Dental teams are used to managing medication details: local anesthetics, emergency supplies, pain management recommendations, and the medications patients bring into the medical history conversation. But one simple question still comes up often: What should you do when a medication is past its expiration date?

In this episode of Medical History Mysteries, Pamela Maragliano, DMD, asks Tom Viola, RPh, CCP, how dental professionals should think about expired medications in the office and at home. Viola explains that some medications may still have activity after their expiration date, while others may become less effective or carry specific concerns. But for patient care, the practical answer is much clearer: expired medications should not be used.

The issue is not only whether an expired drug is “still good.” It’s whether it can be expected to work as intended—and whether someone might respond to reduced effectiveness by taking more than directed. That, Viola explains, can create a more serious risk than the expiration date itself.

The takeaway for dental teams is straightforward: Check the medication supplies in your operatories, cabinets, emergency kits, and home medicine cabinets. If something is expired or close to expiring, replace it. “Probably still active” is not a standard of care.

Episode transcript

Pamela Maragliano: Hey, Viola. Can I take expired meds? Find out today on Medical History Mysteries.

Welcome to Medical History Mysteries, where we solve common and uncommon mysteries regarding medical histories. With me, as always, is Dr. Tom Viola. I'm Pam.

Today we're going to talk about expired medications. So how expired is expired? Could I take them? Should I take them? And/or should I get rid of what I have?

Tom Viola: I get this question in almost every seminar I present. I'm on the lecture circuit and I'm presenting almost 100 times a year. I always get this question, either out there in the general audience or with people pulling me aside at the lunch break saying, “Hey, I've got some expired lidocaine in my office. Can I still use that?”

This always comes up between medical doctors I speak for, dentists, hygienists, and even members of the general public who come to me and say, “I've got this medicine in my medicine cabinet. What do you think I should do? It says it expired last month. It's still good, isn't it?”

Every time I get this question, my answer is basically the same, which is yes or no. And that way I kind of cover myself.

The bottom line is that, more than likely, medications, when they expire, depending on how long they've been expired for, are probably still active to some extent.

But as a health-care professional, I cannot say that it's a good idea or that you can use medications that are expired. It's an oath we all take as health-care professionals to maintain standards of practice. And the standard of practice in medicine is we don't use medications that are beyond their expiration or beyond their use-by date.

Do expired medications become harmful?

Pamela Maragliano: Okay. So has anyone ever found harm in using a medication that's been expired?

Tom Viola: Go look it up. There are case histories to back that up.

Certain medications are just weaker when they're expired. So they're still active, but they're less active than they should have been before their expiration date. After their expiration dates, they’re less active, but they don't cause harm. They just don't work as well.

And you could construe that as causing harm because they didn't do their job, but they're not toxic. Let's put it that way.

Some medications, like tetracyclines, may be considered toxic when they're taken after their expiration date. And there's been a lot of talk about patients using penicillin beyond its expiration date and that potentially—and this is just conjecture—increasing the risk of becoming penicillin allergic later.

So if you're saying to yourself, “Well, why don't you know the answer to this?” the bottom line is there's really no research into, or very little research into, whether or not you can use an expired drug because we're not supposed to be using expired drugs. So that's the reason why there's very little information about this.

As a health-care professional, I would never administer a medication that is expired, nor would I recommend that my patients take something that's expired.

The practical question: What about at home?

Pamela Maragliano: That’s Dr. Pam. What if I'm home and I have a headache and I decide I want to take Tylenol or Advil or both, whatever, and say it expired last month, six months, last year? Could I take it? Will it still help me?

Tom Viola: That's a very good question. And I'll give you the best answer I can.

As a pharmacist, I've often said, and always will say, I'm never going to use expired medication, even if it's an available over-the-counter drug or if it's a prescription drug or whatever.

Have there been occasions when, in the midst of the night, I wake up with a headache, stumble into the bathroom, pull a bottle of Tylenol, take two, and forget all about it, only to discover, to my horror, the day after, that this bottle was expired?

Has that happened? Yes.

Did I suffer any ill effects? No.

Did the Tylenol work any better or any worse? Couldn't tell you because I didn't know at the time they were expired.

So I guess the bottom line is, I think we've all taken expired drugs, maybe knowingly or not knowingly, and have probably done just fine. But I'm always worried more about them not working as they're expected to or as they're intended to.

Why taking “a little extra” can be risky

Tom Viola: I want to make sure that I get that point across because the problem is, let's say you take an expired drug and it doesn't work as well as you'd like it to. Maybe you'll think at that point, “Well, if I just took more, then it would work as well, right? The drug's weaker. I'll just take extra.”

Well, that's a dangerous perspective to have because that leads to overdose.

And then the downward spiral comes: you're taking more of the drug, even though maybe it’s less effective. I'm more worried about the risk of overdose in that situation than I'm worried about the risk of the drug being expired itself.

So to avoid that altogether, I tell everybody the same thing, and I try to practice what I preach as well: Go through your medicine cabinet, or wherever you store your medications, and if it's expired or within 30 days of the expiration date, toss it.

Because there's no data to suggest that it's not harmful. Well, there's some data to suggest that. There's data to suggest that it is harmful. Well, yeah, there's data to suggest that too.

Bottom line is, why bother? Why even take the chance? It's easy enough to just toss it and buy a fresh supply. And then we don't even have to have that debate.

Out with the old, in with the new

Pamela Maragliano: All right. It's definitely not worth the risk. And I do like your purist attitude towards the topic.

So I guess we're still in the beginning of the year. And with a new year, we like to out with the old, in with the new. And that also goes for all of the medications that you have at home.

Look at what you have at home and in the office. Make sure it's not expired. And if it is, time to renew your supply.

As always, thank you for this Medical History Mysteries, and I will see you next week.

Tom Viola: Looking forward to it.

Pamela Maragliano: Thanks. Bye, everyone.