Common Translation Issues on Prescription Labels and How to Get Help

Imagine taking your medicine because the label says "take once a day"-but it actually meant "take eleven times a day". That’s not a typo. That’s what happens when a computer translates "once" from English to Spanish as "once," which means eleven. And it’s happening more often than you think.

For millions of Americans who don’t speak English well, prescription labels are a minefield. A 2010 study in the Bronx found that 86% of pharmacies used automated translation systems-mostly free, low-quality tools-to generate Spanish labels. Half of those labels had dangerous mistakes. Some told patients to take pills twice a week instead of twice a day. Others confused "alcohol" (rubbing alcohol) with "alcohol" (drinking alcohol). One patient nearly overdosed because the label said "take eleven times a day" instead of "once a day."

Why Computer Translations Fail on Prescription Labels

Most pharmacies use cheap, off-the-shelf translation software that doesn’t understand medical terms. These tools treat every word like a dictionary entry, ignoring context. "Take one tablet by mouth twice daily" becomes "Tome una pastilla por boca dos veces diario"-which sounds right, until you realize the pharmacy down the street translated the same phrase as "Tome una pastilla por boca dos veces por semana." Same drug. Same pharmacy chain. Different instructions.

False cognates are the biggest problem. Words that look familiar but mean something totally different:

• "Once" in English = one time. "Once" in Spanish = eleven.
• "Embarazada" in Spanish = pregnant. Not "embarrassed."
• "Actual" in Spanish = current. Not "real" or "factual."

These aren’t just grammar errors. They’re life-or-death mistakes. A 2017 NIH study found that 40% of critical dosage instructions were mistranslated by automated systems. Even small errors-like confusing "every 8 hours" with "every 12 hours"-can cause toxicity or make the medicine useless.

Language Isn’t One Thing-Dialects Matter

Spanish isn’t the same everywhere. In Mexico, "jarabe" means syrup. In Spain, it can mean a type of cough medicine. In Latin America, "alcohol" means rubbing alcohol. In Spain, it means drinking alcohol. A label translated in California might be misleading in Florida if the patient is from Puerto Rico.

Same goes for Chinese. Simplified Chinese used in mainland China isn’t the same as Traditional Chinese used in Taiwan or Hong Kong. Vietnamese translations vary between dialects in the U.S. and Vietnam. Most pharmacy systems don’t account for this. They pick one version-usually the most common-and assume it works for everyone.

Who’s Responsible? And Who’s Getting Help?

Only two states-California and New York-require pharmacies to use professional translators for prescription labels. California passed SB 853 in 2016. Since then, medication errors among Spanish-speaking patients dropped by 32%. ER visits related to prescription mistakes fell by 27%.

But in the other 48 states? There’s no rule. Pharmacies can still use Google Translate. And they do. A 2022 survey found that only 23% of major pharmacies offer translation in Chinese, Vietnamese, or Arabic. Spanish? That’s available at 87% of locations. Everything else? You’re on your own.

Patients are paying the price. A 2023 survey by the National Health Law Program found that 63% of people with limited English proficiency didn’t understand their prescription labels. 28% admitted they took the wrong dose because of the translation.

What Works: Real Solutions That Save Lives

Professional human translators with medical training get it right 98-99% of the time. That’s not a guess. It’s from RxTran’s 2023 whitepaper. These aren’t just bilingual staff. They’re certified medical translators who know the difference between "tablet" and "capsule," and how to translate "take on an empty stomach" without making it sound like a diet plan.

Kaiser Permanente spent two years setting up a system that uses:

1. Certified translators with 5+ years in pharmacy work
2. Two-person verification: one translates, another checks
3. Translation memory tools that store approved phrases
4. Staff trained on Title VI of the Civil Rights Act

The cost? About $15,000 per pharmacy location. But for every dollar spent, they saved $3.80 in avoided hospital visits, according to McKinsey’s 2024 analysis.

Walgreens and CVS are now testing AI systems that combine machine translation with pharmacist review. Walgreens’ MedTranslate AI cut errors by 63% in pilot stores. CVS’s LanguageBridge does the same. These aren’t perfect-but they’re better than Google Translate.

What You Can Do Right Now

If you or someone you care about struggles with English and gets prescriptions:

• Ask for a live interpreter. By law, pharmacies must provide one if you ask-even if they don’t offer it upfront. Call ahead and say: "I need a certified medical interpreter for my prescription."
• Don’t trust the label alone. If you’re unsure, call the pharmacy and ask them to read it back to you in your language. Record it on your phone if you can.
• Bring someone who speaks English. A family member, friend, or community health worker can help verify instructions.
• Use free translation tools wisely. Try Google Translate or DeepL, but never rely on them alone. Copy the exact English text, paste it, then ask a bilingual person to confirm.
• Report bad translations. If a label is wrong, tell the pharmacist. File a complaint with your state’s pharmacy board. California’s Health Advocates forum has logged over 300 complaints since 2021-many led to policy changes.

Some pharmacies, like Walgreens in Miami, have certified translators on staff. They verify heart meds, diabetes drugs, and blood thinners before handing them out. That’s the standard everyone should have.

The Bigger Picture: This Is a Public Health Crisis

More than 25 million Americans have limited English proficiency. That’s 1 in 8 people. And prescription labels are one of the most dangerous places where language fails.

It’s not just about convenience. It’s about safety. A mistranslated dose can cause kidney failure, liver damage, or death. The FDA says patient labels must be clear and accurate. But right now, they’re not.

Progress is happening. The HHS launched a $25 million grant program in March 2024 to help pharmacies pay for better translation tools. Eighteen states are considering new laws in 2025. The market for medical translation is growing fast-projected to hit $500 million by 2030.

But until every pharmacy uses certified translators, patients are still at risk. You can’t wait for the system to fix itself. You have to demand better.

How to Spot a Dangerous Translation

Here are red flags to watch for:

• Words that look like English but mean something else (like "once" for eleven)
• Instructions that don’t match what your doctor said
• Phrases that sound awkward or mixed (like "take two tablet two times day")
• Different labels for the same drug at different pharmacies
• No translator’s name or certification listed on the label

If you see any of these, stop. Don’t take the medicine. Call the pharmacy. Ask for a human interpreter. Write it down. Your life might depend on it.