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Drug Expiration Dates — Do They Mean Anything?

FDA study gets to the heart of expired medicine and safety

Updated: December 13, 2019Published: November, 2003

The big question is, do pills expire? With a splitting headache, you reach into your medicine cabinet for some aspirin only to find the stamped expiration date on the medicine bottle is more than a year out of date. So, does medicine expire? Do you take it or don’t you? If you decide to take the aspirin, will it be a fatal mistake or will you simply continue to suffer from the headache?

The big question is, do pills expire? With a splitting headache, you reach into your medicine cabinet for some aspirin only to find the stamped expiration date on the medicine bottle is more than a year out of date. So, does medicine expire? Do you take it or don’t you? If you decide to take the aspirin, will it be a fatal mistake or will you simply continue to suffer from the headache?

This is a dilemma many people face in some way or another. A column published in Psychopharmacology Today offers some advice.

It turns out that the expiration date on a drug does stand for something, but probably not what you think it does. Since a law was passed in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.

So, the expiration date doesn’t really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state if expired medicine is safe to take, even those that expired years ago. A rare exception to this may be tetracycline, but the report on this is controversial among researchers. It’s true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military. Placing a medication in a cool place, such as a refrigerator, will help a drug remain potent for many years.

Is the expiration date a marketing ploy by drug manufacturers, to keep you restocking your medicine cabinet and their pockets regularly? You can look at it that way. Or you can also look at it this way: The expiration dates are very conservative to ensure you get everything you paid for. And, really, if a drug manufacturer had to do expiration-date testing for longer periods it would slow their ability to bring you new and improved formulations.

The next time you face the drug expiration date dilemma, consider what you’ve learned here. If the expiration date passed a few years ago and it’s important that your drug is absolutely 100% effective, you might want to consider buying a new bottle. And if you have any questions about the safety or effectiveness of any drug, ask your pharmacist. He or she is a great resource when it comes to getting more information about your medications.

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Is expired medicine safe to take?

It happens to everybody—you have a headache or feel sick, and you head to the medicine cabinet to get something to help. But once you get there and pull out that prescription drug or over-the-counter medication, you see the expiration date has flown by. So what do you do? Take it or throw it away? It’s a judgment call that, depending on the medication, could have serious consequences.

What does a drug’s expiration date mean?

Every medication, whether prescription or over-the-counter, has an expiration date. And similar to the expiration dates on food, if you ingest it after that date, the results can be a little dicey. Scientifically speaking, says Reed Supe, Pharm.D., a pharmacist in Alaska, “a drug’s expiration date is when the active ingredient has lost 10% of its potency.” Those dates can be a bit conservative, though, because they’re meant to ensure that the drug product is fully effective and safe to use for its entire shelf life. After that date, the chemical components of the drug may change in unexpected ways, rendering the drug unusable.

Lisa Vogel, Pharm.D., a pharmacist who works at a hospital in Illinois, notes that hospitals will never give expired medication, even if it’s an hour past the date and time listed on the drug.

“When we compound something, it has a ‘beyond use’ date, and that is a date and a time specific to the particular drug,” she says. “Those are strict guidelines.”

At home, though, the situation gets a bit more fuzzy. Carl Rauch, RPh, a pharmacist in Wisconsin, says to never take anything that’s expired—”potency and safety cannot be determined after the date,” he says, and with allergy medicine in particular, the side effects could get worse even as the full potency declines.

How long can you take medicine after the expiration date?

Drs. Vogel and Supe agree it’s good not to take any over-the-counter drug that’s expired, though both say to use your best judgment if you have a stockpile of meds. A week or a month, or even up to a year, after the expiration date probably won’t hurt you, the medicine will just be less effective. Just because the expiration date has passed, doesn’t mean the medication is immediately useless—but that’s different for every medication.

“The molecule breakdown is not linear and not the same from molecule to molecule,” Dr. Supe says. “Therefore, there is no blanket statement as to when something is ‘too expired.’”

That being said, a research team may have found information to debate expiration dates. On a study of 14 unopened medications that were all between 28 and 40 years expired, researchers found 86% of them retained at least 90% of the active drug. Still, though, because these results can’t be guaranteed with medication that’s already been opened or stored in less-than-optimal conditions, the U.S. Food and Drug Administration (FDA) doesn’t support taking expired drugs.

Is it safe to take expired medicine?

Whether it’s safe to take something that’s expired really depends on what it is. Every medicine ages differently. Allergy medication, pain relievers (like ibuprofen or acetaminophen), and cold medicine likely won’t hurt you. But avoid taking expired antibiotics, supplements, and eye drops.

Truthfully, you shouldn’t have any antibiotics expiring on you anyway. The prescriptions should always be taken in full only for the indication for which they were prescribed—if you don’t, Dr. Vogel says, you could get worse or risk your infection developing resistance against the antibiotic. Plus, the fundamental composition of antibiotics changes over time, which can cause issues on its own. “Some antibiotics become hazardous past the expiration date and cause more harm,” Rauch says. “Others lose their potency and have little or no effect with increased side-effects.”

Or, if it’s a life-saving treatment—like nitroglycerin—it might still work if you don’t have any other options, but is it worth the risk? Probably not.

