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Nevada News: Directions for Use
Reprinted from the January 2006 Nevada State Board of Pharmacy Newsletter.
Nevada Administrative Code 453.015 interprets “directions for use” to require a prescription label to specify the dosage, frequency, and route of administration in which a controlled substance (CS) is to be taken. Use of the phrase “take as directed” or similar phrase does not satisfy this requirement. Though this requirement applies to CS, it generates frequent inquiries of the Board of Pharmacy office by pharmacists who believe it applies, or should apply, to all prescriptions, not just CS, particularly in our environment where more than 90% of all prescriptions are paid for by a third-party requiring a days’ supply for adjudication. The pharmacist must always contact the physician for directions of “as directed” on a CS prescription written, and often he or she must do so to determine days’ supply. The Board of Pharmacy recently heard a case involving the death of a patient who overdosed on an narrow therapeutic index drug that was labeled “take as directed.” The patient clearly did not understand what was “directed,” nor was the counseling adequate. Board staff has communicated this concern to the Nevada Medical Society, where it was included in a recent newsletter, hopefully clarifying the use and dangers of using the sig code “u.d.” or “as directed.”
