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Letters to the Editor
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Chemotherapy
Call to review wording of Z-DEX protocol
From Mr J. A. Murphy, MRPharmS
I would like to alert pharmacists to a potentially serious misinterpretation
of a drug protocol used in some hospitals. Through the support provided
to hospital members by legally qualified pharmacists, the Pharmacists’ Defence
Association has learnt of the serious harm that can be caused to patients
as a consequence of incorrectly calculating a drug dose from a hospital
chemotherapy protocol.
Together with Nick Glassbrook, a pharmacist and solicitor who defends pharmacists
on behalf of the PDA, I believe that pharmacists should exercise extra
vigilance when dealing with this particular protocol.
Z-DEX is an unlicensed treatment for multiple myeloma consisting of idarubicin
(Zavedos; Pharmacia) and dexamethasone given orally for four days per cycle.
In common with many chemotherapeutic protocols the dose of idarubicin is
expressed in milligrams of drug per square metre of body surface area.
Unfortunately some hospitals continue to use a protocol where this is given
as total dose per cycle rather than per day. Wording may be “40mg/m2 in divided doses over four days”.
What is intended is that the patient receives 10mg/m2 per day
for four consecutive days.
We have encountered three instances in which patients were prescribed and
dispensed 40mg/m2 per day. Two died shortly afterwards, although
the role of the dosage is unclear. We would urge any pharmacist involved
in using
this protocol to review the wording urgently so that further ambiguity
might be avoided.
A copy of this letter has also been sent to the National Patient Safety
Agency for its consideration.
John Murphy
Director
Pharmacists’ Defence Association |
The
Pharmaceutical Journal