Expiration dates require common sense approach. Not like the med is 100% fine a day before it expires and 100% worthless a day after. Quality of storage is a factor as well, especially temperature and humidity. Some stuff can turn toxic when it goes bad, other stuff just has less value. If for some reason you can't replace something that expired, keep what you have just in case.
I mostly use natural medicine in the form of alcohol based herbal tinctures. If stored in the dark, that stuff is good for many years.

 

Chemical meds do not become toxic after expiry dates. They generally loose their full power to treat what they are made for. Replace them in your first convinience, but use them if you do not have the opportunity to replace.

 

Antibiotics, pain meds, steroids, Epipen, decongestants, and others.

The antibiotics, pain meds, steroids, and decongestants are probably fine, though lack their potency. But you don't want to overdose by using more than recommended, so just stick to the original doses and know that they may take longer to work.

You didn't say HOW OLD they were. A year or two expired is probably ok. After three or four? It would probably be worth it to just buy new stuff and not worry about if they will still work or not.

The Epipen I would get a new one, but DONT THROW OUT THE OLD YET. If it has ever been stored in the sun or heat, it's toast. If you have kept it cool and dry and in a dark place this whole time, it can still save someone's life and an old epipen is better than no epipen. If you do discard of it, ACTIVATE IT FIRST. Inject it into something (not a person) that will activate it, and THEN throw it out. This will cause the automatic needle protection to engage and prevent the needle from sticking anyone in the garbage.

https://www.oakstreetmedical.com/easyblog/entry/ask-a-doctor-is-my-epipen-still-good

And for disposal here: http://www.beyondallergy.com/allergy-abcs/what-to-do-with-an-expired-epipen.php
(read the comments on that one) A few stories about "old" epipens saving someone's life.

 

The antibiotics, pain meds, steroids, and decongestants are probably fine, though lack their potency. But you don't want to overdose by using more than recommended, so just stick to the original doses and know that they may take longer to work.

You didn't say HOW OLD they were. A year or two expired is probably ok. After three or four? It would probably be worth it to just buy new stuff and not worry about if they will still work or not.

The Epipen I would get a new one, but DONT THROW OUT THE OLD YET. If it has ever been stored in the sun or heat, it's toast. If you have kept it cool and dry and in a dark place this whole time, it can still save someone's life and an old epipen is better than no epipen. If you do discard of it, ACTIVATE IT FIRST. Inject it into something (not a person) that will activate it, and THEN throw it out. This will cause the automatic needle protection to engage and prevent the needle from sticking anyone in the garbage.

https://www.oakstreetmedical.com/easyblog/entry/ask-a-doctor-is-my-epipen-still-good

And for disposal here: What to Do with an Expired Epipen » Beyond Allergy
(read the comments on that one) A few stories about "old" epipens saving someone's life.

From what I have been reading the Epipen's seem to have quite a high failure rate. So I would keep any old ones as back up, kind of like keeping expired flairs. There expiration date seems quite short(18 months from manufacture), and the price has gone up astronomically so you may not replace when you see the almost $400 price tag if you don't have any allergies that require them. I wonder if they are available in other countries for less? I know my father was complaining about the price as he is required to have one in his office.

 

Yesterday, after some dental work I took a Vicodin that expired 6 years ago , seemed to work just fine, Thank Goodness.

 

Most medications will retain their potency for years beyond the expiration date. There are exceptions, though, such as nitro glycerine, which rapidly deteriorates beyond the expiration date. Storage is the key to longevity. All meds should be stored in a cool, dry location, preferably in a darkened area. If possible, store them in airtight containers, or place the bottles in vacuum sealed bags. I know of no drug that increases in potency with age.

All the best,

Gary

 

Most medications will retain their potency for years beyond the expiration date. There are exceptions, though, such as nitro glycerine, which rapidly deteriorates beyond the expiration date. Storage is the key to longevity. All meds should be stored in a cool, dry location, preferably in a darkened area. If possible, store them in airtight containers, or place the bottles in vacuum sealed bags. I know of no drug that increases in potency with age.

