Use As Directed By Who?

Use As Directed.

Use As Directed, what does it truly mean? As I continue to travel through the pharmacy world, I realise an increase in prescriptions stating “Use As Directed”.
Use As Directed is the backbone of assumption. As Directed by who? The Doctor, The Nurse or The Pharmacist?

Use As Directed makes the role of the Pharmacist to counsel patients difficult. Some medicines have different indications and each indication will have a different dosage regime.
An easy solution will be to ask the patient what is the underlying condition being treated?
Patient replies : I do not know.

Here are some examples I came across recently:

  • An elderly man was prescribed:
    Colchicine 500mcg
    100 tablets.
    This was after a telephone consultation with the surgery. He was not informed about the dosage or the duration of the treatment.

  • A 25 year old lady was prescribed:
    Tranexamic Acid 500mg
    As Directed
    60 tablets .

BNF 70

  • A 7 year old girl, who complained of pain during urination was prescribed:
    Trimethoprim 50mg/5ml suspension
    As Directed

The phrase Use As Directed in my opinion is not a dosing instruction.  It should be used sparingly.

Comment Below, should Use As Directed be written on prescriptions?


Images are from BNF 70.

CPD Entry 

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  • Mimi
    August 31, 2017 at 21:59

    In my area, the carers at the nursing homes usually refuse or return medication with such instructions “use as directed “. They literally hate the statement because it implies they have been shown or directed on how to use the medicines to/on their clients. Which isn’t the case.
    You can imagine how much of NHS medicines return wastage.

  • Michael Stewart
    August 31, 2017 at 22:41

    I agree it is not good practice and is widespread. Historically it was used for topical preparations but is used increasingly for oral medication. Every time I see this direction I ask the patient if they have been told how to take the medicine. I can then confirm whether the dose is correct, confirm their understanding and promote adherence, or if necessary advise on an appropriate dose and/or confirm with the prescriber. I do find that in most cases the patient has been told the directions, but they are easily forgotten or mixed up and it would be much better to add an appropriate dose to the prescription and hence the dispensing label. If verbally confirmed by the prescriber, I will usually add dosage instructions to labels where the prescription states ‘as directed’ in order to remind the patient. The dose is not a legal requirement on a prescription and so the dispensing label can be amended accordingly without needing to change the prescription.

  • Ogo
    September 2, 2017 at 11:11

    I completely agree especially with medicines that have complex dosing regimen. It goes to show how important checking patients understanding of their medication is. I’m glad you point it out, something to look out for as I’ve just started my pre-reg.


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