Jennifer Gold

Jennifer Gold

If you use the new anticoagulant (blood thinner) Pradaxa (dabigatran), take note. Recent publication of two studies suggests that a lower dose and a lab test may limit the drug’s major drawback: high rates of bleeding.

Our organization often hears from consumers who report the quantity of medicine they receive from the pharmacy is less than the amount prescribed by their physician. For example, we recently received a report from a young patient who had dental surgery and received a prescription for the narcotic painkiller Lortab (hydrocodone and acetaminophen). On the prescription the dentist wrote for 24 pills to be dispensed. The patient’s mother had the prescription filled at a local pharmacy. When she returned home she counted only 21 pills. The mother called the pharmacy because she wanted to make sure the pharmacist was aware that a mistake had been made in the count. But the pharmacist became defensive, even suggesting that the woman’s daughter must have taken the pills without her knowledge.

Many parents like to rub numbing medications on their baby’s gums to treat the discomfort of teething. Products for this purpose, called topical anesthetics, are available for purchase over the counter (OTC). Examples include Anbesol and Orajel. There are also prescription products (e.g., viscous lidocaine) that doctors sometimes recommend. However, because of safety concerns, we do not recommend that babies receive medicines containing topical anesthetics.

Friday, 21 February 2014 18:37

Learn to swallow pills

swallow pillsIt may be easier than you think to learn how to take pills or to teach children how to take pills. If an adult or child can swallow chunky textured food like oatmeal or chunky applesauce without gagging or choking, and can swallow mouthfuls of water, he or she can usually learn to swallow pills. While a toddler is too young to learn to swallow pills, a 6- or 7-year-old child should be ready to learn — some even sooner.

There are several methods with proven track records in teaching children and adults this skill. One method involves a simple behavioral program developed by the New York University Child Study Center that uses tiny candy jimmies to start the process and works up to swallowing Tic Tacs. To learn more about this program, click here. Another pill swallowing method was developed by Dr. Bonnie Kaplan of the University of Calgary. This method provides videos to support training sessions which focus on head positions when swallowing a pill. To learn more about this program, click here. Both training resources have been highly successful and are available FREE on the Internet.

arthritis cap1Figure 1. Popular pain relievers such as Aleve and Advil come in easy-to-open “arthritis caps.”

If young children live with you or visit frequently, be aware that some over-the-counter (OTC) medicines come with "easy open" caps that are not child-resistant. Popular pain medicines such as Aleve (naproxen) and Advil (ibuprofen) (Figure 1) and their generic versions (Figure 2) are available with "arthritis caps" that are easy to open. They are intended to be used by adults who have arthritis and may have trouble using their hands to open containers that are child-resistant. However, children can also open the bottles easily, putting them at risk for accidental poisonings.

equate arthritisFigure 2. Generic versions of popular pain relievers also come in easy-to-open “arthritis caps.”

These medicine bottles with "arthritis caps" are located on store shelves next to the bottles with child-resistant caps. Unsuspecting parents or adults may accidentally select a package with the "arthritis cap" when they intended to purchase the medicine with a child-resistant cap. Once in the home, the medicine may be left accidentally within a child's reach where it can easily be opened.

Here's what you can do to prevent accidental child poisonings with OTC medicines:

  • Whenever possible, purchase medicines that have child-resistant caps if you live with or have young children who frequently visit.
  • Read package labels carefully to be sure the medicine does not use an "arthritis cap."
  • Be sure to store all medicines up and away and out of reach of children, especially if someone in your household needs to use medicine with the arthritis cap.
printed medicine cupFigure 1. Dosing cup with printed markings.
etched medicine cupFigure 2. Dosing cup with etched markings.

A study published in 2010 found that parents made frequent dosing errors whenmeasuring liquid medicines, particularly when using dosing cups.1 When asked to pour a specific dose of medicine using a dosing cup with printed markings (Figure 1), seven in every ten parents (70%) measured the wrong dose. When using dosing cups with etched markings (Figure 2), half of the parents (50%) measured the wrong amount of medicine. The results showed that the largest errors occurred when using a dosing cup.

Accuracy was much higher when parents were asked to measure a dose using a dropper, dosing spoon, and two different oral syringes. With these devices, 85% or more of the parents measured the correct dose. The most accurate measurements were made with a dropper and an oral syringe.

To measure doses of liquid medicine accurately, have your pharmacist show you how to use the device that comes with the medicine. To be sure that you understand, demonstrate for the pharmacist how you would measure the dose before you leave the pharmacy.

How accurately can you measure doses of liquid medicines? Take our Quick Quiz to see!

Reference
1) Shonna Yin H, Mendelsohn AL, Wolf MS, et al. Parents' medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med. 2010;164(2):181-186.

 

Wednesday, 05 February 2014 16:45

Example of a measuring error

dosing cup with markings Figure 1. Using this dosing cup, a parent mistakenly thought the "12.5" mL marking was a "12.5 mg" marking.

