Most of the time, medicines make our lives better. They reduce aches and pains, fight infections, and control problems such as high blood pressure or diabetes. But medicines can also cause unwanted reactions, such as drug interactions, side effects, and allergies.

What is a drug interaction?

A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs, foods, or supplements or when taken while you have certain medical conditions. Examples include:

• Two drugs, such as aspirin and blood thinners
• Drugs and food, such as statins and grapefruit
• Drugs and supplements, such as gingko and blood thinners
• Drugs and medical conditions, such as aspirin and peptic ulcers

Interactions could cause a drug to be more or less effective, cause side effects, or change the way one or both drugs work.

What are side effects?

Side effects are unwanted, usually unpleasant, effects caused by medicines. Most are mild, such as a stomachache, dry mouth, or drowsiness, and go away after you stop taking the medicine. Others can be more serious. Sometimes a drug can interact with a disease that you have and cause a side effect. For example, if you have a heart condition, certain decongestants can cause you to have a rapid heartbeat.

What are drug allergies?

Drug allergies are another type of reaction. They can range from mild to life-threatening. Skin reactions, such as hives and rashes, are the most common type. Anaphylaxis, a serious allergic reaction, is less common.

How can I stay safe when taking medicines?

When you start a new prescription or over-the-counter medicine, make sure you understand how to take it correctly. Know which other medicines, foods, and supplements you need to avoid. Always talk to your health care provider or pharmacist if you have questions about your medicines.

From Minor to Life Threatening

Unwanted or Unexpected Drug Reactions

Drugs approved by the U.S. Food and Drug Administration (FDA) for sale in the United States must be safe and effective - which means that the benefits of the drug must be greater than the known risks. However, both prescription and over-the-counter (OTC) drugs have side effects. Side effects, also known as adverse reactions, are unwanted undesirable effects that are possibly related to a drug. Side effects can vary from minor problems like a runny nose to life-threatening events, such as a heart attack or liver damage.

Several things can affect who does and does not have a side effect when taking a drug – age; use of other drugs, vitamins, or dietary supplements; or other underlying diseases or conditions (for example, diseases that weaken the immune system or effect the function of the kidneys or liver).

Common side effects include upset stomach, dry mouth, and drowsiness. A side effect is considered serious if the result is: death; life-threatening; hospitalization; disability or permanent damage; or exposure prior to conception or during pregnancy caused birth defect.

Side effects can happen when you:

• start taking a new drug or dietary supplement (for example, vitamins)
• stop taking a drug that you’ve been on for a while, or
• increase or decrease the dose (amount) of a drug that you take.

Reducing Your Risk

There are several ways to learn about side effects for your prescription drugs and to reduce your risk of experiencing a side effect.

• Ask your health care professional about any possible side effects and what, if any steps should be taken to reduce the risk when you are prescribed a drug. For example, your health care professional may recommend taking the drug with food to lower the chance of getting nausea or to not take the drug with other drugs.
• Ask your health care professional for information about the drug when you receive your prescription (FDA approved labeling for patients include Medication Guides and Patient Information). These documents will include possible common and serious side effects.
• Read the pharmacy label and any stickers that may be attached to the prescription bottle or box. The label and stickers may have information on how to take the drug and possible side effects.

When a Side Effect Occurs

Should you experience a side effect, you may be able to lessen or eliminate the effects. Work with your health care professional to see if adjusting the dosage or switching to a different medication will ease or eliminate the side effect. Other options, such as a lifestyle or dietary change, may be suggested by your health care professional.

Reporting Side Effects

When side effects do occur, you are encouraged to report them to FDA’s MedWatch, a program for reporting serious problems with human medical products including drugs.

MedWatch has a consumer reporting form, FDA 3500B. Written in plain language and designed to be consumer friendly, the form starts off with a page of some commonly asked questions and answers to help guide you in submitting the form, and then asks simple questions about the problem. In addition to formal reports, MedWatch has a toll free line (1-800-332-1088) to answer questions.

