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A patient with hypertension called her doctor's office to report dizziness and a headache. She told the nurse who took the call that these symptoms had started after her last visit to the doctor.
According to the patient's chart, the doctor had called in an order for Nimodipine (used to treat stroke) to the pharmacy. The nurse asked the patient to read the label on her bottle of pills. Instead of Nimodipine, the patient spelled out Nicardopine (used to treat hypertension). Nimodipine and Nicardopine sound pretty much the same. Apparently, the pharmacist thought the doctor had said Nimodipine when he'd called in the order.
Many pairs of drugs are spelled or pronounced alike. To prevent mix-ups, doctors should make it clear on the prescription why the patient needs to take the drug. If a doctor doesn't do that, the nurse and pharmacist should make sure they know why the drug is being prescribed before administering or dispensing it. Then, in most cases, they can be sure the drug is appropriate for the patient's condition.
Of course, asking doctors to spell the names of drugs may help, too, especially if you know two drugs are spelled or pronounced similarly.