Errors in local pharmacies

Pharmacy Errors and Injuries Can Result From Similar-Sounding Drug Names

April 19, 2012 | Lebowitz & Mzhen

Three medications with similar-sounding names have caused some confusion, and almost caused some serious injuries, in recent months, according to the Philadelphia Inquirer. Two heart medications, Pradaxa and Ranexa, have names that resemble each other and PreNexa, a prenatal vitamin available only by prescription. Medication errors with heart patients or people who are pregnant can have serious short- and long-term consequences, so caution and vigilance are crucial to help patients avoid mix-ups.

Since two of these medications treat heart conditions, mix-ups in pharmacies could be common. Fortunately, that does not currently appear to be the case, but the potential remains for dangerous errors. Any mix-up of these three drugs has the potential for catastrophe, but patients can take a few simple steps to protect themselves. The U.S. Food and Drug Administration generally does not allow drugs used to treat the same or related conditions to have substantially similar or confusing names, but it does happen on occasion. A patient could ask the doctor to include a notation explaining the purpose of the prescription, in order to guide a pharmacist in dispensing the proper medication.

A person filling a prescription also has the ability to discuss the medication with the pharmacist on duty, which is an excellent way to get additional information on the medication and possibly correct errors. If the pharmacist has more information from the patient, the pharmacists can better understand and assist the patient’s needs. A quick conversation with a pharmacist can even reveal, and give an opportunity to correct, errors made in filling the prescription.

A quick review of these three medications can illuminate the risks patients face from drug mix-ups. Pradaxa is an anticoagulant used in patients suffering from atrial fibrillation, a heartbeat irregularity that increases the risk of blood clots. Blood clots can cause stroke and other serious, even life-threatening conditions. Taking the wrong medication leaves the patient at an elevated risk for blood clots. Giving Pradaxa to a patient who does not have atrial fibrillation puts that patient at risk for excessive bleeding and other complications, particularly in people who are pregnant.

Ranexa is an anti-anginal medication that treats chest pain occurring when the heart is not getting sufficient oxygen. Angina sufferers must take the drug on a regular basis for it to have effect, although it cannot cure angina. A person who should be taking Ranexa faces a higher risk of hemorrhaging and bruising if they take Pradexa by mistake.

Two Families Sue Pharmacy, Alleging Their Children Received Incorrect Dosages

March 30, 2012 | Lebowitz & Mzhen

Two mothers are suing a pharmacy in Gig Harbor, Washington, claiming that their sons received incorrect dosages of prescription seizure medications. In both cases, the parents claim that the dosages dispensed by Olympic Pharmacy were big enough to be almost fatal for the children. The Washington state Board of Pharmacy has reportedly begun an investigation of the pharmacy based on the claims made in the lawsuits.

Laura Carlson says that Olympic dispensed the wrong dosage of medication for her son Chad twice in a period of about two years. In 2009, 11 year-old Chad received a prescription for 8 mls of Lorazepam, a powerful medication used to treat seizures and anxiety. The pharmacy allegedly dispensed the medication in a single pre-filled syringe. Chad reportedly became dizzy after taking the medication, eventually becoming unresponsive. He ended up hospitalized for four days while enduring hallucinations. Carlson looked at the packaging and saw that the prescription was for eight syringes, each containing a 1 ml. dose. Chad had significantly overdosed.

In 2011, Chad’s prescription had changed to pills rather than injections. Carlson filled a prescription at Olympic for 300 mg pills of Lorazepam. When Chad took them, he reportedly began vomiting repeatedly and violently. The pharmacy, it turned out, had given him 600 mg pills, doubling his dosage.

Kaeley Triller’s 3 year-old son reportedly had a similar experience in January. She says that Tristan Triller suffered insomnia, convulsions, and hallucinations after he took anti-seizure medication obtained at Olympic. Doctors at the ER determined that he had received four times the prescribed dose of medication. Once Tristan recovered, Triller did not consider the matter again until she learned of Chad Carlson’s two overdoses.

Both parents have filed lawsuits against Olympic, claiming the pharmacy negligently dispensed incorrect dosages of medications to their children at least three times in the past three years. Carlson’s suit reportedly claims that the pharmacy “poses an imminent public health danger” because of repeated medication errors and a lack of procedures and oversight to prevent future misfills.

Washington’s Board of Pharmacy also reportedly initiated an investigation of Olympic, based at least in part on the claims made by Carlson and Triller. The Board reportedly conducted fifty investigations of alleged pharmacy errors around the state in 2011. The Board has the authority to penalize licensed pharmacists, such as through fines or license suspensions, but it is limited to an administrative process. It cannot recover damages for the injured parties through litigation.

