Medication Safety Tips
Featured Resources
About UsReporting Medication ErrorsContact Us
Brought to you by
Left Chevron
Back
Left Chevron
Reporting a Medication Error

When Your Medicine Doesn't Look Right

Republished July 31, 2024

A mother picked up a refill of her child's medicine, Strattera (atomoxetine), a drug used to treat attention-deficit/hyperactivity disorder (ADHD). The capsules were a different color than what they previously received. Even though the prescription bottle said Strattera 60 mg, the mother called the pharmacy to check.

The pharmacist looked at the child's medicine record and realized that a mistake had been made. An antidepressant, Cymbalta (duloxetine) 60 mg, was the medicine that was in the bottle. The mother returned the wrong medicine to the pharmacy in exchange for the right medicine. Luckily, the child had not taken any of the wrong medicine. Be sure to always check your medicine (or your child's medicine) before taking it. If it is not what you expect, check with your pharmacist.

More Safety Articles

A mix-up involving a vaginal ring

Our organization received a report from the Food and Drug Administration (FDA) about a mix-up involving a vaginal ring. The mix-up involved two medications that can both be delivered by a vaginal ring. The medication prescribed was NuvaRing (etonogestrel/ethinyl estradiol) but the doctor actually intended to prescribe Estring ( estradiol). Vaginal rings release medicine over an extended period of time by inserting a plastic ring shaped device into the vagina (see photo).

Learn More

Confusing imprint codes

CVS brand of Arthritis Pain Relief extended-release tablets come in geltabs containing 650 mg of acetaminophen . A single dose is typically 650 mg, or one geltab. Several people who live in a retirement community reported that they found the markings on the geltabs that state “350” to be confusing (image below). Several thought the “350” designation on the tablet meant its strength—350 mg. They thought they had to take two of the geltabs as a single dose, but again were confused because two of the geltabs would equal 700 mg, not the 650 mg dose they thought they were supposed to take.

Learn More

Even Low-Dose Methotrexate Can Cause Harm or Death If Taken Daily or With Certain Other Medicines

Learn More

Steps Parents Can Take to Help Their Child Safely Get Their Medicines at Camp

Learn More