Be an active member of your health care team. By taking time to learn about the possible side effects of a drug and working with your health care provider and pharmacist, you will be better prepared to reduce your chance of experiencing a side effect or coping with any side effect that you may experience.

Where Can I Find Detailed Side Effect Information for a Drug?

FDA’s FDALabel database is used to perform customizable searches of thousands of drug labeling including searching for side effects for a drug. Please use these instructions to find side effect information about a particular drug.

• Go to: https://nctr-crs.fda.gov/fdalabel/ui/search
• If you are looking for a prescription drug for humans, click on “Human Rx”:
  • Go to the “Product Name(s)” search box and enter the entire or part of the drug name.
  • Consider looking for the trade name of the drug you are looking for and then click on “SPL Document” in that row.
  • Go the “6 ADVERSE REACTIONS” to find the side effects for the drug.
• If you are looking for an over-the-counter drug for humans, click on “Human OTC”:
  • Go to the “Product Name(s)” search box and enter the entire or part of the drug name.
  • Consider looking for the trade name of the drug you are looking for and then click on “SPL Document” in that row.
  • Go to the “Warnings” to find the side effects for the drug.

An adverse event is any undesirable experience associated with the use of a medical product in a patient. The event is serious and should be reported to FDA when the patient outcome is:

Death

Report if you suspect that the death was an outcome of the adverse event, and include the date if known.

Life-threatening

Report if suspected that the patient was at substantial risk of dying at the time of the adverse event, or use or continued use of the device or other medical product might have resulted in the death of the patient.

Hospitalization (initial or prolonged)

Report if admission to the hospital or prolongation of hospitalization was a result of the adverse event.

Emergency room visits that do not result in admission to the hospital should be evaluated for one of the other serious outcomes (e.g., life-threatening; required intervention to prevent permanent impairment or damage; other serious medically important event).

Disability or Permanent Damage

Report if the adverse event resulted in a substantial disruption of a person's ability to conduct normal life functions, i.e., the adverse event resulted in a significant, persistent or permanent change, impairment, damage or disruption in the patient's body function/structure, physical activities and/or quality of life.

Congenital Anomaly/Birth Defect

Report if you suspect that exposure to a medical product prior to conception or during pregnancy may have resulted in an adverse outcome in the child.

Required Intervention to Prevent Permanent Impairment or Damage (Devices)

Report if you believe that medical or surgical intervention was necessary to preclude permanent impairment of a body function, or prevent permanent damage to a body structure, either situation suspected to be due to the use of a medical product.

Other Serious (Important Medical Events)

Report when the event does not fit the other outcomes, but the event may jeopardize the patient and may require medical or surgical intervention (treatment) to prevent one of the other outcomes. Examples include allergic brochospasm (a serious problem with breathing) requiring treatment in an emergency room, serious blood dyscrasias (blood disorders) or seizures/convulsions that do not result in hospitalization. The development of drug dependence or drug abuse would also be examples of important medical events.

Do you take two or more prescription drugs or a prescription drug and over the counter drug together? If you do, this can cause more harm than good if you are not careful. 

Recognizing Drug Interactions 

Drug-drug interactions occur when two or more drugs – prescription and/or OTC -- react with each other. Some drug interactions can make the drug you take less effective. And some combinations of drugs can be dangerous. For example, mixing a drug you take to help you sleep (a sedative) and a drug you take for allergies (an antihistamine) can slow your reactions and make driving a car or operating machinery dangerous.

Not all drugs work in the same way in all people. You could be harmed and not helped by a drug designed to treat cold symptoms. For example, if you have high blood pressure, cold medications containing a decongestant may actually raise your blood pressure.

Food and Drug Interactions

There are also times that a drug should not be taken with certain foods or beverages. For example, some drug instructions will say not to drink a citrus juice, like grapefruit, when taking and others will instruct you not to drink alcohol.

Understand Your Drug and Possible Side Effects

You can reduce the risk of harmful drug interactions and side effects by understanding the drugs that you take. Every time you use a drug, take the time to learn about possible drug interactions and read the drug label.