What happens if you take expired medicine?

With most over-the-counter (OTC) medication, taking expired drugs will either help you or have no effect—the medicine could no longer be potent. Side effects may be a bit more pronounced, but you probably won’t get sicker than you already are, especially if you’ve stored your medication properly, in its original containers. A lot of things can degrade medicine more quickly than normal: light exposure, temperature, and humidity.

Contrary to popular belief, the medicine cabinet is not the right place to keep your pills. The bathroom is far too hot and steamy for proper storage of medication. You’ll want to find a cool, dark, dry place, out of the reach of children. Some medications require refrigeration and special handling, Dr. Supe says, so be sure to follow the package directions carefully. If you plan on putting pills in a pill box, find one that’s shaded, not clear, to keep them out of direct light.

You should also consider the source of the medication. “Purchasing medication online or from a foreign country is not a safe practice,” Dr. Supe says. “There is no regulating body ensuring the medication is what it says it is and is safe for consumption. There have been many instances where people have purchased medication online from another country due to cost and it has contained rat poison and no traces of the active ingredients it claims to have.” In other words, medication from outside the United States may be unsafe even before it’s expired.

What medications are unsafe after the expiration date?

Some medications are simply ineffective after their expiration. Others, like these, are harmful.

  • Tetracycline and doxycycline: These antibiotics become hazardous with time, Rauch says. Tetracycline in particular is known to cause kidney damage after the use-by date.
  • Supplements: These aren’t regulated as well as FDA-approved medication, Dr. Supe says, so be more safe than sorry and avoid taking them if they’re expired.
  • Eye drops: Expired eye drops lose their pH balance and can end up burning your eyes, Dr. Supe says.
  • Injectable/IV drugs: This is mostly a concern in hospitals, but Dr. Vogel says patients will never receive expired medicine in a medical facility.

What should you do with expired medicine?

In the past, guidelines on getting rid of expired medicine haven’t always had the best advice.

“I remember when the recommendation was to flush expired medication,” Dr. Vogel says. Of course, we know now that’s a bad idea—it can get into the water supply. The best thing to do, Dr. Vogel says, is to put the medication in a form where people can’t ingest it, on purpose or accidentally. If it’s a capsule, open it up and dump the contents into the trash. If it’s a tablet, mix it with dirt or something else undesirable and trash it. With liquid antibiotics, pour it into cat litter or coffee grounds so it’s absorbed, then toss it.

If you don’t want to dump the expired medicine in your own trash, you can utilize a take back program. “Many city halls, police departments, and fire departments take unwanted medications,” Rauch says. “There is usually no charge to do this. Just remove any private information before bringing it there.”

Supe also notes that cities around the country host biannual drug take back days, which is an option if the hospitals or police stations near you don’t have disposal sites. The U.S. Drug Enforcement Administration (DEA) runs an annual National Prescription Drug Take Back Day, too.

RELATED: How to get rid of unused medications

“Getting rid of expired medication is a valuable thing to do,” Vogel says. “I don’t think keeping things around because you might need it is necessarily a good idea. You don’t want to get into the mindset that it’s OK to take expired medication. The dates are there for a reason.”

Ultimately, it’s important to remember that those drug expiration dates—no matter how flexible they may or may not be—serve a purpose and you should adhere to them.

That Drug Expiration Date May Be More Myth Than Fact

Lee Cantrell, an associate professor of clinical pharmacology at the University of California, San Diego, with a collection of vintage expired medications. Sandy Huffaker for ProPublica hide caption

toggle caption Sandy Huffaker for ProPublica

Lee Cantrell, an associate professor of clinical pharmacology at the University of California, San Diego, with a collection of vintage expired medications.

Sandy Huffaker for ProPublica

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco researcher who specializes in analyzing chemicals. Gerona grew up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country in major medical centers and in neighborhood strip malls routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona, a pharmacist; and Cantrell, a toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted. We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients die or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

What if the system is destroying drugs that are technically “expired” but could still be safely used?

In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.

The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

“Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media are rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston said the 240-bed facility is able to return some expired drugs for credit but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term-care and retail pharmacies and in consumer medicine cabinets.

Pharmacist Candy Tin checks dates and lot numbers with pharmacy technician Nikki Wong to pull expired medications at Newton-Wellesley Hospital. Erik Jacobs for ProPublica hide caption

toggle caption Erik Jacobs for ProPublica

Pharmacist Candy Tin checks dates and lot numbers with pharmacy technician Nikki Wong to pull expired medications at Newton-Wellesley Hospital.

Erik Jacobs for ProPublica

After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.

“Refining our prescription drug dating process could save billions,” he says.

But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

In fact, the federal government has saved a fortune by doing this.

At a goverment stockpile, drugs don’t expire as fast

For decades, the federal government has stockpiled massive stashes of medication, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

Maintaining these stockpiles is expensive. The drugs have to be kept secure and at the proper humidity and temperature so they don’t degrade. Luckily, the country has rarely needed to tap into many of the drugs, but this means they often reach their expiration dates. Though the government requires pharmacies to throw away expired drugs, it doesn’t always follow these instructions itself. Instead, for more than 30 years, it has pulled some medicines and tested their quality.

