How to Eliminate Confusion When Rx Packaging and Concentrations Change


Companies make changes to their products all the time, and pharmaceutical products are no exception.  Pharmacists need to stay alert to these changes to make sure they are administering the medications properly.

Such modifications have recently been made to the concentration and design of several high profile drugs. Drug manufacturers have made substantial adjustments to rabies immune globulin (HyperRAB) and the vitamins A, D and E.

Rabies Immune Globulin

Grifols, the company that produces the globulin, has increased the concentration of the drug. The reason for the change is to enhance the effectiveness of the medication – with greater concentration, more of the drug can reach the wound with less volume being used. The concentration has been doubled – from 150 to 300 units per milliliter.

The drug is now packaged in both one-milliliter and five-milliliter vials. However, pharmacists need to be careful when storing or using the drug because the vials of each version of the drug look exactly alike, as do the packages. Both the one and five-milliliter concentrations come in five-milliliter containers. And the only way to tell the packages apart is by checking the lower left-hand corner of the box where the concentration is printed, and also checking the National Drug Code numbers.

The one-milliliter vial contains enough of the drug to treat a child weighing up to 15 kilograms, while the five-milliliter vial can treat someone weighing up to 75 kilograms. Both types can only be used one time. Confusing the two types can lead to waste and inventory problems.

Vitamins A, D and E

These nutritional supplements are now measured in metric units – micrograms or milligrams – as opposed to international units, as they were in the past.

As an illustration, vitamin D oral drops that had been labeled 400 international units per milliliter are now labeled 10 micrograms per milliliter. The changes are the result of a ruling from the FDA calling for revisions on the labels of nutritional supplements, which require not only listing the amounts of the drugs contained in each dose, but the percent of daily requirements as well.

Many healthcare professionals and consumers are not yet aware of these changes, and this may lead to some confusion. The container labels may include just the metric measure, making it more difficult to determine the equivalency to the international unit measure used previously. Pharmacists are recommending that manufacturers also include the international unit measure in parentheses after the metric units to make the transition easier for consumers.

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