Ask a CHOC Doc: Where Should I Store My Child’s Medications?

Question: Where should I store my child’s medications?  –Anonymous

Answer:

Contrary to its name, a medicine cabinet in the bathroom is not the best place to store medications. This is because the steam from showers can change the properties of the medication and it may lose some of its effectiveness. Storing medications in a cabinet near the stove is not ideal for the same reason. All medications should be stored in a cool, dry place away from light. Medications should be stored up and away out of reach of children. If possible, they should be stored in a locked cabinet.

Some medications require refrigeration. The bottle should say “refrigerate” on it. Liquid Augmentin® is a medication that must be kept in the refrigerator. Some medications, like liquid amoxicillin, don’t need to be refrigerated, but taste better if you refrigerate them. Others, like liquid azithromycin for bacterial infections, should not be refrigerated because it can get too thick and your child likely won’t want to take it.

-Whitney Pittman, clinical pharmacy resident at CHOC Children’s

whitney-pittman-choc-childrens-pharmacy-resident
Whitney Pittman, clinical pharmacy resident at CHOC Children’s

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Is Ibuprofen Safe for Kids?

By Kara Lau, clinical pharmacist at CHOC Children’s

Ibuprofen and naproxen are common over-the counter medicines used to treat fever, headache, toothache, muscle pain and inflammation (swelling). Both belong to the class of medicines known as nonsteroidal anti-inflammatory drugs (NSAID).

Ibuprofen, also known as Advil or Motrin, is safe to use in children at least six months of age and older. One dose of ibuprofen lasts approximately six to eight hours.

Naproxen, also known as Aleve, is safe to use in children 12 years and older. However, doctors may prescribe naproxen to younger children for inflammatory diseases such as arthritis. A single dose of naproxen lasts up to 12 hours and therefore requires less frequent doses than ibuprofen.

ibuprofen naproxen dosage guidelines for kids

Download this guide

Although NSAIDs are safe to use when taken as directed, overdoses and misuse can lead to serious problems including kidney failure, low blood pressure and bleeding. Data from the Poison Control Center estimates about 50,000 incidents involving ibuprofen each year.

Here’s what parents can do to ensure their children use ibuprofen and naproxen safely:

Read the product labels carefully.

Dosing can be confusing, so read labels carefully and ask for help from your pediatrician or pharmacist in determining the correct dose. Parents should limit the amount of ibuprofen or naproxen taken per dose and limit the amount taken daily.

Double-check what kind of liquid concentration ibuprofen you have at home.

Liquid ibuprofen comes in varying strengths for infants and children. The U.S. Food and Drug Administration found that confusion over these types led to overdoses that made infants seriously ill.

Again, read labels to know what you have and how much to give to a child.

Use the dosing device included with the medicine.

Kitchen spoons aren’t all the same, and a teaspoon and tablespoon used for cooking won’t measure the same amount as the dosing device. Rely on what’s included with the product to ensure proper dosing.

Check the age restrictions for safe administration.

Read the medication packaging to see if your child is old enough to take ibuprofen or naproxen. Consult your child’s doctor before giving them ibuprofen or naproxen  if your child does not meet the minimum age requirement.

Look for signs of overdose.

Early symptoms of NSAID overdose include vomiting, nausea, abdominal pain, dizziness and tiredness. If a parent suspects their child has overdosed on an NSAID, call poison control immediately at 800-222-1222.

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Know the Dangers of Food and Drug Interactions

By Jennifer Nguyen, clinical pharmacy resident and Grace Lee, clinical pharmacist at CHOC Children’s

Most of us appreciate food for the pleasure of smell and taste, but the food you put in your body, and feed your children, affects far beyond the taste buds. Compounds packed in foods give you energy and provide nutrients to maintain your overall health. However, these compounds also have the potential of interacting with other substances such as medication.

Food and medications can interact at different parts of the body:

  • Absorption: Medications can interact with food when they mix in the stomach. Sometimes this helps the drug get absorbed into the body, but in other cases, medications are blocked from being absorbed and then may be completely ineffective.
  • Metabolism: Foods may affect the levels of proteins in the liver involved with breaking down the drug. This may cause a medication to be metabolized faster or slower than if it was taken alone and influences how long the drug affects the body.
  • Elimination: Ingesting excessive amounts of certain acidic or alkalinic (basic) foods can change the pH levels in the intestines and kidneys, which are organs involved in drug excretion. Changing these environments can speed up or slow down how quickly a drug is eliminated from the body.

Sometimes, the chemical effects of food can enhance or interfere with a medication response. For example, if your child gets a sugar rush from eating sweets while taking a stimulant medication such as Ritalin they may become excessively hyper by this interaction. On the other hand, the side effects from some antibiotics and over-the-counter pain relievers are better tolerated with food in your stomach as a buffer.