The idea that drugs expire on specified dates goes back at least a half-century, when the FDA began requiring manufacturers to add this information to the label. The time limits allow the agency to ensure medications work safely and effectively for patients. To determine a new drug’s shelf life, its maker zaps it with intense heat and soaks it with moisture to see how it degrades under stress. It also checks how it breaks down over time. The drug company then proposes an expiration date to the FDA, which reviews the data to ensure they support the date and then approves it. Despite the difference in drugs’ makeup, most “expire” after two or three years.

Once a drug is launched, the makers run tests to ensure it continues to be effective up to its labeled expiration date. Since they are not required to check beyond it, most don’t, largely because regulations make it expensive and time-consuming for manufacturers to extend expiration dates, says Yan Wu, an analytical chemist who is part of a focus group at the American Association of Pharmaceutical Scientists that looks at the long-term stability of drugs. Most companies, she said, would rather sell new drugs and develop additional products.

Pharmacists and researchers say there is no economic “win” for drug companies to investigate further. They ring up more sales when medications are tossed as “expired” by hospitals, retail pharmacies and consumers despite retaining their safety and effectiveness.

Pharmacy technician Nikki Wong sorts medications in drug boxes at Newton-Wellesley Hospital. Erik Jacobs for ProPublica hide caption

toggle caption Erik Jacobs for ProPublica

Pharmacy technician Nikki Wong sorts medications in drug boxes at Newton-Wellesley Hospital.

Erik Jacobs for ProPublica

Industry officials say patient safety is their highest priority. Olivia Shopshear, director of science and regulatory advocacy for the drug industry trade group Pharmaceutical Research and Manufacturers of America, says expiration dates are chosen “based on the period of time when any given lot will maintain its identity, potency and purity, which translates into safety for the patient.”

That being said, it’s an open secret among medical professionals that many drugs maintain their ability to combat ailments well after their labels say they don’t. One pharmacist says he sometimes takes home expired over-the-counter medicine from his pharmacy so he and his family can use it.

The federal agencies that stockpile drugs — including the military, the Centers for Disease Control and Prevention and the U.S. Department of Veterans Affairs — have long realized the savings in revisiting expiration dates.

In 1986, the Air Force, hoping to save on replacement costs, asked the FDA if certain drugs’ expiration dates could be extended. In response, the FDA and Defense Department created the Shelf Life Extension Program.

Each year, drugs from the stockpiles are selected based on their value and pending expiration, and analyzed in batches to determine whether their end dates could be safely extended. For several decades, the program has found that the actual shelf life of many drugs is well beyond the original expiration dates.

A 2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

Some that failed to hold their potency include the common asthma inhalant albuterol, the topical rash spray diphenhydramine, and a local anesthetic made from lidocaine and epinephrine, the study said. But neither Cantrell nor Dr. Cathleen Clancy, associate medical director of National Capital Poison Center, a nonprofit organization affiliated with the George Washington University Medical Center, had heard of anyone being harmed by any expired drugs. Cantrell says there has been no recorded instance of such harm in medical literature.

Marc Young, a pharmacist who helped run the extension program from 2006 to 2009, says it has had a “ridiculous” return on investment. Each year the federal government saved $600 million to $800 million because it did not have to replace expired medication, he says.

An official with the Department of Defense, which maintains about $13.6 billion worth of drugs in its stockpile, says that in 2016 it cost $3.1 million to run the extension program — which saved the department from replacing $2.1 billion in expired drugs. To put the magnitude of that return on investment into everyday terms: It’s like spending a dollar to save $677.

“We didn’t have any idea that some of the products would be so damn stable — so robustly stable beyond the shelf life,” says Ajaz Hussain, one of the scientists who formerly helped oversee the extension program.

Hussain is now president of the National Institute for Pharmaceutical Technology and Education, an organization of 17 universities working to reduce the cost of pharmaceutical development. He says the high price of drugs and shortages make it time to re-examine drug expiration dates in the commercial market.

“It’s a shame to throw away good drugs,” Hussain says.

The pharmacy at Newton-Wellesley Hospital. Erik Jacobs for ProPublica hide caption

toggle caption Erik Jacobs for ProPublica

The pharmacy at Newton-Wellesley Hospital.

Erik Jacobs for ProPublica

The AMA tries to extend shelf life — and fails

Some medical providers have pushed for a changed approach to drug expiration dates — with no success. In 2000, the American Medical Association, foretelling the current prescription drug crisis, adopted a resolution urging action. The shelf life of many drugs, it wrote, seems to be “considerably longer” than their expiration dates, leading to “unnecessary waste, higher pharmaceutical costs, and possibly reduced access to necessary drugs for some patients.”

Citing the federal government’s extension program, the AMA sent letters to the FDA, the U.S. Pharmacopeial Convention, which sets standards for drugs, and PhRMA asking for a re-examination of expiration dates.

No one remembers the details — just that the effort fell flat.

“Nothing happened, but we tried,” says rheumatologist Roy Altman, now 80, who helped write the AMA report. “I’m glad the subject is being brought up again. I think there’s considerable waste.”

