Most people are thankful when they leave the doctor’s office with samples of a newly prescribed medication. When your doctor wants you to try a new medicine, he may be able to give you a small supply of samples to take home. This way, he can make sure that you tolerate the medicine and that it’s working as expected before you have to pay for a prescription. Samples may save you a trip to the pharmacy, too.
Unfortunately, there are some hidden dangers with samples. One problem is that samples are packaged in a way that can often be confusing and lead to medication errors. Also, since your pharmacist isn’t involved, there’s also no pharmacy label with instructions.
Angeliq is a hormone-based medicine used to relieve the symptoms of menopause, such as hot flashes, night sweats, and vaginal symptoms. Our sister organization in Canada, ISMP Canada, has received two reports of Angeliq being confused for birth control pills. The drug is also available in the US, although we haven’t received any similar error reports yet. In each of the cases in Canada, a doctor gave a woman some sample packets of Angeliq to take as birth control, even though that is not the purpose. Each of the women took Angeliq for several months until the samples were finished. The mistakes were discovered when the women took prescriptions for a further supplies of Angeliq to their pharmacy, where they referred to these as “birth control pills.”
Angeliq has a number of similarities to birth control pills that might have played a role in the mix-ups. The labelling and packaging of Angeliq is similar in design to the labelling and packaging of birth control pills. Also, Angeliq comes as a punch card (called a “blister pack”) with a 28-day supply. You have to punch out each day’s pill from the card, just like many birth control pills. The term "Angeliq" sounds like a woman's name and many birth control pills also have female-sounding names (for example, Alesse, Portia, Yasmin, and even Yaz). In addition to these similarities with birth control pills, neither the outer nor the inner package of the Angeliq sample package has any information pointing out that the medicine is to be used for symptoms of menopause.
The hormones contained in Angeliq pills appear similar to the ingredients in birth control pills. Angeliq contains a hormone known as a progestin and it also has an estrogen component, similar to what you’d find in birth control pills. However, the dose of progestin in Angeliq is less than that used in birth control pills, and the potency of the estrogen used in Angeliq is also different from the potency used in birth control pills. So the pills are not suitable for birth control. In fact, if a sexually active woman who has not yet reached menopause uses Angeliq instead of an oral contraceptive, she could become pregnant. So obviously, the consequences of the mix-up have very serious implications.
When samples are provided in doctor's offices, proper labeling and certain checks that are usually provided by your pharmacy may be missed. If your doctor gives you sample medication for any reason, let your pharmacist know you are taking the medication, and why. Your pharmacist can add this information to your medication profile, and check that the sample medication does not interact with any medicines you are already taking. You should also ask your pharmacist to provide you with an information sheet about the medication, if available.