Coumadin And Cardura - Prescription Error Causes Death

Bob Carroll
Bob Carroll
Contributor
Posted by Bob CarrollOctober 05, 2005 10:25 AM

Two prescription drugs, both beginning with the same letter, Coumadin and Cardura, were confused by a pharmacy in Florida. As a result of the prescription error a tragic death occurred. Several breaches of internal pharmacy policies must have been tolerated or encouraged by management.


Two prescription drugs, both beginning with the letter "C", Coumadin and Cardura, were confused by a pharmacy in Florida. As a result of the prescription error a tragic death occurred.

The prescription was for Cardura. Cardura (Doxazosin) is used to treat the symptoms of an enlarged prostate. It is also used alone or in combination with other medications to treat high blood pressure. Instead of Cardura, the drug provided was Coumadin. Coumadin (Warfarin) is used to prevent blood clots from forming or growing larger. It works by stopping the formation of substances that cause clots.

Over a short period of time the taking of the Coumadin caused bleeding into the brain of the patient. He was hospitalized but died of the complications of the misfilled prescription.

Prescription errors of this nature should never occur. All pharmacies have very elaborate procedures and safeguards in place to assure that this does not happen. It can only happen when the pharmacy is violating more than one of its rules for the proper filling of prescriptions.

During the course of a Wrongful Death lawsuit, it became obvious that several breaches of internal pharmacy policies must have been tolerated or encouraged by management. This may have been due to understaffing, pressure to produce greater output or other internal circumstances. The reasons for the breaches were never fully determined.

The lesson for the patient/consumer who has a prescription filled is clear - double and even triple check the filled prescription to be sure that it is correct in every respect. Be certain it is the proper drug and that the dosage indicated is what the doctor ordered. There may be legal responsibility for a prescription error assigned to the pharmacy, but it is the patient who will suffer the consequences. If there is any doubt or concern speak directly with the pharmacist when picking up the filled prescription.

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