Family of Woman Who Died After Receiving the Wrong Medication Sues the Pharmacy

March 22, 2012 | Lebowitz & Mzhen

The family of a Kentucky woman who died after allegedly receiving the wrong prescription medication has sued the pharmacy that dispensed the medication. The two medications have similar-sounding names but very different purposes. The family’s lawsuit alleges negligence and violations of state law that caused or contributed to the woman’s death.

Mary Moore, an elderly Louisville resident, had just been discharged from the hospital on November 10, 2010, where she had undergone treatment for congestive heart failure, kidney failure, and high blood pressure. She went to a Walgreens pharmacy to fill a prescription from her doctor for Hydralazine, a drug used to treat high blood pressure. The pharmacy instead gave her Hydroxyzine, an antihistamine considered unsafe for people over the age of 65.

Because of the alleged error, Moore’s high blood pressure was completely untreated for two weeks. The pharmacy discovered the error and gave her the correct medication, but by then the damage was done. Moore reportedly could not tolerate the prescribed dose of the blood pressure medication. According to the lawsuit, the medication could not control her blood pressure, and the stress on the heart caused “decompensation” of her congestive heart failure. This was followed by “decompensation of her chronic kidney disease.” Within a few days of starting the Hydralazine, Moore was hospitalized again. She died on December 6, 2010.

The lawsuit names as defendants both Walgreens and the pharmacist in charge at the time the medication was dispensed to Moore. Moore’s family primarily alleges that Walgreens and the pharmacist were negligent in dispensing the wrong medication. They further allege that, by not offering Moore counseling from a pharmacists when she picked up the medication, Walgreens violated state law. The law, according to their complaint, requires a pharmacist to offer a consultation with a patient picking up a medication for the first time. Had the pharmacist offered a consultation with Moore, the plaintiffs argue, one of them would likely have noticed the error with the medication
Hydralazine is a muscle relaxant used to treat high blood pressure and other conditions. It works by relaxing the blood vessels that allow blood free flow through the body. Hydroxyzine, on the other hand, is an antihistamine used to treat allergy symptoms of allergies such as itching, and to treat nausea-related symptoms resulting from conditions like motion sickness. The National Institutes of Health specifically recommend against the use of Hydroxyzine by people over the age of 65, noting that other medications offer similar benefits at a lower risk. In this case, though, the issue was not the treatment of allergies at all.

Pharmacy Mistakenly Gives Cancer Medication to Multiple Children

March 7, 2012 | Lebowitz & Mzhen

Children who should have received chewable fluoride tablets may instead have received Tamoxifen, a drug used to treat breast cancer, from a CVS Pharmacy in Chatham, New Jersey. Up to fifty families, according to initial reports, may have been affected by the error, in which the pharmacy dispensed the wrong medication over a period from December 1, 2011 to February 20, 2012. The fluoride pills, prescribed by dentists to prevent tooth decay, are typically flavored, while the cancer medication reportedly has a bad taste if chewed. Because of this, pharmacy representatives say that children would probably have noticed that they had received the wrong medication.

CVS issued a statement saying that children from roughly thirteen families mistakenly received Tamoxifen pills mixed in with the fluoride tablets. A spokesperson attributed the error to a “single medication restocking issue” at the one pharmacy location. The error affected the supply of 0.5mg fluoride tablets. The pharmacy reported that, according to the families they contacted, none of the children actually received any of the incorrect pills.

According to the Associated Press, Tamoxifen acts by blocking the female hormone estrogen. As such, it is not likely to cause serious harmful side effects to a child if taken for a short period of time. The New Jersey Attorney General’s office and the state’s Division of Consumer Affairs have nevertheless ordered the pharmacy to produce records for the period from December to February to account for the mixup. The pharmacy reports that it is still investigating the matter and is cooperating fully with state authorities.

The particular incident had a positive outcome because, fortunately, no one was injured, and the particular drug involved in the mixup had limited potential to cause harm. It underscores the critical importance, however, of remaining watchful for errors that can occur. In addition to checking to see that the label on the medication bottle matches the prescription, patients should also confirm that the medication itself matches the description. Many prescription bottles include a physical description of the medication itself, identifying the shape and color of the medication and stating whether it is in tablet, capsule, or another form. Not all pharmacies include this information on the bottle itself, but all prescriptions should include an insert with comprehensive information about the drug, including a physical description. This is a patient’s last line of defense against potential pharmacy errors.

Drug Confusion Causes Eye Injury, $1 Million Lawsuit

January 12, 2012 | Lebowitz & Mzhen

The U.S. Food and Drug Administration (FDA) issued an alert to pharmacists nationwide on December 28, 2011 regarding two drugs with similar-sounding names but very different uses, warning them of the risk of serious injury if one drug is accidentally substituted for the other. Durezol is an FDA-approved eye medicine that consists of a 0.05% solution of ophthalmic chemicals. Durasal, meanwhile, is a topical wart remover. It is not formally approved by the FDA, and it consists of a 26% solution of salicylic acid. Both drugs are available with a doctor’s prescription.

