Medication Safety Articles

 

Some prescription medicines can impair a person’s ability to drive. The 4 most common classes of medicines that cause impaired driving include: antidepressants, stimulants, sedatives, and opioids (narcotics). These medicines can make the driver sleepy, impair thinking, limit motor function, and/or make the driver more aggressive.

In a recent study,1 researchers wanted to find out:

• If the person received a warning (from the doctor, pharmacist, or medicine label) that the medicine could impair their driving
• If the warning increased the perceived risk of driving impaired while taking the medicine.

Participants were selected from 60 locations representing 4 geographical regions across the US based on various criteria. All participants were told their participation was voluntary and anonymous. A total of 7,405 participants completed the survey.

Of those who completed the survey, 19.7% reported taking at least 1 medicine, within the past 2 days, that could impair driving. Within that group, the majority of those taking a sedative (85.8%) or an opioid (85.1%) stated they received a warning that the medicine could impair their driving. However, only 62.6% those taking an antidepressant and 57.7% of those taking a stimulant received a warning. The results also show a significantly higher perception of impaired driving by participants who stated they received a warning. But, a number of participants also indicated that they did not think the medicine could cause impairment if they took it as directed.

The study shows that it is important for doctors and pharmacists to discuss potential side effects of medicines including if the medicine can impair driving. Manufacturers can also improve the information listed on the medicine’s label.

Here’s what you can do: Talk to your doctor or pharmacist about side effects from the medicines that are prescribed for you. Always ask if you can drive while taking the medicine. Ask your doctor or pharmacist for printed material about the medicine. Keep track of how you feel and when the effects occur. Tell your doctor or pharmacist about any side effects you have. Your doctor may be able to adjust the dose or the time you take the medicine.

Pollini RA, Waehrer G, Kelley-Baker T. Receipt of warnings regarding potentially impairing prescription medications and associated risk perceptions in a national sample of US drivers. J Stud Alcohol Drugs. 2017;78(6):805–13.

Sometimes, your doctor may write or send your prescription to the pharmacy with instructions to take the medicine “as directed.” In these cases, you must remember what the doctor has told you about how to take the medicine correctly. The label on the prescription container will not help you remember because the directions will simply say, “Use as directed.”

When you start a new medicine, you may get an upset stomach, feel tired, or get a rash. Is this an allergic reaction or just a side effect? It is important to understand the differences between allergies and side effects because they are handled very differently. Allergies can be serious and require immediate medical attention and avoidance of the medicine in the future. If you have side effects and your doctor thinks this is still the best medicine for you, steps can be taken to prevent the unintended side effects of the medicine. But you can still take the medicine.

The brand name Dramamine is the latest example of a well known, over-the-counter (OTC) medicine name being recycled for use in products that contain a different medicine or ingredients that differ from those in the original product. The original Dramamine (regular or chewable) contains 50 mg of dimenhydrinate (Figure 1). But there is now a Dramamine that contains a different medicine called meclizine 25 mg per tablet (Figure 2). And another product, Dramamine Non-Drowsy Naturals, does not contain a drug at all—it’s a supplement that only contains ginger root (Figure 3).

dram3

Packaging for all these products highlights the Dramamine name. When the same brand name (Dramamine) is used for products with varying ingredients, there is bound to be confusion regarding the product’s actual ingredients, strength, and concentration.

Here’s what you can do: Be sure to look at the package and read the Drug Facts section of the label. This will give you information about what the medicine contains—dimenhydrinate, meclizine, or ginger root. Read the other information on the package to see what the medicine should be used to treat and how often it can be taken. Ask your pharmacist for help to guide you in selecting the appropriate product for your needs.

It is common for people with diabetes to use a blood glucose meter to monitor their blood sugar (glucose) level on a daily basis. The meters are designed to analyze a small amount of blood from a fingerstick that is put on a test strip and inserted into the machine. Usually, in less than a minute, the blood sugar level is reported.

Recently, the US Food and Drug Administration (FDA) learned that pre-owned or secondhand test strips were being sold to consumers. These were often advertised in local newspapers or online as “cheap test strips.” While it is legal for people to sell their unused test strips, the FDA does not recommend this practice and is warning consumers not to purchase pre-owned test strips. They may give you incorrect results, or they may not be safe to use for the following reasons:

• They may not have been stored safely.
• They may be expired, or the expiration date may have been changed.
• They may not have been approved for sale in the United States (the instructions are not in English).
• They may have small amounts of blood on them from the other person if they were opened.

Here’s what you can do: Talk to your healthcare provider if you are not sure where to buy test strips for your meter or if you cannot afford to buy the test strips. Some available programs will provide you with test strips and even a meter at no cost. Buy only unopened vials of test strips from a reputable retailer that have not been pre-owned.

Most people realize human error can happen, including when getting a prescription filled at the pharmacy. Although pharmacists do their best, mistakes sometimes happen. Thanks to safer medicine labels and technologies like barcode scanning, mistakes of the past are rapidly declining. The few pharmacy errors that do slip by usually do not cause serious or permanent harm. Still, that’s little consolation to a consumer who is harmed or could have been harmed if a more serious error had happened.  

A woman with colon cancer recently received a full dose of fluorouracil at home over 4 days instead of 7 days. Fluorouracil is a drug used to treat cancer by causing fast-growing cancer cells to die. The medicine was given directly into a vein (intravenously) through a portable infusion pump that the woman wore while she was at home. For an unknown reason, the full amount ran in too quickly, leading to an overdose of the medicine. The effects of an overdose are serious and can be fatal. The effects from the medicine infusing too quickly include nausea, vomiting, diarrhea, mouth ulcers, stomach bleeding, and a weakened immune system (making it harder to fight off diseases).

A pain relief system known as patient-controlled analgesia (PCA) allows patients to give themselves small but frequent doses of pain medicine without having to call a nurse. It is used most often in the hospital after surgery. The concept is simple: A pump containing pain medicine is attached to an intravenous (IV) line (which goes into a vein). When the patient feels pain, he or she pushes the button on the pump and they receive a dose of medicine. But the button on this pain relief system must be pushed only by the patient, not by others.

The US Food and Drug Administration (FDA), recently released a warning about two opioid (strong narcotic) pain medicines that can cause life-threatening breathing problems in young children. These two medicines, codeine (also used in some cough and cold medicines) and tramadol, need to be prescribed by a doctor (in some states, codeine is available as an over-the counter [OTC] medicine).

Many manufacturers and retailers of pediatric acetaminophen solid dose (non-liquid) medicines including the makers of Children’s TYLENOL®, are transitioning to a single strength of 160 mg in the United States. Prior to 2017 acetaminophen chewable (or meltaway) products were available in both 80 mg (Children’s) and 160 mg (Jr.) strengths. But starting in early 2017, manufacturers began transitioning to a single strength (160 mg) pediatric solid dose acetaminophen product. The 160 mg strength will be named “Children’s” and the 80 mg products will be phased out. This change, at the recommendation of the US Food and Drug Administration (FDA), is intended to help minimize the potential for medication errors due to confusion between multiple strengths.

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