FDA-Approved Medications You Can Flush Down the Toilet: What’s on the List and When to Do It

This isn’t about convenience. It’s about saving lives. Some pills, patches, or liquids are so dangerous that if a child, pet, or stranger finds them in the trash, one dose can kill. The FDA created the Flush List to give people a last-resort option when take-back programs aren’t available. It’s not a green solution. It’s a safety net.

Why Flushing Is Usually a Bad Idea - But Not Always

The Environmental Protection Agency (EPA) doesn’t want you flushing meds. Pharmaceuticals in water systems harm fish, frogs, and ecosystems. That’s why most drugs should go to a take-back program, a pharmacy drop box, or be mixed with coffee grounds or cat litter and thrown in the trash.

But here’s the catch: some medications are too dangerous to risk in the trash. If a child finds a fentanyl patch in the garbage and sticks it to their skin, they could die within minutes. A single pill of methadone or oxymorphone can be fatal to someone who’s never taken opioids before. The FDA’s job isn’t to protect waterways - it’s to protect people from immediate, life-threatening exposure.

That’s why the Flush List exists. It’s not a suggestion. It’s a public health rule written in response to real deaths. Between 2010 and 2022, the FDA documented 217 cases of accidental fentanyl exposure in children, with 9 of them fatal. Most of those cases came from improperly discarded patches.

The FDA Flush List: What Medications Can You Flush?

The list is short - and it’s updated. As of April 2024, only these active ingredients are approved for flushing when take-back options aren’t available:

• Buprenorphine - found in BELBUCA, BUAVAIL, BUTRANS, SUBOXONE, SUBUTEX, ZUBSOLV
• Fentanyl - in ABSTRAL, ACTIQ, DURAGESIC patches, FENTORA, ONSOLIS
• Hydromorphone - specifically EXALGO extended-release tablets
• Meperidine - brand name DEMEROL
• Methadone - DOLOPHINE, METHADOSE
• Morphine - ARYMO ER, AVINZA, EMBEDA, KADIAN, MORPHABOND ER, MS CONTIN, ORAMPH SR
• Oxymorphone - OPANA, OPANA ER
• Tapentadol - NUCYNTA, NUCYNTA ER
• Sodium oxybate - XYREM, XYWAV
• Diazepam rectal gel - DIASTAT, DIASTAT ACUDIAL
• Methylphenidate transdermal system - DAYTRANA

That’s it. Only these 15 active ingredients. If your medicine isn’t on this list, don’t flush it. Even if it’s old, expired, or you don’t need it anymore. Flushing anything else is against FDA guidance.

For patches - especially fentanyl - fold them in half with the sticky sides together before flushing. This keeps the drug from leaking out and reduces environmental exposure. Don’t just toss the patch in the toilet. Fold it. Then flush.

When Flushing Is the Only Option

The FDA is clear: take-back programs are always the first choice.

There are over 12,000 authorized collection sites across the U.S., including pharmacies, hospitals, and police stations. The DEA runs National Take Back Days twice a year - in April and October - where you can drop off meds for free. You can also search for year-round drop-off locations on the DEA’s website.

But what if you live in a rural area? What if the nearest drop-off is 50 miles away? What if it’s 8 p.m. on a Tuesday and you just found your teenager’s old painkiller bottle?

That’s when flushing becomes the right move.

A 2023 survey found that 78% of patients told by pharmacists about safe disposal didn’t know where to take their meds. In some rural counties, there’s one take-back site for every 50,000 people. For many families, flushing is the only way to prevent a tragedy.

Don’t wait. If you have any of the medications on the Flush List and you can’t get to a drop-off within a day or two - flush it. Don’t store it. Don’t hide it. Don’t hope you’ll remember later. Do it now.

What You Should Never Flush

Here’s what’s not on the list - and why you should never flush it:

• Antibiotics (like amoxicillin or azithromycin)
• High blood pressure pills (like lisinopril or amlodipine)
• Antidepressants (like sertraline or fluoxetine)
• Cholesterol meds (like atorvastatin)
• Insulin
• Vitamins or supplements
• Over-the-counter painkillers (ibuprofen, acetaminophen)

These aren’t safe to flush. They don’t pose the same immediate overdose risk. But they still pollute water. For these, mix them with coffee grounds or cat litter, seal them in a plastic bag, and throw them in the trash. Remove labels first to protect your privacy.

And don’t be fooled by old advice. A decade ago, many people were told to flush everything. That’s outdated. The FDA has tightened the list over time. In 2021, they removed 11 medications because newer, safer formulations made flushing unnecessary.

How to Dispose of Medications the Right Way

Follow this simple 3-step process:

1. Check if your medication is on the FDA Flush List. Look at the active ingredient on the bottle. Compare it to the list above. If it’s there, you might flush - but only if step 2 isn’t possible.
2. Find a take-back location. Visit the DEA’s website or call your local pharmacy. Many Walgreens, CVS, and Walmart locations have drop boxes. Some police stations do too. If you’re in a city, chances are there’s one nearby. If you’re in the country, check if your county runs a collection event.
3. Only flush if you absolutely can’t do either of the above. Fold patches. Flush pills whole. Don’t crush them. Don’t dissolve them. Just flush. Then remove your name from the bottle before tossing it in the trash.

That’s it. No guessing. No exceptions.

What Happens If You Flush the Wrong Medicine?

If you flush something not on the list, you’re not breaking the law - but you’re ignoring public health guidance. You’re adding chemicals to water systems that could harm wildlife and potentially enter drinking water supplies.

Scientists from the USGS found traces of 8 Flush List medications in 23% of streams they tested. But here’s the key: those levels were far below what’s needed to affect humans. The real danger isn’t the water - it’s the trash can.

That’s why the FDA’s logic is so clear: if a pill can kill a child in minutes, the environmental risk of flushing it is worth it. But if a pill won’t kill someone from one dose? Then the environment comes first.

What’s Changing in 2025?

The FDA is reviewing the list again. In 2023, there were 17 reported cases of accidental buprenorphine exposure in children - all from patches thrown in the trash. That’s why the agency is considering adding new transdermal forms to the list.

At the same time, they’re looking at removing some existing ones. Three medications may be taken off the list by 2025 because newer versions have abuse-deterrent features - like pills that turn to gel when crushed, making them harder to misuse.

Pharmaceutical companies are also starting to print disposal instructions right on the label. In 2023, 87% of controlled substance packaging included clear disposal steps. That’s a big improvement from 10 years ago.

Final Reminder: Safety Over Everything

Flushing medicine isn’t ideal. But saving a life is more important than keeping water clean. If you have a medication on the FDA Flush List and you can’t get it to a take-back site - flush it. Don’t wait. Don’t hesitate.

And if you don’t have one of those meds? Don’t flush. Mix it with something gross, seal it up, and toss it. Then, next time you get a prescription, ask your pharmacist: "Where can I drop this off when I’m done?"

One small habit - checking the label, asking questions, knowing the list - can prevent a tragedy.