The Pharmaceutical Journal
Vol 273 No 7330 p880
18/25 December 2004

This article
Reprint   Photocopy

PDF 90K, Acrobat Reader

· Dispensing
· Levothyroxine
· CAM
· Hangovers
· CPD (2)
· The Society (2)
· The register (5)
· Retention fee (7)

Letters to the Editor

Dispensing

Occurrence of bisoprolol/carvedilol dispensing confusion

From Ms H. J. Williams, MRPharmS

As a member of a specialist heart failure team and a supplementary prescriber working in an outpatients clinic, I can see first-hand the difficulties both patients and health care professionals face in managing the supply of complex medication regimens for heart failure, particularly beta-blocker dose titration regimens. From experience in my own practice, I would like to raise awareness among pharmacy colleagues of the potential for confusion when interpreting prescriptions and dispensing beta-blockers for patients with heart failure.

Over recent weeks a number of errors from primary care have become apparent in the clinic, where we check through each patient’s medication supplies carefully at each visit as part of a medication review. For example:

· Bisoprolol 1.25mg tablets labelled as bisoprolol 10mg tablets

· A prescription for carvedilol 3.125mg bd, dispensed as bisoprolol (Cardicor) 3.75mg bd but labelled as carvedilol

· A patient who had been dispensed bisoprolol at a dose of 37.5mg daily instead of the prescribed 3.75mg daily

In only one of these cases was the patient aware of the error and had therefore been able to take steps to rectify it.

At the point of prescribing and dispensing there are a number of areas for potential error when using beta-blockers in heart failure:

· Drug choice — only carvedilol (Eucardic) and bisoprolol (Cardicor) are licensed for the management of heart failure. Care needs to be taken here as there is the possibility of confusion between generic and brand names

· Dosing frequency — carvedilol should be prescribed twice daily for heart failure, while bisoprolol (a long-acting beta-blocker) should be prescribed once daily

· Dose titration — each drug must be initiated at low dose and titrated slowly according to the product licence to minimise the risk of adverse effects

Each of the errors highlighted here could have had potentially serious consequences. I would therefore urge pharmacists to check prescriptions for these two drugs, carvedilol (Eucardic) and bisoprolol (Cardicor), carefully at the point of dispensing and ensure the appropriate drug, brand, strength and dosing instructions are provided to the patient.

Helen Williams
Pharmacy Team Leader, Cardiac Services, King’s College Hospital NHS Trust, London

Send your letter to The Editor

Next Topic (Levothyroxine)