Talk to your health care providers and pharmacist about all the drugs that you take. Discuss all OTC and prescription drugs, dietary supplements, vitamins, botanicals, minerals and herbals you take, as well as the foods you eat.

Also, read the package insert for each prescription drug you take. The package insert provides more information about potential OTC and prescription drug interactions. Before taking a drug, ask your doctor or pharmacist the following questions: 

• Can I take it with other drugs?
• What are the possible side effects and what to do if I experience them?
• Should I avoid certain foods, beverages or other products? 

Medications are one of our most powerful weapons against germs and diseases. But sometimes when people take medications, they can have an allergic reaction. That’s when a drug causes the body’s immune system to overreact. When that happens, they may not be able to use the drug again without risking more serious consequences.

Any drug can cause an allergy. But some are more likely to than others. Antibiotics and certain painkillers are among the more common ones. The antibiotic penicillin is the drug most often reported to cause allergic reactions. About 10% of people in the U.S. have a penicillin allergy listed in their medical records.

But probably less than 1% of people are truly allergic to penicillin, says Dr. David Khan, an NIH-funded allergist at the University of Texas Southwestern Medical Center.

The most typical allergic reactions are skin rashes or hives. In rare cases, you can have a severe reaction called anaphylaxis. This can lead to lightheadedness, throat or tongue swelling, and difficulty breathing. Anaphylaxis can also lead to death if untreated.

Sometimes people mistake side effects of a drug for an allergy. Nausea, vomiting, diarrhea, and headaches are usually side effects. Everyone has different abilities to tolerate a drug’s side effects. It depends on how the drug works in your body. When you can’t handle a drug’s side effects, it’s called a drug sensitivity or intolerance.

Certain reactions may have causes other than the drug itself, too. One common example is getting a rash after taking an antibiotic. Sometimes the rash is actually caused by the infection being treated, not the drug.

Drug allergies may fade over time, Khan says. Nearly half of patients with a confirmed penicillin allergy lose it within five years, he says. After 10 years, about 80% will.

Being labeled with a drug allergy isn’t just a minor inconvenience. Alternatives to a drug may not be as good. They can be less effective or have a higher risk of side effects.

“Patients who have a penicillin allergy listed in their chart end up staying in the hospital longer,” Khan says. “They require more outpatient visits, more emergency room visits, and there’s even a higher rate of death in those patients.”

Some alternatives to penicillin can also spur the growth of antibiotic-resistant bacteria. Infections with such bacteria are hard to treat. And they can potentially be fatal.

An allergist can test whether you have a true drug allergy. In certain situations, they can perform skin testing. Your skin is pricked or injected with a needle to allow a tiny amount of the drug into your skin. If you’re allergic, the area quickly swells.

If skin testing is negative, the doctor may confirm it with an oral challenge. They will give you increasing doses of the drug and watch you for an allergic reaction.

Right now, the easiest antibiotic allergy to test for is penicillin allergy. Khan’s team is working on an allergy test for another widely used class of antibiotics, called cephalosporins.

If you think you may have a drug allergy, talk with your health care provider. They may recommend testing by a board-certified allergist. It’s important to get tested before you need the medication again. That can help avoid unnecessary delays in treatment.

Managing a Drug Allergy

• Watch for symptoms of an allergic reaction. These include rashes, hives, itching, swelling, wheezing, lightheadedness, or difficulty breathing.
•  Seek immediate medical help if you have a severe allergic reaction after taking any medication.
• Talk with your health care provider about any possible drug allergies. Ask if they recommend allergy testing, especially for penicillin allergy.
• Consider retesting for confirmed drug allergies. Some allergies fade over time.
• Inform all future health care providers about any drug allergies.

Fun in the sun can be had all year long -- hiking, winter skiing, swimming, or just enjoying the warmth of the sun. However, when taking certain medicines, life in the sun can sometimes be less than fun.

