With vigilance, you can avoid disaster at the drugstore

Pharmacists remain among the most trusted professionals in America, just behind nurses and ahead of doctors, engineers, dentists and police officers. But even pharmacists make mistakes.

We recently received a letter from a reader: “Yesterday, I discovered that when my diabetes prescription was refilled, the druggist made a mistake and gave me something else. I didn’t catch it at first because there was a note on the bottle saying that while the shape was different, it was the same prescription.

“My blood sugar numbers crept up, and I began to think there was a problem. I scrutinized the tablet, and instead of saying 1.5, it read 1.25. I went to the drugstore, and they confirmed that not only was it the wrong dosage, it was the wrong medication.

“Always check refills to make sure they are what they are supposed to be. Some pills can cause harm and even death to those who are not supposed to take them. I have no idea what drug I was given, but I’m glad that it caused me no problems except for uncontrolled blood sugar for several days.”

Another reader averted a potentially serious problem by checking before she left the pharmacy: “My 11-year-old daughter takes Intuniv (guanfacine) for ADHD. When I picked up her prescription, I was given Invega (paliperidone) instead. This is an atypical antipsychotic used for the treatment of schizophrenia.

“Luckily I noticed before I even left the pharmacy. When I asked the tech, she said someone must have made a mistake entering it into the computer. She did it over and gave me the correct medicine.

“I don’t understand why they didn’t check her history and see that she takes Intuniv. I was told there is a many-step process before the prescription is released. So how did I get handed this incorrect medicine? Even more important, what could it have done to my 75-pound daughter?

“It is very scary. I switched drugstores and carefully check every pill that comes into my house.”

Sometimes a mistake leads to tragedy. A pharmacist in Illinois dispensed the diabetes medicine glipizide instead of the gout drug allopurinol. The patient did not notice the error, and his blood sugar went dangerously low. He suffered serious consequences, including a stroke, and ultimately died. The family sued the drug chain, and a jury awarded $31 million in damages (Drug Topics, Nov. 6, 2006).

You can learn more about the many things that might go wrong at the drugstore in “Pharmacy Exposed” by Dennis Miller, RPh. We also provide a list of top-10 pharmacist errors and information on how to protect yourself in our book “Top Screwups Doctors Make and How to Avoid Them.”

Here are some safety tactics to employ the next time you pick up a prescription:

Keep a copy of your prescription, and check the pill bottle you are given to make sure it agrees. Do this before you walk away from the cash register.

Ask your pharmacist how to take the medicine. Find out if it matters whether you take it with food or on an empty stomach, and whether there are any beverages such as grapefruit juice or coffee that are incompatible.

Review with the pharmacist all other drugs you take, including OTCs. Make sure you are not setting yourself up for a dangerous interaction.

Q: What is the best way to remove a tick that has attached itself to your skin? I have read on the Internet that you should put liquid soap on a cotton ball and dab it on the tick. In theory, this is supposed to get the tick to let go and back out.

A: A reader in the Netherlands saw the same Web story you did and responded: “We have ticks in Europe, but we are warned not to use soap or alcohol on the tick. That could cause the tick to spit the contents of its stomach into your skin and maybe cause Lyme.”

We also heard from an emergency-department physician, who said: “Ticks actually glue their mouthparts into the skin during a feed. It takes them several hours to accomplish this, so if you find the tick early, it can be removed intact. If you find them about 12 hours or so later, the mouthparts will generally be impossible to remove intact and don’t need to be.”

He added a recommendation for an inexpensive tick-removal device called Pro-Tick Remedy, available at camping stores. Other readers have recommended The Tick Key, the Ticked Off spoon and the O’Tom/Tick Twister.

Q: I’ve been taking estradiol Mondays, Wednesdays and Fridays for hot flashes for many years. (I used to take Premarin.)My doctor asked me to stop the estrogen because she said she would get in trouble. Now I have hot flashes day and night. I am desperate. What else can I do?

A: We’re not quite sure why your doctor thinks she would get into trouble for prescribing estradiol for hot flashes. Although estrogen has the potential to increase the risk for blood clots, high blood pressure, migraines and breast cancer, it is the most effective way to control menopausal symptoms. Stopping estrogen suddenly can trigger rebound hot flashes (Maturitas, August 1983).

One alternative is Pycnogenol. This compound is derived from the bark of French maritime pine trees and is rich in procyanidins. A randomized placebo-controlled trial found that Pycnogenol was especially helpful for hot flashes and sleep problems associated with menopause (Journal of Reproductive Medicine, February 2013).

We are sending you our Guide to Menopause, in which we discuss the pros and cons of hormones as well as many alternatives, including details on Pycnogenol, black cohosh and progesterone. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (66 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. W-50, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Q: About 10 years ago, our daughter did her practice teaching in an elementary school and got head lice. We tried all the treatments, but the lice kept coming back.She finally found an electronic comb (Robi Comb) that electrocutes the lice. It was a bit pricey, but not as much as multiple bottles of lice shampoo that didn’t work.

A: We have heard from many frustrated parents that standard lice shampoos frequently fail because lice have become resistant to the pesticides.

A dermatologist described his own success with Robi Comb in a similar situation (Journal of the American Academy of Dermatology, February 2005). Daily use for two weeks is required to zap the lice and remove the nits.

“The People’s Pharmacy with Joe and Terry Graedon” airs Saturday at 7 a.m. on WVTF (89.1 FM) and at 4 p.m. Saturdays and Sundays on RADIO IQ (89.7 FM). Joe and Teresa Graedon’s column runs in Tuesday’s Extra.

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