Bengaluru: How dangerous can expired medicines be? The question has gained urgency after police recently busted a fake drug racket in Bidadi and seized expired medicines worth Rs 35 lakh from a farmhouse. While expired drugs do not necessarily turn toxic immediately after crossing their expiry date, doctors say loss of potency can lead to treatment failure, while certain high-alert medicines can cause serious harm if used after expiry.“Expired drugs primarily lose their efficacy. But with high-alert medications used in CCUs and ICUs, chemotherapy drugs and certain cardiac medicines, administering them after expiry can potentially cause toxicity and harm to the patient,” said Dr Preema Khan, consultant — internal medicine, KIMS Hospitals, Electronics City.She added that expired antibiotics were particularly concerning, as reduced effectiveness could result in treatment failure and potentially contribute to difficult-to-treat infections and drug resistance.According to doctors, the consequences of taking an expired medicine depend on the drug, its formulation, storage conditions, dose, and the patient’s health. “An expired medicine does not necessarily become hazardous on the very day it crosses its expiry date. In most instances, the concern is it becomes less effective or ineffective because it loses potency over time. However, stability differs between medicines and also depends on how they have been stored,” said Dr Manohar KN, lead consultant – internal medicine and diabetology, SPARSH Hospital, Hennur Road.Heat, humidity and sunlight can affect the chemical and physical stability of medicines, he added. Liquids, suspensions, and eye drops may be particularly vulnerable to degradation or contamination. Importantly, a medicine may appear normal even when its chemical stability has been compromised.According to Dr Aravinda SN, lead consultant – internal medicine, Aster RV Hospital, heat can accelerate chemical breakdown, while humidity can affect tablets, capsules and powders. Certain light-sensitive medicines can also degrade when exposed to sunlight or UV light.The risk is particularly significant for insulin, injectable drugs and hormones, where maintaining the recommended storage temperature is critical, doctors said.Labels matterThe concerns become more serious when the medicine is spurious or incorrectly labelled. “The risk can be much higher because a spurious medicine might include the wrong ingredient, mismatched strength, contaminants, or even an active component that is missing entirely,” said Dr Aravinda.The effects can range from nausea, vomiting, abdominal pain, dizziness and drowsiness to confusion, palpitations, changes in blood pressure and allergic reactions. Severe poisoning can cause seizures, breathing difficulties, altered consciousness and abnormal heart rhythms.Dr Preema said hypersensitive patients could develop skin rashes and other allergic reactions, while severe cases could involve breathing difficulty, low blood pressure, hypoxia and even cardiac or respiratory arrest.Doctors also cautioned that contaminated, incorrectly formulated, or excessively dosed medicines can cause organ damage, particularly to the liver and kidneys. “The liver metabolises a lot of medicines, while the kidneys help eliminate many drugs and their breakdown products. An unexpectedly high dose, toxic ingredient or medicine unsuitable for a particular patient can therefore increase the risk of organ injury,” said Dr Aravinda.From minutes to daysToxicity can occur within minutes or hours with some rapidly acting or overdosed medicines, while in other cases symptoms may take days to appear. Children, older adults, pregnant women and patients with kidney or liver disease may be particularly vulnerable to medication-related harm.Doctors advised patients who suspect they have taken an expired, spurious or incorrectly labelled medicine not to wait for symptoms before seeking medical advice, particularly if the identity or dose is unclear. “They should also hang onto the medicine strip, bottle, packaging, batch number and expiry details… They should jot down roughly how much was consumed and when it happened. Don’t induce vomiting or take another medicine ‘just in case’ unless a healthcare professional tells you to,” said Dr Aravinda.Medical experts said treatment failure may sometimes be the first indication that a medicine has not worked as expected, rather than an obvious toxic reaction. Dr Preema also stressed the need for healthcare providers to strengthen systems for tracking expired and near-expiry medicines to prevent expired products from being administered or relabelled.
