Taking Medications at Home


Many people rely on prescription and/or over-the-counter (OTC) medicines to treat an array of conditions. When traveling, either for business or leisure, that doesn’t change. So, if you will be traveling outside your home country, there is something important you need to know about medicines. The country you are traveling to may have the same brand name medicine available but it may actually contain a different ingredient that is used to treat a different condition.

Our organization, the Institute for Safe Medication Practices (ISMP), often receives medication error reports that result from confusion with drug names that look or sound alike. One look-alike and sound-alike pair that often results in confusion is hydrALAZINE and hydrOXYzine.

Methotrexate is a medicine used to treat certain types of cancer. Doctors also prescribe methotrexate to treat other conditions such as severe rheumatoid arthritis and psoriasis (a skin condition). However, the dose and frequency of taking the medicine are different based on the condition being treated. For example, when used to treat cancer, methotrexate is often taken daily for 5 days or more at a higher dose. When used to treat rheumatoid arthritis or psoriasis, methotrexate is usually taken just once or twice a week at a lower dose. People often begin by taking a single 7.5 mg tablet once a week, or three 2.5 mg tablets per week, each taken 12 hours apart. The doctor may increase the weekly dose up to about 20 mg if needed. But if you take methotrexate every day by accident, you could be harmed. There are reports of this type of error probably because most people are more familiar with medicines taken every day rather than once a week. Some of these errors have even resulted in death.

Medicines all have one generic name and perhaps one or more brand names. The brand name is chosen by the drug company. The generic name is assigned by an official body, the United States Adopted Names (USAN) Council. You probably know, for example, that Advil and Motrin are brand names for the generic medicine ibuprofen. Knowing that Advil, Motrin, and ibuprofen are all the same medicine alerts you to an important risk—that taking these medicines together could add up to an overdose.

Do you use an inhaler? If so, always replace its cap after use. The importance of replacing caps on inhalers was recently illustrated when a woman accidentally inhaled a small earring while using her asthma medicine. She got her uncapped inhaler from her purse. As she inhaled the medicine, she felt a painful scratch in her throat and started coughing blood. She was taken to the emergency department, where the earring was removed from her lung. If the inhaler's cap had been in place, the loose earring in her purse would not have gotten into the inhaler.

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.

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

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.

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