The Most Common Medication Mistakes That Land Mississippians in the ER

Mistake 1: Stopping a heart or blood pressure medication abruptly

Patients on beta blockers, clonidine, certain heart failure medications, and some other cardiovascular drugs can experience rebound symptoms when these are stopped suddenly. Beta blocker discontinuation can cause rapid heart rate, palpitations, chest pain, and rebound hypertension. Clonidine discontinuation can cause severe rebound blood pressure elevation. Both can land patients in the ER.

What to do instead: never stop a cardiovascular medication on your own. Call your pharmacist or prescriber to discuss any concerns about a medication before discontinuing.

Mistake 2: Doubling up on a missed dose

For most medications, doubling up is the wrong response to a missed dose. It can cause hypoglycemia (with diabetes medications), excessive blood pressure drops, sedation, bleeding (with blood thinners), and other adverse effects.

What to do instead: take the missed dose if it is close to the regular time. Skip if close to the next dose. Continue the normal schedule. When in doubt, call your pharmacist.

Mistake 3: Combining sedating medications

Opioids plus benzodiazepines. Opioids plus alcohol. Sleep medications plus alcohol. Multiple sedating prescriptions stacked. Each combination depresses breathing and consciousness in additive or multiplicative ways. Overdose can result.

What to do instead: any new sedating prescription should be reviewed against the existing medication list. The pharmacist can flag dangerous combinations before the first dose.

Mistake 4: Taking NSAIDs while on a blood thinner

Ibuprofen, naproxen, or aspirin combined with warfarin, apixaban, rivaroxaban, dabigatran, or edoxaban significantly raises bleeding risk. GI bleeding is the most common emergency, often presenting as black tarry stools, vomiting blood, or severe weakness from blood loss.

What to do instead: use acetaminophen for pain if you are on a blood thinner. Confirm with your pharmacist before using any OTC pain reliever.

Mistake 5: Errors with insulin or other diabetes medications

Taking the wrong insulin (long acting instead of short acting or vice versa). Taking the prescribed dose without eating. Taking insulin twice by mistake. Confusing two insulin pens. Hypoglycemia from these errors can be severe and can require ER care.

What to do instead: store different insulins in clearly different locations. Use the manufacturer’s labeled pens consistently. If you are uncertain about your dose, call your pharmacist. Always have a fast acting glucose source available.

Mistake 6: Sharing medications

Patients give a family member their leftover antibiotic, their blood pressure medication, or their pain medication. The recipient takes it and has an adverse reaction. The dose may be wrong for them. They may be allergic. The medication may interact with what they are already taking.

What to do instead: never share prescription medications. Call your pharmacist if a family member needs guidance, and they can recommend an appropriate OTC option or suggest a clinical visit.

Mistake 7: Inadequate monitoring on warfarin

Patients on warfarin who skip INR checks, start new medications without warfarin review, or change their diet significantly can experience INR swings that produce either dangerous clots or dangerous bleeding.

What to do instead: keep INR check appointments. Tell your pharmacist about every new medication, OTC product, and supplement. Eat a consistent amount of vitamin K containing foods rather than starting or stopping large amounts.

Mistake 8: Wrong route or wrong form

Crushing extended release medications. Chewing time release tablets. Cutting pills that should not be cut. Using a topical product internally. Using an oral medication topically.

What to do instead: read the label carefully. Look for instructions like do not crush, do not chew, swallow whole. If the medication is hard to swallow, ask your pharmacist whether an alternative form exists.

Mistake 9: Acetaminophen overdose

Acetaminophen is in many products, often unlabeled as such. Patients take Tylenol for headache, NyQuil for cold, Excedrin for migraine, and a prescription pain medication that contains acetaminophen. The total daily dose adds up beyond the safe limit. Liver damage can develop, sometimes silently for days.

What to do instead: read the active ingredients of every OTC product. Track total daily acetaminophen across all sources. Limit to 3000 mg per day for most adults, lower if you have liver disease or drink alcohol regularly.

Mistake 10: Continuing a medication after the indication is gone

Patients continue taking proton pump inhibitors, sleep medications, or anti anxiety medications for years after the original reason has resolved. The medication that was helpful becomes the medication that causes a new problem. PPIs long term can cause bone loss, magnesium deficiency, and certain infections. Long term benzodiazepines cause cognitive decline and fall risk. Long term sleep aids stop working and develop dependence.

What to do instead: ask your pharmacist at least annually whether each long term medication still has a clear indication, and whether deprescribing makes sense.

Where pharmacy fits

Free medication therapy management for any Mississippi resident. The best time to do this review is before something goes wrong. Serving Hattiesburg, the Pine Belt, Central Mississippi, and South Mississippi.

When to call a pharmacist

• You are about to stop a medication on your own.
• You are uncertain about a missed dose.
• You are adding any new OTC product or supplement.
• You take a blood thinner and need pain relief.
• You take multiple sedating medications.
• You take five or more medications without recent review.
• You are caring for a family member with a complex regimen.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.