At Newton-Wellesley Hospital, outside Boston, pharmacist David Berkowitz yearns for something to change.

On a recent weekday, Berkowitz sorted through bins and boxes of medication in a back hallway of the hospital’s pharmacy, peering at expiration dates. As the pharmacy’s assistant director, he carefully manages how the facility orders and dispenses drugs to patients. Running a pharmacy is like working in a restaurant because everything is perishable, he says, “but without the free food.”

David Berkowitz, assistant director of clinical pharmacy at Newton-Wellesley Hospital, says that the hospital has to throw out many drugs that are probably safe to use. Erik Jacobs/ProPublica hide caption

toggle caption Erik Jacobs/ProPublica

David Berkowitz, assistant director of clinical pharmacy at Newton-Wellesley Hospital, says that the hospital has to throw out many drugs that are probably safe to use.

Erik Jacobs/ProPublica

Federal and state laws prohibit pharmacists from dispensing expired drugs, and The Joint Commission, which accredits thousands of health care organizations, requires facilities to remove expired medication from their supply. So at Newton-Wellesley, outdated drugs are shunted to shelves in the back of the pharmacy and marked with a sign that says: “Do Not Dispense.” The piles grow for weeks until they are hauled away by a third-party company that has them destroyed. And then the bins fill again.

“I question the expiration dates on most of these drugs,” Berkowitz says.

One of the plastic boxes is piled with EpiPens — devices that automatically inject epinephrine to treat severe allergic reactions. They run almost $300 each. These are from emergency kits that are rarely used, which means they often expire. Berkowitz counts them, tossing each one with a clatter into a separate container: “… that’s 45, 46, 47…” He finishes at 50. That’s almost $15,000 in wasted EpiPens alone.

In May, Cantrell and Gerona published a study that examined 40 EpiPens and EpiPen Jrs., a smaller version, that had been expired for between one and 50 months. The devices had been donated by consumers, which meant they could have been stored in conditions that would cause them to break down, like a car’s glove box or a steamy bathroom. The EpiPens also contain liquid medicine, which tends to be less stable than solid medications.

Testing showed 24 of the 40 expired devices contained at least 90 percent of their stated amount of epinephrine, enough to be considered as potent as when they were made. All of them contained at least 80 percent of their labeled concentration of medication. The takeaway? Even EpiPens stored in less than ideal conditions may last longer than their labels say they do, and if there’s no other option, an expired EpiPen may be better than nothing, Cantrell says.

At Newton-Wellesley, Berkowitz keeps a spreadsheet of every outdated drug he throws away. The pharmacy sends what it can back for credit, but it doesn’t come close to replacing what the hospital paid.

Then there’s the added angst of tossing drugs that are in short supply. Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available. He holds up a purple box of atropine, which gives patients a boost when they have low heart rates. It’s also in short supply. In the federal government’s stockpile, the expiration dates of both drugs have been extended, but they have to be thrown away by Berkowitz and other hospital pharmacists.

The 2006 FDA study of the extension program also said it pushed back the expiration date on lots of mannitol, a diuretic, for an average of five years. Berkowitz has to toss his out. Expired naloxone? The drug reverses narcotic overdoses in an emergency and is currently in wide use in the opioid epidemic. The FDA extended its use-by date for the stockpiled drugs, but Berkowitz has to trash it.

On rare occasions, a pharmaceutical company will extend the expiration dates of its own products because of shortages. That’s what happened in June, when the FDA posted extended expiration dates from Pfizer for batches of its injectable atropine, dextrose, epinephrine and sodium bicarbonate. The agency notice included the lot numbers of the batches being extended and added six months to a year to their expiration dates.

The news sent Berkowitz running to his expired drugs to see if any could be put back into his supply. His team rescued four boxes of the syringes from destruction, including 75 atropine, 15 dextrose, 164 epinephrine and 22 sodium bicarbonate. Total value: $7,500. In a blink, “expired” drugs that were in the trash heap were put back into the pharmacy supply.

Expired EpiPens and atropine sulfate await pickup for disposal at Newton-Wellesley Hospital. Erik Jacobs for Propublica hide caption

toggle caption Erik Jacobs for Propublica

Expired EpiPens and atropine sulfate await pickup for disposal at Newton-Wellesley Hospital.

Erik Jacobs for Propublica

Berkowitz says he appreciated Pfizer’s action but feels it should be standard to make sure drugs that are still effective aren’t thrown away.

“The question is: Should the FDA be doing more stability testing?” Berkowitz says. “Could they come up with a safe and systematic way to cut down on the drugs being wasted in hospitals?”

Four scientists who worked on the FDA extension program told ProPublica something like that could work for drugs stored in hospital pharmacies, where conditions are carefully controlled.

Greg Burel, director of the CDC’s stockpile, says he worries that if drugmakers were forced to extend their expiration dates it could backfire, making it unprofitable to produce certain drugs and thereby reducing access or increasing prices.

The 2015 commentary in Mayo Clinic Proceedings, called “Extending Shelf Life Just Makes Sense,” also suggested that drugmakers could be required to set a preliminary expiration date and then update it after long-term testing. An independent organization could also do testing similar to that done by the FDA extension program, or data from the extension program could be applied to properly stored medications.

