Most people are familiar with throat lozenges. Typically, they are a small, medicated, round or oval shaped and dissolve slowly in your mouth. They are used to treat sore throats, coughs, and other throat irritations. Common lozenges include brand name products such as Chloraseptic, Delsym and Vicks (figure 1) and can be purchased over-the-counter (OTC).
However, not all lozenges are used to treat a sore throat. For example, Actiq (fentanyl citrate oral transmucosal lozenge) (figure 2) is a powerful opioid that is prescribed by a doctor to treat severe pain that can occur anywhere in the body. It is usually prescribed for severe pain related to cancer and other chronic non-cancer pain. Because Actiq is so potent, it should ONLY be used by people who have previously taken high doses of prescription pain medicine (opioids) for 7 or more days. Otherwise, the medicine can cause life threatening breathing problems. Actiq is referred to as a lozenge because the active medicine (fentanyl) is delivered in a solid substance attached to a stick. Actiq slowly dissolves in the mouth like a lozenge (or lollipop).
ISMP is aware of several events in which a doctor attempted to prescribe Actiq to treat a sore throat by mistaking the powerful opioid for a typical throat lozenge. In two cases, the pharmacist caught the error and contacted the doctor to change the order. In the third case, the doctor caught his own error. In each case, the patients were not taking other opioids or have a history of opioid use.
If you have a sore throat, Actiq is NOT for you. Any type of lozenge (whether OTC or prescribed by a doctor) should be kept up and away and out of sight and reach of a child. Never call a medicated lozenge (or any medicine) a piece of candy.
Have you ever thought about where medicines are kept in your home through the eyes of your child? Medicines left on counters, nightstands, in purses and bags, or on the ground are easily within reach of a young child. What's more, many medicines are brightly colored and look like candy, making them appetizing to children.
Those who take Pradaxa (dabigatran) capsules may not know they should be swallowed whole. The capsules should never be broken, chewed, or opened to take the medicine. Studies have shown that the medicine absorbs too fast if the capsules are opened, chewed, or broken. This can cause serious bleeding.
Allergy season is here again. Pollen, ragweed, pet dander, and dust mites can trigger allergies. Your body produces histamines when it comes in contact with these triggers. Histamines can cause a number of reactions including, a stuffy nose, your nose and eyes to run, itchy eyes, and an itchy rash or hives.
Before leaving the hospital, a woman with bone cancer was given a prescription for a powerful pain medicine, a fentanyl (Duragesic) patch. During her first 2 weeks at home, she was doing well. The medicine was helping to relieve her back pain. But then her family noticed that she seemed confused and was losing her balance. She was also nauseated and had vomited.
Recently a woman notified our organization after realizing her doctor prescribed the incorrect dose for an antimalarial medicine. The woman, who was soon going to travel to a part of the world where malaria is present, discussed with her doctor about taking medicine to prevent malaria. Having taken antimalarial medicine in the past, the woman asked her doctor to prescribe chloroquine (the same medication she has taken many years ago).
Half of all Americans use herbals and dietary supplements to manage the symptoms of illness and improve health.1 However, contrary to popular belief, a new study published in October 2014 suggests that herbals and supplements are not always safe.2
A toddler was admitted to the hospital after taking an overdose of Quillivant XR (methylphenidate). This medicine is used to treat attention deficit hyperactivity disorder (ADHD). It had been prescribed for the toddler's older brother.
Bactrim and warfarin don't mix. Some medicines should never be taken together because they can interact with each other in ways that alter their effects. These interactions can be dangerous, even deadly on rare occasions. For example, a commonly prescribed antibiotic, Bactrim (sulfamethoxazole and trimethoprim), is often associated with serious interactions with warfarin (Coumadin).These drug interactions are one of the most common adverse events leading to hospitalization in patients taking warfarin. Bactrim causes an increase in the amount of warfarin available in the body. It quickly raises the INR (international normalized ratio), which measures how fast the blood clots. A high INR indicates a higher risk of bleeding. Thus, patients taking Bactrim and warfarin have suffered widespread bruising and serious bleeding episodes. And it's not just Bactrim—other antibiotics interfere with warfarin. A 2012 study in the US found that the risk of bleeding while on warfarin was twice as high for those taking antibiotics, and a study in Canada found a four-fold increase in the risk of bleeding.
If you have diabetes and take insulin using an insulin pen, you may be one of many who are not using the pen correctly. Many insulin pens have a dial on one end of the pen to "dial-up the dose" (Figure 1, top). That same end has a button that needs to be pushed so the dose can be delivered (Figure 1, bottom).