Ordinarily the FDA would screen trade names to see if they were substantially similar to an existing name in a way that might confuse consumers, but it never subjected Durasal to is formal approval process. Durasal reportedly went on the market shortly after the FDA approved Durezol.

Complaints about confusion between the two drugs began as early as 2009, with ophthalmic patients accidentally receiving the wart remover Durasal. Obviously a solution of more than a quarter acid is not ideal to place into one’s eye, and several patients have allegedly suffered severe eye injuries as a result. Durasal’s manufacturer, Elorac, Inc., has reportedly not responded to the FDA’s request to discuss a possible recall of the drug. The Philadelphia Inquirer reported that a company spokesperson at one time said the company planned to introduce a new product, also containing salicylic acid but with a different name. As of early January 2012, however, Durasal remains on the market.

A New York City patient filed a lawsuit against pharmacy chain Walgreens in early 2011 for mixing up the two medications. The man had just undergone minor eye surgery and went to fill a prescription for Durezol, the eye medicine. The pharmacy allegedly gave him Durasal instead, causing what he described as “grievous personal injury.”
The Consumerist reports that, despite packaging and warning labels, medicine mix-ups are a fairly common occurrence. They reference the story of an Arizona woman who mistook superglue for eyedrops in 2010 and needed emergency medical intervention. Eye drops may present a particular problem, since some patients may not able to immediately review the label and instructions due to impaired vision. The packaging for Durasal includes a clear warning that the product is “NOT FOR USE IN EYES,” but media reports do not indicate if pharmacies ordinarily dispense the medication in its original packaging, or if the warning was visible to the particular injured individuals.

Preventing Medication Mix-Ups at the Pharmacy

October 5, 2011 | Lebowitz & Mzhen

Several recent events have illustrated the importance of carefully reviewing prescriptions and medications at pharmacies. Errors in filling prescriptions, either by giving a person the wrong medication entirely or giving a person someone else’s medication, can have serious and even fatal consequences. Patients can take steps to protect themselves from pharmacy errors, and in the event of a medication mistake causing injury, they have remedies under the law.

This Pharmacy Error Injury Lawyer Blog has reported on the case of Mareena Silva, the Denver, Colorado woman who received the wrong medication at a Safeway pharmacy. Silva, who was six weeks pregnant at the time, tried to fill a prescription for antibiotics. Because of the similar-sounding name, the pharmacy gave her medication intended for Maria Silva. Instead of antibiotics, she received methotrexate, a cancer drug which can also be used in certain circumstances as an abortion drug. Silva realized the mistake only after she had taken one pill and began to feel nauseous. Doctors advised her to induce vomiting, and she received treatment at a nearby hospital. The outcome of this incident is still unknown, but could have serious consequences for the baby. The pharmacy formally apologized and offered to pay all medical expenses.

Another recent case occurred in St. Louis, Missouri, where a man, Ron Apenbrinck, has filed suit against Walgreens Pharmacy after he picked up a prescription with his name on the bag, but with another patient’s prescription bottle inside. Both the bag and bottle were correctly labeled, but the bottle was placed in the wrong bag. Instead of the painkiller hydrocodone, Apenbrinck allegedly received Amlodipine Besylate, a heart medication. He took the medication for several days until he collapsed in pain, suffering what he has described as a “mini stroke.” Apenbrinck now claims that he suffers from an irregular heartbeat and permanent damage to his nervous system, as well as his head, neck, and back. Walgreens issued a statement saying it called Apenbrinck to apologize, and that errors such as this are very rare.

Pharmacists owe a duty to customers to accurately and diligently review and fill all prescriptions. The Maryland Board of Pharmacists regulates the licensing of all pharmacists in the state, and it handles complaints and discipline for pharmacists who make errors in filling prescriptions. We previously reported on the duty of Maryland pharmacists to educate patients and prevent medication errors.

Reducing Medication Error Injury by Keeping Health Record Journals

August 30, 2011 | Lebowitz & Mzhen

Our Prince George’s County, Maryland pharmacy error lawyer blog recently reported on the important role communication plays between patients and their healthcare providers—in order to reduce the risk of medication errors or pharmacy misfills, and to promote the safe and effective use of drug therapy.

Every year, 1.5 million Americans experience medication-related injuries, according to a study by the Institute of Medicine. In order to prevent medication errors, the American Pharmacists Association (APhA) reports that it is important for patients to keep accurate health records with them when visiting the doctor and pharmacist, including current prescription medication lists detailing the dosage information along with all health conditions that the medication is treating.