ProPublica asked the FDA whether it could expand its extension program, or something like it, to hospital pharmacies, where drugs are stored in stable conditions similar to the national stockpile.

“The Agency does not have a position on the concept you have proposed,” an official wrote back in an email.

Whatever the solution, the drug industry will need to be spurred to change, says Hussain, the former FDA scientist. “The FDA will have to take the lead for a solution to emerge,” he says. “We are throwing away products that are certainly stable, and we need to do something about it.”

ProPublica is a nonprofit newsroom based in New York. You can follow Marshall Allen on Twitter: @marshall_allen

Help ProPublica investigate wasted health care dollars: Experts say the United States might be squandering a quarter of the money spent on health care. That’s an estimated $765 billion a year. Do you believe you’ve encountered this waste? Tell ProPublica.

An unexpected increase in weight can be concerning for anyone. But it’s an unfortunate side effect of many common medications. Insulin, blood pressure medications, antidepressants, and even migraine medications can all cause weight gain, and some may even worsen the health conditions they’re trying to treat.

Sudden weight gain is never a reason to stop your medication without seeing your doctor first. However, knowing what to look out for and which medications may be at fault can be an important first step in fixing the issue.

How do medications cause weight gain?

As you can imagine, it can be difficult to pin down exactly why a person is gaining weight. Drugs can affect weight in many ways, and it isn’t always by increasing fat storage. Here are five main reasons for medication-related weight gain:

  1. Increased appetite: Some drugs, like certain steroids and antidepressants, can stimulate your appetite, so you eat more. If you’re not changing anything else about your diet or exercise activity, this can lead to extra pounds.
  2. Fluid retention: Some drugs like the diabetes drug, pioglitazone, make the body hold onto more salt, which in turn leads to water build up. So it’s not fat that’s causing weight gain; it’s water.
  3. Increased fat storage: Some drugs increase weight by affecting how much fat you can store. One example is insulin. Insulin is a growth hormone, which means it stimulates the body to create tissues, including fat cells.
  4. Slowed metabolism: Some drugs (like beta-blockers for high blood pressure) can cause the body’s metabolism to slow down, which means that calories are not burned as quickly.
  5. Difficulty exercising: Then there are drugs that make it more difficult to get up and exercise, so you burn fewer calories each day. Some antihistamines can make you sleepy, so you don’t feel like exercising. Others drugs — like amitriptyline and similar antidepressants — can make it more difficult to breath, so it’s harder to exercise.

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Which drugs can cause weight gain?

Here are some of the medications that carry more complaints of weight gain. It’s important to note that drugs in these medication families are associated with weight gain as a side effect, but not all drugs in a given medication family will cause weight gain. (For example, not all blood pressure medications have weight gain as a side effect.) In addition, the amount of weight gained will vary depending on the person and medication.

Medication family Drugs that may cause weight gain
Antihistamines ranitidine, diphenhydramine (Benadryl), cetirizine (Zyrtec)
Blood pressure medications metoprolol (Lopressor), atenolol (Tenormin), propranolol (Inderal)
Antidepressant and anti-anxiety medications paroxetine (Paxil), sertraline (Zoloft), amitriptyline, trazodone, alprazolam (Xanax), diazepam (Valium)
Steroids prednisone, oral contraceptives, norethindrone, Nexplanon, tamoxifen
Diabetes drugs insulin (Humulin N, Lantus), glipizide, pioglitazone
Antipsychotics quetiapine (Seroquel), olanzapine (Zyprexa), aripiprazole (Abilify), haloperidol (Haldol)
Anti-seizure and nerve pain drugs gabapentin (Neurontin), pregabalin (Lyrica), divalproex (Depakote)
Opioids oxycodone, hydrocodone

How do I tell if my medication is making me gain weight?

When it comes to medication-related weight gain, you’ll notice an increase in pounds soon after you start taking the drug — possibly within six months. But the amount of weight gained can vary from person to person. Some people may experience an increase in 10 pounds over a year, while others may see up to a 60-pound gain in just over six months.

If you just started taking a medication and you’re noticing that your clothes feel extra snug, ask yourself these three questions:

  1. Have I changed my diet recently?
  2. Have I stopped exercising as often?
  3. Have I been significantly more stressed?

If you answered “no” to all three of these questions, you may want to consider whether your medication is to blame.

Is there anything I can do about it?

First, many of the above medications are life-sustaining. Do not stop taking your medication without speaking to your doctor first.

If you’re interested in changing medications, in many cases, alternatives medications are available that can address your health issues, but don’t have the side effect of increasing weight. Speak to your healthcare provider to find out whether your medication can cause weight gain and discuss with them whether switching to another option is possible.

In the meantime, you can try adjusting your diet and exercise routine to offset the weight gained from taking your medication. Keeping a food and exercise diary can be a helpful way to track these lifestyle changes as you and your doctor try to manage your medications.

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  • For people struggling with pain after surgery, injury or as part of a plan for chronic pain management, the short-term use of opiates can provide needed relief. But for people who use the drugs for longer periods of time or in larger amounts that prescribed, opiates quickly become a drug of addiction.

