Jennifer Gold

Jennifer Gold

Monday, 26 March 2012 19:02

Drug Interactions: What You Should Know

There are more opportunities today than ever before to learn about your health and to take better care of yourself. It is also more important than ever to know about the medicines you take. If you take several different medicines, see more than one doctor, or have certain health conditions, you and your doctors need to be aware of all the medicines you take. Doing so will help you to avoid potential problems such as drug interactions.

Your pharmacist can help you learn how to use your prescription and nonprescription (over-the-counter) medicines safely and to increase the benefits and decrease the risks. You can also use these tips when talking with your other healthcare professionals.

Although medicines can make you feel better and help you get well, it's important to know that ALL medicines, both prescription and over-the-counter, have risks as well as benefits.

When it comes to using medicine, there is no such thing as completely safe. All medicines have risks. The U.S. Food and Drug Administration (FDA) approval of a drug means that the benefits outweigh the known risks that are outlined on the drug's label.

topten spot-smWith so many different medication names, it's possible for a mix-up to occur between two different drugs. This can occur because many medications share very similar letters. When spoken or written, these names can sound or look very similar. We call these medications, sound-alike or look-alike medications.

Friday, 09 March 2012 17:38

List of Confused Drug Names

Many medications share similar letters. They are frequently referred to as medications with "look-alike" names. These medications can appear very similar when written or may sound alike when spoken. Because of the similarities, these medications have sometimes been mixed up with each other. image of confused drug names 2015

A list of the most frequently confused drug names can be located here. If you find one of the medications you take on this list, look at the other medication(s) that has a similar name. When you pick up medication at the pharmacy, be sure a mix-up has not happened. Handwritten prescriptions for medications with similar names can easily be confused. Or a prescription called into the pharmacy could be misheard as another sound-alike medication.

The best way to make sure a mix-up does not happen is to ask your doctor to include the purpose of the medication on the prescription or to tell your pharmacist the reason the medication was prescribed for you. Most medications with look-alike or sound-alike names are not used for the same purpose. Using a series of capital letters to make the dissimilar letters stand out is another way healthcare professionals prevent mix-ups with these look-alike medication names. In the list below, we have used capital letters (called "tall man" letters) for this purpose with the medications that most often employ this strategy.

ISMP's List of Confused Drug Names

Friday, 09 March 2012 17:00

Throw away your old medicines safely

Now is a great time to see if any of your medicines should be discarded because they are too old or no longer needed. On prescription bottles, the label will often tell you when the medicine should be discarded. On over-the-counter medicines and sample medicines, the expiration date (the date it should be discarded) is often printed on the label under "EXP," or stamped without ink into the bottom of a bottle, carton, or the crimp of a tube. For medicines without an expiration date, unless you know you purchased it within the past year, it's best to toss it. As time passes, medicines may lose their effectiveness, especially if they are stored in a medicine cabinet in a warm, moist bathroom. In rare cases, outdated medicines could become toxic. For example, taking expired tetracycline (an antibiotic) can cause serious kidney problems.

In the past, most people flushed old medicines down the toilet. This was done to prevent accidental poisonings of children and animals who may find medicines in the trash. But today, the Environmental Protection Agency (EPA) no longer recommends this. Sewage treatment plants may not be able to clean all medicines out of the water. This may harm fish and wildlife.

The American Pharmacists Association (APhA) and the U.S. Fish and Wildlife Service say just three small steps can make a huge difference:

1. DO NOT FLUSH unused medications. Consumers were once advised to flush their expired or unused medications; however, recent environmental impact studies report that this could be having an adverse impact on the environment. While the rule of thumb is not to flush, the Food and Drug Administration (FDA) has determined that certain medications should be flushed due to their abuse potential. Read the instructions on your medication and talk to your pharmacist.

2. When tossing unused medications, protect children and pets from the potentially negative effects. APhA recommends that consumers:

  • Crush solid medications or dissolve them in water (this applies for liquid medications as well) and mix with kitty litter or sawdust (or any material that absorbs the dissolved medication and makes it less appealing for pets or children to eat), then place in a sealed plastic bag BEFORE tossing in the trash.
  • Remove and destroy ALL identifying personal information (prescription label) from the medication container.
  • Check for approved state and local collection programs or with area hazardous waste facilities. In certain states, you may be able to take your unused medications to your community pharmacy.