All the best,

Gary

Clearly you never saw Wolf of Wallstreet . Such a hilarious scene.

 

I've found many prescription meds in the US are over the counter in the West Indies. Antibiotics are not one of them! Meds in general are so incredibly cheap down here that there is no reason not to keep those you can get easily, current. But even if you need to get a script, a Dr's visit is also cheap. The problem lies with certain meds that aren't available here, so you need a Dr to give you an equivalent.
The French islands are a lot more expensive than the British islands for Dr's and meds, by the way.

 

For someone who does seasonal cruising, it is legal down in the islands, but when you come back to the US what happens to what was purchased but is now controlled? I am sure the Coasties would not like them.

 

Pamlico-
There's these crazy guys with short hair, big muscles, stubborn damned attitude and khaki green clothing (really, no fashion taste at all) who call themselves "The U.S.Army" and claim to work for the "U.S. Department of Defense". Maybe you've heard of them?

Anyway, they're compulsive hoarders, and they maintain warehouses all over the country, just crammed full of stuff "we might need a lot of, in a hurry". They spend lots of money stocking this stuff, and lots more rotating stock, and lots more on doing crazy things like testing it from time to time to see if it is still there and in working order.

Somewhere online you'll find references to a study they did on drugs, because if they need to send a million soldiers out REAL FAST then they also need to stock a million medical kits, with aspirin and antibiotics and morphine and all that good stuff. So they got real curious, to see if "Discard no later than two years from manufacture or purchase date, maintain at 75F maximum temperature in a dry location" really meant anything.

Offhand I think they tested 15 meds, all with two year expiry dates. 14 of the 15 were still perfectly good and effective after THIRTEEN YEARS in storage. Forgive me if I got my 13's and 15's reversed, it hardly matters compared to what your pharmacist is required to tell you, doesn't it?

Now of course, those are just some dummies with a crazy idea about saving the world (or at least, this corner of it) and they couldn't possibly be as competent as the FDA and the drug companies who say you have to throw all that stuff out every year or two. Could they?

But that's the only MASS SCALE study done under controlled circumstances, and it speaks for itself. Many of the drug companies have said "Well, the FDA mandates that we put an expiry date and we can't keep testing everything forever, so we feel two years is safe enough."

I called the nice folks who make some of the meds (blood clot agents, antibiotics) in our med kits and said "Hey, I keep this stuff at home, in a climate controlled room, where it sits at 75F 45%RHI in a dark closet, unopened. Really, I should throw it out?" and I've never heard anything except "Well, the FDA says we have to put a date on it...."

And personally I've found 4 year old Neosporin works just fine, especially when you apply it to a clean bandage and don't contaminate the tube by touching it to a wound. Don't even ask about the aspirin.(G)

OTOH, I'm quite happy to replace eye drops of any kind after they've been opened.

So if you keep those meds sealed, dry, and cool? Yeah, maybe every four or five years give them to a clinic that can use them, and replace them. They'll still be good when you do.

 

Come back in a documented vessel, with an obviously marked ship's medical kit, with meds in retail boxes or prescription marked containers, and I doubt the USCG will even try to read the labels. Unless you've got anything really prominent to pique their interest.

Even the USCG knows that if you've got perishables (like meds) hermetically sealed in containers with dessicants and anti-oxidants, they will be compromised if the containers are opened. If there's no real good reason to open them, why risk a reprimand from the Commandant's Office?

A couple of mason jars of oxycodone in the galley and no rx for them...that might take some 'splaining, Lucy.

Remember, travelers returning into the US are generally allowed a 90-day supply of any personal meds, even if a script is meeded.

 

I have looked into this extensively. Paul S. Arbauch's wilderness medicine "bible" is a good resource and quotes mostly the Department of defence studies.

Bottom line, most medications retain most of their potency many years after their expiration date. Nitroglycerine and epinepherine being notable exceptions.

Injectable compounds, eye drops, and topical compounds may become dangerous as they degrade and no longer remain sterile or retain their intended PH.

