Do your child's prescription pills look slightly different from the last refill? It may not be your eyes playing tricks on you.

Small differences such as blurred print can separate counterfeit prescriptions from real prescriptions. In 2004, the Food and Drug Administration's (FDA's) Office of Criminal Investigations initiated 58 counterfeit drug cases, almost double the number of cases in 2003. Counterfeit drugs can have unknown levels of ingredients, no active ingredients or wrong ingredients, potentially producing harmful side effects in children.

Purchasing drugs from the Internet puts consumers at a higher risk for counterfeits, said Hari Sachs, M.D., FAAP, medical officer on the Pediatric and Maternal Health Team for the FDA's Center for Drug Evaluation and Research. Growth hormone (Humatrope), isotretinoin (Accutane) and contraceptive products (Mifiprex) are drugs used by adolescents that should not be purchased over the Internet because safety controls are bypassed.

Although the FDA has strict drug manufacturing guidelines, parents should follow these tips to avoid counterfeits:

  • Take your child to see a pediatrician to obtain a diagnosis and prescription.

  • Go to a U.S. state-licensed pharmacy. If you buy your child's prescription on the Internet, look for several details. Legitimate online pharmacies will have the Verified Internet Pharmacy Practice Sites (VIPPS) seal on their Web site. Sites also should require a prescription and have a pharmacist available to answer questions.

  • When you receive your child's prescription, inspect it. Check the outer packaging for signs of tampering, such as cuts, slices, tears or a broken seal. Check the label to make sure you have the correct medicine. Check the medication's color, shape, size and smell.

Tell your child to report any change in taste of the medication, unexpected side effects or worsening of his or her medical condition.

If you suspect that you have purchased a counterfeit drug, contact your pharmacist or another health care professional and the FDA at 800-FDA-1088(800-332-1088) or visit

©2006 American Academy of Pediatrics. This information may be freely copied and distributed with proper attribution.