Common Translation Issues on Prescription Labels and How to Get Help

Getting the right medicine is only half the battle. If you can’t understand the label, you might be taking it wrong-maybe dangerously wrong. For millions of Americans with limited English proficiency, prescription labels are written in a language they don’t speak, and the translations they get are often broken. This isn’t just inconvenient. It’s life-threatening.

How Translation Errors Turn Medicine Into Poison

A simple word can kill. Take the word "once." In English, it means "one time." In Spanish, "once" means "eleven." If your label says "tome once al día," you might think it means "take eleven times a day." That’s not a typo. That’s what happens when pharmacies use machine translation without human review. A 2010 study in the Pediatrics journal found that half of all Spanish-language prescription labels in the Bronx had dangerous mistakes. Many of those errors came from automated systems that spit out "Spanglish"-a jumbled mix of English and Spanish that confuses even bilingual patients.

These aren’t isolated cases. Patients have reported being told to take pills "twice weekly" when the correct instruction was "twice daily." Others were given labels that said "take with food" when the real instruction was "take on an empty stomach." In one documented case, a patient took 11 times the prescribed dose of a blood pressure medication because the label mistranslated "once" as "eleven." That patient ended up in the ER.

The problem isn’t just Spanish. Medical terms vary wildly across dialects. In Latin America, "alcohol" on a label usually means rubbing alcohol. In Spain, it means drinking alcohol. If a label says "avoid alcohol," does that mean no beer? No wine? No hand sanitizer? The confusion isn’t theoretical-it’s happening every day.

Why Pharmacies Keep Using Bad Translation Systems

You might assume pharmacies would hire professional translators for something this important. But they don’t. According to the same 2010 study, 86% of pharmacies in high-Spanish-speaking areas used computer-generated translations. Only 3% used certified medical interpreters. Why? Cost.

Automated translation costs about $0.02 to $0.05 per label. Professional human translation? $0.15 to $0.30. That might not sound like much, but multiply that by millions of prescriptions a year, and the difference becomes millions of dollars. Most pharmacies choose the cheaper option-even though machine translation alone gets only 65-75% accuracy for medical instructions. With no human review, error rates jump to 50%.

Even worse, pharmacy software often pulls translations from third-party vendors that don’t even use consistent terminology. One pharmacy might translate "take as directed" as "tome según indicaciones," while another uses "tome según las instrucciones." Both are technically correct, but patients get confused when they see different versions at different stores. That inconsistency makes it harder to learn what the instructions mean.

Which States Actually Require Accurate Translations

You’d think the federal government would step in. But it doesn’t. Only two states have laws requiring accurate, human-translated prescription labels: California and New York.

California passed Senate Bill 853 in 2016, requiring all prescription labels in Spanish to be translated by certified professionals and verified by a second bilingual staff member. The results? A 32% drop in medication errors among Spanish-speaking patients, and a 27% reduction in emergency room visits related to prescription mistakes. It’s proof that good translation saves lives-and money.

New York followed with Local Law 30 in 2010, mandating translation services for the most common languages. But in the other 48 states? There’s no legal requirement. Pharmacies can-and often do-rely on Google Translate or outdated software.

And it’s not just Spanish. Only 23% of major pharmacy chains offer translation into Chinese, Vietnamese, or Arabic-even though those languages are spoken by over 2 million Americans with limited English proficiency. For many, getting a correct label is pure luck.

How to Get Help When Your Label Doesn’t Make Sense

If you or a loved one can’t read the prescription label, don’t guess. Don’t assume. Don’t take the risk. Here’s what to do:

• Ask for a certified translator. Call ahead or ask at the counter: "Do you have a certified medical interpreter available?" If they say no, ask to speak with the pharmacist directly. Pharmacists are trained to explain medications, even if the label is wrong.
• Use the pharmacy’s phone service. Many chains like CVS and Walgreens offer free phone interpretation in over 200 languages. Ask for the "Language Line" or "Interpreter Services" when you pick up your prescription.
• Request a printed bilingual label. You have the right under Title VI of the Civil Rights Act to receive medical information in a language you understand. If the pharmacy refuses, ask for a supervisor. Write down the date, time, and name of the person you spoke to.
• Take a photo and get a second opinion. If you’re unsure, take a picture of the label and show it to a trusted bilingual friend, community health worker, or even a local clinic. Many nonprofit organizations offer free medication counseling for LEP patients.
• Report the error. If you see a dangerous mistranslation, report it to the pharmacy’s corporate office and to your state’s board of pharmacy. Your complaint could help change policy.

What’s Changing-and What’s Still Broken

There’s progress. In October 2023, Walgreens launched MedTranslate AI, which uses artificial intelligence to flag suspicious translations and route them to pharmacists for review. CVS Health rolled out LanguageBridge in early 2024, combining neural machine translation with mandatory pharmacist verification. These systems have cut translation errors by over 60% in pilot locations.

The federal government is also stepping up. In March 2024, the HHS launched a $25 million Language Access Grant Program to help pharmacies pay for professional translation tools. The FDA also released new draft guidance in January 2024, pushing for plain-language labels that are easier to translate accurately.

But here’s the truth: 61% of federally funded health centers still don’t have certified translation services. Most small pharmacies can’t afford the $12,000-$18,000 it costs to set up a proper system. Until every pharmacy is required to use certified translators, the risk remains.

What You Can Do Right Now

You don’t need to wait for laws to change. You can protect yourself today:

• Always ask: "Can you read this label to me in my language?"
• Don’t rely on the printed label alone. Ask the pharmacist to explain dosage, timing, and warnings out loud.
• If you’re helping a parent, grandparent, or neighbor, go with them to the pharmacy. Bring a phone with translation apps as backup-but don’t trust them alone. Human verification matters.
• Keep a written list of all your medications, including the correct instructions, in your native language. Update it every time you get a new prescription.
• Support organizations pushing for language access. Your voice helps.

Medicine is meant to heal. But a broken label turns healing into harm. The system isn’t working for millions of people-and it doesn’t have to be this way. You have the right to understand your prescription. Use it.