Old Drugs

The next issue of The Medical Letter (1483; December 7, 2015) includes an update of one of my all-time favorites, an article on drugs past their expiration date. We had received several inquiries over the years about whether outdated drugs were safe enough to use in an emergency, including one from a surgeon in Bosnia during the Yugoslavian civil war who said he had crates of outdated antibiotics and nothing else to treat the wound infections he was seeing.

I asked Dr. Gerhard Levy, a renowned pharmaceutical scientist who was on our advisory board, what he thought about using old drugs when nothing else was available. He told me that he couldn’t say how effective they would be, but he was positive that there was only one report in the medical literature of any toxicity associated with drugs past their expiration date, and that was a 1963 report on a formulation of tetracycline that was no longer marketed (it caused Fanconi syndrome). I found that hard to believe, but we have thoroughly reviewed and published that statement several times since, and the only exception that has come up is that outdated eyedrops carry a risk of infection.

That seemed to me to be the bottom line, that even if the old drugs didn’t work, they were worth trying if that was all you had because at least you couldn’t hurt anyone. But when we looked into it a little more, it turned out that the FDA and the Department of Defense had been testing the stability of outdated drugs for many years (since 1986) and had a mass of data showing that many drugs stored under controlled conditions in their original containers could retain substantial amounts or almost all of their potency for years and even decades, so that the military did not necessarily have to keep replenishing stockpiles of strategic chemicals such as potassium iodide, for which there would be an unprecedented demand in the event of a nuclear disaster. And more data keeps coming on this fascinating topic, so we keep publishing updates.

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  1. Lou Fontana says:

    to paraphrase: Lack of evidence of harm is not evidence of no harm. Potassium
    Iodide is a stable molecule much like sodium chloride (salt), I would expect little deterioration unless exposed to radiation/light. On the other hand, most pharmaceuticals are complex organic molecules. Advising that individuals use these drugs beyond tested/published limits of stability should place the burden of liability squarely on the shoulders of the party making this recommendation. If the government has stability data they should share it, but the medication storage conditions in the typical home/bathroom medicine cabinet are hardly a controlled environment.

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