Help Patients Understand Drug Expiration Dates

Understanding and keeping track of drug expiration dates can be difficult for patients.

There are times when patients may unintentionally stock up on medications and forget to check the date on their OTC medication packages or prescription bottles, which might be printed in small font and in a location that is not obvious. Patients may consistently receive their supply of maintenance prescription medications, take them as scheduled, and yet still have excess doses.

Some patients may have prescription medications that are indicated for use only as needed and thus seldom taken. These medications can be forgotten or used intermittently, only to be discovered with an expired date on the bottle. Now patients must dispose of the medication properly; however, patients might hesitate to do that if a particular medication is expensive. They may think that surely the medication is still good to use, and they may then decide to call their pharmacy and inquire.

The pharmacy technician is the most likely pharmacy staff member to answer the phone call and impart crucial information to the patient.

Techs play an important role in helping patients understand medication expiration dates. Their knowledge allows them to aid the pharmacist in answering simple questions about the stability of medications past their expiry date and what to do with excess doses, including proper disposal, if required.

Thus, it is the tech who often provides information to patients about medication expiration dates and related information. The tech is the first check to ensure the medication is appropriate to dispense to the patient.

Techs should be aware of the time frame in which the patient’s medication is potent and stable. By law, the FDA requires expiration dates be displayed on medication bottles and prescriptions.¹ Since 1979, drug expiration dates indicate to patients and pharmacy staff how potent and stable the medication is in its unopened container. Ingesting expired medications can have potentially harmful effects because it may be difficult to determine how much the medication has denatured since being removed from the original packaging. This is especially problematic for patients with compromised immune systems or impaired ability to metabolize drugs, such as those with liver or renal conditions.

It is not recommended for patients to use expired medications because
it remains unclear how much potency is retained.² Patients should not be tempted to use expired medications. However, if a patient happens to ingest an expired medication, which often occurs with OTC medications such as acetaminophen, there is no need for panic.³ There have been no published reports of human toxicity due to ingestion, injection, or topical application of a current drug formulation after its expiration.

Certain drug formations such as liquid drugs are less stable after expiration than solid dosage formulations.⁴ Some solid dosage formulations may extend their potency for at least 5 years past expiration.^3,5 Techs should bring these questions of drug potency and stability past expiration dates to the pharmacist and then help facilitate honest conversations with patients.

The issue of drug expiration dates becomes that much more salient when the medication has special storage requirements, as is the case for drugs such as insulin that must be refrigerated. Typically, insulin left out at room temperature is only good for 28 days because its potency and stability degrade more rapidly than if kept refrigerated.⁶

It is not uncommon for a pharmacy to receive a phone call from a patient stating that he or she left a box of insulin pens on the counter, saying, “It’s unopened and unused; I just forgot.”

Techs often field these inquiries. With their basic knowledge of drug expiration dates, they can help patients understand what an expiration date for an unused and unopened box of insulin pen means and what to do next. Clear lines of communication with the pharmacist are paramount. Pharmacists and techs must work together to discern the types of information and questions that techs can field and what should be referred to a pharmacist. This comes with a mutual understanding and might be dependent on the tech’s level of certification, experience, and knowledge.

Techs are positioned to provide reminders to patients picking up medications to store them properly through a simple statement such as, “Your refrigerated prescription is ready. Make sure to place any unused medication in the fridge once you get home.”

Of course, for medications with special requirements, using the open-ended questions employed in other aspects of patient counseling might also be useful.

Making sure that patients understand drug expiration dates is part of the important role that techs play in keeping patients healthy and safe. Techs’ basic knowledge of medications allows them to be the first line of defense for patient safety and maintaining pharmacy workflow.

AUTHOR BIOS

Sarah Carpio, BS, is a PharmD candidate at Touro University California College of Pharmacy.

Shane P. Desselle, PHD, RPH, FAPHA, is a professor of social and behavioral pharmacy at Touro University California College of Pharmacy.

REFERENCES

1. Expiration dates – questions and answers. FDA. Updated April 26, 2018. Accessed February 9, 2021. https://www.fda.gov/drugs/pharmaceutical-quality-resources/expiration-dates-questions-and-answers
2. Don’t be tempted to use expired medicines. FDA. Updated Feb- ruary 8, 2021. Accessed February 9, 2021. https://www.fda.gov/drugs/special-features/dont-be-tempted-use-expired-medicines
3. Cantrell L, Suchard JR, Wu A, Gerona RR. Stability of active ingredients in long-expired prescription medications. Arch Intern Med. 2012;172(21):1685-1687. doi:10.1001/archinternmed.2012.4501
4. Drugs past their expiration date. JAMA. 2016;315(5):510-511. doi:10.1001/jama.2016.0048
5. Zilker M, Sörgel F, Holzgrabe U. A systematic review of the stability of finished pharmaceutical products and drug substances beyond their labeled expiry dates. J Pharm Biomed Anal. 2019;166:222-235. doi:10.1016/j.jpba.2019.01.016
6. Turner JM, Unni EJ, Strohecker J, Henrichs J. Prevalence of insulin glargine vial use beyond 28 days in a Medicaid population.
   J Am Pharm Assoc (2003). 2018;58(4S):S37-S40. doi:10.1016/j. japh.2018.04.019