Tetracycline, Doxycycline, and Minocycline are thought to cause Fanconi Syndrome (bad things happen to your kidneys) once they are well expired. The evidence for this isn't rock solid, but it was good enough for me to trashcan my bottle of Doxycycline that I keep in the boat kit.

More light reading here:http://www.nytimes.com/2014/02/11/science/do-some-drugs-become-dangerous-after-expiration.html?_r=0

MedSailor

 

Here is a good Wall Street Journal article on the army testing of drugs.. All were effective LONG past the expiration date.

Many Medicines Are Potent Years Past Expiration Dates - WSJ

HOWEVER... There is speculation that tetracycline can become toxic over time. As such, I don't keep this Antibiotic on-board.

 

Sounds kinda like everyone agrees... For the most part expiration dates are arbitrary.

Now they put expiration dates on beer and I know that's bogus. Some of my first experiments with it were with 10 year old Schlitz my brother kept on a sunny windowsill. It worked just fine.

Hello Sailor, the army study sounds particularly relevant. Thanks for that!

 

Sounds kinda like everyone agrees...

Say it ain't so! We all agree? I don't believe it. I'm going to wait for a few more posts. There's bound to be an argument here somewhere. :devil

 

I do have to chuckle a bit, every time someone asks for tax, medical or legal advice from strangers on the internet.

 

A couple of mason jars of Oxycodone! I'd never throw that out. Old lipitor, probably. kev

 

I heard a report on CBC radio, in which they found a source of meds 28 years old, and 40 years old. When tested, all were over 95% effective with no negative side effects.
When asked about the dangers, the best the drug companies could come up with, was a problem with tetracycline, which happened 52 years ago. They could point to no other problems encountered.
Expiry dates may be a multi billion dollar scam. Governments could save a fortune, by doing their own independent tests on expiry rates.

 

Since the introduction of injection pens, there is no longer a need to carry needles and syringes for diabetics. Now, I pack hydro-morphine with me on long trips, and it's in a prescription bottle, so there is no problem with opiates either as long as you conform to the laws. Oh, and the morphine never goes bad either.

As for providing medical advice, I usually don't! Though I have an extensive medical background, I have long since retired from the field and find it better just to let folks kill themselves in any manner they wish. Just don't take me along with you.

Oh, and I do my own taxes using Turbo Tax, and I don't provide tax information either. As for legal advice, Google is usually better than most of the lawyers I've come in contact with over the past half century. But, that's another topic.

All the best,

Gary

 

Gary, I commented that I got a chuckle that people would ask, not that people would answer. The replies are just trying to be helpful, I'm sure.

Would you come here to ask for medical advice? What if I told you I had an extensive medical background (I could, but wouldn't, make the dated argument)? Would you then take whatever advice I had on a topic you weren't familiar with? Please don't.

I'm not picking on anyone that is trying to give advice that was solicited. I'm just questioning the sanity of thinking anyone can rely on advice from strangers on the internet.

As for google, looking up authoritative information, from valid sources like Mayo or the CDC, etc, can be relied upon. Even then you have to be sure you've asked the right question.

 

Think carefully about how you cruise and with who. I'm a retired doc. Admiral soon to be retired RN. We are in a situation to be able to treat fairly major trauma, M.I. etc. Our med list maybe different than yours. We store meds is several different airtight and watertight bags divided by broad diagnostic groups e.g. major trauma, minor trauma, codes, anaphylaxis, minor skin infection, systemic infection etc. that way meds are totally undisturbed unless needed. Locker is opaque. Bags are clear but labeled. Bags are examined twice a year and contents replaced if any question. Frequently used meds such as OTCs are stored elsewhere.
One would note for multiple Dx. the same agent may be required i.e. morphine or like for major trauma or M.I. We store appropriately. Do not want to be rummaging around searching for things in an emergency.
Strongly suggest if you are going to be a long term cruiser, even if coastal and domestic some basic first aid/responder education be undertaken. Outcome from a broken bone or code or other mishap doesn't care where you are. Even coastal cruising domestically may place you in a situation where time to a ED can be quite prolonged.

