A pharmacist’s guide to safe and proper medication disposal

By Melody Sun, clinical pharmacist at CHOC Children’s

Medications can have harmful consequences if they are not properly handled. The following steps will help you ensure the medication in your home is properly disposed, with minimal chance for discarded medications to cause illness. Consult your local pharmacy, or local garbage and recycling facility with specific questions.

General guidelines

Medicine take-back days are the preferred way to safely dispose of most types of medications. The U.S. Drug Enforcement Agency holds periodic national drug take-back events, where temporary collection sites are set up in communities for safe disposal of prescription medications. Find out more about upcoming drug take-back days.

If there are no specific instructions in the medication package insert, you can follow these simple steps to dispose of most medicines in the trash:

  • Pour unwanted or expired medications out of their original containers into a zip baggie.
  • Pour hot water (over 110OF – about as hot as a cup of coffee) into the baggie.
  • Insert kitty litter or another inedible product such as dirt or used coffee grounds into the baggie. Seal baggie. Place in trash bin.
  • Remove all personal information on the prescription label or empty pill bottles. Shred them or use a black marker to cross out label information.

Injectables

Devices that penetrate the skin to deliver medication are known as sharps. Any medication that requires delivery with a needle, such as an Epi-pen or insulin pen, comes with a high risk of accidental injuries, so it must be properly disposed in a sharps container. Some drug companies provide a red sharps container for using their medications. Please refer to their website for directions on how to obtain it. You can also purchase a sharps container through various approved mail-back services or make your own.

A sharps container is:

  • Made of heavy-duty plastic
  • Puncture- and leak-resistant with a tight-fitting lid when closed
  • Upright and stable when used
  • Properly labeled to provide caution about hazardous/sharps waste
  • Example containers to use: plastic detergent bottles, liquid fabric softener bottles, empty bleach bottles

Remember:

 Inhalers (aerosols)

Most inhalers can be safely thrown into the regular trash or recycled. Contact your local garbage or recycling facility for specific instructions.

 Patches

 Children may mistake medicated patches as stickers, which can lead to overdoses or even death. When discarding medicated patches, keep in mind the following safety steps to prevent kids from being accidentally exposed to unneeded medicine:

  • Fold the patch together with the medication side inside
  • Mix in an undesirable substance such as cat litter or coffee grounds
  • Place in a sealed container or bag and throw into the regular trash
  • Some patches can be flushed down the toilet. Refer to the Food & Drug Administration flush list.

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Budding pianist gives back to CHOC through piano recital

Lucie, age 13, is no stranger to performing. The budding pianist started playing piano when she was 6 years old, won her first local competition at 7, first international competition at age 9, and currently takes private lessons in addition to attending a performing arts school.

Earlier this year, Lucie’s piano teacher encouraged her to perform in a solo recital for the first time. Lucie’s first thought wasn’t about which songs she would perform or if she would feel nervous on stage — it was about turning the recital into a benefit concert.

Lucie had briefly been a patient in CHOC Children’s emergency department when she was a baby, but her connection to CHOC runs deeper. Her mom Carolyn has been a clinical pharmacist at CHOC for a decade.

“Lucie has grown up hearing about exciting new treatments we’re continuously offering at CHOC, the new technologies we get in the pharmacy, and the important work done for children in our community,” Carolyn says.

Like many people in her community, Lucie has known family members and friends who have received care at CHOC as well.

All of that made Lucie’s decision to choose CHOC as a beneficiary of her concert an easy one.

“I’m grateful to CHOC for treating my friends, relatives, neighbors, and classmates, and I wanted to give back. And this was the perfect opportunity,” Lucie says.

choc-fundraiser-letterboard-thank-you
Lucie’s sign to thank recital attendees who donated to her CHOC fundraiser.

Her decision to give back to CHOC made her mom very proud.

“As much as I wanted Lucie to choose CHOC, I felt it was important for her to choose a non-profit that was close to her heart. So, when she told me she chose CHOC, I was beyond thrilled,” Carolyn says.

Lucie’s concert raised more than $2,000 in support of KidsCARE, a fund that provides unrestricted financial support to meet the greatest needs of the hospital.

Throughout this experience, Lucie has gained a deeper understanding of the importance of giving back, her mom says.

lucie-choc-fundraiser
Lucie speaks to her audience before her recital, which she used as a CHOC fundraiser.

“When children learn the importance of philanthropy, it helps instill altruistic values and helps them develop empathy for others,” Carolyn says. “By giving back, they learn they can make a difference in society, even at a young age. This experience reminded Lucie of everything positive in her life. She gained an important lesson in humanity that will be helpful for the rest of her life.”

Lucie hopes to inspire others to give back.

“To any other young person who wants to give back, I would say don’t be intimidated. It may seem overwhelming to start your own fundraiser, but it’s not. It doesn’t have to be this grand event; it could be something as simple as a neighborhood bake sale or lemonade stand,” she says. “Think of an activity you will enjoy doing. Enlist your family members and friends to help out. Take advantage of social media to spread the word about your fundraiser. Regardless of how much you raise in the end, know that what you did is important and makes an impact for the patients at CHOC.”

Start your own CHOC fundraiser

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Ask a CHOC Doc: How do I properly use a spacer with my handheld inhaler?

