What is food poisoning?

Food poisoning, also known as foodborne illness, are the symptoms that people experience after eating or drinking something that has been contaminated by germs, bacteria, or other toxins. These symptoms include diarrhea, nausea, stomach pain, vomiting, headaches, and even fevers. These symptoms are typically mild and go away on their own after 1-3 days, though some cases may last up to a week. However, more serious episodes of food poisoning can lead to complications like severe infection that require a visit to the doctor or hospitalization.

How does it happen?

The food we eat can be contaminated in many different ways. For example, bacteria can grow in food when it is not fresh, properly cleaned, or undercooked. It can also happen when perishable foods like meat, dairy, or salads are left to sit at room temperature instead of being stored in the refrigerator.

Some foods, like fruits and vegetables, can become contaminated if they are not thoroughly washed. Other contaminants can happen when people do not wash their hands when preparing food or through cross contamination. For example, using a cutting board or utensils to prepare raw meat and then using them again to prepare ready to eat foods like salads or fruits without washing them thoroughly.

Food poisoning is also very common when traveling. When traveling to new countries, they may have different sanitation practices than we are used to, which can contribute to something called traveler’s diarrhea.

Common causes

As the name suggests, foodborne illness usually occurs after eating contaminated food. Common causes of these foodborne illnesses are pathogens such as salmonella, E. coli, or listeria, or hepatitis A. These pathogens are found in common everyday foods:

Common pathogens	Common Sources
Norovirus	Undercooked shellfish, leafy greens, fresh fruits, and person-to-person contact
Salmonella	Raw eggs and undercooked poultry
E. Coli	Undercooked meat and raw vegetables
Listeria	Cheeses, raw sprouts, deli meats, and hot dogs
Hepatitis A	Shellfish, fresh produce, or water and ice contaminated by fecal matter (human waste).
Campylobacter	Undercooked poultry, contaminated vegetables, and raw milk
Shigella	Cream or mayonnaise-based salads like tuna, potato, macaroni or chicken salad

Is food poisoning contagious?

Yes, food poisoning can be contagious. Foodborne illness is mainly caused by eating contaminated food. In some cases, it can pass between people, like direct contact with an infected person’s hands or bodily fluids.  Outbreaks can occur in shared spaces such as cruise ships, dormitories, and hotels, particularly with highly contagious pathogens like norovirus. Good hand hygiene and sanitation practices significantly reduce these risks.

Additionally, some pathogens spread between people more easily than others. For example, norovirus, one of the most common causes of stomach flu, spreads early through close contact, contaminated surfaces, or food. It is linked to ~50% of cases of foodborne illness in the United States. Other bacteria, such as Salmonella and Campylobacter, are more often linked to eating contaminated food rather than spreading directly from person to person.

Management

• OTC medication: In adults, mild symptoms of food poisoning can be managed with some over the counter medications. However, these medications will only provide relief – they will not treat the underlying cause. But in mild cases, relief of these symptoms is enough to keep us comfortable enough while the illness runs its course.
  • Fluids –> First line management strategy
    • Fluids are helpful for preventing dehydration by replacing the volume lost from vomiting and diarrhea. It is best to sip clear liquids, and some oral rehydration solutions are available like Pedialyte. When selecting fluids to prevent dehydration, it is best to avoid dairy, caffeine, and sugary drinks.
    • Helpful tip: if you are experiencing vomiting, try starting with a small amount and increasing as tolerated.
  • Loperamide (Imodium)
    • Loperamide is an antidiarrheal medication that is available over the counter and provides relief to symptoms of food poisoning.
    • How to take it: For adults, It is dosed at 4 mg by mouth initially, then 2 mg by mouth for every loose stool thereafter. Max daily dose of 8 mg in one day.
    • Side effects: Loperamide is generally well tolerated, but common side effects can include constipation, dizziness, nausea, or abdominal cramping.
    • WARNING: it is important to avoid loperamide if your symptoms include a fever, bloody/black tarry stools, or severe abdominal pain.
  • Bismuth Subsalicylate (Pepto Bismol)
    • Pepto Bismol is another antidiarrheal medication available over the counter. However, Pepto Bismol may also help relieve additional symptoms like nausea, vomiting, and stomach cramps.
    • How to take it: For adults, Pepto Bismol is available as both liquid or capsules. The liquid formula is dosed 30 mL by mouth every 30-60 minutes with a maximum daily dose of 240 mL. The capsules are two 262 mg capsules by mouth every 30 minutes with a maximum daily dose of 16 capsules.
    • Pepto Bismol can cause constipation and discoloration of the tongue and stool. Your tongue and stool can become black. This is a harmless side effect and should return to normal after you stop taking the medication

When to seek help

Most instances of food poisoning are mild. It can look like diarrhea, occasional and manageable vomiting, or stomach upset. These milder episodes also tend to go away on their own after 1-3 days and can be self-managed with over-the-counter products like those mentioned above.

