Preventing Accidental Poisoning by Medicine

Next week is Poison Prevention Week and I thought I would observe (celebrate?) this with an appropriate blog topic.  We can poison ourselves with almost anything as what makes something toxic is usually more the dose than the substance.  A good example is the woman a few years back that died of water intoxication after ingesting huge amounts of water during a radio contest to win a Nintendo Wii.  I think few people would take away from the story that water is a bad thing or a poisonous substance. It does show that something seemingly innocuous can have tragic results when ingested in excess.  Though we probably have many substances in our homes that could result in a poisoning episode, as a pharmacist I will focus on accidental poisonings resulting from misuse of pharmaceutical products.

Accidental poisonings can happen to adults (Whitney Houston most recently), teenagers ("let's get some Robo") and of course children.  Adult cases can be results of abuse,  drug-food/alcohol interactions, drug-drug interactions or just plain confusion in the prescribed dose to take.  That's where the pharmacist can play an important role.  Make sure that you tell the pharmacist everything that you are taking so drug interactions can be screened.  Also make sure you know exactly how to take the medicine before you leave the pharmacy.

Cases involving teenagers tend to involve abuse and the pursuit of mind altering experiences.  Surveys from the past few years show an increase in prescription drug abuse in high school students with figures as high as 20% of students trying out a medication that was not prescribed for them.  I remember the good old days of sneaking the odd beer here and there as a teenager but I profess I would never have thought to chug a whole bottle of cough syrup to get buzzed.  "Robo" (short for Robitussin) is just one of the cute names  that is given to this activity.  Dextromethorophan is the active ingredient in many over the counter cough products which is chemically related codeine.  This drug can have euphoric effects at high doses but can also result in seizures, hallucinations, and respiratory depression.  And if that isn't enough, if a combination product were abused which commonly has acetaminophen (Tylenol) as well, this can lead to acute liver failure.  All of these instances you see in the news from time to time.

When I think of accidental poisonings, the image conjured in my head, is of the small child finding the bottles of tablets that look exactly like candy to them and proceed to eat the candy.  This sort of situation does happen and as most small children are by definition small it doesn't take nearly as much to result in a toxic dose.  Open anyone's cupboard and you will find at least one over the counter medicine.  Benadryl is a pretty common medicine to have in the home for those various allergic conditions that come up.  A toxic dose can result in heart arrhythmia and respiratory depression and seizures.  For a child under 20 pounds a potentially toxic dose is just four adult strength tablets.  Prescription medications that are not contained in child proof containers can be another source.  Make sure you only request non-child proof caps from the pharmacy when there will never be any children in the house, even for a short visit.  Or alternatively the medications are locked up appropriately.  Another source of toxic doses can be from the parent.  I have fielded several calls from parents that are worried because one parent gave the prescribed dose to a child and the other parent gave  another dose thinking the child had not received the dose yet.  Luckily the times that I remember did not result in harm but a lesson should be taken from this.  

Parents purchasing cough and cold products for their small children may notice that the labeling has changed in the past couple years.  It states that it should not be given to children under four years old unless under the supervision of a physician.  This was implemented because the medications contained did not have any good evidence for effectiveness in this age group but conversely resulted in many ER visits due to overdose.  In this age group I would recommend various non-pharmacological interventions such as nasal saline and humidifiers.  

This is about prevention so what can we do to minimize the risk of something like the above situations happening in our homes.

•  Get expired and unused medications out of the home.  My pharmacy and others participate in medication take back programs  which will take your medications back for free.  If you can't get to the pharmacy, you can dispose of the medication in the trash after mixing it with something to make it unpalatable like coffee grounds or kitty litter.  In most cases the trash is the preferred method as opposed to flushing the meds but there are a few exceptions.  Examples are oxycodone and morphine tablets due to the danger that even one tablet can expose the person to.  
• Medications that come in patch form have a large amount of medication left on them even when it is time to change.  Fold the patch on itself and dispose in the trash so children or pets can't get to them.
• Always use child proof caps at the pharmacy unless there is never children in the home.
• Make sure you know how alcohol will react to prescription medications 
• Make sure you know the dosage and if there is any concern or questions ask before taking or giving the medication.  There have been cases of people not seeing the decimal point in the instructions ie. "Give 1.5 teaspoonfuls every six hours" and they give 15 teaspoonfuls.  I don't expect everyone to know the proper doses of medications but this should have raised some red flags.   If something seems a bit off please ask.
• In the case of medication for teenagers especially Adderall and Ritalin keep control over the doses and don't let them administer themselves.  I have had more than one experience when a parent comes to fill the medicine for their teenager and it turns out to be 2 weeks early.  Where did the medicine go?  The kid's friends that's where.  So you must be aware of the potential of these sorts of medications for diversion and abuse.

When an accidental poisoning is suspected you can call poison control at 1-800-222-1222 or go to the ER if immediate danger.  Never induce vomiting unless told to by an expert.  This can make the situation worse in most cases.  I hope the information in this blog will help to keep you and yours safe from the potential dangers of the medicine cabinet.
Cheers 

Dr. Steven Jensen PharmD. recently opened  in Saline at The Oaks plaza. This independent pharmacy offers both traditional and compounded prescriptions.