Some medicines contain ingredients that may cause photosensitivity -- a chemically induced change in the skin. Photosensitivity makes a person sensitive to sunlight and can cause sunburn-like symptoms, a rash or other unwanted side effects. It can be triggered by products applied to the skin or medicines taken by mouth or injected.

There are two types of photosensitivity – photoallergy and phototoxicity.

Photoallergy is an allergic reaction of the skin and may not occur until several days after sun exposure. Phototoxicity, which is more common, is an irritation of the skin and can occur within a few hours of sun exposure. Both types of photosensitivity occur after exposure to ultraviolet light – either natural sunlight or artificial light, such as a tanning booth.

There are certain types of medicines that can cause sensitivity to the sun. Some of these include:

• Antibiotics (ciprofloxacin, doxycycline, levofloxacin, ofloxacin, tetracycline, trimethoprim)
• Antifungals (flucytosine, griseofulvin, voricanozole)
• Antihistamines (cetirizine, diphenhydramine, loratadine, promethazine, cyproheptadine)
• Cholesterol lowering drugs (simvastatin, atorvastatin, lovastatin, pravastatin)
• Diuretics (thiazide diuretics: hydrochlorothiazide, chlorthalidone, chlorothiazide.; other diuretics: furosemide and triamterene)
• Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen, celecoxib, piroxicam, ketoprofen)
• Oral contraceptives and estrogens
• Phenothiazines (tranquilizers, anti-emetics: examples, chlorpromazine, fluphenazine, promethazine, thioridazine, prochloroperazine)
• Psoralens (methoxsalen, trioxsalen)
• Retinoids (acitretin, isotretinoin)
• Sulfonamides (acetazolamide, sulfadiazine, sulfamethizole, sulfamethoxazole, sulfapyridine, sulfasalazine, sulfasoxazole)
• Sulfonylureas for type 2 diabetes (glipizide, glyburide)
• Alpha-hydroxy acids in cosmetics

Not all people who take or use the medicines mentioned will have a reaction. Also, if you experience a reaction on one occasion, it does not mean that you are guaranteed to have a reaction if you use the product again.

If you have concerns about developing a reaction, try to reduce your risk:

• When outside, seek shade, especially between 10 a.m. and 2 p.m. – some organizations recommend as late as 4:00 p.m. Keep in mind that the sun’s rays may be stronger when reflected off water, sand and snow.
• Wear long-sleeved shirts, pants, sunglasses, and broad-brimmed hats to limit sun exposure.
• Use a broad sunscreen regularly and as directed. Broad-spectrum sunscreens provide protection against ultraviolet A (UVA) and ultraviolet B (UVB) radiation. An SPF 15 is the minimum number needed to provide measurable protection; however, a sunscreen with an SPF value of 30 or higher is recommended. Rarely, some sunscreen ingredients can cause photosensitivity themselves.

If you have questions about your medications and the possibility of a photosensitivity, contact your health-care professional or pharmacists. Taking a few precautions can help limit your risk of photosensitivity and keep the sun shining on your fun.

An adverse drug event (ADE) is when someone is harmed by a medicine. Approximately 200,000 children (17 years old or younger) visit emergency departments each year because of adverse drug events.

Children less than 5 years old are more likely than older children to visit the emergency department for an adverse drug event, and each year one in every 150 two-year-olds visits an emergency department for a medication poisoning.

To reduce the risk of harm from adverse drug events in young children, parents should:

• Use prescription and over-the-counter medicines only as directed.
• Carefully give medicines as directed on the label or as instructed by a physician or pharmacist.
• Make sure that safety caps are locked and that medications are kept in a place young children cannot reach or see.

Toddlers can be seriously harmed if they get into medicines when no adult is watching

Finding and eating or drinking medicines, without adult supervision, is the main cause of emergency visits for adverse drug events among children less than 5 years old. Approximately 50,000 children less than 5 years old are brought to emergency departments each year because of unsupervised ingestions. Nearly 70% of emergency department visits for unsupervised medication ingestions by young children involve 1- or 2- year old children.

