Wrong medication dispensed: understanding LASA drug errors

Recently, it was reported that data provided by NHS Resolution showed compensation for medication errors had reached its highest level in nearly 10 years. In 2016/2017, spending was around £21.5 million for these compensation claims, and by 2023/2024, this had increased to £54.9 million.

The NHS have a term called Look Alike, Sound Alike Medicines or LASAs. This is where medicines have similar names, similar packaging and/or similar strengths and doses, which leads to an error when either a GP prescribes the medication or when the Chemist dispenses the medication. In 2021, it was estimated that out of the 1 billion prescriptions issued a year, 2.2 million had resulted in LASA errors.

The World Health Organisation and the British Government have published guidance surrounding these errors, including why they happen and what should be in place to avoid them happening.

There have been many reported instances of prescribing errors and some examples have included Penicillin and Pencilliamine, Promazine and Promethazine, Procyclidine and Prochlorperazine, Heparin and Dalteparin, and Metoprolol and Metoclopramide. This is not an exhaustive list and realistically, it can be any medication that has a similar name, or part of the name, that can result in this error.

One of the most recent concerns this year has been with Promazine and Promethazine. There have been publications in the Kent and Medway area, the Community Pharmacy in Hampshire and Thames Valley, and Surrey and Borders NHS Partnership Trust regarding incidents involving these medications. Promazine is an anti-psychotic medication and Promethazine is an antihistamine and these errors are understood to have been reported in both the prescription and dispensing stages. Reviews have now taken place to try and identify patients affected by this over the last six months in some areas. They are also looking to implement additional alerts on their systems for this medication going forward. The potential side effects caused by Promazine can be significant, particularly with patients who have pre-existing medical conditions or who are already taking certain medications. Like all medications, there are potential side effects. Some more common effects of Promazine may include: agitation, fatigue, dizziness or drowsiness and seizures; however, there are also more uncommon but severe side effects such as: low white blood cell counts (compromising your immune system), confusion and death. Usually, with patients on this medication, there would be regular monitoring in place to ensure such side effects are identified at the earliest opportunity. These provisions, however, would not be in place if you are not meant to have been prescribed this medication.

Where a wrong medication is received, some patients may realise the error before taking any medication. In these circumstances, it is always best to contact the Chemist to raise the concern and for the correct medication to be provided. If the error was by the GP, at the prescribing stage, then it may need to be escalated to them first to ensure that the correct medication can then be prescribed and dispensed by the Chemist.

In other cases, a patient may not realise the error due to the similar packaging and/or name and may begin taking the medication. Subject to the medication they have been given, these may pose a serious risk to the patient’s health and potentially their life. It can also result in difficulties finding the underlying causes of any symptoms you have because of the medication, as they may not realise the error that has been made.

How Forbes Solicitors Can Help You

At Forbes Solicitors, we understand the serious impact that prescription and dispensing errors, especially involving Look-Alike, Sound-Alike (LASA) medications, can have on patients and their families. If you’ve been affected by receiving the wrong medication or have suffered adverse effects due to a LASA error, you are not alone. These mistakes can lead to life-altering consequences, and seeking legal advice may help uncover what went wrong and prevent further harm to others. Our experienced medical negligence team is here to support you with clear, confidential advice. Contact us today on 0800 037 4625 to explore your options - our team is ready to listen and help you pursue the justice you deserve.