Study: 200 of top-selling nonprescription liquid medications had inconsistent directions
Article Source: msnbc.com
from:msnbc.comMost meds for kids have inaccurate dosing
Seeded on Tue Nov 30, 2010 5:25 PM EST (msnbc.com)
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I never understood the confusion. There's no "b" in teaspoon. And a person who uses non-measuring tools to measure something as important as medication is foolhearty.
As far as confusing units of measure, you can look up equivalents online, or you can ask the pharmacist. If you get a dropper that isn't labeled, the pharmacies will give you plastic measuring syringes for free.
Just like you can't spell "foolhardy," some people can't spell tablespoon.
Looking up the equivalent measurements online is great, but sometimes medicines are measured in mass, like grams, and that cannot easily be converted to volume without knowing the product's density. Also, the droppers that pharmacies have are often not accurate enough for children's medicines, forcing parents to "eyeball" it at some midway point. The lines on a turkey baster are more precise than the last syringe I got from a pharmacy.
If that was intended as more than a simple spelling-jab at me, I fail to see the comparison. Foolhardy and Foolharty are pronounced the same way. Teaspoon and Tablespoon are not. The "B" sound in tablespoon would tip me off that there's a *B* in there somewhere.
You are absolutely correct, that's why people use scales to measure weight.
Would you use a turkey baster to administer medicine to your children? I would trust the syringes at pharmacies to be more accurate. But to each his own.
The main point is *personal responsibility*. If you make every effort to measure correctly, you will get the correct dose, period.
A scale would not be useful to measure grams of an active ingredient, because they have already been mixed in with the filler ingredients (water, sugar, dyes) when you purchase the product. You aren't working with pure active ingredient. And even if you were, few people have access to medical grade pharmaceutical scales. Kitchen scales don't accurately measure such small amounts. In reality, you have to calculate the amount of active ingredient based on its concentration in solution, which is displayed on the label. However, levying this kind of math problem on the general public is destined to produce errors.
It's really not that difficult to measure an accurate dosage. If you don't know the difference between teaspoons and tablespoons then perhaps you need to look it up before medicating your child.
Also, I think the title of the article is pretty misleading.
+1, its not the meds that are inaccurate, its the parents......
Have two of my own. Never had a problem with the dosage. It's not rocket science, people!
If a company includes a handy measuring device, shouldn't it kinda dispense an accurate dose?
A number of them already include a little bitty measuring cup that is in teaspoons or whatever their dasages are in.
I'm sorry it is "rocket science", and yes I agree it shouldn't be. I'm a paramedic clinical instructor currently teaching a pharmacology course to new paramedic students. This article couldn't have been published at a better time. I'm also a parent and at times a patient, just like everyone else.
Dosing of drugs is a serious issue for both experienced and inexperienced people. I strongly agree that product labels should be clearer and standards developed to avoid confusion. I further agree that standardized dosing spoons be provided with all medications to avoid accidental errors.
This issue is huge, not with just pediatric patients but with the elderly as well. Often times product labels are confusing, difficult to read as a result of the type face and misleading. Many of the adult population is aging which means a higher probability of vision impairment and the inability to see the label.
We certainly wouldn't tolerate and don't accept dosing errors in the professional setting. We shouldn't tolerate anything less at home to our own families.
lawandorder, those are excellent comments. As a licensed pharmacy technician, I often ran across parents who couldn't figure out the difference between tsp. (teaspoon), tbl. (tablespoon), or ml. (milliliter). The fact that we still use teaspoons and prescriptions are often labeled in milliliters doesn't help either.
What gets me though, is the overreaction by the FDA because a handful of parents don't get it right. They pull the meds off the market rather than educate the public on the correct dosing. What also isn't explained properly is that dosages are based on the weight, not the age of the child. That's where a lot of the mistakes are made.
Most of the measuring devices are marked with teaspoons, tablespoons, and mililiters. You just have to read them. As far as vision impairment, corrective lenses in the form of contacts or eyeglasses work real well. I have a couple myself. If not, how about a magnifying glass. If people would just think, this wouldn't be a problem.
On most over-the-counter medicines, dosages for infants (under age 2) are specifically omitted. A pediatrician will tell you the proper dosage in grams (of the active ingredient), which must then be converted to volume in order to measure the correct dosage of liquid medication. But the concentration of active ingredients differs by brand, and I can imagine that a lot of parents would get tripped up on the simple calculation. Instead of omitting the dosage instructions for infants, they should simply give them and advise parents to consult a doctor. Seriously, who is going to take their feverish infant to a doctor unless it is very high, and what doctor is going to see a child on such short notice (other than the emergency room)? Might as well take the guesswork out of it.
If your kid is under 2, you should probably be using the formulation for infants - tylenol comes in an infant formulation and the included dropper is accurate.
The new Tylenol bottles do not offer dosage for infants under age 2, even though it is labeled "Infant Tylenol." You must consult a doctor, or else just use the line marked on the dropper that doesn't correspond to the next higher dose. It's pretty obvious what infants are supposed to get, but the label doesn't explicitly say it. Why the guesswork?
I believe the reason the dosages are not clear for under age 2 is because a seemingly mild illness at that age can rapidly become more serious, and the best thing to do is at least call your doctor. That is why it usually says, "under 2 years of age, consult a physician." Also, at that age, it goes by the child's weight. It's been my experience that the pediatrician's office has no problem giving dosage info. by phone, and they just tell you to monitor the child and bring them in if things worsen rapidly.
Absolutely there should be standards and regulations! These are our children!! They are relying on us to protect them and keep them safe...and help them feel better when they are sick.
Dosing instructions for over the counter medications should be clear and understandable to as broad a cross section of consumers as possible.
Lawandorder, thank you for your post.
