Doctors sometimes provide patients with drug samples to get them started on a needed medication in a timely manner. Hospital emergency departments (EDs) have also sent patients home with starter doses or unit dose packages from the hospital pharmacy. This allows the patient to start taking the medicine as soon as possible, giving them extra time to get the prescription filled at their local pharmacy. Dispensing samples and starter doses are often seen as “patient friendly” services, but the services can also have unintended consequences. One issue is that packaging and labeling of the medications can sometimes present problems for patients.
One patient experienced severe burning in her eyes and blurred vision when she instilled what she thought was eye drops. A co-worker took the bottle from her and saw the very small notation on the label: “For dermatological (skin) use only. Not for use in the eye.” The tiny sample bottle, which had no pharmacy label since it wasn’t dispensed by a pharmacist, was a professional sample of a cortisone-like medication meant to be applied to the skin. The product also contained 40% isopropyl alcohol (rubbing alcohol), which severely irritated her eyes. It had been given to her by her allergist for application after allergy shots. But she inadvertently combined it with the eye drops she keeps at work and grabbed the wrong bottle. The patient saw her eye doctor and the eye was flushed, but the patient suffered blurred vision for several hours.
Another issue is the ambiguous way that drug companies sometimes label these products. It’s not always patient-friendly. When the popular pain medication Celebrex was first marketed, the manufacturer, Pfizer, gave doctors samples to hand out to patients. Each package contained 3 capsules labeled “Celebrex 200 mg.” A rheumatologist gave one of these to a patient along with a prescription for 200 mg twice daily. When the patient got home and looked at the label she didn’t know whether she should take all three capsules for the 200 mg dose, or just one. She called the doctor's office and clarified that each capsule was 200 mg and she should take just one at a time.
Many patients might not have called to clarify the confusing Celebrex label or other drug sample packages just like it. In fact, we checked with Pfizer when the patient called us about this and a drug information professional admitted that they’d received reports of overdoses where 600 mg was taken. The FDA recently clarified that the product strength should always describe the milligram amount of drug per single unit (e.g., tablet, capsule) so there is no confusion as to how much product is contained in a single unit as compared to the total contents of the entire blister card.