Melanie Cole, MS (Host): Have you thought about cleaning out your medicine cabinet, but you're not really quite sure what to do with expired or old prescription medication or over the counter medication? Do you flush them or do you throw them out? What do you do with them? Well, we're here to talk about that today, on It's Your Health Radio with Henry Mayo Newhall Hospital.

I'm Melanie Cole, and joining me is Courtney Mattley. She's the Pharmacist and Manager of Pharmacy Services at Henry Mayo Newhall Hospital. Courtney, I'm so glad to have you join us today. So first, tell us a little bit about why it's important for people to learn to dispose properly of their expired medications.

Courtney Mattley, PharmD: So, so nice be back here again. I'm really excited to talk about this topic because it's one of those topics that people don't really think about when it comes to medication safety but it is very important to dispose of medications properly. And I actually looked at the statistics for this, when this topic came about, when I knew I was gonna be doing this, and just last year there was 36,000 admissions into the hospital for kids under five years old who had accidentally taken some medications that were at their house.

And that's just when it comes to the kids safety. But there's also pets, there's also things we need to consider with expirations and the safety of taking things that might already be expired and not working anymore. So it is very important to know how to dispose of medications properly and when to do so.

Host: So before we get into disposing of them, and I want to start with over the counter medications, but Courtney, expired medication, we all want to know whether it's Robitussin or Tylenol or something like an antihistamine, one of these things. If we look at it and it says, and we all know we have them in our medicine cabinet, Benadryl, any of these things.

We look at it and it says August of last year. Now that's only maybe six months. Is this medication still good? I mean, these are expensive. Do we throw them out? We'll talk about disposing, but can we still use them? That's the question I'm asking.

Courtney Mattley, PharmD: So there's two things to consider. Is it going to work? And is it safe? So let's talk about is it going to work. If it's expired, that means after that date, the manufacturer has not tested that medication to say that it's still going to work after that date. So it might have activity, it might not.

Different medications will degrade at different rates. So there's really no guarantee. Let's just take an antibiotic for example. So, if you have an infection, you really want to make sure that it works, right? So, if you're taking a medication that's only half effective, it may not work against that infection.

It might increase the risk of antibiotic resistance. And then there's the other hand of like, you want to make sure that it's effective and you're actually getting the treatment. So, there's both things to consider is, is it safe? There's even some medications that change composition as it degrades and as it becomes a whole different molecule.

So, is it safe? Maybe. Is it going to be effective? Not as effective. And there's just no guarantee at when that transition will happen because there's no testing after that date. So, ideally, no, we would not be taking medications after it's expired.

Host: Good answer. Because that does really make a lot of sense that it might not be as effective. Whether it's safe or not is debatable, but it might not work the way that it's supposed to. And especially when you're talking about an antihistamine, an allergy medication, something like that, you really want it to work.

So starting with over-the-counter medications. What do we do with those Benadryl and those Robitussins and those things that we haven't used? If we're lucky, we haven't had to use them. And now it's six months past the date. Or in my mother's medicine cabinet three years past the date. Do we dump them down the toilet? Do we throw them out? What do we do with just over-the-counter medications?

Courtney Mattley, PharmD: Yeah, so my answer will be the same whether it's an over-the-counter or a prescription. But there's three paths that somebody could take. The best path, hands down, most recommended is to bring any unused or expired medication to a drug take back program. And, usually that's going to be available at any pharmacy.

So wherever you pick up your medications, you can usually bring back unused or expired medications and they will make sure that it's disposed of in an incinerator that there's a whole, you know, legal thing that we do as pharmacy to make sure that they are disposed of and broken down properly.

So that's the best, no matter what option that somebody can take. And it's almost every outpatient pharmacy is going to have that option. Most hospitals will have that option as well. So, we are part of a drug take back program as well here at Henry Mayo. Now let's say somebody has no access to a drug take back program.

Now the answer is depends on the drug. So if the medication is considered acutely toxic in small quantities, the recommendation is actually to flush it down the toilet. And that list is available on the FDA website. So if somebody Googles FDA flush medication list. It's not a very long list and it's very easy to access.

So because it's something that can be acutely toxic and if somebody gets a hold of it from the trash or a pet or a kid or just somebody intentionally going through the trash, if they are exposed to it in small quantities, it can be toxic. So it's best to actually just get it out of access from anybody.

And that's the flush list. If it's not on the flush list, then it should be disposed of in the trash, if you can't access a drug take back program and there is an actual way to dispose of this safely and that is to remove them from the bottle, assuming they're tablets or capsules, and put them in a, let's say, a Ziploc bag mixed with the dirt or cat litter.

That's the recommendation. And if it's a tablet or capsule, don't break it down. Don't grind it up. They might think destroying it is better, but no, that's actually more exposure to the environment. So leaving it whole in the capsule or the tablet form is better. But not in one big bottle. Have it mixed with cat litter or dirt.

