Scary experience - giving meds to a toddler - pharmacy mislabel

My 3 year old is a little sick, and has a nasty cough. In the morning,
I gave her some Delsym, which usually works pretty well, but by early
afternoon, she was still coughing, and was pretty miserable about it.
I looked in the medicine chest, and discovered that I had a
prescription strength cough medicine that a doctor had prescribed for
her about a year ago, called Tussionex. I have also had it for me, and
it's great. Makes me sleepy so I only take it at night.

I called our doctor (we just moved, so she's not the prescribing
doctor), and asked if it was safe to give her the prescription strength
stuff since she'd already had the over-the-counter stuff, and she gave
us the green light. She told me it wasn't a codeine cough syrup,
rather it had hydrocodone. Yikes, I hadn't realized it. Strong stuff.

So at about 5:00pm, I gave her a half dose. I figured it was strong, it
was daytime, she already had the over-the-counter stuff in her system,
so I gave her a half teaspoon (the instructions said 1 teaspoon). 90
minuted later, she had saggy eyes, and was acting very sleepy, and
quite dopey - in short, she looked drunk. Warning bells went off in my
head. I called the hospital, and the first thing they had me do was
call a pharmacist. I called a local pharmacy, and the pharmacist on
duty told me that Tussionex doesn't come in different concentrations -
there's only one, and the difference is the amount given. She confirmed
that one teaspoon is an adult dose. She told me there are 10 mg of
hydrocodone per teaspoon, and we are estimating that my 32 pound kid
got about 4-5 mg, which is the dose for kids 6 - 12 years of age. I
was fighting back tears at this point. She said that it was definitely
an overdose, but far from a toxic one, that she was at the peak of the
symptoms, and they wouldn't get any worse, and that she didn't think
we'd need to keep her up or anything - that if had supressed her
breathing, we'd know about it already. She did say to check with her
pediatrician just in case. I couldn't get ahold of our regular doctor,
so I called the hospital back.

Here's the wierd part. They weren't terribly concerned, but suggested I
call poison control as my next step. So I did so. Poison control was
VERY reassuring and said basically that there was nothing to worry
about - they confirmed that 2 hours after a dose was the peak time,
that we didn't have to worry, and to go ahead and put her to bed at the
usual time. I put her down in our room on the toddler bed, rather than
in her own room. I wanted her close, so I could listen to her
breathing.

Today she's fine (though still kind of sick).

The pharmacy that mislabeled the medication was bought out (they were a
great drug store, but everyone makes mistakes) so I can't alert them to
the mistake. But I feel awful, because part of this is my mistake.

After I thought about it, I remembered that the cough medicine had been
prescribed to *me*, that it wasn't the dosage info that was misprinted,
but rather it just had the wrong name. I knew it at the time, and
hadn't bothered to cross her name off, and put my name on it instead.
I figured I'd just remember. All of our medicines are out of reach,
etc, we're so careful, etc. I called the doctor first, etc. It all
could have been prevented if I'd just alerted them at the time, to put
the correct label on the bottle, or if I'd hand written it in (which I
did last night). Wrong - a year later and of course I'd forgotten.

So thank God I'd given her the "1/2" dose, instead of the full one.
But shame on the pharmacy for mislabeling the meds, and shame on ME for
not having fixed it when I knew about it.

So folks, be careful, and learn from my mistake.

Cathy Weeks
Mommy to Kivi Alexis 12/01

That is scary, Cathy. I had to reread the post 3-4 times to figure out what
the mislabeling issue was. I think it's a great lesson -- in case of a
labeling mistake, either take it back to the pharmacy right away for a
corrected label, or mark it when you get home. It's amazing the things we
think we're capable of remembering. HA. I'm lucky if I can remember to
change my underpants. Ever since having kids, my brain is mush.
--

Jamie
Earth Angels:
Taylor Marlys, 1/3/03 -- Little Miss Independent, who says "NO, TayTay do!"
when we try to undress her every night.
Addison Grace, 9/30/04 -- The Pterodactyl, who screeches and is practicing
her talking, "dododododo wowowowowlalalalala!" If only I knew what she was
saying!