3. Talk To Your Pharmacist. Research shows that pharmacists are one of the most accessible healthcare professionals. As the medication experts on the healthcare team, pharmacists are available to guide you on how to properly dispose of your unused medications.

Following these simple steps can help protect your family and community, minimize a potential negative impact on the environment, and prevent the illegal diversion of unused medications.

Additional resource: 

last updated July 23, 2014

Wednesday, 07 March 2012 19:51

General Advice on Safe Medication Use

Your doctors, nurses and pharmacists work hard to keep you healthy, but you are also responsible. Learn what questions to ask. Expect answers--it's your life and your health!

Unfortunately, medication errors happen. They happen in hospitals, in pharmacies, or even at home. And sometimes people get hurt because of these errors.

The more information you have, the better able you are to to prevent errors and to take care of yourself. You have to ask your pharmacists, doctors and nurses about your medications, and you have to expect answers.

Also, if you have any chronic illnesses, pick up one of the consumer guides about medications at a bookstore or from the library. Find out all that you can about your illnesses and the medications you are taking. What you learn will help protect you later.

What you can do: 

At Home
  • Make a list of medications you are taking now. Include the dose, how often you take them, the imprint on each tablet or capsule, and the name of the pharmacy. The imprint can help you identify a drug when you get refills.
  • Any time that your medications change, change your list, too. Double-check the imprints on the tablets and capsules.
  • Also list your medication and food allergies, and any over-the-counter medications, vitamins, nutritional supplements or herbal products that you take regularly.
  • Keep medications in their original containers. Many pills look alike, so by keeping them in their original containers, you will know which is which and how to take them.
  • Never take someone else’s medication. You don’t know if it will interact with your medications, the dose may be wrong for you, or you may be allergic to it.
  • Read the label every time you take a dose to make sure you have the right drug and that you are following the instructions.
  • Turn on the lights to take your medications. If you can’t see what you’re taking, you may take the wrong thing.
  • Don’t store medications in the bathroom medicine cabinet or in direct sunlight. Humidity, heat and light can affect medications’ potency and safety.
  • Store medications where children can’t see or reach them, for example, in a locked box or cabinet.
  • Keep medications for people separate from pets’ medications or household chemicals. Mixups are common and can be dangerous.
  • Don’t keep tubes of ointments or creams next to your tube of toothpaste. They feel a lot alike when you grab quickly, but a mistake could be serious.
  • Don’t chew, crush or break any capsules or tablets unless instructed. Some long-acting medications are absorbed too quickly when chewed, which could be unsafe. Other medications either won’t be effective or could make you sick.
  • To give liquid medication, use only the cup or other measuring device that came with it. Dosing errors can happen if you use a different cup or if you use the cup with other liquids because the cups often are different sizes or have different markings. Also, household teaspoons and tablespoons are not very accurate, which is important with some medications. Your pharmacist may give you a special oral syringe instead.
  • For information on how to throw away medication, click here.


 In The Hospital   At the Doctor’s Office
  • Take your medications and the list of your medications with you when you go to the hospital. Your doctors and nurses will need to know what you are taking.
  • After your doctor has seen them, send your medications home with your family. While you are in the hospital you may not need the same medications. Tell your doctor you want to know the names of each medication and the reasons you are taking them. That way, if anyone tells you anything different, you'll know to ask questions, which might prevent errors.
  • Look at all medicines before you take them. If it doesn't look like what you usually take, ask why. It might be a generic drug, or it might be the wrong drug. Ask the same questions you would ask if you were in the pharmacy.
  • Do not let anyone give you medications without checking your hospital ID bracelet every time. This helps prevent you from getting someone else's medications.
  • Before any test or procedure, ask if it will require any dyes or medicines. Remind your nurse and doctor if you have allergies.
  • When you're ready to go home, have the doctor, nurse or pharmacist go over each medication with you and a family member. Update your medication list from home if any prescriptions change or if new medications are added.
  • Take your medication list every time you go to your doctor’s office, especially if you see more than one doctor. They might not know about the medications other doctors prescribed for you.
  • Ask your doctor to explain what is written on any prescription, including the drug name and how often you should take it. Then when you take the prescription to the pharmacy, you can double-check the information on the label.
  • Tell your doctor you want the purpose for the medication written on the prescription. Many drug names look alike when written poorly; knowing the purpose helps you and the pharmacist double-check the prescription.
  • If your doctor gives you samples, make sure that he or she checks to be sure that there are no interactions with your other medications. Pharmacies have computers to check for drug interactions and allergies, but when your doctor gives you samples, this important check may be missed.