However, sometimes these symptoms can become serious. You should see a doctor if your symptoms become more severe. These severe symptoms can include but are not limited to:

• Blood in the stool
• Fever over 101.3ºF or 38.8ºC
• Vomiting so severe that you cannot keep any liquids down
• Signs of severe dehydration (not enough water in your body) like dizziness, confusion, or you are unable to pee
• If symptoms persist beyond 5 days

At Risk Populations: Certain groups of people are also at higher risk of severe food poisoning complications. These include young children, older adults, pregnant people, and people with weakened immune systems. These individuals may become seriously ill more quickly and should seek medical care sooner if symptoms are severe or persistent.

More severe cases of food poisoning may require prescription medications such as ondansetron to help control nausea and vomiting. Antibiotics may not be necessary, especially if symptoms begin to improve or if foodborne illness is caused by a virus.  However, they may be prescribed in certain situations like severe cases of traveler’s diarrhea, or if a patient is at a higher risk for developing complications.

Prepared By Jester Kyle Calalang PharmD Candidate 2026

References

Switaj TL, Winter KJ, Christensen SR. Diagnosis and Management of Foodborne Illness. Am Fam Physician. 2015;92(5):358-365.

Centers for Disease Control and Prevention. Preventing Food Poisoning. Published November 24, 2025. Accessed April 19, 2026. https://www.cdc.gov/food-safety/prevention/index.html

Mayo Clinic Staff. Food poisoning (foodborne illness): Symptoms and causes. Published August 16, 2025. Accessed April 19, 2026. https://www.mayoclinic.org/diseases-conditions/food-poisoning/symptoms-causes/syc-20356230

Cleveland Clinic. Food Poisoning: Symptoms, How You Get It & Treatment. Updated May 28, 2025. Accessed April 19, 2026. https://my.clevelandclinic.org/health/diseases/21167-food-poisoning

Please see our Naloxone handout regarding how to use it, the 6 steps to follow when responding to an overdose as well as important tidbits on “high-dose” naloxone and what to do about expired products.

You’ve just come from a doctor’s appointment, and they wrote you a prescription for a new blood pressure medication. Your doctor tells you that it should be ready to pick by the time you get to the pharmacy. When you get there, there is only 1 person ahead of you in line; but when you get to the counter, the pharmacy tells you it will be 30 minutes until your prescription is ready. How can this be??

THE TRUTH BEHIND DISPENSING MEDICATION

There is more than what meets the eye when it comes to processing prescriptions. Though it may seem simple (how hard can it be to grab a medication off the shelf, fill a bottle, and pass it to the patient?), there is a reason pharmacists go through 6+ years of higher education and are required to obtain a doctorate degree. Each prescription that comes through is clinically evaluated, no matter how simple it may seem. Patient safety and wellbeing are at the forefront of everything we do at the pharmacy.

SO WHAT ACTUALLY HAPPENS WHEN THE PRESCRIPTION IS SENT IN?

Prescriptions can be sent to the pharmacy in one of a few different ways: via electronic communication, physical paper, or over the phone. When a script is sent electronically, it can have a delay of up to 10 minutes before the pharmacy actually receives it. It must go through a clearing house before it hits the pharmacy’s system. The doctors themselves may also be balancing back-to-back appointments and might not have a chance to send the prescription until much later after your appointment has concluded. When a prescription is received either physically or over the phone, the person receiving it must transcribe all the information into the computer, which can take a bit of time depending on how complex the prescription is. Unfortunately, pharmacies legally cannot begin processing prescriptions until we have physically received them, even if we know we should be receiving them shortly.

MY PRESCRIPTION HAS BEEN RECEIVED, NOW WHAT?

Depending on how many prescriptions are already waiting in the system, there may be some time before the pharmacy actively begins processing it. Scripts are “typed” or processed in the order that they were received, unless the patient requests it sooner. If there are already 100 prescriptions waiting to be looked at, your new one will become number 101 in the queue.  Scripts can even continue to come in after pharmacy hours – which results in an even longer queue the next opening morning! Processing time can be further prolonged as the pharmacy team consistently balances other responsibilities including vaccine appointments/walk-ins and patient counseling.

Sometimes during the typing process, we notice details that might be missing or unclear. This could include vague instructions, an unexpected change in dosing, or may be missing details that make a prescription valid and complete. In these cases, we call the prescriber’s office to collect more information and get clarification. Quite often, the prescriber is unavailable as they are very busy individuals too. We can leave a message and wait for a callback or even try again at a later time. But ultimately, we will need to get a response from them before we can proceed.