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"Cathy Weeks" wrote in message
oups.com...
My 3 year old is a little sick, and has a nasty cough. In the morning,
I gave her some Delsym, which usually works pretty well, but by early
afternoon, she was still coughing, and was pretty miserable about it.
I looked in the medicine chest, and discovered that I had a
prescription strength cough medicine that a doctor had prescribed for
her about a year ago, called Tussionex. I have also had it for me, and
it's great. Makes me sleepy so I only take it at night.

I called our doctor (we just moved, so she's not the prescribing
doctor), and asked if it was safe to give her the prescription strength
stuff since she'd already had the over-the-counter stuff, and she gave
us the green light. She told me it wasn't a codeine cough syrup,
rather it had hydrocodone. Yikes, I hadn't realized it. Strong stuff.

So at about 5:00pm, I gave her a half dose. I figured it was strong, it
was daytime, she already had the over-the-counter stuff in her system,
so I gave her a half teaspoon (the instructions said 1 teaspoon). 90
minuted later, she had saggy eyes, and was acting very sleepy, and
quite dopey - in short, she looked drunk. Warning bells went off in my
head. I called the hospital, and the first thing they had me do was
call a pharmacist. I called a local pharmacy, and the pharmacist on
duty told me that Tussionex doesn't come in different concentrations -
there's only one, and the difference is the amount given. She confirmed
that one teaspoon is an adult dose. She told me there are 10 mg of
hydrocodone per teaspoon, and we are estimating that my 32 pound kid
got about 4-5 mg, which is the dose for kids 6 - 12 years of age. I
was fighting back tears at this point. She said that it was definitely
an overdose, but far from a toxic one, that she was at the peak of the
symptoms, and they wouldn't get any worse, and that she didn't think
we'd need to keep her up or anything - that if had supressed her
breathing, we'd know about it already. She did say to check with her
pediatrician just in case. I couldn't get ahold of our regular doctor,
so I called the hospital back.

Here's the wierd part. They weren't terribly concerned, but suggested I
call poison control as my next step. So I did so. Poison control was
VERY reassuring and said basically that there was nothing to worry
about - they confirmed that 2 hours after a dose was the peak time,
that we didn't have to worry, and to go ahead and put her to bed at the
usual time. I put her down in our room on the toddler bed, rather than
in her own room. I wanted her close, so I could listen to her
breathing.

Today she's fine (though still kind of sick).

The pharmacy that mislabeled the medication was bought out (they were a
great drug store, but everyone makes mistakes) so I can't alert them to
the mistake. But I feel awful, because part of this is my mistake.

After I thought about it, I remembered that the cough medicine had been
prescribed to *me*, that it wasn't the dosage info that was misprinted,
but rather it just had the wrong name. I knew it at the time, and
hadn't bothered to cross her name off, and put my name on it instead.
I figured I'd just remember. All of our medicines are out of reach,
etc, we're so careful, etc. I called the doctor first, etc. It all
could have been prevented if I'd just alerted them at the time, to put
the correct label on the bottle, or if I'd hand written it in (which I
did last night). Wrong - a year later and of course I'd forgotten.

So thank God I'd given her the "1/2" dose, instead of the full one.
But shame on the pharmacy for mislabeling the meds, and shame on ME for
not having fixed it when I knew about it.

So folks, be careful, and learn from my mistake.

Cathy Weeks
Mommy to Kivi Alexis 12/01

So folks, be careful, and learn from my mistake.

scary, I'll always check labels on any medicines I store in future. In the
UK we are always told to throw medicines away, but I have to say I rarely
do, obviously something like antibiotics I finish the course, but with other
meds when you are not sure if your symptoms are entirely gone etc. I do tend
to keep them, on occasions it can be very useful.

Anne