My father has taken his tablet twice: what should I do?

Practical steps to act calmly when an older person takes a duplicate dose, what information to have ready and when to call the emergency services.

If your father has taken a tablet twice, the first thing is to give him nothing else and get professional advice: his pharmacy, his doctor or the Spanish Poison Information Service (91 562 04 20), which answers 24 hours a day. If serious symptoms appear, call 112 straight away.

In many cases one extra dose of a regular medicine has no serious consequences, but that depends on the medicine, the dose and the person, and you cannot know without asking. We explain how to act step by step and how to stop it happening again.

What should I do in the first few minutes?

Stay calm, check which medicine he has taken too much of and get advice before doing anything. The Spanish Poison Information Service reminds people that nothing should be given by mouth before consulting it.

1. Find out which medicine it was: name, strength (mg) and how many extra units.
2. Write down roughly what time he took it.
3. Keep the box or blister pack and the list of medicines he takes to hand.
4. Do not make him vomit or give him other medication "to compensate".
5. Do not decide on your own to skip his next dose: ask what to do about it.
6. Call the pharmacy, the doctor or the Poison Information Service.

Who should I call and what information will they ask for?

For questions about an extra dose you can call the usual pharmacy, the health centre or the Poison Information Service of the Spanish National Institute of Toxicology and Forensic Sciences on 91 562 04 20, which answers 24 hours a day, every day of the year. The same number appears in the "If you take more... than you should" section of Spanish leaflets.

The service asks for exactly these details of who, what, how much and when so it can answer quickly. Call 112 if there is difficulty breathing, chest pain, loss of consciousness, fits, severe drowsiness or confusion, or significant bleeding.

Which medicines are more delicate if taken twice?

Not all medicines have the same safety margin. With some, an extra dose can show quickly and it is best to get advice without waiting, especially in older people who take several at once.

• Anticoagulants such as acenocoumarol: the leaflet says to see the doctor immediately if too many tablets are taken and warns that overdose can cause bleeding (bruising, blood in the urine, bleeding gums or nosebleeds).
• Blood pressure medicines: the leaflet for a generic enalapril describes dizziness or vertigo due to a sudden drop in blood pressure, which increases the risk of falls.
• Insulin and some oral diabetes medicines: they can cause low blood sugar; follow the diabetes team's instructions.
• Medicines for sleep, anxiety or strong pain: they can cause drowsiness, confusion and falls.
• Heart medicines such as digoxin or other antiarrhythmics: always get advice.

While you wait for an answer, stay with him, stop him getting up suddenly and keep an eye on how he feels.

A practical example: Luis and his blood pressure tablet

Take the case of Luis, 84, who lives with his wife and takes eight medicines. His daughter Marta rings in the afternoon and finds out that her father has taken his blood pressure tablet twice because he could not remember whether he had already taken it.

• Marta asks her mother not to give him anything else and to keep the box to hand.
• She calls the usual pharmacy, which asks about the strength, the time and how Luis feels.
• Following their advice, Luis stays seated, gets up slowly and his wife watches for dizziness.
• They ask what to do about the next day's dose and follow that advice, without improvising.
• If Luis had fainted or had chest pain, they would have called 112.

After the scare, Marta reviews how the medication is organised at home. If you suspect mistakes are happening again and again, our article on how to spot an overdose when organising medication will help you recognise the signs.

How can you stop a duplicate dose happening again?

Most duplicate doses in older people come from doubts about whether the tablet has already been taken or from boxes that look alike. Organising each dose separately and having one person in charge greatly reduces the risk.

• Use a pill organiser or a personalised dosage system (SPD) with a pocket for each day and time: if the pocket is empty, the dose has been taken.
• Remove boxes of medicines he no longer takes from the house.
• Keep an up to date list of his medication, with times, somewhere visible.
• If several people help him, agree who gives each dose.
• Ask his doctor or pharmacist for a medication review if he takes many medicines.

If the problem is the opposite, a missed dose, see our guide on what to do if you forget to take a dose.

How can IMA Health help?

With medication prepared by day and time it is much easier to know whether a dose has already been taken. At IMA Health we coordinate with a specialised pharmacy that prepares each person's medication in a personalised dosage system, we deliver it to the home and we provide personalised follow-up so the family can feel more at ease. You can read more about what an SPD is.

Sources

• Spanish Ministry of Justice: Poison Information Service (SIT) (Spanish)
• Spanish Ministry of Justice: SIT frequently asked questions (Spanish)
• CIMA (AEMPS): leaflet for Sintrom 4 mg (Spanish)
• CIMA (AEMPS): leaflet for Enalapril Cinfa 20 mg (Spanish)
• NHS Specialist Pharmacy Service: missed doses and high risk medicines

This article is for information only and does not replace advice from your doctor or pharmacist.