BDT 351Basic Dispensing Theory IV
Cautionary and Advisory Labels
9 minute read
What you will learn
- Distinguish the general label from cautionary and advisory labels
- List the information that a dispensing label must carry
- Choose suitable cautionary labels for common medicines
- Give special instructions for particular classes of medicines
- Work out the quantity to supply from the directions on a label
- Check a label for errors before handing it out
Key points
- The general label carries the patient, drug and directions. Cautionary and advisory labels add warnings and advice.
- A cautionary label warns of a danger, such as drowsiness or alcohol. An advisory label gives advice on how to take the medicine.
- Wording must be simple, short, and in a language the patient understands.
- Different classes of medicines need different instructions, such as 'Complete the course' for antibiotics.
- Too many labels confuse the patient, so use only the ones that matter most.
- Every label is checked against the prescription before handing out.
- Counselling by voice backs up the label and does not replace it.
Where this fits
The lessons on labels and labelling and on dispensing in BDT 251 cover what a label is, its functions and its qualities. This lesson goes deeper into the kinds of label and the instructions for particular classes of medicines.
Categories of label
| Category | Purpose | Example |
|---|---|---|
| General label | Identifies the patient, the medicine and how to take it | "Mr A. Obi. Amoxicillin 500 mg capsules. Take ONE capsule THREE times a day" |
| Cautionary label | Warns about a danger or something to avoid | "Avoid alcohol", "May cause drowsiness" |
| Advisory label | Gives advice on how to get the best from the medicine | "Take with or after food", "Complete the course" |
| Special instruction | Extra instructions for a particular medicine or group | "Dissolve under the tongue", "Store in a refrigerator" |
Information on the general label
- The patient's name (and age for children).
- The name and strength of the medicine, and the form.
- The quantity supplied.
- The directions: dose, how often, when, and for how long.
- The date of dispensing.
- The name and address of the pharmacy, and the dispenser's or pharmacist's details.
- Storage instructions and the discard or expiry date, as needed.
- "Keep out of the reach of children."
The label should be clear, accurate, legible and in plain words. Write "Take ONE tablet THREE times a day" rather than "1 t.d.s."
Common cautionary and advisory labels
The wording below is a guide. Use the wording that your school's reference book or your pharmacy has approved.
| Label | Suitable for |
|---|---|
| Complete the prescribed course | Antibiotics, antimalarials |
| Take with or after food | Anti-inflammatory painkillers such as ibuprofen and diclofenac, prednisolone |
| Take on an empty stomach, about half an hour before food | Some medicines, such as rifampicin |
| Avoid alcohol | Metronidazole, and medicines that cause drowsiness |
| May cause drowsiness. If affected, do not drive or use machinery | Many antihistamines, strong painkillers, sedatives |
| Do not take milk, antacids or iron preparations at the same time | Tetracyclines such as doxycycline, and ciprofloxacin |
| Swallow whole. Do not chew or crush | Modified-release tablets |
| Dissolve under the tongue | Glyceryl trinitrate tablets |
| Do not stop taking this medicine unless your doctor tells you to | Steroids, antiepileptics, antihypertensives |
| Protect your skin from sunlight | Doxycycline and similar medicines |
| Shake the bottle well before use | Suspensions |
| For external use only | Creams, lotions, liniments |
| Keep in a refrigerator | Insulin, some eye drops, some liquids |
| Space the doses evenly through the day | Antibiotics |
Special instructions by class of medicine
| Class | Key instructions |
|---|---|
| Antibiotics | Finish the course. Space the doses. Do not share with others. Some need food and some need an empty stomach |
| Antimalarials | Finish the course. Take with food if the label says so. Seek help if the fever continues |
| Painkillers (analgesics) | Do not exceed the stated dose. Do not take another medicine that contains the same drug, for example paracetamol in a cold remedy |
| Anti-inflammatories (NSAIDs) | Take with food. Report black stools or stomach pain |
| Antihypertensives | Take daily, even when you feel well. Do not stop suddenly. Rise slowly from lying down if you feel dizzy |
| Antidiabetic medicines | Take as directed with meals. Know the signs of low blood sugar. Do not skip meals |
| Insulin | Store in a refrigerator. Rotate injection sites. Use the correct syringe or pen |
| Steroids | Take in the morning, with food. Do not stop suddenly |
| Iron tablets | May turn stools dark. Take as directed, and keep out of reach of children |
| Eye and ear drops | Wash hands first. Do not touch the dropper to the eye or ear. Many are discarded 4 weeks after opening, as the label says |
| Inhalers | Teach the technique. Rinse the mouth after steroid inhalers |
Working out the quantity from the directions
Example. Amoxicillin 500 mg capsules. One capsule three times a day for 7 days.
- 1 × 3 × 7 = 21 capsules
Example. Suspension, 5 mL twice a day for 5 days.
- 5 × 2 × 5 = 50 mL
The quantity on the label must match the quantity supplied.
Good practice
- Choose the most important labels. Too many labels confuse the patient.
- Put the label on the bottle, not the lid, and keep it clean.
- Use plain language and, where needed, the local language or pictograms.
- Counsel the patient out loud, as well as using labels. Ask them to repeat the main points back.
- Check every label against the prescription before the medicine leaves the counter.
Common label errors
| Error | Risk |
|---|---|
| Wrong patient or wrong medicine | Serious harm |
| Wrong dose or frequency | Under- or overdose |
| Missing warning | Patient is unaware of a danger |
| Smudged or unreadable label | Wrong use |
| Different quantity from the label | Course too short or too long |
Exam focus
- State the information on a dispensing label.
- Give the cautionary label for a named medicine, for example metronidazole or an antihistamine.
- Explain the difference between a cautionary and an advisory label.
- Common mistake: leaving out 'Complete the course' on an antibiotic or an antimalarial.
Quick check
Test yourself before you move on. Pick an answer to see the explanation.
1.Which cautionary label best suits metronidazole?
2.A cautionary label differs from an advisory label because it:
3.An antihistamine causing drowsiness should carry:
4.A capsule is to be taken one three times a day for 7 days. How many capsules are supplied?
5.Why should a dispenser avoid putting many cautionary labels on one bottle?