And then there's the bottle because that's your information, right? That's your personal information, your medication. So if you're disposing of the empty bottle at that point, just make sure you scratch out or get a sharpie and, make sure it's covered.

Host: Wow, that was some of the best information I've ever heard. didn't know there was a flush list. First of all, I always

We're not supposed to flush anything. That was, that's really cool to learn and also that we should be putting them in with cat litter or with dirt or something and not grinding them up for pills and things.

That's just so interesting. Now you mentioned before, antibiotics, if they're not expired and we know you're supposed to take your whole course of antibiotics and we know about antibiotic stewardship, we're learning a lot about that.

But if you didn't take the whole amount, and you're saving them. And I'm also going to include on antibiotics, pain pills, like after surgery.

You know, I had surgery, and I didn't take any of those pain pills, but I still have them in my medicine cabinet, in case I'm ever in extreme pain, and don't go to a doctor, and I think, Okay, these were prescribed for me, can I still take them? What do you think about hoarding or saving these pills for a time when we might need them?

Courtney Mattley, PharmD: So let's start with antibiotics. Antibiotics are very specific to maybe the previous infection that somebody had against a specific bug or a source. Like there's certain medications we use more commonly for respiratory infections, like if you have pneumonia, and then there's other medications we might use more commonly for a urinary tract infection, and these antibiotics get to the body differently, so some antibiotics can penetrate the urine, some cannot. So, if somebody's saving their medications for a future date and then all of a sudden they have a UTI, that antibiotic in your cabinet, even if it's not expired, may not even get into the urine and do what it's supposed to do.

So now you're just leaving yourself at risk of that infection getting worse or spreading or, maybe it affects it a little bit, but not enough. So now there's antibiotic resistance that can be developed. So, very mindful when somebody's taking antibiotics that it's the right medication.

And I think if there's any question, you should be talking to the provider about, like, hey, I have this in my cabinet, can I use it? And they'll probably just say, no, I'm going to give you a new prescription. and they are active. If they're in your cabinet and they're not expired, they're active.

But it doesn't mean it's going to work because it may not even get to the body where your infection is if it's not used appropriately. Now pain medications, they're going to treat pain no matter what, so it's not like it's not going to get to the right site or things like that, it treats pain everywhere.

Now, the dosing is very important, so if somebody's saving it for themselves, that's one thing, because you know at least that dose was appropriate for you on a previous time you had pain, but if it's being shared, that's where I would really be cautious because your tolerance towards that pain medication could be different than somebody else's, especially if it's somebody smaller than you or has never been exposed to that medication. So I would caution anybody with sharing pain medications because it will affect somebody differently than you and that can lead to some major problems.

Host: That's great advice, except, really, there is nobody smaller than I am, Courtney. I mean, literally, four foot nine, so I'm guessing there's not too many people smaller than I am, but that is really great advice. Before we wrap up, you've said that there's a flush list. You've told us how to dispose of over the counter medications and expired other medications.

What would you like to wrap up, key message to be today for this vodcast and podcast. If we're looking in our medicine cabinet, what are we looking at? Can things like wraps and gauze bandages and band aids, any of these kinds of things, because, you know, some of us have band aids in there with yellow around the edge or something along those lines, and even Neosporin.

Okay, so before we wrap up today, I want you to look in my medicine cabinet and say, okay, you've got neosporin and this antibiotic cream, hydrocortisone cream. Do those kinds of things expire? What do we do with them if they do? And wrap it all up for us.

Courtney Mattley, PharmD: Yeah definitely. So any medication, whether it's over-the-counter or a prescription, a cream, a tablet, a liquid, they're all medications. They all have an expiration date and they all will degrade and become less effective over time. Some of them might actually become a more toxic form of themselves, if it's kept long enough.

So I would recommend every year, January is a great time to make that on your list of a New Year's resolution is to go through your medicine cabinet and look at everything. Look at all your expiration dates and just be mindful of the safetiness of it and how many people might accidentally expose somebody else to medications because they're just left there.

There's so many medications in cabinets that maybe the wrong person gets into and if it's a kid, I mean, that can really lead to somebody needing to be hospitalized if there's an accidental ingestion. Those child caps are not very childproof. I have a two year old and a five year old and they can open them.

So, just be very mindful of the fact that keeping medication, just in case can cause harm to somebody else down the line if they're not supposed to be ingesting them. And then for yourself, you don't want to take something that's not effective or something that can harm you. So look at your cabinet once a year and then make sure you're disposing of it correctly.

If you're in the Santa Clarita Valley, you have many options for a drug take back program, whether it's an outpatient pharmacy or bringing them to Henry Mayo and we'll make sure that they're disposed of properly.

Host: Thank you so much, Courtney. What a great guest you are. And to learn more about Henry Mayo's Prescription Medication Drop Off Program, you can visit henrymayo.com/dispose. You can also visit the free health information library at library.henrymayo.com. There's so much free information there.

Thank you so much for joining us today. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.