Medication Safety Articles

 

Electronic cigarettes—also called e-cigarettes or “vapes”—have become a popular alternative for smokers addicted to nicotine. These devices are electronic nicotine delivery systems (ENDS), which are battery operated. A heating element turns liquid contained within a cartridge in the device into a vapor that the user breathes in and out. In most e-cigarettes, this liquid contains nicotine and sometimes a flavoring agent (e.g., fruit, candy, or mint).

Recently, “wellness” vaping products that contain vitamins and/or essential oils are being sold illegally. These products are being offered with unproven health or wellness claims stating they improve mental clarity or treat tumors or asthma. Some examples of false claims are:

• “Fight off tumors and alleviate symptoms of chemotherapy.”
• “It’s been used as an organic asthma remedy, ADHD remedy, and dementia treatment.”
• “Helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak.”
• “Neroli oil...has long been used as a treatment against anxiety and depression, to calm the mind and soothe away tension.”

The US Food and Drug Administration (FDA) has NOT approved any vaping product to prevent or treat any health condition or disease. These false claims may be unsafe, ineffective, and may prevent or delay you from seeking appropriate medical treatment.

Some vaping products can trigger severe coughing, cause airway tightening, and make speaking and breathing difficult. People with other medical conditions, such as heart disease, diabetes, asthma, or chronic obstructive pulmonary disease (COPD), may be at greater risk of severe complications. The bottom line is, there is no way to know if these “wellness” vaping products contain ingredients that can make symptoms worse or cause permanent damage, such as “popcorn lung” (bronchiolitis obliterans which is a buildup of scar tissue in the lungs).

In addition, studies have found that some vaping products contain cancer-causing chemicals, petroleum, toxic heavy metals, herbicides, and other hazardous chemicals, including diethylene glycol, a chemical found in antifreeze. These ingredients are often hidden on the product label as “proprietary blends.”

Here’s what you can do: Talk to your healthcare provider if you are considering using a vaping product. Avoid any vaping products that claim to contain vitamins or other natural ingredients that promote wellness, as well as products that claim to treat a wide range of illnesses or diseases. Many of these claims are false. Products claiming to be a “miracle cure” or “guaranteed results” are other red flags of unproven health claims. Finally, check government and consumer protection groups for safety alerts, recalls, and other product warnings.

Advice from FDA is a feature brought to you by the FDA. You can find this information and more on FDA’s Consumer Health Information website at: www.ismp.org/ext/889. This website features the latest updates on medicines and products regulated by the FDA. Sign up for a free email subscription at: www.ismp.org/ext/262.

In December 2021, CVS Pharmacy announced it would be expanding the use of Spoken Rx audio prescription labels in all of its pharmacies. The Spoken Rx feature, developed in collaboration with the American Council of the Blind, is now part of the CVS Pharmacy mobile app that can read prescription label information in either English or Spanish. Spoken Rx is FREE. To use the feature, register for a CVS account, download the app, and enroll in Spoken Rx – this can be done over the phone or at a CVS pharmacy. Future prescription labels will be tagged with an RFID (radio-frequency identification) label that the app-equipped smartphone can read aloud when held within four inches of the tagged label. If you do not have a smartphone, a standalone speaker device is also available, at no cost. At this time, the Spoken Rx app only reads labels from CVS Pharmacy.   

Over the years, we have received many reports and have written about errors involving powdered medicines that are not mixed with water before being dispensed from the pharmacy. A recent report reminded us that this error still occurs. So, we thought we would share examples of this error again and then provide recommendations to help prevent these errors from happening.

We received several reports about wasted Trulicity (dulaglutide) pens that were prescribed for hospitalized patients with type 2 diabetes mellitus. This happened because nurses tried to prepare the injection of medicine by priming the pen. Priming is when you try to remove the air bubbles from the device and ensure the needle is ready to use. There are some medicine pens used to treat diabetes that require the pen to be primed. However, Trulicity pens do NOT need to be primed because they are ready-to-use and each pen contains only one dose. If priming is done, the medicine inside the Trulicity pen will empty out. 

Actemra syringe dispensed instead of pen. Actemra (tocilizumab) is medicine used to treat rheumatoid arthritis and other conditions. The medicine is available in a prefilled syringe and a prefilled pen (Actemra ACTPen) for self-injection at home. People who use this medicine may need to give themselves the medicine once a week, every 2 weeks, or every 3 weeks depending on what it is being used to treat.

A woman was recently admitted to the hospital. During her admission, a pharmacist asked her what medicines she took at home. The woman stated that she takes methotrexate injections to treat her psoriasis (a skin condition). She stated that she draws the methotrexate “up to the 10” mark on the syringe, but she did not know the dose in milligrams (mg). The woman uses vials of the medicine that contain methotrexate 25 mg/mL. So, the pharmacist thought, if the woman drew the medicine up to the “10” mark on a syringe, the dose must be 10 milliliters (mL) or 250 mg.

Most people realize that errors 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 is little consolation to a consumer who has been harmed or could have been harmed if a more serious error had happened.

Have you ever picked up a prescription or over-the-counter medicine (OTC) from your local pharmacy and realized, once you are home and ready to take the medicine, that you have questions about it? Of course, you can call your local pharmacy and ask to speak to the pharmacist. But did you know that you can also call 1-855-543-3784 or email This email address is being protected from spambots. You need JavaScript enabled to view it. to ask a pharmacist at the US Food and Drug Administration (FDA) questions about your medicines?

FDA’s Division of Drug Information (DDI) has a number of pharmacists who respond each day to hundreds of calls and emails from consumers who have questions about their medicines. They can help identify tablets or capsules, discuss side effects, and even tell you the best way to dispose of unused or expired medicines.

It is important to tell the pharmacist, whether it is your local pharmacist or a pharmacist at the FDA, about other medicines you take, including prescription and OTC medicines as well as vitamins and supplements. That way, the pharmacist can determine if there may be any interactions with taking the medicines together. Your pharmacist should also know your:

· Medical history, including the reason you are taking each medicine

· Any allergies you may have

· If you are pregnant or breastfeeding

· If you have trouble swallowing tablets, opening bottles, reading labels, or remembering to take your medicine

Pharmacists play an important role in providing consumers with information about medicines so that they are used accurately and safely. It is a good idea to use a single pharmacy for all of your prescription and OTC medicines, so your pharmacist can identify any interactions. Please do not hesitate to pick up the phone or send an email to your local pharmacist or an FDA pharmacist when you have questions about your medicine.

Colds are a common illness that affect both adults and children. Most colds do not cause serious problems. In fact, most children get better on their own, without the need for medicine. However, since many cold symptoms (cough, nasal congestion, headache) are similar to symptoms of coronavirus disease 2019 (COVID-19) and the flu (influenza), it is important to talk with your healthcare provider to determine what the best course of action is to take.

Educational campaigns to keep medicines up and away and out of sight of young children (www.upandaway.org) are widespread. These campaigns, along with packaging changes for some medicines, are making an impact in reducing the number of childhood medicine poisonings. But even today, far too many young children are getting into medicine containers when their parents or caregivers are not looking. US poison control centers receive about 49 calls per hour about medicine poisonings in young children. Every 9 minutes, a young child goes to the emergency department (ED) because they got into a medicine container and took the medicine. Sadly, every hour, a young child is hospitalized because of a medicine poisoning, and every 12 days, a young child dies from the poisoning. So how are young children most often getting into medicines? 

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