// August 12, 2014

Do You Find Prescription Labels Hard to Read? You Are Not Alone

Each year, over a million Americans experience a health problem because they don’t take their medicine as their doctor intended. But it is not for lack of trying.

An estimated 90 million adults in the United States misunderstand prescription drug labels or have trouble following their directions.

Mistakes are Common

"So many people make mistakes taking their medicines," said Dr. Joanne Schwartzberg, director of aging and community health at the American Medical Association and a member of USP's Nomenclature, Safety and Labeling Expert Committee.

“Many mistakes result from dosing directions. For example: patients may read ‘Take two pills twice daily,’ and believe it means to ‘take two pills a day,’ rather than the intended instruction to take a total of four pills,” explained Schwartzberg.

Drug names are another source of confusion. For example, a patient may be prescribed a brand name drug by their doctor, but has a generic version of the drug filled at the pharmacy. Patients unfamiliar with a medicine labeled with the generic (or non-proprietary) name alone, may:

  1. Not take it at all;
  2. Take it to treat an entirely different illness or symptom than the one it was prescribed to treat; or
  3. Double the dose - there have been cases when a patient has two bottles of the same medicine, and believing them to be two different medications, takes a pill from each bottle, thereby doubling the dose.

Legibility is Key

Errors aren’t limited to patient health literacy.  Many times the problem involves the appearance of the label itself.

Many patients, especially older patients with limited vision, find small print or crowded text difficult to read. Yet, a recent study of pharmacies in Canada found that few follow professionally recommended guidelines for legibility. Less than half met the recommendation for a minimum font size of 12 points and all used capital lettering instead of the easier to read sentence case.

As a patient's most tangible (and often only) source of information about how a drug has been prescribed and how that drug should be taken, the label on a container of prescription medication is a crucial line of defense against medication safety problems. Yet, until recently, there have been no “best practices” to standardize how the information on prescription labels is organized or written.

USP Offers “Patient-Centered” Guidelines

In 2012 USP developed a prescription container labeling standard that reflects how most patients seek out and understand medication instructions.

These “patient-centered” guidelines offer recommendations for the format, appearance, content, and language of prescription medication instructions. The guidelines in the standard are designed to make it easier for all patients to read and understand medication information and instructions.

The National Association of Boards of Pharmacies was among the stakeholder organizations that contributed to the development of the USP standard. But, it is up to each individual state’s board of pharmacy to choose whether to adopt USP standards into their state’s regulations.

Here are Some of USP’s Recommendations:

  1. Information on the label should:

    • Feature only the most important patient information needed for effective understanding and use;
    • Include BOTH the drug brand name and the generic drug name;
    • Include “Purpose for Use” when provided by the doctor and allowed under privacy laws (or requested by the patient).
  2. To make the label easier to read:

    • Critical information (the patient’s name, drug name and directions for use) should be
      • At the top of the label;
      • Minimum 12 point font.
    • All information should be
      • High contrast print (black ink on a white label);
      • Sentence case, all capitals should be avoided;
      • Minimum 10 point font;
      • Simple, uncondensed font (like Arial or Times New Roman);
      • Horizontal text only (patient should not have to turn the container to read information).
      • Less critical information (pharmacy name, pill quantity, prescription number)
      • Less prominent location (for example near the bottom of the label).
  3. To make information easier to understand, language on the label should be:

    • Simple, clear, concise and familiar;
    • Use standardized terms to promote understanding through consistent language;
    • Provided in the patient’s preferred language whenever possible.
      • But the drug name should always be in English (to help emergency personnel and other intermediaries).
  4. To make dosing instructions easier to understand:

    • The dose amount and the timing of each dose should be clearly separated;
    • Numbers should be represented by numerals, not spelled out;
    • Dosing instructions should be explicit
      • morning, noon, evening and bedtime are GOOD examples.
    • Dosing instructions to AVOID include:
      • Intervals – twice daily, every 6 hours - these instructions require numeric proficiency;
      • Specific times – 8 am and 6 pm – instructions should promote adherence, regardless of lifestyle.

Have you ever had difficulty reading or understanding a prescription container label? Share your experience with us in the comment section below.