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Publication Type: Note Messages
Single or Multiple Incident: Multiple
Date: 7/28/2020 12:00:00 AM
Country: Denmark

This alert discusses the potential and actual risk of a medication error due to a drug shortage. Digoxin 250 micrograms had been backordered. It was necessary to substitute Digoxin 250 micrograms with 4 tablets of 62.5 micrograms. However, a miscalculation can lead to an increased risk of incorrect dosing. One case of digoxin toxicity is described. Recommendations for the prescribers as well as dispensers and those administering digoxin are provided.

Additional Details

digoxin oral

Risk of incorrect dosing due to backorder of Digoxin 250 micrograms