Counterfeit drugs

Illegible handwriting, look-alike drug names, counterfeit drugs, dangerous drug interactions, and nearly identical abbreviations for dosage directions (in handwriting, qn—"take at night"—can be mistaken for qh—"take hourly"): Three years after the Institute of Medicine warned that at least 1.5 million serious drug errors happened each year in the United States, the situation is still dire. In May the watchdog group Consumers Union reported that there is "no reliable evidence that we are any better off today."

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"The handoff at the counter is the time to be sure that what you have in your hand is the medication your doctor prescribed for you—the right drug, the right dose," says Michael R. Cohen, RPh, ScD, president of the Institute for Safe Medication Practices, based in Horsham, Pennsylvania.

Here, cases in which one of the top four drug errors played a part, and how you can protect yourself.

Counterfeit drugs:

What Can Go Wrong: Weekly injections of Procrit, a red-blood-cell booster, suddenly stopped working for Maxine Blount, a St. Louis breast cancer patient—plunging her into debilitating fatigue. FDA investigators discovered that the $500-per-injection medication, which Blount had purchased at a local pharmacy, contained just one-twentieth of the active ingredient listed on the label; authorities tracked down 110,000 counterfeit vials in all.

How Common: About 1 percent of drugs sold in the United States may be counterfeit, according to the FDA, though estimates range as high as 7 percent. So you've got roughly one in 100 odds of getting a fake, says counterfeit-drug expert Marv Shepherd, PhD, director of the Center for Pharmacoeconomic Studies at the University of Texas at Austin. "There are about 5,000 drug products in a pharmacy—that would mean about 50 counterfeits—and that's not insignificant." [And even if they may not be counterfeit, they may not be approved by the FDA]

What You Can Do: Stay alert for any changes in the look, size, taste, feel, or smell of drugs you take regularly. (Consumers discovered a fake statin because it tasted too bitter, and tainted heparin because the injections stung more than usual.) Call your doctor if your drug doesn't seem to be working and to report any side effects. Beware of online and overseas drug sellers, say experts; stick with sites accredited by the National Association of Boards of Pharmacy.

What Can Go Wrong: Gwen Taylor, a Kirkland, Washington, realtor who filled her prescription at her local drugstore, says she received a bottle of the opium-based narcotic oxycodone instead of the oxybutynin prescribed for her overactive bladder. She took the narcotic for a month before a pharmacist spotted the error during a refill. By that time, she was addicted and had to be weaned from the sound-alike drug.

How Common: Twenty-five percent of the nation's million-plus drug errors are due to mix-ups over sound-alike or look-alike drug names, according to the Institute of Medicine. The nonprofit United States Pharmacopeia (USP), which sets national drug standards, reports that 3,170 pairs of drugs have similar names—such as the attention-deficit drug Adderall and the blood pressure medication Inderal, or the pain reliever Celebrex and the antidepressant Celexa.

What You Can Do: Ask your doctor to say the name of the drug and its purpose—and to write it down separate from your prescription. "At the pharmacy, review the drug with your pharmacist once the prescription is filled," says Shawn Becker, MS, RN, director of healthcare quality and safety for the USP. "Be sure your name is on the prescription and that the pill in the bottle matches your prescription." For extra protection, be sure it's intended for your medical condition. Print this list to take with you
Hand full of pills

What Can Go Wrong: Michelle LaRowe, a Hyannis, Massachusetts, mom, knew something was wrong when the label on her 10-month-old daughter's liquid antibiotic, cephalexin, called for three teaspoons, three times a day. "It was too much," she told a local newspaper. A call to the drugstore revealed that the prescribed dose was really three cc—about a half-teaspoon. The pharmacy had inadvertently written the metric dose in teaspoons, an overload that could have proved fatal.

How Common: Statistics on drugstore dosage mistakes are hard to come by, but in one study that tracked all the prescriptions filled in a large, busy Boston hospital, nearly 4 percent had dosage errors. And in a University of Arizona study published earlier this year, of the electronic prescriptions filled at 68 chain pharmacies, 18 percent of errors were related to dosage.

What You Can Do: Again, review the dose—the strength of your prescription and how often and how much you should take—with your doctor; have her write down the prescription separately, and then recheck it with your pharmacist when you pick up your drugs. Potential pitfalls abound, including poor handwriting and confusing prescription-pad abbreviations.
Drug interactions

What Can Go Wrong: Researchers from Massachusetts General Hospital reported that a 46-year-old woman who took five different drugs for depression, asthma, and other conditions and for two days used an over-the-counter cold remedy developed crushing head pain, blurry vision, and nausea, and then suffered a stroke. The cause? An overload of serotonin, thanks to an interaction between her antidepressant and her cough medicine, causing her arteries to constrict.

How Common: In a study of 2.8 million people, researchers found potentially dangerous drug interactions in 2 percent of prescriptions. Risk rises after age 44—when your body is less able to metabolize meds. The odds that you'll have an interaction are 13 percent with two drugs, 38 percent with five drugs, 82 percent with seven. Herbs, vitamins, and over-the-counter remedies ranging from ibuprofen to decongestants and beyond are also subject to interactions.

What You Can Do: Carry a list of all prescription drugs, over-the-counter meds, vitamins, and supplements you take; show it to your doctor and your pharmacist. (You'll find a printable blank list at "Your doctor and pharmacist may not have a record of all the drugs you take, particularly if you see more than one doctor or have your prescriptions filled at more than one pharmacy," Cohen says.