Important food and drug interactions you should be aware of for your child are listed in the chart below, organized by food:

Food & Beverages Medications Interaction Symptoms to recognize
Dairy or calcium-fortified juices Some antibiotics:

  • Ciprofloxacin
  • Doxycycline
  • Minocycline
  • Tetracycline
Calcium contained in dairy or juices may decrease antibiotic absorption in the stomach Infection not improving or taking longer to see improvement
Soybean and walnuts

  • Soybean flour can be found in various baby milk formulas
  • Soy is also found in some dietary supplements as a composition of the capsules
  • Levothyroxine
Soybean increases elimination of thyroxine through the gastrointestinal track.   Caution is indicated for patients requiring thyroid hormone therapy Decreased effect of levothyroxine, or low thyroid levels
Caffeine

  • Coffee
  • Soda
  • Teas
  • Chocolate
  • Energy Drinks
Some bronchodilators:

  • Albuterol
  • Theophylline (specifically the once daily, sustained-release formulation)

 

Some antibiotics:

  • Ciprofloxacin
Caffeine can increase side effects of excitability, nervousness, and rapid heartbeat from bronchodilators by mimicking the same effect

Ciprofloxacin slows the  metabolism of caffeine in the liver leading to increasing effects of caffeine on the body

  • Excitability
  • Nervousness
  • Rapid heart beat
  • High blood pressure
Grapefruit juice
  • Fexofenadine (over-the-counter allergy medicine)

 

  • Amlodipine
  • Levothyroxine
  • Carbamazepine
  • Statins (Atorvastatin, Lovastatin, and Simvastatin)

 

  • Amphetamines (Adderall)

 

Grapefruit juice blocks the absorption of fexofenadine in the stomach

Grapefruit juice slows the breakdown of these drugs in the liver,  leading to  longer duration of drug action and side effects

Acidic juices such as grapefruit juice lessen amphetamine absorption in the small intestine.

  • Decreased effect of antihistamine (more allergy symptoms)
  • Increased carbamazepine levels, leading to dizziness, drowsiness, headache
  • Increased amlodipine side effects increased irregular heart beat
  • Increased statin toxicity includes muscle soreness and dark cola colored urine
  • Less drug effect from Adderall
Tyramine-containing foods:

  • Aged-cheeses
  • Salami, sausages, pepperoni
  • Avocadoes, figs, dried fruits (prunes, raisins)
  • Sauerkraut
  • Soy sauce
  • Caffeine
  • Monoamine Oxidase Inhibitors (MAOIs):
    • Phenelzine
    • Tranylcypromine
    • Selegiline
    • Rasagiline
  • Linezolid
  • Isoniazid (TB medication)
Tyramine increases the release of brain chemicals that can boost your blood pressure.

MAOIs block the breakdown of brain chemicals that also have an effect on blood pressure, leading to an additive effect

Linezolid and isoniazid are also MAOIs, in addition to their other antibiotic effects

Sudden, dangerous increase in  blood pressure
Histamine-containing foods:

  • Tuna
  • Tropical fish
  • Isoniazid
Isoniazid blocks the metabolism of histamine in the body. Increased histamine in the body leads to the same effect as having an allergic reaction
  • Headache
  • Sweating
  • Fast or irregular heart beat
  • Flushing
  • Low blood pressure
Foods with high amount of vitamin K:

  • Brussel sprouts
  • Broccoli
  • Kale
  • Spinach

Cranberry juice

  • Warfarin
Foods high in vitamin K counteract the effects warfarin has on clotting, making it less effective
  • Potential for increased clotting
  • Swelling in one arm or leg (from a blood clot)
Food
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):
    • Ibuprofen
    • Aspirin
NSAIDs can cause side effects such as stomach upset or stomach bleeds. Taking food at the same time can help protect the stomach  Stomach upset relief

While most foods have neutral or minimal effect on drug effect, consult your child’s pediatrician or pharmacist before starting a new medication. The best way to avoid drug-food interactions is to take medication with plain water and space medications at least an hour before or after a meal. If food must be used to mask the taste of medication, consult with a pharmacist to determine what is compatible.