THE INSURANCE DILEMMA

Love it or hate it, insurance and prescription coverage are a critical part of dispensing medications. Most of the time, insurance can bring the cost of expensive medications down to a reasonable price  the patient can afford. However, in some instances where a medication is not covered, it can significantly delay the dispensing process. There are many different reasons why insurance might reject coverage: it may not be listed as an approved drug to be covered, incorrect dosage, refill too soon, or refilled already at another pharmacy. In some cases, we may be able to submit a prior authorization (PA) request. This is a request sent to your doctor to submit an appeal to your insurance company explaining why you need the medication. Even after the PA has been submitted by your doctor, the insurance company may take additional time to respond with their decision.

There are also rare situations where the doctor accidentally sends a prescription to two different pharmacies. Depending on who processes the prescription first, another pharmacy may have already billed your insurance and filled the medication. If this happens, the other pharmacy must unbill the insurance before our pharmacy is able to dispense the medication for you. Unfortunately, the only way to bypass all the insurance processes is to pay for the prescription out of pocket. However, for many people this is not a feasible option.

FINALLY TIME TO FILL

We’ve finally made it to the exciting stage of the prescription filling process where we can dispense the actual medication! Picture this: you’ve gone through all the steps of receiving a prescription, typing it up, running it through insurance, and when you go to grab the bottle off the shelf, there is nothing there. This is an unfortunate reality sometimes, and it is frustrating for all parties involved. Fortunately, we are typically able to place an order to be received the next day. Understandably, some people need their prescriptions ASAP and this situation further delays them getting treatment. In some cases, we can partially fill the prescription and fill the remainder once more stock has arrived.

PHARMACIST CHECK

One of the very last things that happens before a prescription is ready for pickup is a pharmacist double check. This is when our clinically trained PharmDs evaluate each dispensed prescription one last time and ensure it is appropriate for the patient to take home. This means double checking the prescription to confirm everything is filled out correctly, that the dose and what the medication was prescribed for makes sense, that the medication won’t cause further problems based on the patient’s past medical history, that there are no drug or allergy interactions that could be harmful, and that what was dispensed is the correct medication. Though it may look like the pharmacist is just taking a quick look at each bottle before hitting verify on autopilot, there is quite a lot running through their brain for each bottle.

CAN I HAVE MY MEDICATION YET?

We have finally reached the very last step of the dispensing process: giving you your medicine. You head to the counter, the team member rings you up, and you sign for your bottle. They then let you know that the pharmacist needs to speak with you about the new blood pressure medication. You think: can’t I just read the bottle?

It is important (and required by law) that we counsel patients (or at least offer counseling) on all new medications. This is not because we want to take more time out of people’s day, but to ensure everyone knows what to expect and has the opportunity to ask questions. We never assume you’ve had a chance to talk to your doctor about everything. Our job is ultimately to ensure people feel confident in their health management, and know what symptoms to look out for and how to approach them when starting a new therapy. Patient safety is always at the forefront of everything we do!

HOW CAN I SPEED UP THIS PROCESS?

Though we try our best to be efficient, there are many ways that you as the patient can help us get your medication to you as quickly as possible. This includes answering the phone if you see a phone call coming from us, letting us know ahead of time if you will be coming in to pick up a prescription and/or requesting an ETA on when it will be ready to pickup if you are coming soon after it was prescribed, sharing any allergies or health conditions we may be unaware about, and staying ahead of your refills. As you can see, there is a lot that goes into filling a prescription, and there can be many roadblocks that we might hit along the way. Sometimes processes, even refills, can take a couple of days to be resolved, so anytime you can plan ahead helps us out a ton! Each pharmacy is unique in terms of workflow, volume of prescriptions, staff responsibilities, and internal checking systems, so it is also important to check with your specific pharmacy if you have further questions.

Prepared by Kathryn Versteeg PharmD Candidate 2026

What does it mean when someone asks, “Is my iron pill working?”

When someone asks if their iron pill is working, they usually want to know if their body is starting to fix low iron levels. Iron pills help the body make healthy red blood cells, which carry oxygen to all parts of the body.

If your iron is low, you may feel tired, weak, dizzy, or short of breath. Iron pills do not work right away. Your body needs time to absorb the iron and use it to make new red blood cells. This is why improvement happens slowly over several weeks.

Because of this, iron pills are checked by how you feel over time and sometimes by blood tests, not by instant results.

How long does it take for an iron pill to start working?

Iron pills do not work right away. Many people start to feel more energy after taking iron every day for about 2 to 4 weeks, and blood tests may slowly improve during this time. Healthcare providers do not rely on hemoglobin alone. They often evaluate several lab values  including hemoglobin, ferritin, serum iron, and total iron-binding capacity (TIBC) etc.. to assess iron deficiency and response to treatment. Hemoglobin, the part of the blood that carries oxygen, may begin to rise within a few weeks, but reaching a normal level can take 2 to 3 months or longer, depending on the person. In adult women, typical hemoglobin ranges are roughly 12–15.5 g/dL, while adult men often range around 13.5–17.5 g/dL. However, normal values can vary by age, sex, and laboratory standards, and children have different ranges that change as they grow. Hemoglobin is measured in grams per deciliter (g/dL) and reflects how well the blood carries oxygen. Levels below the usual range may be a sign of anemia, including iron-deficiency anemia.