Extra care is needed because Humalog is a high-alert medicine.

High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed.

Top 10 List of Safety Tips for Humalog

When taking your medicine
1. Know your insulin. Humalog is a rapid-acting form of insulin that should be injected below the skin within 15 minutes before or immediately after a meal. Have food ready before injection. After injecting the insulin, do not skip a meal or delay eating.
2. Prepare your insulin. An intermediate- or long-acting insulin is often prescribed with Humalog. Humalog can be mixed with insulin NPH (intermediate-acting insulin), but always draw Humalog into the syringe first. Never mix Humalog with Lantus. Do not mix Humalog with other insulins if using an insulin pen or external pump. Do not vigorously shake insulin before use.
3. Don't reuse or recycle. Dispose of used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle, special sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Do not reuse or recycle syringes/needles or lancets.
4. Don't share. Even if you change the needle, sharing an insulin pen or syringe may spread diseases carried in the blood, including hepatitis and HIV.
To avoid serious side effects
5. Avoid mix-ups. If you use more than one type of insulin, make each vial or pen look different by putting a rubber band around one type of insulin.
6. Check your medicine. Humalog can be confused with NovoLog or Humulin (other insulins). When you pick up your insulin at the pharmacy, be sure it's the right type of insulin.
7. Treat low blood sugar (hypoglycemia). Carry a quick source of sugar, such as glucose tablets, candy, or juice, to treat low blood sugar. Signs of low blood sugar are listed on the other side of the page.
8. Test your blood sugar level. Ask your doctor how often you should test your blood sugar level. Keep a log of your blood sugar levels and how much insulin you take each day. Bring the log with you each time you visit your doctor.
9. Get a periodic lab test. You should have a hemoglobin A1c test at least twice a year to determine how well your diabetes is being controlled. The test shows an average of your blood sugar control over a 6- to 12-week period. Your goal is a hemoglobin A1c of 7% or less.
When you should call your doctor
10. Call for illness or changes in habits. Your insulin needs may change because of illness, stress, changes in eating habits or physical activity, and other medicines you take. Call your doctor if you experience these conditions. Never change your insulin dose unless advised by your doctor.

Signs of hypoglycemia (low blood sugar)

  • hunger
  • feeling shaky
  • fast heartbeat
  • lightheadedness
  • dizziness
  • sweating
  • headache
  • confusion
  • irritability

Hypoglycemia is caused by too much insulin or increased work or exercise without eating. Symptoms of hypoglycemia may be different for each person and can change from time to time. Hypoglycemia can affect your ability to think and react quickly, so driving a car could be risky. Severe hypoglycemia can lead to loss of consciousness, seizures, brain damage, or even death. Know the symptoms of hypoglycemia and treat it quickly by drinking juice or a sugar-containing beverage, or eating sugar or candy. Talk to your doctor if hypoglycemia is a problem for you.