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Antibiotics Aren’t Always the Answer

By Tuan Tran, infectious disease pharmacist at CHOC Children’s

The Centers for Disease Control’s annual recognition of Antibiotics Week, November 14- 20, is a good opportunity to review basic safety practices of antibiotics and educate yourself so that you can protect yourself and your family. Don’t forget:

  • Antibiotics can have reactions and side effects. Harmful effects from antibiotics, such as side effects and allergic reactions, cause 1 in 5 emergency department visits for adverse drug events and lead to 50,000 emergency department visits in children each year
  • Antibiotic resistance is growing. An estimated 2 million illnesses and 23,000 deaths occur each year in the U.S. due to antibiotic-resistant infections. Overuse and misuse of antibiotics are the main drivers of resistance.
  • Antibiotics can only cure infections caused by bacteria. For example, cough and cold illnesses caused by viruses would not be cured by an antibiotic

Parents are an essential part of a child’s care team. You should feel comfortable asking the following questions to your child’s provider when considering an antibiotic:

  • What is the best treatment for my child’s illness? Antibiotics aren’t needed for common illnesses like colds, most sore throats, the flu, and even some ear infections, which are often caused by viruses and do not respond to antibiotics. Sometimes the best treatment is over-the-counter symptom relief.
  • Is this the right antibiotic for the type of infection my child has? If an antibiotic is needed, it’s important to use an antibiotic that is designed to fight the bacteria causing your child’s specific illness. Ask your healthcare professional if it’s the most targeted drug to treat the infection while causing the least side effects
  • What can I do to help my child feel better? Pain relievers, fever reducers, saline nasal spray or drops, warm compresses, liquids, and rest may be the best things to help your child feel better. Ask your healthcare provider or pharmacist what symptom relief is best for your child.
Illness Usual cause: virus Usual cause: bacteria Antibiotic needed?
Cold/Runny nose  NO
 Bronchitis/Chest cold* NO 
 Whopping cough YES 
Flu NO 
 Strep throat YES 
 Sore throat (except strep) NO 
 Fluid in the middle ear** NO 
 Urinary Tract Infection YES 

*In otherwise healthy adults

**Otitis media with effusion

When your doctor prescribes an antibiotic, it’s essential that you take it exactly as prescribed. Follow the directions of your physician and pharmacist, do not skip doses or share the medication, and finish the prescription even if you feel better. Do not save it for later.

There are several things you can do to help prevent infections- starting with receiving an influenza vaccine every year. Aside from getting your flu shot, hand washing is the single most effective way to prevent the spread of pathogens. Scrub for at least 15 seconds when using soap and water. When necessary, cough into a tissue or elbow.

Clinicians at CHOC are committed to optimizing antibiotic use. A multidisciplinary team reviews and monitors antibiotic use to ensure optimal selection, dosing and duration. This reduces adverse events and improves patient outcomes, and slows an emergence of resistance.

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Debunking Myths on Over-the-Counter Medication Safety

By Giang Lam, clinical pharmacist at CHOC Children’s

Over-the-counter (OTC) medications provide quick access to treatment options for a variety of minor ailments. They enable patients to self-treat many symptoms with relatively low cost, and avoid unnecessary visits to the doctor’s office. Unfortunately, the accessibility and affordability of OTC medications has also led to many misconceptions regarding over-the-counter medication safety.

Many consumers believe that OTC medications are completely safe with no risk of side effects. Since they don’t require a physician visit or a prescription, many people think OTCs are harmless. The truth is many of these OTC medications start out as prescription medications before going over the counter. The way that they work in our body is exactly the same as the prescription version and has the same potential for harmful side effects when not taken properly.

Some consumers believe that it is safe to take larger doses or to take the medication more frequently when the recommended dose doesn’t seem to work, instead of seeking a consultation with their pharmacist or physician. The product is often taken as long as symptoms persist. Active ingredients, warnings, and recommended dosing listed on the product label are often ignored due to the perceived safety of OTC medications. Many OTC medication labels will not provide dosing until your child is a certain age or weight since they are not approved or studied in younger children.

One of the most frequent complications faced when evaluating over-the-counter medication safety is the duplication of ingredients. The same active ingredient can often be found in prescription and OTC formulations. For example, acetaminophen is a common pain reliever and fever reducer that is often combined with other ingredients. It can be found in narcotic pain relievers, cough and cold medications, and sleep aids. Duplicating an ingredient such as this one can result in an accidental overdose with serious and dangerous consequences. Download a copy of A Parent’s Guide to Acetaminophen for Children.

Brand name manufacturers will list all the active ingredients in the product label on the side of the box, but, the ingredients may not always appear on the front label. It is essential to compare product labels when taking multiple OTC and prescription medications to prevent duplicating ingredients. Over-the-counter medication safety is crucial, as they can still have interactions with prescription medications so it is important to discuss with your pharmacist or physician.

Keep these tips in mind to ensure your family is taking medications safely:

  1. Read the product label. Know what you’re taking or giving to your child, how to take it and possible side effects.
  2. Try to avoid products with multiple ingredients or mixing of OTC products if possible.
  3. Discuss risks and benefits of OTC and prescription medications with your pharmacist and physician.
  4. Seek medical attention if symptoms persist or worsen.
  5. Like prescription medications, store OTC medications safely and out of the reach of children.

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