Question: I suffer from asthma, and recently got a spacer for my handheld inhaler. How can I make sure I am using it properly? ­-Anonymous

Answer:

A spacer is a small device that can attach onto the mouthpiece of a handheld inhaler device via the inhaler adaptor that allows you to receive the correct dose of medication with each puff. The medication fills the inside of the spacer chamber (body) and allows you to have ease of inhaling the medication through the mouthpiece.

handheld-inhaler
© 2009 – 2019 www.asthma.ca

Once the inhaler dose has been administered, simply replace the cap over the mouthpiece and remove the oral handheld inhaler device from the inhaler adaptor port. Replace the cap over the mouthpiece of the inhaler device and store both at room temperature (68 – 77 degrees F or 20-25 degrees C) in a clean, dry area. To protect from moisture, store the handheld inhaler in a plastic zip-sealed bag.

Proper techniques to rinse mouth after using certain oral inhalers to prevent thrush:

There are certain oral handheld inhalers, referred to as inhaled corticosteroids or steroid inhalers, that can increase the risk of developing oral thrush, a fungal infection in the mouth. Thrush looks like a white, patchy rash inside the mouth and on the tongue, which can be painful and requires an anti-fungal medication to treat it. If you are prescribed a steroid oral inhaler, it’s recommended that you rinse your mouth with water and spit after each dose of the inhaler. After rinsing your mouth with water, it is best to also brush your teeth. By following these easy steps, the risk of developing this is significantly reduced.

oral-thrush
Image: Oropharyngeal / oesophageal candidiasis (oral thrush). www.mymed.com (2019)

If you have specific questions about your inhaler, consult your primary care doctor.

violet-valencia-pharmacy

-Dr. Violet Valencia, clinical pharmacy resident at CHOC Children’s Hospital

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Ask a CHOC Doc: Can I Use a Kitchen Spoon to Measure Medicine?

Question: Is it okay to use a kitchen spoon to give my child their medicine?  -Anonymous

Answer:

No! Household spoons are not accurate for measuring the correct dose. Always ask the pharmacist for a syringe or dosing cup. Have the pharmacist show you which line to draw up the volume to make sure your child receives the exact dose prescribed.

 If you’re ever unsure about something regarding your child’s medication, ask your pharmacist! You can call a 24-hour pharmacy any time you need more information about a side effect, how to give your child their medication, or to ask if it should be taken with food.

-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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I’m a Pharmacist. Here’s What I Want you to Know about Mental Health

By Katie Bui, clinical pharmacist at CHOC Children’s

Mental health is an important part of our overall health. It affects our energy level, our ability to connect with family and friends, our confidence, and our performance at school and work. Sometimes, it means taking medicine to help maintain our mental health. These medicines are safe and effective when taken appropriately under a doctor’s supervision.

Take medicine exactly as it’s prescribed

It’s important for patients taking medicines to take them exactly as prescribed. If you closely follow the medication schedule and directions, it will help your doctor know if the medication is working or not. It will also help minimize unwanted side effects from stopping it abruptly. When you take a medicine inconsistently, it is hard to figure out if the medicine is working or not, if the dose needs to be changed, or if your physician should have you try a new medication. If you have trouble sticking to a medication schedule, or if you have trouble helping your children follow their medication schedule, set a daily medicine reminder, plus a refill reminder so you don’t run out of medicine. Using a pill box can help you stay on top of a medication schedule and be mindful of when you’re due for a refill.

Possible side effects of antidepressants

Since these medicines affect the chemicals in the brain, they may take time to work, sometimes up to a month. Sometimes you might experience side effects before seeing positive changes results in mood. Most of these side effects are relatively minor and may include nausea, vomiting or sleepiness. If you experience major side effects like confusion, fever, rapid heart rate, high blood pressure, increasing depression or suicidal thoughts, no matter how long you have been on antidepressants, seek immediate medical help. These side effects are rare but it is important to know the signs and symptoms that require emergency treatment.

How mood medications interact with other medications

Sometimes, the medicine you take to treat a mental health condition can interact with other medicines you might be taking. This is another reason to follow the directions as prescribed by a doctor, and to ask your pharmacist any questions you have when you pick up a prescription. For example, mood medications such as fluoxetine (Prozac) or citalopram (Celexa) can interact with certain antibiotics like linezolid (Zyvox) and cause high fevers and confusion. Others can cause more sleepiness with sedating medicines like diphenhydramine (Benadryl) and clonazepam (Klonopin). As mentioned earlier, most of these interactions and side effects are rare and patients should talk to their doctors and pharmacists regularly when taking new medicines.

How lifestyle choices may positively impact mental health

Some lifestyle choices can also have a positive impact on your mental health. These can include simple daily activities such as going for a walk and being physically active, eating lunch outside to get fresh air and sunlight, listening to calming music, meditating, yoga and getting enough sleep each night. These activities help with relieving stress, which can directly help with mental health. It’s important to have an ongoing, open and honest conversation with your primary care physician and mental health professional about your mental health, what resources you need, and what lifestyle changes you can make.

-Reviewed by Dr. Hoang (Wayne) Nguyen, medical director of child and adolescent psychiatry at CHOC Children’s

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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