Even if you start to feel better sooner, it can take several additional months to fully refill the body’s iron stores. Because of this, most people need to keep taking iron for 3 months or more, and sometimes continue for a short period even after blood levels return to normal. The exact length of time depends on the person and should be decided with a doctor or pharmacist.

It is important to take iron exactly as directed and not stop early unless your healthcare provider tells you to.

Are side effects a sign that the iron pill is working?

Having side effects does not always mean the iron pill is working, but some side effects are common. These may include dark or black stools, constipation, nausea, or stomach upset.

Dark stools are normal when taking iron and are usually not a problem. Constipation or stomach discomfort can happen even if the iron is working well.

If side effects are bothersome, a pharmacist may recommend:

• Using a stool softener for constipation

Using a stool softener or a gentle bulk-forming laxative for constipation (such as docusate or psyllium)

• Adjusting how or when the iron is taken

Adjusting how or when the iron is taken (for example, taking it with food if stomach upset occurs or taking it every other day if advised by a healthcare provider)

• Changing the iron brand or form to reduce stomach upset

(Some iron forms such as heme iron, carbonyl iron, iron amino-acid chelates, and polysaccharide-iron complexes may cause fewer stomach side effects than traditional ferrous or ferric iron salts. Examples of over-the-counter products include Proferrin® (heme iron), Feosol® Carbonyl Iron, and NovaFerrum® polysaccharide iron.)

Do not stop taking iron without first talking to a pharmacist or doctor.

I’ve been taking my iron for more than 2 months, but my symptoms and blood tests are not improving why?

An iron pill may not seem to be working for several reasons. One common reason is missing doses or not taking iron regularly. Iron needs to be taken consistently to work well.

Iron may also not absorb well if it is taken with certain foods or medicines, such as calcium supplements, antacids, or dairy products. These can block iron absorption. Iron is absorbed better in an acidic environment, so taking it with vitamin C or a glass of orange juice may help.

In some cases, the body may have trouble absorbing iron, or the cause of low iron may still be present, such as ongoing blood loss. If there is no improvement after several weeks, a pharmacist or doctor can help review how the iron is being taken and recommend next steps. In some cases, if oral iron still does not improve symptoms or blood tests, a doctor may consider intravenous (IV) iron, which delivers iron directly into the bloodstream and may work faster for people who cannot absorb or tolerate oral iron.

When should someone talk to a pharmacist or doctor about their iron pill?

Someone should talk to a pharmacist or doctor if they do not start feeling better after 6 to 8 weeks of taking their iron pill regularly. This may mean the dose is not right or a different iron product is needed.

They should also ask for help if side effects are strong or do not improve, such as ongoing stomach pain or constipation. A pharmacist can review how the iron is being taken, suggest changes, or decide if a doctor visit is needed.

What is the bottom line about knowing if an iron pill is working?

Iron pills can work well, but they take time. Common signs that iron is helping include feeling less tired, having more energy, and seeing improvement on blood tests.

Some people may also notice that their skin looks less pale and healthier as iron levels improve. These changes happen slowly and may take several weeks.

Taking iron regularly, helping absorption, and managing side effects can improve results. If symptoms do not improve or side effects are hard to manage, a pharmacist or doctor can help decide what to do next.

Prepared by Suzan Alobaidi PharmD Candidate 2026

References

1. National Institutes of Health, Office of Dietary Supplements. Iron: Fact Sheet for Consumers. Updated March 22, 2023. Accessed January 19, 2026. https://ods.od.nih.gov/factsheets/Iron-Consumer/
2. MedlinePlus. Iron in Diet. National Library of Medicine. Updated February 6, 2024. Accessed January 19, 2026.
   https://medlineplus.gov/ency/article/002422.htm
3. Mayo Clinic. Iron deficiency anemia. Updated January 11, 2024. Accessed January 19, 2026. https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034
4. Jimenez K, Kulnigg-Dabsch S, Gasche C. Management of Iron Deficiency Anemia. Gastroenterol Hepatol (N Y). 2015;11(4):241-250.
5. Goddard AF, James MW, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. Gut.2011;60(10):1309-1316. https://gut.bmj.com/content/60/10/1309

You have hypertension and take lisinopril 10 mg every morning to help manage your blood pressure and keep it within your target range.

One busy morning, you wake up late and rush to get ready for work. Between packing your kids’ lunches and helping them prepare for school, you head out the door without realizing you forgot your medication. The day flies by with back-to-back meetings, and after lunch, it hits you — you didn’t take your lisinopril this morning.

Don’t worry — you’re not alone! Many people find it challenging to remember their daily medications, especially on hectic mornings. Let’s go over some simple strategies that can help you stay on track and make taking your medication part of your daily routine.

