The use of expired resuscitation medications for life-threatening first aid conditions: a systematic search and narrative review

Abstract

Introduction

First aid providers may encounter life-threatening conditions requiring treatment with medications. Given that resuscitation medications in first aid kits may be administered infrequently, first aid providers may face situations where only expired medications are available.

Objective

This systematic search with a narrative review aims to evaluate the efficacy and safety of expired life-saving medications commonly used in first aid.

Methods

We conducted a search of PubMed, EMBASE, Web of Science, CINAHL, and Cochrane Library (inception–April 2025) for studies regarding expired albuterol, epinephrine, aspirin, or naloxone. Two reviewers independently screened titles and abstracts, followed by full-text reviews to determine eligibility. We included randomized controlled trials (RCTs), clinical trials, systematic reviews, meta-analyses, and observational studies evaluating expired medications’ potency and safety. Data extraction focused on study design, population, interventions, comparators, outcomes, and key findings.

Results

After deduplication, 1398 records were screened, and 17 studies met inclusion criteria: albuterol (n = 2), aspirin (n = 4), epinephrine (n = 8), and naloxone (n = 3). Albuterol (salbutamol) retained 98 % active drug 20–30 years past expiration. Aspirin (acetylsalicylic acid) could retain active drug for up to 40 years after expiration. Epinephrine autoinjectors could retain epinephrine for at least 36 months after expiration. Naloxone retained active drug for at least 19 months after expiration. There was minimal evidence of harmful degradation products.

Conclusions

Under individual study conditions, the evaluated expired first aid medications maintained active drug and were largely free of harmful byproducts beyond their labeled expiration dates. Scientific and ethical principles may suggest possible benefits from expired medications in emergency settings when alternatives are unavailable.