    Opiates are naturally-occurring substances derived from the opium poppy and are part of a larger drug category called opioids.1 Opioids include both naturally-occurring substances and synthetic forms of the drugs. Opiates work in the brain to change the way the body perceives pain and produce feelings of euphoria in the user.

    Opiates are found in some prescription pain medications and are considered Schedule II narcotics by the U.S Department of Justice Drug Enforcement Administration.2 Opiates are highly habit forming and using the drugs in ways other than prescribed by a physician can lead to addiction.3 Morphine, codeine, and thebaine are all medications classified as opiates. Understanding more about each drug can help you or a loved one recognize problems like weight gain or loss or developing dependence.

    Opiate Basics

    Morphine is the most common natural alkaloid in the opium poppy. It’s frequently prescribed to patients that have undergone major surgery and are in need of significant pain relief. Codeine, synthesized from morphine, is frequently combined with Tylenol when prescribed for pain. The effects of codeine are less intense than those of morphine. Thebaine is poisonous, so it is not used in medicine. However, it can be converted into opioids. Some examples of these are hydrocodone and oxycodone. Opioids are often prescribed for the treatment of pain.

    Both natural and synthetic opiates cause dependence, and many people abuse these drugs for their ability to induce euphoria.

    Opiate use can have major effects on the body, including ruining a user’s eating habits and appetite. Common side effects of opiate abuse include constipation, nausea, and vomiting. These symptoms can lead to a lack of nutrients and an imbalance of electrolytes. The side effects of nausea and vomiting often decrease the user’s appetite, making it difficult to maintain a healthy diet. Another side effect of opiate abuse is fatigue. This can lower the user’s metabolic rate, causes a change in eating habits due to lack of appetite.

    How Opiate Abuse Affects Weight

    People that abuse opiates may experience either weight gain or loss as a result of their drug use. Opiate users that experience side effects, such as nausea and vomiting, may experience weight loss. However, users that do not experience these side effects may experience weight gain.
    The high the drug causes may encourage them to eat more food to feel even better. Opiate users may even gain weight because substance abuse often leads to inactivity. People that become addicted to opiates may abuse drugs so often that they do little else. As a result, they may not participate in many activities that require physical exercise. But for most people struggling with opiate addiction, the opposite is true.

    Because an addicted person needs more of the drug to feel normal, whatever money he or she has is spent on getting more of the drug rather than on nutritious food.

    Finding Help for Opiate Addiction

    Extreme weight loss is only one of the many dangerous side effects from opiate abuse. And getting help is the only way to prevent accidental overdose and death. If you or someone you love is struggling with an addiction to opiates, we are here for you.

    Call our toll-free helpline, 706-914-2327, and speak to an admissions coordinator about available treatment options. Our staff is available 24 hours a day to take your call and to connect you to the help you need to achieve recovery. You are not alone. Call us now.


    1 “Opiates/Opioids.” The National Alliance of Advocates for Buprenorphine Treatmen. Accessed May 29, 2018.

    2 “Controlled Substance Schedules.” U.S. Department of Justice, Drug Enforcement Administration, Mar. 2018.

    3 “How Opioid Addiction Occurs.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Feb. 2018.

    Please Share:

    Articles posted here are primarily educational and may not directly reflect the offerings at Black Bear Lodge. For more specific information on programs at Black Bear Lodge, contact us today.

    Date: April 23, 2018 12:40 pm

    Tags: addiction, Eating Disorders, Opioids, Treatment

    Categorized in: Drug Abuse

    Pain is complex, so there is no “one pill fits all” treatment. Hydrocodone is the most prescribed medication in the United States, also marketed in combination with acetaminophen (Tylenol) under the brand names Vicodin, Norco and Lortab.

    As of October 6, 2014, all drugs containing hydrocodone are schedule II drugs, and that means they are now much harder to get. There is no question this is a hassle for some patients and physicians but we (doctors) are too quick to prescribe it and for most pain, you don’t really need hydrocodone.

