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Posts for category: Medicine

By Dr. Steven Miller
May 31, 2020
Category: Medicine

Biotin containerBiotin, also known as vitamin B7 and nicknamed vitamin H, is present in many multivitamins. The recommended daily dose for adults is around 30 mcg (30 micrograms, which is much smaller than a milligram). However, some supplements promoted for hair, nail, and skin health contain biotin at much higher doses, as much as 10,000 mcg (over 30,000% the recommended daily need).

Consuming large amounts of biotin can be problematic. Some lab analyzers use an immunoassay that contains biotin. In patients with excess biotin in their blood samples, there is an increased risk of false lab values due to the inability of the patient’s blood to bind properly.

There is insufficient data to know if waiting for hours or days before running lab tests would help. Furthermore, waiting is obviously impractical when running critical lab tests such as for a heart attack or pregnancy.

By Dr. Steven Miller
July 07, 2019
Category: Medicine

Unused and expired medicineThe preferred method for disposal of unused or expired medicine is a medicine take back option. The medicine can be brought to a registered collection site, such as a pharmacy, which safely and securely disposes them. A list of locations is available from the U.S. Drug Enforcement Administration (DEA).

The DEA also periodically hosts National Prescription Drug Take Back Day where temporary collection sites are set up for safe disposal.

The next best option for MOST medicines is to dispose of them in the household trash. First, mix the medicines (without crushing tablets or capsules) with an unpalatable substance such as dirt, cat litter, or used coffee grounds. Then place the mixture in a container such as a zip-top or sealable plastic bag; and throw this bag in your household trash.

A small number of medicines, most notably opioids (narcotics), should NOT be thrown in the trash, because this method may still provide an opportunity for a child or pet to accidentally take the medicine.  Instead, they should be flushed down the toilet when no longer needed and a take-back option is not readily available. The U.S. Food and Drug Administration (FDA) concluded that these medicines present negligible risk to the environment.

The majority of medicines currently found in water are believed to be the result of the body’s natural routes of drug elimination (in urine or feces).

Even a fentanyl skin patch that has been worn for three days still contains enough fentanyl to harm or cause death in a child, pet, or another household member. The patch should be folded in half so that the sticky sides meet, and then flushed down the toilet.

Here are two case summaries to illustrate how some medicines can result in death if they are accidentally taken by children. A 2 year old was seen drinking an unknown liquid from a stray plastic bottle. The next day she was unresponsive with labored breathing. Urine drug screen was positive.  She was determined to be brain dead after 10 days. A 15 month old was found with a buprenorphine/naloxone film wrapper in her mouth. Many hours later she suffered cardiac arrest and died.

One final note. Before throwing out an empty pill bottle or other packaging, remember to scratch out all personal information on the prescription label to make it unreadable (by someone else who may find it).