 Topics Fast Facts
Generic name
  • insulin lispro (pronounced IN soo lin LYE spro) (no generic available)
Common brand names
  • Humalog, Humalog KwikPen, HumaPen, other Humalog pens
Type of insulin, onset, duration
  • Rapid-acting insulin; begins working in 15 to 30 minutes and lasts for 5 hours or less
  • Treatment of type 1 and type 2 diabetes mellitus to improve control of blood glucose
When to take the insulin
  • Humalog should be injected under the skin within 15 minutes before or immediately after a meal
Usual dose
  • The frequency and dose of insulin are unique to each individual
  • Daily doses of insulin are based upon body weight, diet, activity level, age, individual sensitivity to insulin, type of diabetes (1 or 2)
  • Multiple daily doses according to blood glucose levels are typical
Injecting the insulin
  • See safety tip #2 to determine if Humalog can be mixed with another insulin before injection
  • Ask your doctor, nurse, or pharmacist to show you how to draw your dose of insulin into a syringe and inject it, select the dose on a pen device and inject the insulin, or use an insulin pump
  • Before injecting a dose, take the chill off refrigerated insulin by gently rolling the vial, pen, or cartridge between the palm of both hands (do not shake the insulin vigorously)
  • Using a syringe or insulin pen, inject the insulin below the skin (not in the muscle) in the upper thighs, upper arms, buttocks, or abdomen; the site of the injection should be changed (rotated) with each dose
  • Don't use Humalog if the insulin appears cloudy instead of clear and colorless
Special instructions and precautions
  • Meals should be eaten no longer than 15 minutes before or immediately after injection
  • Follow the diet prescribed by your doctor
  • Keep your eating habits and exercise regular
  • Tell the doctor who prescribes insulin about any new medicines you are taking
  • Do not share insulin pens, cartridges, or syringes/needles with others
Safety during pregnancy/breastfeeding
  • Talk to your doctor about managing your diabetes during pregnancy and breastfeeding
Storage and disposal
  • Store unopened vials, cartridges, and pens in the refrigerator until first use (do not freeze)
  • After first use, store vials in the refrigerator or at room temperature; discard after 28 days
  • After first use, store cartridges and insulin pens at room temperature (do not refrigerate); discard after 28 days
  • Safely dispose of used syringes/needles, pens, and lancets (safety tip #3)
Most common side effects
  • Hypoglycemia (low blood sugar); see signs and treatment of hypoglycemia above
  • Low potassium blood levels, fast heart rate, fatigue, headache, hunger
Other conditions to report to your doctor
  • Chest pain or palpitations, persistent fatigue, confusion, numbness of mouth, lips, or tongue, muscle weakness or tremors, vision changes, flu-like symptoms
  • Swelling, itching, redness, warmth, or pain at the injection site
Herbals that should not be taken with Humalog
  • These herbals can lower your blood glucose: chromium, garlic, gymnema
Prescription medicines that should not be taken with Humalog
  • Many prescription medicines can affect your blood sugar levels and insulin needs
  • Tell your doctor about all the medicines you take, particularly new medicines
Special tests your doctor may prescribe
  • Patients are often asked to test their own blood glucose using home testing equipment, test their urine for sugar and acetone, and take their blood pressure regularly
  • To monitor your diabetes, your doctor may periodically test your blood levels for hemoglobin A1c, potassium, cholesterol, and substances that measure kidney function

This information does not replace the need to follow your doctor's instructions and read the drug information leaflet provided with your prescription.

This project was supported by grant number R18HS017910 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.

Friday, 02 March 2012 20:20

Insulin Pen Safety

sanofiInsulin pens have become a popular way for diabetics to give themselves insulin. Insulin pens are available for multiple insulin types. However, as with any technology, pens can be misused leading to medication errors and inaccurate administration of insulin. Although an insulin pen is easy to use, certain precautions must be taken to assure proper use.

Below is a list of safety tips to keep in mind when using an insulin pen:

1. Do not share your insulin pen with anyone:

Insulin pens should never be used for more than one person. Using insulin pens on more than one person puts people at risk for infection with blood-borne pathogens such as hepatitis viruses and HIV, which causes AIDS, the agency warns. Infection can occur even if an insulin pen's needle is changed. We are aware of this happening in hospitals, where, for example, a nurse may not realize the risk.  Pen needles are changed in between patients but the very same pen is used for multiple patients! This is dangerous because even if the needle is changed, it's still possible for insulin in the pen to become contaminated. Then, when subsequent patients are injected, there's a danger of passing along harmful bacterial or virus.

2. Do not withdraw insulin from an insulin pen cartridge

Using insulin pens as "mini" insulin vials, by drawing up insulin into an insulin syringe, can lead to inaccurate dose measurement the next time the insulin pen is used for dose delivery. The reason for this is related to air entering the pen unintentionally, interfering with the proper mechanics of the pen.

3. Do not leave an open needle attached to an insulin pen

Leaving an insulin needle attached to an insulin pen can lead to unintentional air entering into the insulin pen. If unintentional air enters into the insulin pen, it can contribute to air bubbles accumulating within the insulin and pen and ultimately improper dosing of insulin.  It could also lead to insulin contamination.

4. Insulin pens must be stored at room temperature

Storing your insulin pen in extreme temperatures can lead to changes in the concentration of the pen's insulin.  For example, going from a cold place to a hot place causes your insulin to expand. As insulin expands, it could leak out of the needle passageway, and change the concentration of the insulin. This change in concentration will change the strength of your insulin and may lead to an inadvertent overdose.

5. Proper insulin pen mixing

Every time you use a pen containing NPH (neutral protamine Hagedorn) insulin, it must be rolled between the palms 10 times and then tipped up and down 10 times to mix the insulin properly. The same mixing process is needed for pens with mixtures of NPH insulin and Regular insulin (e.g., 70/30, 75/25, etc.). The insulin should look uniformly cloudy or milky after mixing. If there are clumps floating in the insulin, or white particles stuck to the bottom or sides of the pen giving it a frosted look, don't use it. Otherwise, large doses of insulin can come out during the first injection, leaving less in the pen for injections that follow.

