FDA’s Flush List for Certain Medicines

 

If you received specific disposal instructions from your healthcare provider (e.g., doctor, pharmacist) for your unused or expired medicine, you should follow those instructions to dispose of your medicine. The best disposal option is to find a drug take back location, which may be found in retail, hospital, or clinic pharmacies; and/or law enforcement facilities.

If you don’t have a drug take back location near you, check the FDA’s flush list to see if your medicine is on the list. Medicines on the flush list are those (1) sought-after for their misuse and/or abuse potential and (2) that can result in death from one dose if inappropriately taken.  If children, adults, or pets in your home accidentally or intentionally ingest, touch, misuse, or abuse a medicine on the flush list, they can suffer serious consequences including death. An example of a medicine on the flush list is fentanyl transdermal system (also known as a fentanyl patch), which contains an opioid.  If a drug take-back program is not available, flushing medicines on the flush list helps keep everyone in your home safe by making sure these powerful and potentially dangerous medicines (when used inappropriately) are not accidentally or intentionally ingested, touched, misused, or abused.

Remember, don’t flush your medicine unless it is on the flush list.

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Impact of flushing medicines on the environment:

FDA recognizes that the recommendation to flush a few specific medicines when a take back program is not readily available raises questions about the impact of the medicines on the environment and the contamination of surface and drinking water supplies.

In an effort to address this concern, FDA staff published a paper entitled "Risks Associated with the Environmental Release of Pharmaceuticals on the U.S. Food and Drug Administration ‘Flush List’". This paper evaluates the environmental and human health risks associated with the flushing of 15 active ingredients found in these medicines. FDA concluded that these medicines present negligible risk to the environment. However, some additional data would be helpful for confirming this finding for some of the medicines.

FDA believes that the known risk of harm, including toxicity and death, to humans from accidental exposure to medicines on the flush list far outweighs any potential risk to human health and the environment from flushing these unused or expired medicines. Remember only flush medicines on the flush list if a take-back option is not readily available. FDA will continue to conduct risk assessments as a part of our larger activities related to the safe use and disposal of medicines.

Check out the Medication Disposal Q&A for more information about flushing.

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Drugs That Contain Opioids

Any drug that contains the word “buprenorphine”

BELBUCA, BUAVAIL, BUTRANS, SUBOXONE, SUBUTEX, ZUBSOLV

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Any drug that contains the word “fentanyl”

ABSTRAL, ACTIQ, DURAGESIC, FENTORA,ONSOLIS

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Any drug that contains the word “hydrocodone” or “benzhydrocodone”

APADAZ, HYSINGLA ER, NORCO, REPREXAIN, VICODIN, VICODIN ES, VICODIN HP, VICOPROFEN, ZOHYDRO ER

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Any drug that contains the word “hydromorphone”

EXALGO

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Any drug that contains the word “meperidine”

DEMEROL

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Any drug that contains the word “methadone”

DOLOPHINE, METHADOSE

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Any drug that contains the word “morphine”

ARYMO ER, AVINZA, EMBEDA, KADIAN, MORPHABOND ER, MS CONTIN, ORAMORPH SR

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Any drug that contains the word “oxycodone”

CODOXY, COMBUNOX, OXADYDO (formerly OXECTA), OXYCET, OXYCONTIN, PERCOCET, PERCODAN, ROXICET, ROXICODONE, ROXILOX, ROXYBOND, TARGINIQ ER, TROXYCA ER, TYLOX, XARTEMIS XR, XTAMPZA ER

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Any drug that contains the word “oxymorphone”

OPANA, OPANA ER

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Any drug that contains the word “tapentadol”

NUCYNTA, NUCYNTA ER

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Drugs That Do Not Contain Opioids

Any drug that contains the term “sodium oxybate” or “sodium oxybates”

XYREM, XYWAV

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Diazepam rectal gel

DIASTAT, DIASTAT ACUDIAL

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Methylphenidate transdermal system

DAYTRANA

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Dispose "Non-Flush List" Medicine in Trash

 

If no drug take back sites, locations, or programs are available in your area, and there are no specific disposal instructions (such as flushing) in the medication guide or package insert, you can follow these simple steps to dispose of most medicines in your trash at home*:

1. Mix medicines (liquid or pills; do not crush tablets or capsules) with an unappealing substance such as dirt, cat litter, or used coffee grounds;

2. Place the mixture in a container such as a sealed plastic bag;

3. Throw away the container in your trash at home; and

4. Delete all personal information on the prescription label of empty medicine bottles or medicine packaging, then trash or recycle the empty bottle or packaging.