Patient medication lists can reduce the risk of pharmacy misfills, incorrect dosages, medication duplication, allergy interaction, and any harmful side effects from potential dangerous drug interactions. The APhA also states that by keeping drug lists with them at all times, patients can prevent medical error by providing emergency staff and hospital pharmacists with important information that could saves lives in an emergency.

According to a recent Chicago Tribune article, doctors are now recommending that individuals turn the medication lists into a comprehensive health journal, to keep healthcare providers informed and to prevent medication error injury.

Risperdal Recalled by Manufacturer Due to Drug Contamination

July 29, 2011 | Lebowitz & Mzhen

Our Talbot County, Maryland pharmacy error injury lawyer blog recently discussed a series of recalls drug maker Johnson & Johnson made last year, in an effort to maintain the health and safety of consumers—after complaints of an unusual smell causing nausea, vomiting, diarrhea and gastrointestinal pain were reported, due to trace amounts of 2, 4, and 6-tribomoanisole (TBA), a chemical used to preserve wood necessary in the construction of pallets used for transportation and shipping of the product packaging materials.

In related news, Ortho-McNeil-Janssen Pharmaceutical, the drug manufactures of Risperdal (risperidone), an antipsychotic drug used for the treatment of schizophrenia, bipolar disorder, and irritability associated with autistic disorder in adolescents and children, recently voluntarily recalled 16,000 bottles of the brand name drug and 24,000 bottles of the generic drug—also because of an unusual odor.

The Risperdal drug manufacturers found that the unusual smell was also caused by trace amounts of TBA, used to preserve wood pallets for the transportation and storage of product materials. While not considered to be toxic, a small group of patients have reported gastrointestinal symptoms when taking products with this offensive odor. The drug maker claims that the presence of TBA has not caused any reported serious adverse events, but the company has instituted a series of actions to reduce the potential of TBA contamination in the future, to avoid personal injury or harm to any consumers.

This is the second medication error warning surrounding Risperdal this year. Last month our attorneys discussed another warning involving Risperdal in a Baltimore pharmacy error injury blog, issued by the U.S. Food and Drug Administration, discussing potentially dangerous medication errors associated with Risperdal and Requip, a drug used for the treatment of Parkinson’s disease and Restless Legs Syndrome, with 226 reports of patients receiving the incorrect medication.

Report Warns Consumers to Take Precautions With Drug Labels and Instructions

July 25, 2011 | Lebowitz & Mzhen

In a previous Baltimore medication error injury blog post, our attorneys discussed a recent investigation by Consumer Reports Health that found evidence of inconsistency among prescription drug labels for warfarin, a blood thinner. The report found that important safety warnings and medication guides that are required by the federal government in order to prevent medication errors, were often omitted or left out of patient’s warfarin prescriptions.

As our Maryland pharmacy mistake lawyer blog has reported previously, every year, according to research by the Institute of Medicine, there are 1.5 million preventable medication error injuries, one third of which take place outside of hospitals, where consumers must make their own decisions about following medication instructions. Consumer Reports Health suggests that these medication errors happen because consumers are confused by the material that is included with prescriptions, and that they rely heavily on the medication bottle label—a problem if there are omissions or inconsistencies with the drug label.

The report found the following discrepancies:

• Four out of five pharmacies neglected to provide the medication guides that are required by the FDA for certain drugs, including warfarin.
• All of the pharmacies provided their own materials for the patients, but these conflicted with the guides for warfarin approved by the FDA. The FDA recommended that patients abstain from alcohol while taking the drug, while two pharmacies warned patients that they should just limit or avoid alcohol usage.

Consumer Reports Health Investigation Finds Drug Label Warning Inconsistency

July 18, 2011 | Lebowitz & Mzhen

A recent investigation that our Hartford County pharmacy error injury attorneys have been following found evidence that drug labels are often missing the important safety warnings necessary to prevent medication error and that many pharmacies neglect to include the proper medication guides that are required by the U.S. Food and Drug Administration (FDA).

The investigation was performed by Consumer Reports Heath, by filling warfarin prescriptions at five different New York drugstores. Warfarin is a blood thinner used for stroke prevention that is one of the most frequently prescribed drugs in the country.

The results found that four out of the five pharmacies neglected to provide the FDA-approved medication instructions that are required for specific drugs, warfarin included. Although the pharmacies reportedly provided their own medication materials, they were different from the warfarin drug information approved by the FDA, in that the warnings about the usage of alcohol were different. Warfarin can reportedly cause life-threatening internal bleeding if used incorrectly, and is the second in line for drugs that cause emergency room visits in hospitals across the country, due to medication error.

Another goal in the investigation was to see how certain drug labels, consumer drug information sheets, and medication warning stickers differed in each pharmacy. Although a certain degree of variation was expected, as various drugstore chains use different software to print labels and drug instructions, the findings raised significant concern.