    • Is hydrocodone better than over the counter pain meds? In many studies done on specific types of pain: acute or chronic, musculoskeletal or postoperative among others, non-opioid medications were just as good if not better.You see, the classic line taught in medical school is that NSAIDS/ non-steroidal anti-inflammatory drugs (ibuprofen, Motrin, naproxen) work just as well for pain but hydrocodone makes you care less about the pain. That’s because you will be much more dopey on hydrocodone—oh, and more constipated.
    • Explore other options for postoperative pain. After an operation is a time when most doctors will prescribe you hydrocodone but for some simpler surgeries, you may not need it. NSAIDS work just as well most of the time. The use of a single dose of Celebrex (celecoxib) in the treatment of acute postoperative pain found that 33% of patients receiving celecoxib 200 mg, and 44% of patients receiving 400 mg, experienced at least 50% pain relief.Listen to this too: a single dose of ibuprofen was found to provide at least 50% pain relief in approximately half of patients with moderate to severe postoperative pain. An NSAID may be all you need.
    • Low back pain. In most cases, first-line treatment of low back pain (LBP) should consist of an NSAID or acetaminophen. Long-term use of NSAIDs is associated with gastrointestinal and kidney risks, so a short course of a low dose NSAID, possibly along with a proton pump inhibitor (omeprazole, etc) to protect your stomach and you should be set.When pain is severe and disabling, guidelines cautiously recommend opioid analgesics like hydrocodone although the risk of addiction or dependence is noted and continued long-term use is a bad idea.
    • Arthritis pain/knee and hip pain. Several classes of drugs are recommended by the American College of Rheumatology for osteoarthritis (OA) pain in the hand, knee, and hip. For hip OA, first-line therapy is acetaminophen, NSAIDs, tramadol, and steroid injections into the joint. Opioid treatment like hydrocodone is recommended only in cases of knee or hip pain that have not responded to the above-listed medications or physical therapy.
    • Headache/migraine. NSAIDs like ibuprofen and naproxen have been found to be effective in the treatment of migraines. Approximately one-fourth of people with migraine pain experienced a reduction from severe or moderate pain to no pain within 2 hours of taking a 400 mg dose of ibuprofen.
    • When should you use hydrocodone? Opioids are recommended only for severe pain (a score of at least 7 out of 10), as in a post-surgical setting or other situations in which NSAIDs, acetaminophen, or other treatments provide inadequate pain relief.
    • Why is liberal use of hydrocodone a bad idea? Opioids are associated with serious side effects, including respiratory depression, motor and cognitive impairment, sedation, and the development of tolerance. Long-term use of opioids can also result in the development of an increased sensitivity to pain, known as opioid-induced hyperalgesia.
    • Hydrocodone doesn’t work as well as NSAIDs for many types of noncancer pain. This always surprises people because they think hydrocodone is “stronger” and thus better. Most of the time it’s not better.A 2004 meta-analysis of 18 randomized clinical trials of opioids for the treatment of various types of noncancer pain found that the mean reduction in pain intensity was approximately 20% to 30% for arthritis pain, but was approximately 10% for musculoskeletal pain. That’s not great.
    • Why are we using more hydrocodone in the U.S.? No reason. There should be widespread concern that the use of opioids is increasing at an unwarranted and possibly hazardous rate. With the increased use of opioids, there has been an increase in opioid-related overdoses and deaths.CDC data on poisoning deaths indicate that the number of deaths related to opioid use increased nearly 4-fold from 4030 in 1999 to 14,800 in 2008. In 2008, the number of overdose deaths involving the use of opioid pain relievers exceeded the number of deaths caused by heroin and cocaine combined.

    Dr O.

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    • Drug Interactions between hydrocodone and prednisone

      No interactions were found between hydrocodone and prednisone.This does not necessarily mean no interactions exist. Always consult your healthcare provider.


      A total of 504 drugs are known to interact with hydrocodone.

      • Hydrocodone is in the following drug classes: antitussives, narcotic analgesics.
      • Hydrocodone is used to treat Pain.


      A total of 466 drugs are known to interact with prednisone.

      • Prednisone is a member of the drug class glucocorticoids.
      • Prednisone is used to treat the following conditions:
        • Acute Lymphocytic Leukemia
        • Adrenocortical Insufficiency
        • Adrenogenital Syndrome
        • Allergic Reactions
        • Allergic Rhinitis
        • Ankylosing Spondylitis
        • Aspiration Pneumonia
        • Asthma
        • Atopic Dermatitis
        • Autoimmune Hemolytic Anemia
        • Berylliosis
        • Bullous Pemphigoid
        • Bursitis
        • Chorioretinitis
        • Cluster Headaches
        • Cogan’s Syndrome
        • Conjunctivitis, Allergic
        • COPD
        • Corneal Ulcer
        • Crohn’s Disease, Acute
        • Dermatitis Herpetiformis
        • Dermatomyositis
        • Diffuse Large B-Cell Lymphoma
        • Eczema
        • Epicondylitis, Tennis Elbow
        • Erythroblastopenia
        • Fibromyalgia
        • Giant Cell Arteritis
        • Gouty Arthritis
        • Graft-versus-host disease
        • Herpes Zoster
        • Herpes Zoster Iridocyclitis
        • Hypercalcemia of Malignancy
        • Idiopathic Thrombocytopenic Purpura
        • Immunosuppression
        • Inflammatory Bowel Disease
        • Inflammatory Conditions
        • Interstitial Lung Disease
        • Iridocyclitis
        • Iritis
        • Juvenile Rheumatoid Arthritis
        • Keratitis
        • Leukemia
        • Lichen Planus
        • Lichen Sclerosus
        • Loeffler’s Syndrome
        • Lymphoma
        • Mixed Connective Tissue Disease
        • Multiple Sclerosis
        • Mycosis Fungoides
        • Nephrotic Syndrome
        • Neurosarcoidosis
        • Osteoarthritis
        • Pemphigoid
        • Pemphigus
        • Pharyngitis
        • Polymyalgia Rheumatica
        • Polymyositis/Dermatomyositis
        • Psoriasis
        • Psoriatic Arthritis
        • Ramsay Hunt Syndrome
        • Rheumatoid Arthritis
        • Sarcoidosis
        • Scleroderma
        • Seborrheic Dermatitis
        • Sinusitis
        • Skin Rash
        • Synovitis
        • Systemic Lupus Erythematosus
        • Systemic Sclerosis
        • Thrombocytopenia
        • Toxic Epidermal Necrolysis
        • Tuberculosis, Extrapulmonary
        • Tuberculous Meningitis
        • Ulcerative Colitis, Active
        • Uveitis, Posterior

