Double Dosing: Helping Patients Understand the Risks During Cold Season

Cold and flu season is upon us. With many coughing, sniffling patients searching for relief in the pharmacy aisles, it’s a good time to talk to patients about the potential risks of taking over-the- counter (OTC) cold and flu medication and other OTC or prescription analgesics and antipyretics concomitantly.

The American Association of Poison Control Centers estimates that in 2016, 30% of unintentional pharmaceutical errors involved double-dosing, which is taking more than one medicine with the same active ingredient.¹

As an example, some estimates indicate that 50 million Americans use medications containing acetaminophen each week. It is the most common drug ingredient in America-more than 500 OTC and prescription medicines contain acetaminophen. Given this, it is easy to see how patients could unknowingly duplicate ingredients and take too much, which can have dangerous consequences.²

Follow the Drug Facts Label

As pharmacists, we are all too aware that people rarely slow down and read the drug facts label in full. Below are safety tips to reinforce with your patients every cold and flu season:

• Remind patients to always read the Drug Facts label.
• Highlight that patients should double check the active ingredients and the dosing instructions, and compare that against all the medication they are concurrently taking.
• Understand Your OTC Medicine Labels is a useful resource that includes educational material for both health care professionals and patients. This helpful website includes printable material that explains to patients how to read a Drug Facts label, identify the active ingredient(s) in their medications as well as directions and warnings.
• Emphasize that when in doubt, patients should always talk to you or another health care professional before using any medication, including OTCs.
• Take ONLY 1 medicine that contains the same kind of active ingredient at a time.
• Explain to patients that taking more than one medication with the same active ingredient at a time can increase their chances of harmful side effects. Explain to them that if, for example, they take more than one medicine that contains acetaminophen at the same time, it increases their chance of taking too much (more than 4,000 mg/24 hours) and this could harm their liver.
• Stick to the recommended dose and track the medications you take.
• Explain to patients that it’s important to know the correct dose and frequency, and to not take more than the daily limit. For acetaminophen, the maximum dose is 4,000 mg in 24 hours. It may be helpful to recommend that patients to keep a log of ALL the medications they are taking, including prescriptions, OTC medication, vitamins and supplements, and to make note of the time they took a dose, how much they took and when they should take the next dose.

Ask for Help

As always, encourage patients to call you or another health care professional if they have questions. Also remind them that if they think they may have taken too much of an active ingredient, tell them to get medical help or contact a Poison Control Center (800-222-1222) right away.

Kaelen Dunican, RPh, PharmD is a professor in the Department of Pharmacy Practice at the School of Pharmacy-Worcester/Manchester, MCPHS University, in Worcester, MA. She has received consulting fees from Johnson & Johnson Consumer, Inc., McNeil Consumer Healthcare Division, which also supported Dr. Dunican in the development of this article.

References

1. American Association of Poison Control Centers Releases 33rd Annual Report of the National Poison Data System [news release]. Alexandria, Va. AAPC website. Accessed Oct. 19, 2017 http://www.aapcc.org/press/73/

2 Get the facts about acetaminophen. Knowyourdose.org. http://www.knowyourdose.org/get-the-facts/. Accessed October 19, 2017.