Prevent Mix-Ups With Meds That Require Reconstitution

You play a key role in preventing reconstitution errors with oral powders for suspension (amoxicillin, oseltamivir, etc).

There have been many reports over the years of patients getting these meds from the pharmacy with too much water...not enough...or even NONE added.

This is scary...accidentally taking the dry powder could cause throat irritation or other side effects, or lead to an overdose.

Help prevent these types of errors from entering the mix.

Avoid covering up mixing instructions on the med package or bottle with Rx or auxiliary labels.

For small containers, consider "flagging" or "butterflying" the label to ensure the info remains visible.

Hold off on mixing suspensions until the Rx is sold...so that the med isn't wasted if it's not picked up or needs to be returned to stock.

Store Rxs that require reconstitution in a different area of the pharmacy...or include a note or sticker that says "ADD WATER" or "MIX." This will help alert your colleagues that the med needs to be reconstituted BEFORE it goes home with the patient.

Before reconstituting, turn the bottle upside down and tap it a few times...to loosen the powder and prevent it from sticking to the bottom.

Read mixing directions carefully. Most suspensions require water to be added in two PORTIONS...to prevent the powder from clumping.

Use the specific amounts of water listed on product labelling.

But if directions only list the TOTAL amount of water to include, generally add about one-half of the total to the bottle first...and shake the bottle vigorously. Then add the remaining water...and shake again.

Point patients to "Shake well" auxiliary labels...and explain proper storage and disposal. For example, cephalexin suspension needs to be stored in the fridge after mixing...and discarded after 14 days.

Get our new tech tutorial, Mixing It Up With Medications for Reconstitution, for more safety strategies to use in your practice.

Key References

  • ISMP Med Safety Alert! Community/Ambul Care 2020;19(4):1-4
  • www.ismp.org/resources/improving-medication-safety-community-pharmacy-assessing-risk-and-opportunities-change (10-27-20)
Pharmacy Technician's Letter Canada. November 2020, No. 361111



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