It is unfortunate that the basics of measurement are not a requirement of our educational system. I realize it is taught but many high school students do not have enough experience in this area to really know it. All of us should know teaspoons vs tablespoons as well as we know dimes vs quarters.
Another thing is the small measuring cups provided with many medications do not have the tsp marking darkened so it is easily read. I agree with a previous comment that the measuring cups are part of the problem.
Basic measurements are a requirement of the educational system. Doesn't mean all students comprehend or remember it years later.
Are so many people that stupid not to be able to measure medicine for their own childern that the FDA has to make guide lines for the drug maker to make the medicines more idiot proof then they are now?!!
*than, not "then"
Some people can't tell the difference between "then" and "than." Some people can't tell the difference between "tbs" and "tsp." It's probably just an oversight, like your post, but with potentially fatal consequences.
dont worry America, soon you will be able to get an app for this too
I am a parent of a 21 month old. I have a college degree and I work in the medical field. I know the difference between tbsp and tsp. I also know mL. I am use two types of medicine for my child and it is very confusing. I use a store brand dye-free infants' concentrated ibuprofen oral suspension that comes with a syringe with black markings of 1.875 mL, 1.25 mL, and .625mL. There is 50 mg per 1.25mL of pain reliever/fever reducer and my baby weighs 21 pounds. So after doing the math I think my child is supposed to receive 2.0 mL of the medicine and that's not even listed on the syringe. I call my pharmacist everytime with my child's weight so that she can figure it out for me and I don't overdose my baby, then I eyeball the amount in the syringe.
The only complaint about the other medicine that I use which is also the same store brand just acetaminophen instead is that the medicine is white, the dropper is clear and the measurements on the dropper are white. It is so difficult to read. When my parents babysit they can't read it at all.
I agree that there needs to be some standards set for the safety of our children. I know I take the time to find out exactely what my daughter should be getting; but I know there are a lot of parents out there that don't have the time or put in the effort to figure out what they're giving their child. It does get hectic with a crying, sick baby; but that is no excuse to not go the extra mile to make sure that they're getting the correct amount of medication.
Right on about the clear medication inside the clear dropper. Try waking up from a dead sleep and seeing that without rubbing your eyes 50 times! I forgot about that... acetaminophen is usually dyed pink, but the ibuprofen is virtually invisible!
So that parents are measuring inaccurately? What does that mean? OD of non-perscription drugs does not happen with the difference between a tbsp and a tsp. Heck, a tbsp might be more suitable for our ever obese population.
Yes most of the brands do give out samples of their products. Look for "123 Get Samples" online and get the samples. They are the best. You wont need CC.
It has been a while since we have used any children's medicines at my house, but I do remember a number of them actually said for infants under six months, or sometimes a year, to call the doctor. I wonder how many parents just guess instead?
When my oldest caught his first cold, I called the pediatritian at the base hospital and got an airman 1st class, who after I told her repeatedly that the tylonal bottle said to call the doctor for dosage, continued to refuse to even get a nurse and repeated (kind of like a conversation with a parrot) "read the bottle." It was very tempting to just guess. I called the base ER after regular hospital hours, got a doctor, who told me how much. Thank goodness I did, my guess would have been too much.
I have had doctor's offices refuse to recommend a dosage without seeing the child. Of course, they cannot schedule the child for an appointment in less than a week, and the child has a fever NOW. It's just something you have to remember to ask at the well-child checkups, so you have it on hand.
I agree; it's a pain. Children need rest to recover, and no one gets rest when they're running a fever of 101 and you can't give them anything to reduce it. A bath helps, but you can't bathe them all night.
But how many first time moms are going to think of asking before the baby catches that first cold?
You're right. They learn the hard way, perhaps with an expensive and unnecessary ER visit in the middle of the night. It shouldn't be that difficult to get basic information.
One question I have for the medical professionals: Are dosing instructions more accurate when they distinguish by the child's age or by the child's weight or by some combination thereof?
The most accurate dosages are by weight and not age, but many go by age. I agree the clear markings on clear dosing cups are silly. I can't see them and I doubt many can. Mark them dark, guys, if you want us to dose correctly.
I have twin 6 year olds who are small for their ages compared to their friends (although many of the other kids are overweight, so who is really the healthy size?) and the dose for my smallest child still is supposedly the same as her friend who weighs a lot more than she does but is still 6. Doesn't make sense to me that an 11 year old way bigger than she is would still take the same dose.
Dosing most appropriately is weight based. Generally it's based on the child's weight in kilograms. This is once instance where metrics might make life easier and save lives.
However, most people are too stubborn to learn it or insist it be taught at an early age.
Why would you use kilograms instead of pounds? Pounds are smaller units, and therefore more accurate. A weight of 9 kilograms can be anywhere from 20 to 22 pounds.
One should go by the child's weight, and use age only if weight is unknown. This recommendation is right on the label. However, you have to consider organ development also. A 20-pound newborn's liver isn't going to handle acetaminophen as well as a 20-pound toddler. So if your baby is huge, you might consult a doctor before going by weight.
Joseph, you are absolutely right about the dosing issues. This is a major problem with these products. You need to look at Accudial Pharmaceuticals. They have a very elegant solution to this problem which includes weight based dosing, which as we all know is the most accurate way to dose children's medication. Their website is www.accuratedose.com. I would love to see your comments on this product as well. For full disclosure I am the patent holder of the label technology used by Accudial.
I have a 2 year old and when my daughter was born I printed dosing charts from askdrsears.com . I have followed them when needed and every instruction on the chart has matched what her pediatrician recommended.
Thank you, Mals's Mom! This just verifies my point from a couple weeks ago when the article first came out that it's not rocket science, and people, such as yourself, are intelligent and resourceful, especially when it comes to your kids, and can find ways to be accurate with dosing without the government having to step in!