What are some strategies to help me remember my medicines?

Use a weekly pillbox 

• Benefits
  • Simple, low cost, helps visually track missed doses and useful for multiple daily meds
• Considerations
  • Requires regular refilling, can be confusing if new medication schedule changes, not portable for all-day dosing, limited daily medication space (Big pills and pt taking lot of pills)
• Options
  • Weekly pillbox options are usually under $10
  • There are options for once daily, twice daily, or three or four times daily pillboxes, depending on your needs
  • Monthly daily pillbox with an alarm is ~$75
  • Some pharmacies will package your medicine into monthly pill packs for an added fee. Feel free to call our 7th and Madison location at 206-324-6990 to inquire!

Combine taking the medication with a task 

• Benefits
  • Builds consistency and routine
  • No extra tools needed
  • Works well for once-daily meds
• Considerations
  • May not work if routine changes (traveling)
  • Less effective for multiple doses per day
• Examples
  • After waking up
  • Making coffee in the morning
  • When putting on makeup
  • Before breakfast or after breakfast
  • Before shower/after shower
  • Before/after brushing teeth

Use a calendar 

• Benefits
  • Visual reminder and record
  • Helps track long-term adherence
  • Easy customize
• Considerations
  • Requires marking down days daily
  • Might be difficult for multiple day dosed medications
• Examples
  • Medication logbook
  • Diary

Set an alarm reminder 

• Benefits
  • Immediate, real-time reminder
  • Works for multiple daily doses
  • Easy to set on phone or watch
• Considerations
  • Easy to ignore or snooze
  • Alarm fatigue can occur
  • Requires keeping device charged and nearby
• How to set up an alarm
  • iPhone: https://youtu.be/YL2PqiTHHQw?si=ZjKZrekON3y4S5Tw
  • Android: https://youtu.be/3CweQpNHR1Y?si=luzRtvDkaJ4IVVbs

Download an app 

• Benefits
  • Can provide customizable alerts
  • Tracks adherence history
  • Can help with refill and keep medication data
• Considerations
  • Need to be good with technology
  • May require internet/data
  • Notification can be silenced or missed
• See some examples of apps below

 

Ask a family member or friend to give reminders 

• Benefits
  • Adds social support/accountability
  • Can help if patient forgets often
• Considerations
  • May feel dependent on others
  • Family/friend may forget
  • Privacy concerns

 Arrange to receive text or phone messaging daily reminder

• Benefits
  • Automated and convenient
  • Low effort for patient
  • Can be used with healthcare team monitoring
• Considerations
  • Requires working phone and access
  • May become routine and ignored
  • Not ideal for patients who prefer less contact
• See some examples of daily reminder options below

Prepared by Edward Kim, PharmD Candidate 2026

 The Importance of Vaccination During Pregnancy 

The immune system protects the body from things it recognizes as non-self, like viruses and bacteria. However, a fetus can be recognized as non-self too. Therefore, during pregnancy the immune system becomes less reactive so that it does not harm the fetus. Pregnant patients are at high risk for complications of illnesses because their immune system is less reactive.  

It also takes time for the immune system of newborns to become stronger, putting them at risk for illnesses early in life. Most vaccines cannot be given to children until they are at least 6 months old.  

How Does Vaccination Help?  

It is safe to give inactivated vaccines during pregnancy, because people cannot get sick from them.  

Vaccination is a safe way for the immune system to learn to recognize specific illnesses without the pregnant person becoming sick. Vaccination during pregnancy allows immunity to be passed from the parent to the infant. This helps protect infants in the first few months of life before they can be vaccinated.  

Vaccines are very effective at decreasing the severity of sickness and decreasing the risk of becoming sick if exposed to a given germ. The RSV, flu, COVID-19, and Tdap vaccines are particularly important to receive while pregnant.  

Which Vaccines to Avoid in Pregnancy? 

It is recommended to avoid most live vaccines during pregnancy. Live vaccines use weakened versions of a virus. Pregnant people's weaker immune system puts them at risk of becoming sick from these types of vaccines. Live vaccines include chicken pox (Varicella), measles/mumps/rubella (MMR), smallpox/monkeypox (JYNNEOS), cholera oral vaccine (Vaxchora), and typhoid oral vaccine (Vivotif). Pregnant patients should talk to their doctor about the yellow fever vaccine (YF-VAX) if they think they need it.  

After receiving a live vaccine, it is recommended to wait at least 4 weeks before trying to conceive.  

What are the Risks of Vaccination? 

The RSV, flu, COVID-19, and Tdap vaccines can cause a sore arm, redness, or swelling where the vaccine was given. People may experience tiredness, headaches, nausea, and fever that last about 1-3 days. Talk to your doctor if you have a fever.  

Serious reactions to vaccines are very rare.  

