During counselling, a very common instruction to give patients is to shake well, especially with suspensions to ensure even drug distribution. While some of these are quite intuitive, some of these might make you rethink whether to shake or not shake.
1) Metered-dose inhalers: Not all inhalers require shaking to mix the medication and the propellant. In fact, Alvesco (ciclesonide) and Qvar (beclomethasone) are inhaled corticosteroids which do not require shaking, so this will make it easier for patients and ensure consistent administration.
2) Nitroglycerin spray: Used for angina and chest pain, patients should not shake the nitroglycerin bottle as this could potentially cause bubbles to form in the solution and affect the delivery of medication during the spray. Ensure patients prime the spray by giving a few test sprays.
3) NPH insulin: Insulins are, for the most part, ready to go, except for products containing NPH insulin (and mixes). This suspension requires inversion 10 times and rolling 10 times to properly resuspend the solution. Failure to do so results in an improper dose.