Rx Shelf Life

I’ve made it to middle age taking almost no medication. True, I consume the occasional NSAID or antibiotic for time-limited purposes, but I don’t get up each morning and gulp a handful of pills as do many of my colleagues of even younger age.

Thus, with the exception of one – Synthroid (levothyroxine sodium 0.15 mg tablets) for hypothyroidism – I do not personally support Big Pharma’s bottom line.

Actually, I’ve tried not to even support Abbott Labs (the original maker of Synthroid) over these past 25 years. One of the perks of being a physician – there are still a few left – is having access to samples. I’m not talking about controlled substances, mind you, but instead those agents that fall into the ‘maintenance Rx’ category, such as Synthroid.

Back in 2003, I contacted the Abbott rep who covered my territory. I said that I was taking Synthroid and did he have any samples he could leave for me? I was hoping that I might be provided a few months’ worth that would save me, for a short while, the effort and (minor) expense of going to the drug store every four weeks for a refill. Plus I figured I’d make his acquaintance for purposes of future invitations to pharmaceutical events, as we were still allowed by the Ethics Police back then to attend such gatherings.

The rep – I don’t even remember his name as he left the company shortly thereafter – came around to my office the following week, saying that he had “a few samples he could leave with me.”

He wasn’t kidding.

He hauled a huge box around which he could barely wrap his arms. Putting it down on the floor, he said “they’re going to expire before long, but maybe you can get some use out of them until then.”

At 150 mcg per day, it was well over a decade’s worth of Rx in that box. But the contents were stamped with a ‘use by’ date in 2005, then still two years in the future.

This morning, 29 April 2014, I took the very last dose from that original supply, nine years after expiration. And that milestone spurred me to write today of expiration dates in general.

Most of what is known about drug shelf life comes from a study conducted by the Food and Drug Administration at the request of the military back in the 1970s. 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 that 90% of the more than 100 drugs analyzed, both prescription and over-the-counter, were perfectly good to use even 15 years after expiry.

Granted, this doesn’t apply to every active moiety; tetracycline arguably has a much shorter shelf life, as do nitroglycerin, insulin, and most chemo agents and other liquid preparations.

So the expiration date doesn’t really indicate a point after which a medication has ‘gone bad.’ Medical authorities state that most expired drugs are safe to take, even those that expired years ago. It’s true that the efficacy of a drug may decrease over time, but much of the original potency still remains even a decade after expiry, especially if kept in cool dry storage.

In case you’re wondering, my family doc tests my thyroid panel regularly, and it has always been in the normal range, thanks to these long-expired pills.

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