Vaccination Recommendations During Pregnancy  

 Prepared by Alicia Sasaki, PharmD Candidate 2026

References 

1. CDC. Vaccine Recommendations Before, During, and After Pregnancy. Pregnancy and Vaccination. Published May 30, 2025. Accessed November 11, 2025. https://www.cdc.gov/vaccines-pregnancy/recommended-vaccines/index.html ‌ 

1. Influenza in Pregnancy Prevention and Treatment. Acog.org. Published 2025. Accessed November 11, 2025. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2025/08/influenza-in-pregnancy-prevention-and-treatment ‌ 

1. ACOG Releases Updated Maternal Immunization Guidance COVID Influenza RSV. Acog.org. Published 2025. Accessed November 11, 2025. https://www.acog.org/news/news-releases/2025/08/acog-releases-updated-maternal-immunization-guidance-covid-influenza-rsv ‌ 

1. Piekos SN, Price ND, Hood L, Hadlock JJ. The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes. Reprod Toxicol. 2022;114:33-43. The impact of maternal SARS-CoV-2 infection and COVID-19 vaccination on maternal-fetal outcomes – ScienceDirect 

1. Dugdale C, Santos E, Ciaranello A. Respiratory Syncytial Virus Vaccination in Pregnancy: Safety, Efficacy, and Global Implications. Obstet Gynecol. 2025;145(2):144-146. doi:10.1097/AOG.0000000000005822 

1. World. Diphtheria. Who.int. Published July 12, 2024. Accessed November 11, 2025. https://www.who.int/news-room/fact-sheets/detail/diphtheria ‌ 

1. Washington sees 25-fold increase in whooping cough cases in 2024 compared to previous year. Washington State Department of Health. Published 2024. Accessed November 26, 2025.  

 

 

Generic or Brand-name drugs: Is there a difference?

Generic drugs make up about 90% of prescriptions in the U.S and they typically cost 70–85% less than brand-name drugs, yet brand drugs account for most prescription spending due to their higher prices. With costs rising, many patients ask the same question: Is switching to a generic drug the right move?

What are generic drugs?

A generic drug is a chemical copy or “bioequivalent” of a brand-name medication. It contains the same active ingredient and strength, works the same way, and provides the same benefits. Generics must meet FDA standards for safety, quality, and effectiveness.
They usually become available after brand-name patents expire, which is about 20 years after filing initially with the FDA.

Why do they cost less?

Brand-name drugs are expensive because of the high cost of research, development, and marketing. For this reason, companies are given an exclusive patent for 20 years where they market and set the price of their drugs to recoup the investment they put into developing the drug. Once the patent expires, other companies can produce the drugs using the same active ingredient without having to go through the whole process again, which allows the competitors to push their products to the market quicker. This competition from multiple companies producing the same drug also helps keep prices low.

What’s different between brand and generic drugs?

• Appearance: Generics may differ in color, shape, or size due to trademark laws of each company.
• Inactive Ingredients: Fillers, dyes, or preservatives may vary but should not affect how the drug works.
• Name: The generic name is usually the active ingredient of the branded drug.

Are they as safe and effective as the brand-name drugs?

Yes. Generics provide the same results and side effects as brand drugs. The FDA monitors both for safety, inspects manufacturing sites, and recalls any unsafe products.

Is it safe to switch from a brand name drug to a generic?

In most cases, yes, however, some medications with a narrow therapeutic range may not be interchangeable.  A narrow therapeutic range is when small differences in drug dose or blood concentration may lead to adverse drug reactions or go over/under the desired therapeutic effect. For example, the anticoagulant response to warfarin (Coumadin) can increase with age, which may make older patients more susceptible to adverse outcomes resulting from small differences in bioavailability between generic and brand products⁴. Always consult with your doctor or pharmacist before switching.

Choosing what is right for you

• If your doctor wants you to stay on a specific brand, they can note this on your prescription, so the pharmacy doesn’t switch it to a generic version.
• You may also request a brand drug but may pay more. Always check with insurance because prices can vary per drug. sometimes branded drugs are not on the drug formulary of the insurance company, so it is ultimately not covered.
• You can also request brand if the generic drug gives you side effects or if you have an allergy to an inactive ingredient. Sometimes insurances will cover the medicine if you have tried and failed a less expensive option.

Prepared by Thanh Tran, PharmD Candidate 2026

Sources:

1. FDA listing of authorized generics. April 1, 2025. US Food and Drug Administration (FDA). Accessed October 13, 2025 at https://www.fda.gov/about-fda/center-drug-evaluation-and-research-cder/fda-listing-authorized-generics

2. “Generic Drug Facts,” U.S. Food & Drug Administration, accessed October 13, 2025, https://www.fda.gov/drugs/generic-drugs/generic-drug-facts
3. “Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration,” National Library of Medicine, accessed October 13, 2025, https://pubmed.ncbi.nlm.nih.gov/19776300/
4. Desai RJ, Gopalakrishnan C, Dejene S, et al. Comparative Outcomes of Treatment Initiation With Brand vs. Generic Warfarin in Older Patients. Clin Pharmacol Ther. 2020;107(6):1334-1342. doi:10.1002/cpt.1743

Have you ever visited the pharmacy to pick up your refill and noticed that the pills look different than last time? There are several reasons why this may happen, and it is not something that should concern you.

