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Wednesday, December 9, 2020

Problems With Vitamins

From a professional view, I loathe dosing on vitamins/supplements. (This is not about my opinions on vitamins/supplements themselves, for that is another beast altogether.) The current, normal dosing is based on advertising and not ease-of-use for the patient. 
In much the same way as food labels are based on servings, so are supplements. (When is the last time you shared a can of Chunky Soup with someone? You should because a single can is two servings.)

Melatonin 5mg Gummies. It says so right on the front of the bottle. It says it on the sticker at your pharmacy. "5MG". Clear as can be. No way to misinterpret "5MG". 
Except. . . 
When you, as a do-your-due-diligence practitioner, read the back of the label and check "serving size", you notice the serving is actually two (2) gummies. Hmm. That would make each gummy only 2.5mg. Does that make each dose 2.5? 
When I, as a pharmacist, use these to fill a prescription, I will write "Chew 1 gummy once a day" to convey the simple fact that your dose is 2.5mg. 
When you, the patient, grab a bottle off the shelf, and see "5mg", will you only give your child one gummy? This would mean you are underdosing her at 2.5mg, right? Right.
See why I don't like this? 
Can you see what other issues may arise? 
Maybe a patient doubling the dose and actually taking the 5mg dose, (all the while believing they were taking 10mg) then buying a 10mg, thereby unintentionally doubling that dose?
Sound farfetched? Sound cynical? Sound like something I have complained about before? 
It sounds like something that actually happened recently. A mom bought the same bottle OTC that I used to fill her daughters' prescriptions. Had she not come to me for counsel, she would have doubled their dose. 

Fine. It's melatonin. No big deal. 
Okay. What about the Glucosamine-Chondroitin products? They clearly state if they are double- or triple-strength.
Sure. Just like buying paper products, the math here is frustratingly complicated. 
First, you have to know what "Single-Strength" is. And is that in 1 tablet? 2 tablets? 4? 
Then, is the "Double-strength" a single tablet? Or 2? Or 3? 
Don't get me started on the "Triple Strength" where a single dose is 2 tablets. 

It's all marketing. Unless people can do the math or are wise enough to seek counsel with the White Coats in the back, there can be issues with taking too much or too little of many OTC products. 

(Anticipatory Devil's Advocate rebuttal: geesh CP. they're only OTC supplements. who cares? it's not like they can OD or anything. they don't really do anything anyway, right? it's not like they're real medications.)
Right. Except lots of children take melatonin (and other OTC products) and lots of people believe that "if one is good, two is better" and many patients never report their OTC products while giving medication histories. 

Also, it's not just about Melatonin and Osteo-Bi-Flex. There are many OTC products that can be easily under- or overdosed due to unclear labels. 
Shouldn't there be a call for a change to happen? 
If the label says "10mg" then I expect the bottle to contain 10mg doses, not 2.5mg or 5mg "partial servings". 
I wonder how often mistakes are made based on OTC labeling because it's designed on marketing instead of safety?

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