Recommendations
1	Milliliter (mL) should be the universal standard unit of measure used on prescription container labels of oral liquid medications.   e-Prescribing software must not permit prescriber override for U.S. customary (household) units (e.g., teaspoon).   Pharmacy systems should only generate dosing instructions for oral liquids in metric units.
	• Metric units should be adopted as the standard units of measure. Non-metric and non-volumetric units of measure should not be used.   • When the prescription Sig (signatura) contains dosing designations in mL, mL dosing instructions should be used on the prescription container label.   • When the prescription Sig contains dosing designations in non-metric (e.g., U.S. customary or household units such as teaspoonful) or non-standard (e.g., dropperful) units, convert to only volumetric metric units (mL) for dosing instructions on the prescription container label.   • When the prescription Sig contains dosing instructions in non-volumetric units (e.g., mg), convert the dosing instructions to mL, and use only mL dosing instructions on the prescription container label.   • When dispensing non-standardized concentrations of extemporaneously prepared formulations, it is critical that caregivers be instructed carefully about the volume to administer since it may differ from instructions they received with previous formulations of the oral liquid. They should be instructed to follow the current dosing instructions to avoid inadvertent underdosing or overdosing.   • The standard abbreviation “mL” should be used on the prescription container label. Other abbreviations for milliliter (e.g., mls, cc) should not be used. If use of mixed case is not possible (e.g., because of legacy software limitations), lowercase (“ml”) or uppercase (“ML”) may be used while changes to the preferred “mL” are implemented.   • Mnemonics, Sig codes, or any defaults used in computer systems to print prescription labels should produce dosing designations using mL.   • e-Prescribing software should present prescribers with Sig options that apply metric volumetric units only and must not permit an option for prescribers to override metric with U.S. customary (household) units (e.g., teaspoon).
2	Dose amounts should always use leading zeros before a decimal point for amounts less than one and should not use trailing zeros after a decimal point on prescription container labels of oral liquid medications.   • The dose designation on a prescription container label should be “0.5” mL, NOT “.5” mL.   • The dose designation on a prescription container label should be “5” mL, NOT “5.0” mL. Do not use trailing zeros in the hundredths, or thousandths position (e.g., “2.5” mL NOT “2.50” mL or “2.500” mL) either.   • Place adequate space between the dose and unit of measure (e.g., “5 mL” NOT “5mL”).
3	Dosing devices with numeric graduations and mL units that correspond to the prescription container labeling should be made easily and universally available such as including a device each time oral liquid prescription medications are dispensed.   Dosing devices should be of appropriate volume and graduated accuracy for the amount prescribed and should not use multiple units of measure (i.e., metric only not metric plus household).   For volumes up to 10 mL, oral syringes generally are the preferred dosing devices.
	• The standard abbreviation “mL” should be used on the dosing device to correspond with the prescription container label. • Leading zeros before a decimal point should always be used on dosing devices and trailing zeros after a decimal point should never be used on dosing devices to correspond to the prescription container label.