When a company develops a new drug, they can apply for a patent to gain exclusive rights to the drug. When the patent expires, other companies are allowed to manufacture and sell the generic version of the product, leading to more competition among producers and reduced prices for patients. But this also results in some drugs having multiple different manufacturers and appearances, as different companies may produce their own version of the generic medication with a specific size, shape, color, etc. For example, the generic medication lisinopril (used for high blood pressure) is manufactured by more than 10 different companies!

                         

Lisinopril 20 mg, manufactured by Lupin                         Lisinopril 20 mg, manufactured by Ivax Pharmaceuticals

The tablets shown in the images above are both lisinopril 20 mg but they look completely different, potentially leading to some patient confusion about whether they received the right medication.

Why does this happen?

As a pharmacy, we prioritize the health of our patients, and we accomplish this by ensuring we have adequate levels of medication inventory in order to fill prescriptions. When we order medications through our distributor, they often have several different manufacturers providing them with medication. If Kelley-Ross pharmacy has a low supply of lisinopril 20 mg, we would order more from our distributor, but we may receive a manufacturer different than what we had last time. This results in the lisinopril possibly looking different for the patient than the last time they got it.

Will this change in appearance affect how the medication works?

Will a different generic medication change how the drug will work on me? The short answer is – it shouldn’t. For companies to create the generic, they must have the same Active Pharmaceutical Ingredient (API) as the brand name product, meaning the therapeutic effect of the generic drug is identical to the brand name. So, different generic lisinopril 20 mg tablets are proven bioequivalents to the original brand name medication, but they are not exactly alike.

Companies are allowed to change the inactive ingredients in their generic drug, including fillers, binders, coloring, or flavoring. These differences are usually minor and likely do not impact how the medication impacts the patient.

What if this happens to my prescription?

At Kelley-Ross we place a label or sticker on the medication to note a manufacture change and the potential that the drug may look different from last time. With the same active ingredient as the brand name medication, the generic has demonstrated identical safety and efficacy as the brand name but may contain different inactive ingredients. This should not change how it affects you, but it is good to keep in mind! While it is unlikely, if you are experiencing abnormal side effects after a manufacture change, please reach out to the pharmacy or a health care provider. If your medication looks different than last time but does not have a label or sticker noting a manufacture change, please contact the pharmacy so we can provide further assistance.

Prepared by Matthew Hohenwalter PharmD Candidate 2026

As the days grow shorter and colder in Seattle, we often hear the same questions: “What vitamin D product is the best?”, “How much vitamin D should I take?”, “Do I even need more vitamin D?” These are valid questions, especially when our northern climate does not give enough sunlight for our bodies to produce enough vitamin D during the fall and winter months. Therefore, it makes sense to think about boosting your health with a little extra vitamin D, since it plays such an important role in supporting your immune system, strengthening your bones, and even regulating your mood.

However, navigating the world of supplements can feel overwhelming. With so many vitamin D products, different forms, doses, brands, and labels that don’t always match up, it’s easy to get confused. What is most important is you really only need a few key pieces of information to make the right choice. This guide is here to help you break it all down and empower you to make informed decisions about your vitamin D supplement.

Vitamin D2 vs. Vitamin D3 – What is the difference?

There are two main forms of vitamin D you will encounter in supplements and food:

• Vitamin D2 (ergocalciferol): This form is usually derived from yeast or fungi and is often found in fortified foods.
• Vitamin D3 (cholecalciferol): This form is the same type of vitamin D that your body produces in response to sunlight. It’s mainly animal-based, derived from lanolin (sheep’s wool) or other animal sources (fatty fish).

While both work well in raising your vitamin D levels in the blood, studies suggest that vitamin D3 is more effective at raising and maintaining your levels compared to D2. Vegan D3 (lichen) alternatives do exist in the market, but the best practice is to contact the manufacturer about any ingredients that concern you.

Understanding Dosage – How Much Do You Need?

There are a lot of guidelines established by different health organizations about how much vitamin D should be taken daily. The general consensus is that the daily minimum requirements for most healthy patients are:

• Infants (age less than 12 months): 400 (10 mcg)
• Children and Adults (age 1-65): 600 IU (15 mcg)
• Pregnant and Breastfeeding: 600 IU (15 mcg)
• Older Adults (age 70+): 800 IU (20 mcg)
• Maximum daily dose: 4,000 IU per day for most healthy adults

However, these are general guidelines. In practice, many healthcare professionals may suggest taking 1000-2000 IU daily to maintain adequate levels of vitamin D. If you are vitamin D deficient, your doctor may recommend higher doses. A blood test for vitamin D (calcifediol) can determine your vitamin status and help guide your dosing. Screening for vitamin D is not done routinely at your annual check-up, so ask your doctor if you want a vitamin D test.

