January 14, 2015: SafeMedicationUse.ca Newsletter - Confusion with a Baby’s Dose of Medicine
When it comes to infants, we must be extra careful with the dose of any medicine administered. SafeMedicationUse.ca has received a report from a consumer whose 1-month-old baby received too much phenobarbital because of a mistake at a pharmacy. Phenobarbital is a medicine used to treat seizures. The dose of phenobarbital has to be carefully monitored. If the dose is too low, seizures may not be controlled. If the dose is too high, phenobarbital can cause serious side effects that may even lead to death.The baby’s doctor faxed a prescription for phenobarbital to the pharmacy. The doctor wrote that the baby should receive 9 mg (milligrams) of phenobarbital twice a day. However, the pharmacy‘s instructions said to give the baby 9 mL (millilitres) of a liquid that contained 5 mg of phenobarbital in each millilitre. This mistake meant that the baby was receiving 45 mg of phenobarbital per dose (9 mL × 5 mg/mL)–5 times the intended amount. Read more...
