As a doctor, I tell patients to get rid of these 5 medications

Some of us have a medicine cabinet that looks less like a pharmacy and more like a museum. It’s why I make a point to do an inventory at least once a year with my spring cleaning.

You never know what you’ll catch: a half-empty bottle of sinus medication from the winter-that-shall-not-be-named, or a leftover prescription medication that you should’ve tossed a while ago but instead shoved to the back of the drawer “just in case”- only for it to languish in darkness for years.

You might even find medications that made sense with the advice at the time but aren’t worth holding onto today. Every year, medical guidance evolves — sometimes quietly — and our cabinets don’t always keep up.

I find myself consistently surprised by how many people are still faithfully taking medications that science has either proven ineffective or determined to be actively harmful for them. Here are five that deserve a second look, a quick conversation with your physician and, quite possibly, disposal.

Aspirin for primary prevention of heart disease

For decades, a daily low-dose aspirin became a rite of passage for many people over 50 who wanted to protect their hearts. (It’s sometimes called “baby aspirin” because it’s such a low dose, often around 81 mg, but it’s not safe for children, so you should probably retire that name, too.)

Doctors recommended it because aspirin reduces clotting, which can contribute to heart attacks. But in 2022, the U.S. Preventive Services Task Force updated its guidance to recommend against initiating aspirin for primary prevention of cardiovascular disease — meaning people who have never been treated for a heart attack or stroke — in adults 60 and older.

The 2023 American Geriatrics Society Beers Criteria — which is the gold standard list of medications that are potentially inappropriate for older adults — went further, moving aspirin to a flat “avoid initiating” designation.

The reason? For people who have never had a heart attack or stroke, the data found that the bleeding risks from aspirin, including gastrointestinal bleeding, outweighed the cardiovascular benefits.

An important caveat: If you have already had a heart attack or stroke, aspirin becomes useful for secondary prevention — meaning it may help prevent future problems — and that’s a different conversation.

The same goes for adults ages 40-59 who are at increased risk of heart attack or stroke but haven’t had one. These categories require an individualized decision in consultation with your physician. But, too often, I’ve seen older adults who have been on low-dose aspirin for years without any history or high risk of cardiovascular disease — mainly because no one took the time to pause and review why and whether it made sense to continue.

The ‘decongestant’ in many cold medicines

Phenylephrine is the active ingredient in many popular over-the-counter nasal decongestants. However, in September 2023, a Food and Drug Administration advisory committee voted unanimously that, based on the data, phenylephrine is no more effective than a placebo. It turns out phenylephrine gets so thoroughly absorbed in the gut before it reaches circulation, very little of it makes it to your nasal passages.

We saw a rise in phenylephrine’s dominance after pseudoephedrine — which actually works — was moved behind pharmacy counters in 2006 to prevent its use in methamphetamine production. Drug manufacturers reformulated their products with phenylephrine — and we’ve been paying for a placebo ever since.

So if you want a product that really works, you can still easily get pseudoephedrine — you just have to ask for it at the pharmacy and show your ID. But that bottle of pure phenylephrine sitting in your cabinet? Do yourself a favor and toss it.

This stand-alone stool softener

Colace doesn’t work. Or more precisely, it doesn’t work meaningfully better than a placebo when used as a stand-alone stool softener — and the evidence has been pretty clear for years.

Randomized controlled trials dating as far back as the 1950s have found that docusate sodium provides no statistically significant benefit over a placebo for constipation. In one of the most rigorous of these, a 2013 randomized double-blind placebo-controlled trial found that hospice patients — a population that often struggles with constipation — were randomized to receive either docusate plus senna or a placebo plus senna.

The researchers found no difference between the two groups in terms of stool frequency, volume, consistency or even patients’ perceptions of how complete their evacuations were. Because both groups received senna, the trial was well-designed to isolate docusate’s contribution — and that was essentially zero.

Talk to your physician if you have constipation about more effective options that you can buy over the counter, such as psyllium.

This antihistamine for sleep or allergies in older adults

Diphenhydramine, which is the active ingredient in Benadryl, feels harmless because it’s been around forever and is fairly inexpensive. It is not harmless, particularly for older people.

The 2023 Beers Criteria lists diphenhydramine with a “strong” recommendation to avoid in older adults, citing its potent side effects, which include confusion, sedation, dry mouth, constipation, urinary retention and a higher risk of falling down. Older adults clear it from their systems much more slowly than younger people, meaning it hangs around longer and hits harder.

This is especially crucial to consider when you’re already on other common medications with anticholinergic properties, such as certain antidepressants, bladder drugs or stomach medications. Adding diphenhydramine can rapidly compound the problem.

For allergies, second-generation antihistamines such as loratadine or fexofenadine are at least as effective and less sedating because they don’t cross the blood-brain barrier as easily.

If you’re over 65 and using diphenhydramine for any reason, sleep or otherwise, it’s worth having a discussion with your doctor.

Codeine-containing cough syrup

That bottle of codeine cough syrup in the back of your cabinet, the one from a respiratory infection three winters ago, has two problems. First, it’s expired. Second, it probably didn’t work as well as you think.

A 2014 Cochrane review found that based on two older randomized control trials, codeine is no more effective than a placebo for reducing coughs from the common cold.

What codeine does reliably produce is constipation, sedation and, in rare cases, respiratory depression. It also carries the risk of dependence, so leftover bottles are exactly the kind of thing that shouldn’t be left sitting around accessible to family members (and the FDA has restricted codeine in children under 12 for good reason).

What I want my patients to know

Evidence changes, so our medicine cabinets should, too. Start with your expired medications. Most drugs lose potency gradually after their expiration date. For critical medicines like EpiPens, which can save your life if you have a dangerous allergic reaction, get a fresh set.

Check out the guidance from the FDA website for how to safely dispose of your unused medications. And remember, don’t flush your medications unless they’re listed on the FDA’s “flush list.”