TIPS FOR PARENTS

• Store medications in a place that is too high for young children to reach or see.
• Do not leave medicines out after using them (such as at a sick child’s bedside). Immediately return medicines to your safe storage location after each use.
• Never leave children alone with medicines. If you are giving or taking medicine and you have to do something else, such as answer the phone, take the medicine with you.
• Never tell children that medicine is candy so they’ll take it, even if your child does not like to take his or her medicine.
• Remind babysitters, houseguests, and visitors to keep purses, bags, or coats that have medicines in them out of children’s reach and sight.
• When purchasing medicines for young children, check to make sure they are in child-resistant packaging that you are comfortable using.  Make sure to fully re-secure the cap each time you use the medicine.
• Put the Poison Help number, 1-800-222-1222, on or near every home telephone and save it on your cell phone.

Parents are more likely to make mistakes when giving medicines to infants and toddlers than to older children

For most of the emergency visits involving medication errors, young children were given the wrong dose of medicine by mistake.

TIPS FOR PARENTS

• Read all of the information on the package label and follow the directions. Do not give a child medicine more often or in greater amounts than is stated on the package.
• Use only the dosing device (oral syringe, dosing cup) that is included with the product. If a measuring device is not included with the product or you do not receive one, purchase one at a pharmacy or ask for one from your pharmacist. A kitchen spoon should not be used to give medicines to children.
• Check the “active ingredients” in prescription and over-the-counter medicines. Make sure that you do not give your child two medicines that have the same “active ingredient.” If you have questions ask your doctor or pharmacist.
• If you do not understand the instructions on the label, or how to use the dosing device (oral syringe, dosing cup), talk to your pharmacist or doctor before giving the medicine.

Some medicines may not be effective in improving children´s health

Antibiotics can kill bacteria, but not viruses. The flu and most colds, coughs, sore throats, and runny noses are caused by viruses. Taking antibiotics will not cure a viral infection, keep others from catching the illness, or help your child feel better. Although antibiotics are good drugs for certain types of infections, they are also one of the types of medicines that cause the most emergency visits for adverse drug events. More than 60,000 children are brought to emergency departments each year because of adverse events from antibiotics.

Cough and cold medicines do not cure the common cold. Although cough and cold medicines may be used to treat the symptoms of the common cold in older children, they should not be used in children less than 4 years old. Too much cough and cold medicine can cause serious harm or even death in children.

TIPS FOR PARENTS

• Do not ask for antibiotics when a doctor says they are not needed. Taking antibiotics when they are not needed increases your child’s risk of getting an infection later that resists antibiotic treatment.
• If your children are prescribed an antibiotic, make sure they take all the medicine as prescribed, even if they feel better. Do not save antibiotics for later.
• Do not use cough and cold products in children under 4 years of age unless specifically told to do so by a physician.
• Do not give children medicine that is packaged for adults unless specifically told to do so by a physician.

An adverse drug event (ADE) is when someone is harmed by a medicine.  Older adults (65 years or older) visit emergency departments almost 450,000 times each year, more than twice as often as younger persons.

Older adults are nearly seven times more likely than younger persons to be hospitalized after an emergency visit, but most of these hospitalizations are due to just a few drugs that should be monitored carefully to prevent problems. Blood thinners (such as warfarin), diabetes medications (such as insulin), seizure medications (such as phenytoin), and opioid analgesics are some examples of these medications.

To reduce the risk of harm from adverse drug events in adults:

• Keep a list of your medicines
• Follow directions
• Ask questions
• Keep up with any blood testing recommended by your doctor
• Take all medicines only as directed

Adverse drug events are a large public health problem

Adverse drug events cause approximately 1.3 million emergency department visits each year. About 350,000 patients each year need to be hospitalized for further treatment after emergency visits for adverse drug events. People typically take more medicines as they age, and the risk of adverse events may increase as more people take more medicines.