6. The way that insulin pen needles are used may differ

The introduction of insulin pens has risen sharply in recent years and allows patients to inject their insulin in a convenient, discrete and relatively easy to use way. The needles used with most pens are interchangeable and are sold separately. But the way they are used may differ between needle brands. Consumers must be aware because using different and unfamiliar insulin needles can cause an error with your treatment.

For example, patients who are familiar with the NovoFine Autocover must remove a needle shield to inject. Then after injection the needle is withdrawn and automatically covers itself so it cannot be used again. But a pen needle that’s available from BD actually requires that two covers be removed (see figures 1 and 2). If you don’t remove the second cover no insulin will be injected.

Novofine.figure 1and2

Patients who use Autocover devices and then switch to standard pen needles must be educated about the need to remove both caps. Removing the gray cap is an extra step that is not required with the NovoFine Autocover needles.

Errors have also occurred with the BD AutoShield Duo pen needles which resulted in failure to deliver insulin. The BD AutoShield Duo pen needle is a safety pen BD auto shieldneedle with shields on both ends of the needle to prevent needlestick exposure during injection and disposal. The shield closest to the patient retracts when the pen and the needle are pressed against the patient’s skin. Afterwards, the shield slides back over the needle, locks into place, and a red indicator becomes visible (figure 1). If the pen is not pressed hard enough (and the white shield is not flush with the skin), the cover will not retract enough resulting in no insulin delivery. Failure to delivery insulin can also occur if the user injects the insulin on an angle that does not allow the retraction mechanism to work properly. Current insulin deliver recommendations note that the pen needle must be injected into the skin at a 90 degree angle, with no skin fold pinch for 4-5mm needles, or with a skinfold pinch for longer needles. Proper demonstration of the BD AutoShield Duo pen needle can be viewed here

7. Using your pen correctly

If you are using an insulin pen for the first time, or recently switched to a new insulin pen, errors can occur when dialing the correct dose.

Example 1

A patient accidently injected too much insulin when she accidently over dialed her insulin pen. The patient using a NovoLog FlexPen gave herself 46 units of NovoLog, not 6 units as prescribed. In error, the patient read the numbers to the right of the dose indicator window not within the window.

                                                  dosing window2

Example 2

A Lantus Solostar pen was prescribed for a patient who only had prior experience administering Lantus from vials using insulin syringes. The patient was not counseled before using the pen and assumed he understood how to use it correctly. However, he misunderstood how the insulin pen worked and accidently administered 225 units of Lantus instead of 75 units.


The error was related to a minor difference in how this particular insulin pen works. The Solostar insulin pen looks like a syringe, or other pen devices. Normally during an injection of insulin the syringe plunger moves all the way to where the needle attaches to the syringe. However, the Solostar pen is not designed to deliver the entire amount of insulin in the reservoir. Therefore, the plunger only moves partially, resting on a reservoir scale that shows the remaining quantity of Lantus in the pen. The patient, who expected the plunger to move like a typical syringe, didn’t notice the subtle movement and repeated the injection three times, delivering 75 units each time.

If you are new to using an insulin pen, always demonstrate to a health care professional how you will measure and administer the dose.

Example 3

Our organization is aware of at least two cases in which improper injection technique led to elevated blood sugars. In both of these cases, ongoing elevated blood sugars led the healthcare provider to investigate the insulin injection technique. After direct observation of the individual injecting the insulin, a crucial error was detected. In both incidences the person injecting insulin correctly dialed up to the prescribed amount of insulin units using the Lantus Solostar (insulin glargine) insulin pen. The person then properly completed the next step and injected the needle into the skin. However, instead of pushing the purple button at the end of the pen to inject the insulin they twisted the dial back down to zero. By dialing back down to the zero, they had believed the twisting mechanism was injecting the insulin. The Lantus Solostar insulin pen is designed to be twisted "up or down" until the user has established the correct amount of insulin to inject. But the button must be pushed to inject the insulin. Both patients in this example had in fact not been receiving any insulin as a result of this error.

insulin pen dial error

The ability to dial up and down on the insulin pen is not just unique to the SoloStar pen. Other insulin pens also have this feature. If you or a family member is using an unfamiliar insulin pen, be sure to first demonstrate to your healthcare provider how you will be using it.