In training prime rule is "first do no harm". Therefore, if there is any question about a med even if it's just the label destroy it. Please destroy responsibly. I would like to catch no three eyed fish or twenty pound silversides.

If you are cruising abroad go to your PCP and discuss your plans. Have that provider delineate what ( if any) vaccines are required and write 'scripts for an appropriate med list. If PCP doesn't have knowledge base many tertiary centers now have "travel clinics" which do an excellent job.

 

"the other from customers glasses "
This is what makes health department inspectors rich by turning their heads. My grandfather was in the food business and he said most of the owners he knew would "go across the street" if they wanted to have dinner. Because they each knew very well that their own kitchen was doing, but across the street, he never went further than the dining room.

You can ruin meds in a single month by letting them get hot and soggy. Or, keep the aspirin in the medicine cabinet, and it ain't gonna explode on the day after the expiration date. Something about using common sense...and understanding, that expiry date is USUALLY just there from being convenient, not from anyone spending money to test and determine it, or the storage conditions along the way. Usually.

Now of course, if you use toothpaste after the "sell by" date, we all know your teeth will fall out. That's dangerous stuff.

 

Pamlico-
That was all common in the restaurant industry and is still often done today. The savings from using garbage instead of buying new product is substantial. If you want to be frightened, remember that any bread left in the basket or on your bread plate, will be toasted and turned into bread crumbs on cooked dishes as well.
Ever have "Italian" meatballs? Made with bread and bread crumbs in them? You think every joint buys all that bread fresh, when there's so much coming off the tables?
Well in theory, enough heat and alcohol will kill whatever cooties the last guests had too. In theory. The e.coli and salmonella and listeria that "fresh" food may come preloaded with, ah, well, look at poor Chipotle, they can't seem to get a break.
If someone drops a steak or prime rib on the kitchen floor...it doesn't get thrown out either, it gets dusted off and put back on the plate. (Not talking about Chipotle, but about pricey steak houses here.)

The places that have consistently earned health inspection "A" ratings for five and ten years and longer, are the ones you want to eat at. Assuming of course you can find any. I found one about five years ago and said "Let's try this place" to some friends. We figured, an Argentine steakhouse, a perfect health department record, how could that not be worth trying? And three months later it was a Korean BBQ place. Damfino.

If you saw the FDA allowances for insect parts and rat droppings in prepared foods, you might never got to the supermarket again, either. And then there's Blue Bell Ice Cream, which seemed to finally be getting re-organized. Except, I think I read just Thursday that criminal charges are being filed. (Finally.)

As they say, "No one wants to go on the tour of the sausage factory, but they all want sausage for breakfast."

Or as W.C.Fields said when he was asked why he never drank water,
"Because ffish ff*** in it."

 

We have a supply of Meds that we have taken with us as we have been cruising- just in case we are out of reach with a pharmacy etc.

Antibiotics, pain meds, steroids, Epipen, decongestants, and others. Some have passed their expiration date. What is the general thought about expiration dates? Are some things more affected than others?

For most traditional small molecule pharmaceuticals, expiration dates are established by stability studies during/after the formulation of the final drug product. Simulated stress conditions are used to expose the product to variables which mimic real world storage scenario's (heat, cold, light, oxidation, etc). Yes, potency is obviously tracked, but maybe not for the reason most consumers assume.

The primary driver is to identify if the active ingredient degrades under any specific conditions and if so, what does it transform into and at what rate. Some drugs are allowed to have a 90%-110% swing in label claim, maybe even higher. Provided the degradents are identifiable and not harmful, the FDA is OK with that. In general, any impurity whether known or unknown, needs to be accounted for once it is present and at a level of 0.05% or higher of the active ingredient. Once formed, it is monitored throughout the stability study.

The rate limiting step in determining expiration of a drug product is either the formation/increase of an impurity, or the term of the stability study is met/exceeded w/o any harmful degradent being formed beyond the regulated level. In the case of the later, the study may be as short as a year or could go as long as 5 years. While nowhere near the cost of clinical trials, stability studies are expensive and at some point the manufacturer makes the determination that a reasonable stability term has been established and is within the established regs of the market's governing powers.

