Captopril, Salicylic Acid, Isosorbide Mononitrate and Other Drug Mix-Ups

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These are five cases of medication misuse and facts about the involved drugs - Enalapril and Captopril; Ibuprofen and Fenofibrate; Isosorbide Mononitrate and Moexipril; Salicylic acid and the United Home Burn ointment; and Diatab as an antidiabetic drug.

Salicylic acid for burns? Isosorbide Mononitrate for hypertension? These are definitely some drug mix-ups. Drug outlets encounter these situations from time to time, quite hilarious when you think about it. These types of incidents can be considered as harmless and laughable if they can be detected at once. But, what if not?

The following are cases of medicine misuse:

  • Wrong anti-hypertensive drugs

This incident happened in a private clinic. The prescription was Enalapril Stadenace, manufactured by Stada. It was to be taken twice a day as a maintenance medicine. For some reason, the pharmacy aid gave the patient, Captopril Vasostad, also produced by the same manufacturer.

The patient lived next town. He had no proper address and had no phone number that the option left for the employee was to wait for the patient to come back for refills.

Five days later, the patient showed up at the pharmacy. The guilty employee automatically changed the prescription into its proper order, explaining that it was the doctor’s request. The patient agreed nonchalantly, but was back again the following week. He bought the’ first prescribed anti-hypertensive drug’- the Captopril Vasostad, telling the surprised pharmacy aid that it was more effective than the replacement.

Captopril and Enalapril are both anti-hypertensive drugs. They both fall on the same category as ACE inhibitors. They almost have the same side-effects. The major difference between the two is that the Captopril has the short-acting effect than the Enalapril. The effect of Captopril is evident 15 minutes after oral ingestion; on the other hand, Enalapril doesn’t give the immediate effect since it is a long-acting drug. Yet, while the effect of Captopril only last for about two hours, Enalapril’s effect last for eleven hours.

  • Ibuprofen to be taken at bedtime

A new pharmacy aid at a popular drugstore chain received an unreadable prescription from an old lady. Still not familiar with that situation, he gave the drug order to the branch manager for instruction. The branch manager told him that the drug prescribed was Ibuprofen 200 mg - a non-prescription, non-steroidal anti-inflammatory medicine. He made things clearer by writing a brand ‘Midol’ over the generic name.

However the manager didn’t notice the sigma or the instruction for use below the prescribed drug. It was stated that the medicine should be taken once at bedtime. The drug Ibuprofen is usually taken three times a day or as needed.

Image by the author

As it turned out, the old lady came back to the drugstore with a daughter. The customer’s daughter had been very formal to tell them that her mother was buying Fenofibrate Fibrafen 200mg - a drug for the treatment of hyperlipidemia. The old lady has very poor eyesight that she didn’t recognize the name of her medicine.

  • Isosorbide Mononitrate treating hypertension

Moexipril HCL + hydrochlorothiazide with the brand name Uniretic - a product of Schwarz Pharma is beige colored tablet. It is an anti-hypertensive drug with a diuretic property available as a loose tablet in plastic containers of 100’s.

A woman was buying this kind of drug in an off-white color. The pharmacist had been patient in explaining that beige was the only color of Uniretic. Frustrated, the customer went home to get the sample that she bought from another drugstore. She returned shortly with an off-white loose tablet. The pharmacist was troubled recognizing it at once. It was an Isosorbide Mononitrate 60 mg manufactured also by Schwarz Pharma.

Image by the author

The pharmacist immediately showed the costumer their stock of Isosorbide Mononitrate 60mg tablet. She told the woman that it is used in the treatment of cardiac disease.

The customer didn’t argue, realizing that the white tablet had not been effective in lowering her husband’s high blood pressure. She was buying the wrong drug all along.

  • Salicylic acid for burns

A middle-aged woman-lawyer bought an ointment for a tiny burn on her wrist. Arriving home, she applied a thin film of the ointment on her blister. But instead of experiencing a soothing feeling from the drug, she felt a sting from it that slowly became painful.

Examining the ointment, she realized she was given United Home Whitfield’s ointment instead of United Home Burn ointment.

Whitfield’s ointment is a topical antifungal and anti-parasite drug. It is contraindicated in cases of open wounds, including blisters or burns since it contains salicylic acid.

The woman-lawyer had to sue the drugstore for its negligence.

  • Diatab as an anti-diarrheal

The brand Diatabs 2mg with the generic name Loperamide and manufactured by United Laboratories is advertised as an OTC anti-diarrheal medicine. Yet, there is another brand - Diatab without the ‘s’. The latter is manufactured by Spimaco, Saudi Arabia and is used as an anti-diabetic agent having the active ingredient Glibenclamide 5mg. While the anti-diarrheal Diatabs is in capsule form, the anti-diabetic Diatab is in tablet form.

The victim was a 33 year old male. He was admitted to a hospital because of psychiatric illness, but was later assessed in fact to be in sensorial changes because of drug induced-hypoglycemia.

A day ago, this man was suffering from diarrhea. He was looking for Loperamide- Diatabs, but accidentally took six tablets of his father-in-law’s Glibenclamide-Diatab.

The patient went crazy; He tried to kill his wife with a pillow and had hurt his daughters arm. When he was brought to the hospital for treatment, his blood sugar was detected at 40mg/dl (normal value is from 90 to 120mg/dl) and was corrected with IV glucose and fluids. Because of his unusual behavior, he was confined in a psychiatric ward.

He became clear the following day and was able relate his intake of some medicine but did not get well as he was still having diarrhea. The wife then suspected that he had taken the wrong medicine when she saw the package had been move from its usual location at home.

 Drug info reference:

SIGNALS in Adverse Reaction Monitoring, the official Newsletter Volume 7 Number 01 January 2002.

MIMS Philippines 2009

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