Taking Medications at Home


Calcium is the most abundant mineral in your body. It is needed to keep your bones and teeth healthy. Calcium also helps the heart, nerves, and muscles work well. To properly absorb and use calcium in your body, you need several other nutrients, including magnesium, phosphorous, and especially vitamin D and vitamin K. The best way to get calcium is through the food you eat. Calcium is found naturally in dairy products (e.g., milk, cheese) and is added to some drinks (e.g., orange juice, soy milk). But some people may need to take calcium supplements to get the recommended amount, especially older people as they start to lose bone with age.

We recently described how medical marijuana labeling problems have led to errors. In this issue, our focus is on cannabidiol (CBD) products. These products have flooded the market and are widely available in stores and through online retailers without a prescription.

Today, 33 states plus the District of Columbia (Washington, DC) have legalized medical marijuana (and 11 states plus DC have legalized recreational use of marijuana). Medical marijuana is different than the street product. With medical marijuana, growers must confirm the products’ contents, so this information can be passed on to dispensaries and patients. However, each state has its own regulations for medical marijuana. This has resulted in a wide variety of medical marijuana products and safety concerns, particularly with the labeling of these products.

Asthma is a chronic lung condition that affects millions of Americans of all ages. It causes the airways in the lungs to become irritated and narrow, making it difficult for the person to breathe. An asthma attack can result in severe coughing, wheezing (a whistling sound when you breathe), chest tightness, and shortness of breath. There is no cure for asthma and, most of the time, the causes are unknown.

It is important to work with your healthcare provider, such as an allergist or pulmonologist (lung specialist), to develop an asthma action plan to help reduce the number and severity of asthma attacks you have. The action plan will help you determine what triggers an asthma attack for you. Some common triggers include:

  • Tobacco smoke
  • Dust mites
  • Air pollution
  • Cockroaches
  • Pet dander
  • Plant pollen
  • Mold
  • Infections
  • Exercise
  • Strong scents (such as perfumes)

You may be prescribed medicines that can be used to control your asthma or treat symptoms of an asthma attack. Not everyone has the same symptoms so different medicines may be needed. If left untreated, long-term lung damage may occur as well as life-threatening attacks that may require emergency care or hospitalization.

Most medicines used to treat asthma are inhaled medicines that are prescribed by a healthcare provider. The US Food and Drug Administration (FDA) recently approved an over-the-counter (OTC) medicine, Primatene Mist* (epinephrine inhalation aerosol), to treat symptoms of a mild, intermittent asthma attack. However, it is important to ask your healthcare provider if this medicine would be safe for you to use to treat your asthma. Also, Primatene Mist is only approved for people 12 years of age and older. It is not known if it works or is safe for a child 12 or younger.

Here’s what you can do: If you, a family member, or a friend are diagnosed with asthma, talk to your healthcare provider about your treatment options. Develop an action plan that lists the common triggers that make your asthma symptoms worse and try to avoid those triggers. With your healthcare provider, outline a plan to treat your asthma both long-term and when you have an attack. Learn what medicines you can use and when and how to use them. Do not take any OTC medicine (including Primatene Mist) without talking to your healthcare provider first.

*Primatene Mist was taken off the market in 2011 as part of the 1989 Montreal Protocol of Substances that Deplete the Ozone Layer and the Clean Air Act of 1990 because of environmental concerns (it contained a chlorofluorocarbon [CFC] propellant). The new product contains hydrofluoroalkane (HFA) propellants that are permitted under current international and US laws.

Advice from FDA is a feature brought to you by the US Food and Drug Administration (FDA). Find this article and more on FDA’s Consumer Health Information website at: www.ismp.org/ext/152. This website features updates on medicines regulated by the FDA. Sign up for free email updates at:  http://go.fda.gov/subscriptionmanagement.

Clonidine is a medicine used to treat high blood pressure (hypertension). It is available as a medicine patch (clonidine transdermal system [Catapres-TTS]) in various doses (Catapres-TTS-1 [0.1 mg/day], Catapres-TTS-2 [0.2 mg/day], and Catapres-TTS-3 [0.3 mg/day]). This medicine is packaged in a carton containing individually labeled pouches of 4 clonidine patches and 4 adhesive covers (Figure 1). The adhesive cover does not contain any medicine and should be applied directly over the clonidine patch only if the patch begins to separate from the skin.

The United States (US) is experiencing a devastating opioid crisis despite national efforts to curb the problem. More than 100 Americans die every day from an opioid overdose, and millions are addicted to opioids. Opioids are powerful pain medicines. You can find opioids in the home in pill forms, syrups, or prescription patches. Commonly prescribed opioids include hydrocodone, morphine, oxycodone, methadone, tramadol, and fentanyl.

The oral syringes that come with risperidone oral solutions are uniquely labeled and may cause confusion. Risperidone is a medicine used to treat certain mood disorders. Unlike other oral syringes, risperidone oral syringes have a barrel (the part that holds the medicine) that does not have any lines or numbers (markings). Instead, the markings appear on the plunger (Figure 1). To measure a dose, the plunger must be pulled back until the dose marking aligns with the flange (winged end) of the barrel. Even though these syringes are different than other oral syringes, the instructions do not provide detailed, clearly illustrated information on how to read the markings when measuring a dose. We recently learned about a man who may have taken too much risperidone due to confusion with the dose markings.

With birth control pills (e.g., Tri-Estarylla, Tri-Linyah), confusion is possible between the week 1 tablets that contain norgestimate and ethinyl estradiol and the week 4 tablets that do not contain any medicine. Different brands of these birth control pills have the same medicine and dose in the active tablets, but the tablet colors vary (Table 1).

Pharmacists from the Maryland Poison Center recently published several cases of what they refer to as “pill dumping.” An article in the American Journal of Health-System Pharmacy1 describes the term “pill dumping” for when patients use a spare medication vial to hold multiple medications taken from different labeled prescription vials.

A woman accidentally put ear wax removal drops (carbamide peroxide 6.5%) into her eye. This caused irritation and redness that persisted after rinsing her eye with water for 15 minutes. The bottle of ear wax removal drops (Figure 1) looks like a container used for eye drops. A warning that the drops are for the ears only is not on the front of the bottle (and carton) label. On the back of the carton, it says, “When using this product, do not get into eyes” in the Drug Facts table, but it does not stand out. This is mentioned on the side of the bottle, but the warning is buried in the middle of a paragraph in very small print.

Page 1 of 9

Medication Safety Alerts

FDA Safety Alerts

Show Your Support!

ISMP needs your help to continue our life saving work