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Another Heparin Worry — Overdose

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As more heparin makers step up production to make up for the recent Baxter heparin recall, some are concerned that shipments of the drug in unfamiliar packaging and quantities could lead to accidental overdoses.  The concern is so great, according to an article in Newsday, that the Institute for Safe Medication Practices near Philadelphia is planning to warn about the higher risk of medication error in the next newsletter it sends to the country’s 6,000 hospitals.

Even before the recent problems, heparin overdose was a cause for concern. In February 2007, the  Food & Drug Administration (FDA) and Baxter International issued a two-page safety alert warning of the fatal dangers of mistaking high 10,000 unit and low 10 unit dose vials of heparin. The memo advised hospitals to double-check their inventory to ensure dispensing errors did not occur. The 2007 alert was issued after three infants died in Indiana when they were mistakenly given adult doses. In December 2007, actor Dennis Quaid and his wife named Baxter in a lawsuit after their newborn twins were mistakenly given potentially fatal overdoses of heparin. In addition to the Quaid twins, at least six newborns and two other patients are known to have received an overdose of heparin since 2001. But some the recent upheaval in the heparin supply may have increased the chances that heparin overdoses will occur.

Baxter International recalled nearly all its heparin injections in the US after some patients experienced extreme – and in some cases fatal – allergic reactions, including difficulty breathing, nausea, vomiting, excessive sweating, and rapidly falling blood pressure that was life threatening after being administered the products.  Baxter, which supplied roughly 50 percent of the heparin injections used in US, temporarily suspended heparin manufacturing, and is said to be considering getting out of the business all together.

Other drug manufacturers have stepped up their production of heparin, and the FDA says a shortage of the vital blood thinner has been avoided. Unlike the single-dose products typically distributed by Baxter, many of the vials now contain larger or more potent quantities. Pharmacists and others are reportedly worried that doctors and nurses may be unfamiliar with new packaging for heparin, and could easily give a patient a more potent dose than intended.

According to Newsday, some hospitals are taking precautions to avoid heparin overdoses.  For example, some facilities in Long Island, New York are regularly reminding nurses to draw the drug from a vial instead of using a pre-filled syringe. The hospitals have removed the syringes so nurses won’t make a mistake while switching between two different products.

No heparin overdoses have been reported as result of confusion over new packaging or quantities, but health officials say they are on alert in case it becomes an issue.

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