The expiration date of medicines is the period during which the manufacturer guarantees their effectiveness. But what happens if you take a pill past its expiration date? A pharmacologist discussed an unexpected consequence of taking expired antibiotics.
We often buy medicines in advance, hoping that we won’t need them. As a result, dozens of packs of expired pills accumulate in the home medicine cabinet. It’s good if you notice and dispose of them in time. But what if you hurriedly took one without checking the expiration date on the package, or hoped that the medicine would work even after its expiration date?
Such situations do occur. You decide to take an antibiotic, but you can’t buy it over the counter at the pharmacy. And then you find an unfinished pack in your home supplies. However, experts warn: taking expired antibiotics is particularly dangerous, as they can cause the potentially fatal Fanconi syndrome. We explain what this is and how it manifests.
“Spoiled milk can be detected by its smell. With medicines, this is impossible,” says Olga Veselova, head of the Department of Pharmacology and Clinical Pharmacology at Krasnoyarsk State Medical University.
The expert emphasized that medicinal products are safe and effective only within the timeframes specified by the manufacturer and provided they are stored correctly.
“Taking expired medicine is categorically prohibited, as its toxic effect may manifest. For instance, prolonged storage of antibiotics leads to the formation of oxidized products that cause Fanconi syndrome—a potentially fatal disease with impaired kidney function,” explains the pharmacologist.
The disease is named after Guido Fanconi, a Swiss pediatrician who first described the pathology. Fanconi syndrome is a kidney disease in which the renal tubules are unable to reabsorb glucose, amino acids, and other substances necessary for the body. As a result, all of this is lost in urine, leading to numerous problems.
Fanconi syndrome can be congenital or acquired. In children, the disease develops due to genetic mutations and manifests as developmental delays and rickets. In adults, Fanconi syndrome can develop due to poisoning with heavy metal salts such as lead, mercury, uranium, and cadmium, due to chemical exposure, kidney diseases, and multiple myeloma (a bone marrow tumor). Another common cause of the disease is the consumption of expired antibiotics.
There have been reported cases associated with expired oral antibiotic tetracycline that led to Fanconi syndrome. The sources of such toxicity are the degradation products of tetracycline (such as epiangidrotetracycline or anhydrotetracycline). They damage the cells of the kidney tubules, disrupting their function.
“Patients experienced symptoms such as nausea, vomiting, and metabolic acidosis (increased acidity in the body—editor’s note) within 2–8 days after taking the expired antibiotic,” clinical cases are described in the journal Antibiotics.
Other signs of Fanconi syndrome include increased thirst, frequent urination, weakness, fatigue, and muscle atrophy, as well as bone pain.
Additionally, medications associated with the development of the syndrome include some antiviral agents, such as nucleoside reverse transcriptase inhibitors, chemotherapeutic agents (e.g., cisplatin), immunosuppressants (e.g., azathioprine), and carbonic anhydrase inhibitors (e.g., acetazolamide).
With timely treatment, detoxification, and replenishment of lost nutrients, Fanconi syndrome caused by expired medicines resolves, and the function of the renal tubules is restored. However, recovery may take several weeks.
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