Receiving a Prescription

 

Consumers sometimes have allergies to certain medicines. In some cases, the allergy may not be related to the medicinal ingredient in the medicine. Instead, it may involve one of the other ingredients in the medicine, such as a preservative or a dye. These are called “nonmedicinal ingredients.”

Are you (or is someone you know) scheduled to have wisdom teeth removed? Pain after wisdom teeth removal is common, so dentists and oral surgeons may prescribe strong medicines that combine a common non-opioid pain medicine (such as acetaminophen, ibuprofen, or aspirin) with a stronger opioid pain medicine (such as codeine, hydrocodone, and oxycodone). Examples of such combination medicines are Lorcet Plus, Vicodin ES, Norco, Endocet, and Percocet, or generic equivalents of them. Opioids are effective in treating pain, but even short-term prescriptions can lead to dependence or addiction.

Confusion between the medicines Wakix (pitolisant) and Lasix (furosemide) was reported. Wakix is used to treat adults with narcolepsy (sleep disorder) for excessive daytime sleepiness. Lasix is a diuretic (or “water pill”) which increases the flow of urine to rid the body of excess fluid and salt. Using an online secure messaging system, a man was asking his doctor about a change in his dose of “Wakix” and whether he should get blood tests drawn. The man was also taking Lasix, and the dose had been changed several times over the years. The man had made several spelling errors when typing messages to his doctor. The doctor assumed the man had made a spelling error when typing “Wakix” and was instead talking about Lasix. Further questioning revealed the man actually was asking about Wakix.

Why is it important for pharmacy staff to ask for your birthdate, address, or other identification every time you pick up a filled prescription? It is a way to help make sure that medicines are handed to the right person.

After nearly 2 weeks in a neonatal intensive care unit, a newborn baby was discharged to home with a prescription for liquid phenobarbital (20 mg per 5 mL) twice a day to prevent seizures. Before leaving the hospital, the baby’s doctor reviewed the prescription with the parents. He made sure the parents knew the baby’s dose (6.5 mg) and how much of the liquid medicine to give the baby for each dose (1.6 mL).

One of the most frequent errors in the pharmacy is giving a correctly filled prescription medicine to the wrong customer. Recently, we received another report of this type of error. A parent of a 16-year-old teen picked up what was supposed to be an antibiotic to treat his acne, minocycline. The next month, when looking at the prescription label to call in a refill of the medicine, the teen’s mother realized the prescription medicine was for a different person, and the medicine dispensed was not minocycline. Instead, Xarelto (rivaroxaban), a medicine used to prevent blood clots after surgery or in people at risk of having a stroke, was listed on the label. Fortunately, the teen was not injured. However, the risk of bleeding from taking Xarelto in error for a month is certainly significant.

Here’s what you can do: An effective way to detect this error right away is to open the bag of medicine when picking up filled prescriptions at the pharmacy. Make sure the correct person’s name and the expected medicine, dose, and directions are listed on each bottle. Always provide your full name (or the name of the person the prescription is for) and date of birth when picking up medicines. Ask to speak to the pharmacist to review how to take the medicine. This can also help catch errors if the medicine, dose, or directions are different than you expect, or if the reason for taking the medicine does not match your needs. If the medicine is not what you expected, don’t be afraid to tell the pharmacist you do not think it is right.

Most prescriptions can be transferred between pharmacies in the US. You may need to do this for several reasons:

· You are moving to a new location

· You are looking for a more convenient pharmacy location

· You recently made changes to your health insurance that require you to use a different preferred pharmacy

· You need to obtain a temporary supply of your medicines because you did not bring enough with you while traveling

But take care, as errors have happened when transferring prescriptions between pharmacies.

Some medicines, including many prescribed for children, come in a powder form. Water must be added to the powder so the medicine can be easily measured and taken. The ratio of water to powder must be precise, so that the prescribed amount of the final liquid mixture provides the correct dose of medicine per milliliter (mL). It is best for the pharmacist to add water right before the medicine is picked up. Once mixed, the medicine often needs to be refrigerated to stay potent. But if the pharmacist forgets to add the water, or if the wrong amount of water is added at home, a serious dosing error can occur.

Sometimes, your doctor may write or send your prescription to the pharmacy with instructions to take the medicine “as directed.” In these cases, you must remember what the doctor has told you about how to take the medicine correctly. The label on the prescription container will not help you remember because the directions will simply say, “Use as directed.”

Most people realize human error can happen, including when getting a prescription filled at the pharmacy. Although pharmacists do their best, mistakes sometimes happen. Thanks to safer medicine labels and technologies like barcode scanning, mistakes of the past are rapidly declining. The few pharmacy errors that do slip by usually do not cause serious or permanent harm. Still, that’s little consolation to a consumer who is harmed or could have been harmed if a more serious error had happened.  

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