      Drug and food interactions


      HYDROcodone food

      Applies to: hydrocodone

      Do not use alcohol or medications that contain alcohol while you are receiving treatment with HYDROcodone. This may increase nervous system side effects such as drowsiness, dizziness, lightheadedness, difficulty concentrating, and impairment in thinking and judgment. In severe cases, low blood pressure, respiratory distress, fainting, coma, or even death may occur. If you are taking certain long-acting formulations of hydrocodone, consumption of alcohol may also cause rapid release of the drug, resulting in high blood levels that may be potentially lethal. Likewise, you should avoid consuming grapefruit and grapefruit juice, as this may increase the blood levels and effects of hydrocodone. Talk to your doctor or pharmacist if you have questions on how to take this or other medications you are prescribed. Do not use more than the recommended dose of HYDROcodone, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medication without first talking to your doctor.

      Switch to professional interaction data

      Therapeutic duplication warnings

      No warnings were found for your selected drugs.

      Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

      Expired Hydrocodone: Rules of Storage and Dangers of Taking Old Opioids

      As an opiate painkiller, hydrocodone is taken by many in the United States. However, the substance is also expensive, especially if required for long periods. This can sometimes lead to people choosing to take expired medication, rather than taking a newly purchased drug. So does taking an expired drug affect health? Is hydrocodone ER a drug that can expire and does effective storage change its shelf life?

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      Table of Contents

      • Does Hydrocodone Expire?
      • What is the Shelf Life of Hydrocodone?
      • What are the Possible Dangers of Taking Expired Hydrocodone?
      • How to Keep Hydrocodone Properly?
      • How to Dispose of Expired Hydrocodone?

      Does Hydrocodone Expire?

      Like all drugs, opioids have an expiration date. However, according to Harvard Medical School, 90% of drugs are perfectly fine to use for up to 100 years after they have expired. Despite this, it is not recommended to take drugs after their expiry date, as even a 10% chance could lead to an unwanted situation, with unpredictable side effects of hydrocodone.
      In this 10% of cases, expired hydrocodone acetaminophen goes through a chemical balance change due to aging, rendering it a danger.

      How Long Is Hydrocodone Good For?

      The shelf life of hydrocodone is between 12 and 36 months. However, in many cases, it can last far beyond its expiry date. Despite usually being safe, expired Hydrocodone always comes with a slight risk. An old drug can have unpredictable effects so it is better to look for physical signs that the substance may be going bad. For these reasons, it is better to take caution and only consume pure hydrocodone as well as the combination drugs when they are within expiry dates.

      What Are The Possible Dangers Of Taking Expired Hydrocodone?

      On most occasions, there is no danger from taking expired hydrocodone. However, drugs can sometimes become less potent. This leads to the person taking more and more of the medicine, thus getting used to the larger number of pills consumed every day. Taking more of the substance is part of the cause of hydrocodone overdose deaths.

      The side effects of hydrocodone when expired can be unpredictable and dangerous. However, it is far more likely that danger will come from a possible overdose or case of addiction.

      Consequences of taking expired opioid could include:

      • Headaches
      • Nausea
      • Taking more of the substance to get the same effect (due to the drugs lower potency) – Easier to overdose and become addicted
      • Unforeseen physical and psychological issues (unrelated to normal side effects)
      • Sweating

      How To Keep This Opioid Properly

      Keeping the medication properly will ensure it lasts longer and to the full extent of its lifespan. The substance should be stored in a cool, dry place at room temperature. This is because excessive sunlight and moisture could alter the composition of the drug. In addition, extreme heat or cold could do the same. Hydrocodone/chlorpheniramine er suspension should also be stored in the same manner.

      The substance should also be kept away from children and water, such as in a bathroom. It should always be locked with a safety cap.

      How To Dispose Of Expired Hydrocodone

      When hydrocodone expires, like any substance, it should be correctly disposed of. According to the US Food And Drug Administration, the best and safest way to do this is to do as follows:

      1. Mix the medication with an unpalatable substance, such as dirt or cat litter. Ensure one does this without crushing the tablets.
      2. Place the mixture a sealed plastic bag, usually zip top.
      3. Throw the bag into household waste bin.
      4. Remove all personal information from the empty medication container.

      By completing this process, it ensures that people who have not been prescribed the drug do not get hold of it and use it for an illegal high. Other options for disposing of old expired medication include flushing the medication or take back services, where the state disposes of the drug.

      Where to Get Help With Opioid Abuse

      Taking a drug after expiry date can lead to its effects being lessened. This often causes people to take more of the substance and quickly become addicted to it. Because of this, it is important to check hydrocodone expiration and to look out for the signs of addiction to opioids.
      If one does become addicted to this medication, there are a number of types of treatment programs available. For the most suitable treatment, contact a medical professional. They will help and guide through each option, and to weigh up the pros and cons of each.

      Find the best treatment options.
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