. Jaramillo said these populations would be most at risk if they were to take expired medications. Additionally, any conditions that require strict medication regimens, such as heart medications and blood thinners, are less likely to be adequately treated if the patient is taking expired doses.


As the director of Medication Cleanout™, a medication take-back program, Jaramillo said she has seen thousands of pounds of unused medications go to waste because they were never used.


“My first recommendation regarding medication use is to only purchase what you will use,” Jaramillo said. “Purchase the smaller count packages of non-routine over-the-counter medications. We tend to think we are getting a better deal if we buy the large quantity bottle in which the pills are three cents cheaper each, but if we don’t use them, we’ve really not saved money at all.”


Also, when it comes to prescription medications, she explained many people tend to want the quantity the insurance company will pay for, regardless of whether or not he or she will use it. Based on studies reported in medical literature, if you or a family member are having a minor surgical procedure, such as the removal of wisdom teeth, or nearly any type of day surgery, it is unlikely that you will need any more than 15 prescription pain pills. If you are suffering from a sports injury, it is unlikely that you will need more than 15 prescription pain pills.


“If your physician has given you a prescription for 60, or even 30, tell your pharmacist that you would like only a partial fill of 15,” Jaramillo said. “If you need the remainder, you can request the rest (there are time limitations on this) This will help you avoid having an excess of prescription pain medications in the home. I make this recommendation because the easy availability of prescription painkillers in homes has resulted in countless incidents of abuse and addiction. And studies are now indicating that prescription medication abuse often leads to heroin abuse in the future. No one thinks they will become an addict until it happens.”


If you find yourself in need of disposing unused medications, there are several options. Pharmaceutical incineration is the “gold standard” method for medication disposal because it results in minimal impact to the environment. The Medication Cleanout™ program offered twice a year is another program.


There are also a limited number of pharmacies that have installed permanent medication disposal bins (drop boxes) within their stores. These pharmacies must be registered with the U.S. Drug Enforcement Administration in order to offer this service. To find out which pharmacies in your area offer this, visit www.dea.gov, select “drug disposal,” and then “search for an authorized collector location.”


“If none of these options are convenient, the next best thing to do with unused medications is to pour them into a zipper bag with kitty litter or coffee grounds, add enough water to create a slurry, seal the bag, then place it inside an empty butter tub or other disposable plastic container, attach the lid securely and throw the container in the trash,” Jaramillo said.


With the cold and flu season in full swing, families historically may have kept a “stock” of medications in their homes for unanticipated illness. This was reasonable back in the day when we did not have 24-hour pharmacies and easy availability of over-the-counter medicines at nearly every corner store. However, Jaramillo said less is better.


“Keeping a small amount of over-the-counter pain medication, such as ibuprofen or acetaminophen, may be helpful,” Jaramillo said. “Also, perhaps an antidiarrheal and antacid for stomach illness preparation. I recommend the purchase of no more than a 24-count bottle or package on hand for non-routine use. Otherwise, consumers will likely find that the medication expires before they are able to utilize all of it.”


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