Some medicines require blood testing and these are more likely to cause serious adverse events

Getting a blood test is one way to make sure the dose of your medicine is just right for you. More than 40 percent of emergency visits that require patients to be hospitalized are caused by just a few medicines that require regular blood test monitoring.

Tip: Ask your doctor or pharmacist if you are taking any medicines that need blood testing. Pay particular attention to taking these drugs properly and getting regular blood tests and follow-up.

Examples of common drugs that can require monitoring are:

• Blood thinners (warfarin)
• Diabetes medicines (insulin)
• Seizure medicines (phenytoin, carbamazepine)
• Heart medicine (digoxin)

Unintentional overdoses of pain relievers cause many deaths

However, overdoses of opioid analgesics have contributed to a national epidemic. In 2015, more than 15,000 people died from overdoses involving prescription opioids.

Tip: Take pain relievers only as directed. If you are taking opioid pain relievers, be sure to tell your doctor about all other medicines you are taking because some medicines, when taken together with pain relievers, can cause an overdose.

Sometimes medicines will not help improve your health condition

Although antibiotics are good drugs for certain types of infections, they are also one of the types of medicines that cause the most emergency visits for adverse drug events. Approximately 150,000 adults are treated in emergency departments each year because of adverse events from antibiotics.

Antibiotics can kill bacteria, but not viruses. Most colds, coughs, flu, sore throats, and runny noses are caused by viruses. Taking antibiotics will not cure a viral infection, keep others from catching the illness, or help you feel better.

• Tip: Do not ask for antibiotics when a doctor says they are not needed. Learn more about when antibiotics work.
• If you are prescribed an antibiotic, make sure to take all the medicine as prescribed, even if you feel better. Do not save antibiotics for later.

Learn more about adverse drug events from specific medicines, including antibiotics, blood thinners, and insulin.

Medicines are generally safe when used as prescribed or as directed by the label, but there are risks in taking any medicine. An adverse drug event is when someone is harmed by a medicine. Certain types of adverse drug events are more common for specific medication classes, such as low blood sugar (hypoglycemia) related to insulin use.

Adverse Drug Events from Antibiotics

Antibiotics are one of the top medication classes resulting in emergency department visits for adverse drug events (ADEs). Based on data from 2013-2014, each year in the United States there are an estimated 200,000 emergency department visits for adverse events related to antibiotics.

• Overall, antibiotics are responsible for almost one in six (16%) estimated emergency department visits for ADEs.
• Antibiotics are involved in more emergency department visits for ADEs than any other class of drugs in patients under 50 years of age.
• In children 5 or younger, antibiotics cause more than half (56%) of estimated emergency department visits for ADEs.
• About four in five (82 percent) emergency department visits for ADEs from antibiotics alone are due to allergic reactions.

Antibiotics are one of the most prescribed medication classes in the United States, which contributes to the high number of emergency department visits for adverse drug events from these medications. But, even after accounting for how often antibiotics are prescribed, there is a substantial risk of an emergency department visit for an antibiotic-associated adverse drug event. From 2004-2006, there was approximately one in 1,000 risk that a person prescribed an antibiotic would require a visit to the emergency department because of an antibiotic side effect. But it is estimated that there is only one in 4,000 chance that an antibiotic would prevent a serious complication from an upper respiratory infection. An allergic reaction is the most common type of antibiotic-associated adverse drug event, so minimizing unnecessary antibiotic use is the best way to reduce the risk of adverse drug events from antibiotics.

Adverse Drug Events from Anticoagulants

Anticoagulants (blood thinners) are important for preventing and treating blood clots, but are associated with an increased risk for bleeding. Using anticoagulants safely requires a careful balance between risks and benefits.

Among older adults, oral anticoagulants are the most common causes of adverse drug events (ADEs) leading to emergency room visits and emergent hospitalizations. Oral anticoagulants include warfarin and the direct-acting oral anticoagulants (DOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban.

Each year between 2013 and 2014, warfarin was responsible for:

• 32% of estimated emergency room visits for all ADEs among older adults (≥65 years of age), and 36% of estimated emergent hospitalizations for all ADEs among older adults.
• Warfarin, rivaroxaban, and dabigatran were among the top 10 most common causes of ADEs resulting in emergency department visits among older adults.