A doctor told the father of a 5-year-old child with a bad cold to give his child diphenhydramine (Benadryl) to help decrease swelling and inflammation in his airway. The father purchased a store brand diphenhydramine, which contained 12.5 mg in 5 mL of the medicine. The medicine came with a dosing cup. The dose listed on the medicine label for children less than 6 years old was 1 to 2 teaspoons, which equaled 12.5 mg to 25 mg. The dosing cup had markings on it for both teaspoons (tsp) and milliters (mL) (Figure 1). Halfway up, the cup was marked with 12.5 mL. The father thought this marking measured 12.5 mg, not 12.5 mL. He poured out a dose to the 12.5 mL marking, but the correct volume of medicine he should have poured out was 5 mL (1 teaspoon) to 10 mL (2 teaspoons). The father was about to give 12.5 mL of the medicine to his son, which would have equaled 31.25 mg of the medicine. This dose is too large for a 5-year-old child. Fortunately, the father realized the mistake and gave his child the correct dose (5 mL, 1 teaspoon).

iStock heart.medicineNonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with an increased risk of heart attack and stroke (except low-dose aspirin). Over-the-counter NSAIDs include aspirin, naproxen (Aleve, Naprosyn, Anaprox, others), and ibuprofen (Motrin, Advil, Nuprin, others). For people without a history of heart disease, the risk of a heart attack and stoke is doubled when taking most NSAIDs. For those with heart disease, the risk is increased 10-fold. NSAIDs are not recommended for those who have already had a heart attack.

In 2004, the US Food and Drug Administration (FDA) pulled Vioxx (rofecoxib), a prescription NSAID, off the market due to a high risk of heart attack and stroke in those taking the drug. Since then, FDA beefed up the warnings about heart safety risks on all NSAIDs, including OTC NSAIDs (naproxen, ibuprofen).

However, FDA released early in 2014 a review that said naproxen may pose a lower risk of heart attack and stroke than ibuprofen.1 The review was based on the results of a very large study of 350,000 people taking different pain relievers that concluded naproxen does not carry the same heart risks as other NSAIDs. A panel of outside experts has been pulled together by FDA to discuss the study results and recommend whether naproxen should be relabeled to note its lower heart safety risks than other NSAIDs. Although not required, FDA usually follows expert group recommendations.

If that happens, Aleve and other naproxen medicines could become the first choice for people taking an NSAID, particularly those with a higher risk for heart problems. However, NSAIDs will continue to carry warnings about bleeding and ulcers—two other serious side effects.

Reference
1) Aleve (naproxen sodium), Naprosyn (naproxen), & Anaprox (naproxen sodium) briefing document for US Food and Drug Administration Advisory Committee Meeting. Bayer Healthcare LLC, Consumer Care Division, Hoffmann-La Roche Inc. January 10, 2014. http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/ Drugs/ArthritisAdvisoryCommittee/UCM383181.pdf

 

Tuesday, 28 January 2014 22:12

Common pain relievers and when to take them

headacheJudy still needs to write this

Some over-the-counter (OTC) medicines can be cut, crushed, chewed, opened, or dissolved prior to taking them. But other specific dosage forms of medicines must be swallowed whole and are not safe to cut, crush, chew, or dissolve. These medicines are designed to release an even amount of medicine over a specific period of time in the body. Or, they may have a specially designed coating to prevent stomach irritation. Some lozenges or effervescent tablets are intended to be dissolved in a specific amount of liquid or to be dissolved slowly in the mouth. Medicine that is not meant to be cut, crushed, chewed, or altered may cause harm if it is not taken exactly as instructed on the label. Doing so can affect the way the medicine works and how quickly the medicine is released and absorbed.

drug facts dont crushFigure 1. The directions on the Drug Facts label for this medicine specify to swallow the tablets whole—do not chew or crush the tablets.

Crushing, chewing, or dissolving these tablets also increases the risk of adverse reactions. Injury can range from minor to severe, depending on the type of medicine ingested. Severe injuries are often related to rapid release and absorption of the medicine.

Always read the Drug Facts label to determine how the medicine should be taken. If a specific medicine should not be cut, crushed, chewed, or otherwise altered, a special warning will be provided in the Directions section of the Drug Facts label (Figure 1).

 

 What's in a name? Other clues on the label

As a good rule of thumb, the following slideshow shows examples of descriptions found on the label of a medicine package that mean the medicine should not be cut, crushed, or chewed.

  •  

    Extended-Release tablets or capsules


    Extender-Release
  •    Time Release tablets or capsules

       melatonin time release

  • Slow Release tablets or capsules

    Slow Release tablets or capsules
  • Sustained Release tablets and capsules

    sustained-release
  • Tablets and capsules that indicate 8, 12, or 24 hours of relief

    8-12-24-hours
  • Tablets that are labeled as Lozenges, which are intended to be dissolved slowly in the mouth

    lozenges
  • Tablets that are labeled as Effervescent, which are designed to be dissolved in a specific amount of fluid before ingestion

    effervescent
  • Tablets that are labeled as Safety Coated

    bayer-safety-coated
  • Tablets or capsules that are labeled as Enteric Coated

    enteric coated
  • Tablets that are labeled as Comfort Coated

    comfort coated
  • Other key terms that might signal the medicine can't be split, crushed, or chewed:

    st-johns-wort

    Controlled Dose

    Long Acting

    Sustained Action

    Time Delayed