Winter break back at home with my family may as well have counted as a preceptorship session or two. Ear infections, the common cold, the flu — if you can name it, there’s a good chance someone in my family caught it. We have never collectively consumed as much cough syrup, pain relievers, and antibiotics as we did over these last two weeks. Seriously, the quantity was awe-inspiring.
Even though each person was juggling multiple medications, I didn’t expect there to be issues because hey, it was mostly just over-the-counter (OTC) stuff, right? Not quite. Helping my family manage their medications made me realize just how complicated even OTC medications can be, and over the course of this break, I found three issues to be especially challenging:
Active ingredients. We had about five different brands of cough syrups floating around our home, each purporting to handle a slightly different constellation of cold and flu symptoms. But examination of the labels revealed that each bottle actually contained the exact same active ingredients in the exact same strengths. There’s concern for accidental overdose in patients who think they’re getting different forms of relief by taking all these “different” medications, especially for example, when there are over 600 OTC medications that contain acetaminophen. Seventy percent of patients take OTC medications to manage their respiratory tract infection symptoms, but most are not aware of the drug overdose risks of simultaneously taking multiple medications — risks that include liver and kidney toxicity, as well as gastrointestinal bleeds.
Expiration dates. About a week ago, during a middle-of-the-night search for some cough syrup, I went digging through my family’s medicine cabinet. I came across the bottle I was looking for, turned it over to check out the dosing information, and lo and behold, I discovered that this bottle had expired nearly a decade ago. There is absolutely evidence to suggest that medications don’t necessarily “go bad” per se and may not even lose much potency over time. However, expiration dates are no joke when a patient’s strategy is often just to take extra to “compensate” for the expiration.
Dosing. My family uses plastic spoons for everything, and medication is no exception. Despite their convenience, plastic spoons vary in size, and as a result, unfortunately, they are not a standardized form of measurement. Experts agree that dosing medication in this way, instead of using a dosing cup, for example, can actually cause harm to patients, especially children. After all, the individual is almost always taking more or less medicine than intended; this, of course, means that he or she is either a) not going to get the necessary relief, or b) is going to receive an excessive dose, which can lead to potentially serious side effects. In fact, there has been a national Safe Storage, Safe Dosing, Safe Kids campaign underway since 2012 to help address, among other things, the fact that dosing errors are responsible for about 5 percent of all medication poisoning-related ER visits in children under 5.
One issue that was new even to me was how variable the recommended dosing could be, which creates the opportunity for even the most careful and health literate of patients to make mistakes. For example, thanks to different formulations, two different OTC cough syrup brands with the exact same active ingredients in the exact same strengths can recommend vastly different doses (sometimes triple the quantity) for the same symptom relief.
Moreover, the non-drowsy and the drowsy versions of medications have you taking different quantities, and I even found an instance where an older batch of a specific medication told you to take double the quantity recommended in the newer batch.
All in all, these last two weeks helped me see that, in spite of perceived OTC medication safety, ensuring their proper dosing can actually be quite complex, and administration of even these medications necessitates careful attention. But with all the headaches, sore throats, and stuffy noses I helped my family manage this winter break, I feel much better equipped to address these issues with my future patients — or at least with my family again when winter break 2017 strikes.
Subha Mohan is a medical student.
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