Delivery Forms – Which One to Choose?

Vitamin D is a fat-soluble vitamin, which means it needs to be dissolved in fat to be absorbed rather than water. This is why it is best to take vitamin D with fatty foods (e.g., eggs, fatty fish, yogurt, nuts, avocados). Some supplement products bypass this by pre-dissolving their vitamin D in oil. Here are some delivery forms that you will likely see in many vitamin D products:

• Softgels:
  • Contain vitamin D already dissolved in liquid oil to enhance absorption in the gut.
  • The type of oil used is typically olive oil, sunflower oil, or MCT oil. Some products may also use fish oil or soy oil.
  • Softgel shells are made from gelatin typically derived from animal collagen (cow skin, pork skin) but there are alternatives made from seaweed or starch.
• Tablets:
  • Solid, compressed powders that have longer shelf life compared to other forms.
  • Cheaper but have lower absorption if taken on an empty stomach.
  • Best taken with meals containing healthy fats (e.g., avocado, nuts, olive oil).
  • Tablets are compressed with other ingredients along with vitamin D.
• Liquid Drops:
  • Liquid-oil formulation similar to the liquid in softgels. Highly absorbable.
  • Good option for those with swallowing and digestive problems.
  • Liquid drops are easier to adjust based on specific needs.
  • Many products come with droppers for precise dosing, but it is important to check the product label on how many drops are needed per vitamin D dose.
• Oral Sprays:
  • Also liquid-oil formulation similar to softgels and drops.
  • Sprays are absorbed through the soft tissue under the mouth and the sides of your cheek.
  • Another good option for those with swallowing and digestive problems.
  • Not very cost effective and the amount of sprays needed per dose may vary.
• Gummies:
  • Chewable, flavored, and kid-friendly formulation of vitamin D.
  • Generally less stable overtime, especially the vitamin D content.
  • May have high added sugars which will contribute to daily sugar intake.
  • Unreliable dosing between products may require multiple gummies to be taken daily.
  • Gummies are made of gelatin and may contain artificial flavorings and dye.

Choosing the Right Supplement – What Should I Look For?

With countless vitamin D supplements on the market, it is hard to know which one is a quality, trusted product. Here are some tips to consider:

• Check the labels: Verify the dosage per serving and any additional nutritional information at the “Supplement Facts” panel. The label should be able to tell you about additional ingredients such as binders, fillers, artificial colors, hydrogenated oils, or allergens like gluten and soy. For vegetarians and vegans, check whether the source is listed to be from fungal, yeast, or lichen.
• Third-Party Testing: There are third-party organizations like U.S. Pharmacopeia (USP) and National Sanitation Foundation (NSF) International that perform independent quality testing for many supplement products. The tests verify that the products contain the ingredients listed on the label at the correct potency, are free from harmful contaminants, and will break down properly when consumed. Products that passed the tests will have a seal of verification on the label. You can also look up a product on their database as well.

Examples of verified seals on supplement products. Source: NSF and USP International

• Combination products: Vitamin D may also come in combination with other supplements (e.g, vitamin K2, calcium, multivitamins). Some products may contain high enough vitamin D that you won’t be needing an additional vitamin D product. Best to avoid taking more than you need by checking the label to see if they contain the right amount of vitamin D for you.
• Expiration dates and storage: Supplement’s potency can degrade over time. Check to see if the product you are getting is close to expiration or if there are any signs of damage (e.g. dampness, discoloration) caused by improper storage.

Talk To Your Doctor If You Need Any Help

It is a good idea to consult your doctor if you have any concerns about your vitamin D needs. They might be able to help you assess your individual needs, order a blood test to check your vitamin D levels, recommend the appropriate dosage and form, and advise you on any potential risks or interactions.

Prepared by Van Nguyen PharmD Candidate 2026

Reference:

1. Demay, Marie B et al. “Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline.” The Journal of clinical endocrinology and metabolism vol. 109,8 (2024): 1907-1947. doi:10.1210/clinem/dgae290
2. Fleet, James C. “Differences in the absorption and metabolism of vitamin D2, vitamin D3, and 25 hydroxyvitamin D.” The Journal of steroid biochemistry and molecular biology vol. 249 (2025): 106718. doi:10.1016/j.jsbmb.2025.106718
3. Limbaugh, Savannah. “Dietary Supplement Forms: Understanding the Pros, Cons, and Myths.” Wholistic Matters. https://wholisticmatters.com. Accessed Aug. 20, 2025.
4. Vitamin D: Fact sheet for health professionals. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional. Accessed Aug. 20, 2025.
5. Vitamin D. NatMed. https://naturalmedicines.therapeuticresearch.com. Accessed Aug. 20, 2025.