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Medicine Expiration Dates – What Do They Mean?

As we went through Grandpa’s belongings after his passing one of the things we came upon were some carefully labeled but expired medicines.  And I don’t mean a couple of months expired; generally they had expired a decade or so ago.  Grandpa was always a frugal guy – cutting the mold off the cheese and eating the rest or grabbing and consuming the two-week-old casserole with a questionable odor before we could get it to the disposal.  So what about these expired meds?  Had his frugality in keeping these old prescriptions for later use posed any threat to him?  My bet is that almost all of us keep and take a few meds past their expiration date.  So just how risky is that?

In 1979 a law was passed requiring drug manufacturers to put an expiration date on their meds.  Up to this date the manufacturer guarantees the potency and safety of the medication.  So far so good, but how quickly do medicines lose their safety and efficacy after these expiration dates have passed?  Some years back, the Food and Drug Administration carried out a study to answer that question at the request of the military. The military had a large and expensive stockpile of drugs which they hated to just discard and replace every few years. The study was carried out on over 100 drugs, including both prescription and over-the-counter meds.  They found that more than 90% were both safe and effective even 15 years after their expiration date.

Ok, so for many medicines passing the expiration date doesn’t really mean the medication is no longer effective or is unsafe to use.  But are there exceptions to this?  One important exception is the EpiPen.  They have been in the news recently because of how crazy expensive they can be so there is a temptation to not refill them after the expiration date has passed.  Unfortunately a study done several years back found that the pens do in fact lose potency soon after passing their expiration date.  That means you really do need to keep your EpiPens up to date.  By the way, if somehow you find yourself treating a severe allergic reaction with an EpiPen and notice it’s expired, give it anyways (as long as it isn’t discolored and you can’t see particles in the fluid) since some potency is better than nothing.  But do this as you dial 911 or get immediate emergency care.  Other important exceptions would be nitroglycerin, insulin, liquid antibiotics, and aspirin.  Tetracycline may also be an exception although there is still debate about it.

So you’ll have to decide whether to take Grandpa’s approach and save almost everything or the other extreme of tossing everything the moment it hits its expiration date or some place in between.  For most meds, a little laxity with that stamped on expiration date is pretty reasonable.  Hey, Grandpa lived a healthy 90 years with his approach.

Andrew Smith, MD is board-certified in Family Medicine and manages the Trinity Medical Associates office at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835.  He is accepting new patients with commercial insurance in a typical fee-for-service model and those without insurance or with Medicare in a Direct Primary Care model.


Red Eyes

Recently, just as I thought I was turning the corner on dealing with my own upper respiratory infection, one of the eyes looking back at me from the mirror was red with some thick crusty stuff in and around it (affectionately termed “eye boogers” by many).  I had that common malady which goes by a variety of names such as conjunctivitis, pink eye, or red eye.  This is an inflammation or infection of the conjunctiva which is the thin clear tissue covering the white part of the eye and the inside of the eyelid.  When it gets inflamed it turns pink or reddish.

So what causes conjunctivitis?  The big three are bacterial, viral and allergic.  The first two of these are infectious and are about equal in frequency.  Bacterial conjunctivitis tends to look a bit more angry and red and to have a thicker discharge, sometimes leaving the lids pasted shut in the morning.  Viral conjunctivitis tends to have a more watery discharge, but there is a lot of overlap of signs and symptoms between these two types of conjunctivitis.

The main practical difference is that bacterial responds well to antibiotic drops while viral does not, needing to just run its course.  By the way, with my recent case of bacterial conjunctivitis I was reminded how challenging the simple job of putting drops in your own eyes can be.  My eyelashes and cheeks were more likely to be watered by my eye drops than the actual eye.  At any rate, both of these types of conjunctivitis are quite contagious.  So if you have either one in one eye it is vital to not rub that eye and then the other or wipe a towel or wash cloth from one to the other as it will spread the infection to the unaffected eye.  Even more important is to not share towels or wash cloths with uninfected family members while you have conjunctivitis.  Likewise, rubbing your eyes leaves your hand with infectious material that can then be spread to others.

This is why most daycares and schools encourage children with conjunctivitis to be kept home until symptoms have cleared.  Unfortunately, in the case of viral conjunctivitis, that can be up to 1-2 weeks in some cases.  Bacterial conjunctivitis is usually considered non-contagious after 24 hours of antibiotic drops.

Although these kinds of conjunctivitis are usually not dangerous, there are a couple of special cases that are more worrisome.  In newborns, any conjunctivitis should be checked out quickly and treated aggressively as there are some sight-threatening infections that occur in the newborn period.  That’s why states, including Tennessee, mandate an antibiotic eye ointment for all newborns. Other types of conjunctivitis, which are more serious but also more rare, include herpes, gonorrhea and chlamydia.  All require aggressive, specific treatments to clear them up and prevent eye damage.

Allergic conjunctivitis looks similar to viral, with watery discharge, pink color and itching.  It tends to persist through an allergy season and responds to oral allergy meds and allergy eye drops.  It is, of course, non-contagious but can worry teachers and daycare overseers if they think it is one of the contagious types of pink eye.

Another tricky thing about a pink or red eye is that it is not always conjunctivitis.  Similar symptoms can be caused by getting something in the eye (foreign body, chemical, or other irritant).  This is particularly likely if only one eye is affected.   Other conditions such as glaucoma or inflammations of other structures in the eye (iritis, uveitis) are also causes of a pink or red eye.

So if you wake up to that not-so-pretty color of pink in your eye, or a bunch of eye boogers, given the varied causes and repercussions, it’s a good idea to let your doc have a look.


Direct Primary Care Presentation and Open House

I will be hosting the next presentation on Trinity’s Direct Primary Care program this Saturday, October 29th at 12:30pm at the Trinity Medical Associates of Hardin Valley office located at 10437 Hardin Valley Rd.  Feel free to come hear about the program, ask questions, and view the new office.  Overflow parking will be at the church next door, Hardin Valley Church, which is just east of our office.

In this time of year as so many people are having to change their health INSURANCE coverage, this is an opportunity to hear how you can obtain lower cost, personable, and relational healthCARE regardless of which insurance you might have.

If you have more questions feel free to call 244-1800 to reach the Hardin Valley office or email me directly at