While possible, I find it unlikely that big pharma is conspiring to establish premature expiration dates just to sell more pills. Sure, they stop the stability study as soon as it's allowed by the FDA/EMEA in order to reduce the cost of development, but it's probably not a primary driver for increasing sales. It's expensive to manufacture drugs in a regulated environment. A much easier mechanism to increase revenue is to just jack up the cost per pill/dose and/or adjust supply. We're hearing a lot about it in the news these days, but the pharma industry has a long and sordid history of price controlling their product(s).

So, long story short and with a few exceptions, if a drug has an expiration of 1 to 5 years and has been in a relatively controlled storage environment, I'm much more likely to use it after the expiration than something with a shorter term.

Injectables/lyophilized and refrigerated drugs are an entirely different story and I wouldn't play around with them much past their published expiration date.

But knock on wood, my pharmaceutical intake amounts to a couple of Ibuprofen a year so what do I know.

 

Tanley your post is congruent to my understanding.

 

You gents say Big Pharma actually conducts tests, but conveniently, there is no documentation from Big Pharma or the FDA that documents anything beyond "effective", is there?

Every article I've seen in the responsible press, echoes the same findings that the US Department of Defense found: Meds are often good for more than a decade after the expiry date.

And, those same responsible press sources have actually quoted the pharmaceutical companies, on the record, as saying they test for one or two years and they feel that is long enough. That further testing would be too expensive, too complex for environmental variables, and as it is not required, they simply don't do it.

"While possible, I find it unlikely that big pharma is conspiring to establish premature expiration dates just to sell more pills. "
Oh, really? Nelson Rockefeller didn't help Henry Ford kill off electric cars, so he could sell more Kerosene? (A brand name, not just a product. As was "Gasoline".) Ford and others didn't put out fake press releases about exploding steam cars, to kill off their competition even when they knew very well the steamers were safer and better?
And perhaps you hadn't heard of price fixing, cartels, anti-monopoly acts, and documented history, like trolley companies being bought and their tracks and overheads torn down--making it economically impossible to restore them--in order to sell busses that also happened to need rubber tires regularly replaced?

Or the mining strikes in the early 1900's, when military and militia were called out as political favors to certain rich gentlemen in order to end the strikes and destroy the unions?

Big Pharma doesn't have to conspire. All they have to do is play on FUD. The same way that, oddly enough, every mattress store will tell you that you NEED a mattress which is twelve inches thick, the ones only 6" thick that we all grew up on, will kill you. Or at least, leave you so exhausted and uncomfortable, that they will contribute to your early demise.

Sorry, gents, but if the military says their aspirin and ointments have been TESTED a full decade after the expiry date and found perfectly functional...I can't see why they would make that up. Remember, they have incentives to throw it out and place new purchasing contracts too.

Please, do document the loss of effectiveness and the failure of meds, in general, in proper storage. Epipens in hot glove boxes may be trashed in 60 days. Insulin left on the countertop in even less. But those are the exceptions that prove the rule: Most meds, under proper conditions, continue to perform perfectly well.

In fact, there are a class of products sometimes called "blood stoppers" aka coagulation agents, made into a mass market by the military to stop bleeding in field wounds. Blood loss is perhaps the leading cause of death for combat casualties, so they have good reason to look at these products. I spoke directly to one manufacturer about why their product, a fairly simple and stable chemical, had a two-year expiration date and whether I really should throw it out at that point, when we had just used some that was four years old and perfectly effective. Their response? Well, off the record....if it had been stored properly, which they could never be sure of, they just put on the two year date because they had no control over storage conditions, but the FDA required SOME date, and two years seemed to keep everyone happy, so they put it on the labels.
Good for inventory churn, good for safety, good for FUD and profits, too. And if hadn't restocked the aid kit before the expiry date? Sure enough, the product would still be a life-saver, no hazards to keeping and using it, as long as it was kept sealed and stored properly.