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Analyzing temozolomide medication errors: potentially fatal.

Al's Comment:

   I have heard of a few cases where people took the wrong dosage of Temodar.  It is pretty complex compared to the medicines we are used to taking.  There are 3 main sources of errors:  Doctor prescribing wrong dose, pharmacy giving you wrong dose or instructions, and patient making a mistake in understanding the instructions.

   First - do a reality check. Go to and figure out what the ideal dosage should be for you.  The doctor may have reasons for changing it but if it is not close to what this app says, ask him why it is different.   

 Next: Make sure the pharmacist has clearly marked how to take the capsules. There are different sizes that are used to add up to the correct dosage.  Make sure to double check before taking each dose: how many mg you are supposed to take and then how many you are about to take.

IF you have any questions, call the doctor, nurse or pharmacy before taking them.  If your mind is not completely sharp, ask someone else for help to double check the medication before you take it.  Read the warning instructions before starting.

Posted on: 08/16/2014

J Neurooncol. 2014 Jul 16. [Epub ahead of print]
Analyzing temozolomide medication errors: potentially fatal.
Letarte N1, Gabay MP, Bressler LR, Long KE, Stachnik JM, Villano JL.
Author information: 
1Faculte de pharmacie, Université de Montreal, Montreal, QC, Canada.
The EORTC-NCIC regimen for glioblastoma requires different dosing of temozolomide (TMZ) during radiation and maintenance therapy. This complexity is exacerbated by the availability of multiple TMZ capsule strengths. TMZ is an alkylating agent and the major toxicity of this class is dose-related myelosuppression. Inadvertent overdose can be fatal. The websites of the Institute for Safe Medication Practices (ISMP), and the Food and Drug Administration (FDA) MedWatch database were reviewed. We searched the MedWatch database for adverse events associated with TMZ and obtained all reports including hematologic toxicity submitted from 1st November 1997 to 30th May 2012. The ISMP describes errors with TMZ resulting from the positioning of information on the label of the commercial product. The strength and quantity of capsules on the label were in close proximity to each other, and this has been changed by the manufacturer. MedWatch identified 45 medication errors. Patient errors were the most common, accounting for 21 or 47 % of errors, followed by dispensing errors, which accounted for 13 or 29 %. Seven reports or 16 % were errors in the prescribing of TMZ. Reported outcomes ranged from reversible hematological adverse events (13 %), to hospitalization for other adverse events (13 %) or death (18 %). Four error reports lacked detail and could not be categorized. Although the FDA issued a warning in 2003 regarding fatal medication errors and the product label warns of overdosing, errors in TMZ dosing occur for various reasons and involve both healthcare professionals and patients. Overdosing errors can be fatal.
 PMID: 25026995 [PubMed - as supplied by publisher] 


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