In 2017:

• Bleeding from oral anticoagulants resulted in approximately 235,000 emergency department visits.
• Older adults (≥65 years of age) were involved in approximately 80% of DOAC-related bleeding visits and 77% of warfarin-related bleeding visits.
• DOACs contributed to approximately 40% of estimated oral anticoagulant bleeding visits.

Tip: To reduce the risk of anticoagulant-related bleeding, carefully follow your doctor’s advice about medication dosing, blood test monitoring, and diet, and do not discontinue your medication without first talking to your doctor.

Adverse Drug Events from Insulin

Insulin is an important part of diabetes treatment, but it can be difficult for some patients to manage and monitor.

Insulin can cause adverse drug events that lead to emergency room visits.

From 2007 to 2011, nearly 100,000 estimated emergency department visits occurred each year in the U.S. for insulin-related low blood sugar (hypoglycemia) or errors when taking insulin. Of these emergency department visits:

• Nearly two-thirds of the patients had symptoms of severe hypoglycemia, such as shock, seizures, or loss of consciousness.
• Almost one-third of the emergency department visits resulted in hospitalization.

Older adults are most vulnerable to insulin-related hypoglycemia leading to emergency room visits.

One in every eight insulin-treated patients aged 80 years or older visited the emergency department for insulin-related hypoglycemia or errors. When compared to insulin-treated adults aged 45 to 64 years, those aged 80 years or older were:

• More than twice as likely to visit the emergency department for insulin-related hypoglycemia or an error when taking insulin.
• Nearly five times more likely to be hospitalized.

MEAL-RELATED MISHAPS AND TAKING THE WRONG INSULIN PRODUCT WERE THE MOST COMMON REASONS FOR EMERGENCY ROOM VISITS FROM INSULIN-RELATED HYPOGLYCEMIA OR ERRORS.

Meal-planning is a well-recognized component of diabetes education. However, among the emergency department visits with information on what caused the visit, a meal-related mishap was the most common factor in nearly half of the cases. Common meal-related mishaps include:

• Not eating shortly after taking rapid-acting insulin, such as insulin aspart or insulin lispro.
• Not adjusting insulin doses when eating less.

The second most common factor was patients taking the wrong insulin product, documented in nearly one-quarter of visits with information on what led to the visit. The most frequently reported type of product error was confusing rapid-acting and long-acting insulin products. In these cases, more than half the time a patient intended to take a long-acting insulin product (such as insulin detemir or insulin glargine) but took a rapid-acting one instead.

THE NUMBER OF AMERICANS WITH INSULIN-TREATED DIABETES HAS INCREASED IN THE PAST DECADE.

It is important for patients to continue working with their doctors to safely and effectively manage their diabetes. Patient education should focus on meal-planning and the safe administration of insulin for the safest and most effective care. Balancing the risks with the benefits of diabetes treatment with insulin is now an important component of nationally-recognized diabetes treatment guidelines.

Tip: To reduce the likelihood of hypoglycemia, plan meals and pay close attention to the insulin products administered.

Adverse Drug Events from Opioid Analgesics

In the United States, the use of opioid (narcotic) analgesics (pain-relievers) as part of pain management regimens has contributed to a poisoning epidemic. The increase in drug poisoning coincides with an increase in the prescription of major types of opioid analgesics, as physicians were encouraged to prescribe stronger analgesics (i.e., opioids) for pain management. When sales of opioid analgesics increased, the occurrences of opioid analgesics on death certificates increased at a similar rate. In 2013, the rate of drug poisoning deaths involving opioid analgesics remained higher than the rate for deaths involving heroin, but the rate of deaths involving heroin had almost tripled from 2010. The overall goal should be to identify ways to reduce deaths from opioid analgesics without reducing the quality of care for patients who legitimately need pain management. The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer prescribing of opioids among adults in primary care settings.