ISMP Warns Of Potential Remdesivir, Propofol And Vincristine Compounding Errors

A medication safety group warns about the risk of potential compounding errors linked to several drugs, in part due to labeling confusion and a rush to treat COVID-19 cases.

The Institute for Safe Medication Practices (ISMP) published a warning this month in  Pharmacy Today, which warns of errors reported in the compounding of remdesivir, propofol, and vincristine, which could put patients at risk.

One of the drugs, remdesivir, sold under the brand name Veklury, is a broad-spectrum antiviral medication sold by Gilead, which the FDA approved in May for the treatment of severe COVID-19 cases in adults and children. However, the drug comes in different versions, including a 100 mg lyophilized powder for injection, and an injectable solution.

While the injectable solution has the equivalent amount of drug as the powder, 100 mg, the label only lists it as having 5 mg/mL, with a total volume of 21.2 mL. When given to adults, the first dose is meant to be 200 mg, followed by subsequent 100 mg doses.

This, along with the labeling confused a pharmacy technician at one hospital, who made all the doses, including the follow-ups, 200 mg doses. The hospital where this occurred noted that the labeling of the injectable solution played a role in the technician’s error.

“To prevent this error, pharmacies should consider adding a printed barcode label to each remdesivir container to allow bar code scanning for product and dose verification,” the ISMP advised. “Another recommendation is to affix an auxiliary label to remdesivir injectable solution vials to note the total amount of drug (100 mg).”

The fact that investigational drug container labels are not required to follow the same standards as approved drugs is also a factor in these types of errors, ISMP President Michael Cohen said.

Another drug linked to compounding errors has been Propoven 2%, which was just approved in May, and has double the amount of the active ingredient, propofol, as the brand name version Diprivan 1%. However, ISMP reports that clinicians are accustomed to using Diprivan, and that errors could result in overdoses.

Propofol is a short-acting anesthesia medication that is used for sedation during medical procedures, such as colonoscopy and endoscopy, as well as in dental surgery.

The manufacturer is providing stickers for each bottle once it arrives at the pharmacy. The ISMP advises making certain pharmacists immediately apply the sticker and be sure staff is aware of the new concentration, as well as ensuring the bar code works with the pharmacy’s scanning system.

The third drug the report warns about is vincristine, which is a drug designed for intravenous use only, as giving it via other routes can be fatal. In June, the FDA requested Pfizer eliminate syringe administration from the drug’s prescribing information and product packaging due to reports of accidental spinal injections.

“Accidental spinal injection of vincristine is uniformly fatal, yet it keeps happening again and again,” Cohen said.

Vincristine, a chemotherapy drug sold under the brand names Marqubo and Vincasar PFS, has been linked to more than 140 deaths, all due to syringe administration, Cohen said.