Table 3

 Forty prescription-only medications used in different doses or regimens than prescribed in discharge letter

SexAge (years)DrugPrescribed useActual useIndication for useImplication of incongruent use
COPD, chronic obstructive pulmonary disease.
Other prescription-only medication used in different doses and/or regimens than prescribed: inhalation therapy in obstructive pulmonary disease (11 patients), analgesics (6 patients), diuretics (2 patients), sedatives (6 patients), others (2 patients).
Female85Nifedipine60 mg ×160 mg ×2HypertensionRisk of hypotension
Female76Glimepiride3 mg ×16 mg ×1DiabetesRisk of hypoglycaemia
Male62Terbutaline7.5 mg ×17.5 mg ×2COPDRisk of side effects
Female82Isosorbide dinitrate80 mg ×180 mg ×2Angina pectorisRisk of hypotension
Female64Citalopram20 mg ×110 mg ×1DepressionRisk of insufficient treatment
Female58Citalopram90 mg ×160 mg ×1DepressionUnprescribed but probably relevant dose reduction
Female79Levothyroxine0.1 mg ×1 and 0.15 ×1 on alternate days0.1 mg ×1 and 0.2 ×1 on alternate daysHypo-thyreoidismDose reduced during hospitalisation. Poorer regulation of myxoedema
Male57Phenobarbital100 mg ×1100 mg ×2EpilepsyRisk of side effects
Female88Allopurinol100 mg ×2100 mg ×1GoutRisk of insufficient treatment
Male79Verapamil240 mg ×1240 mg ×2Heart arrhythmiaRisk of hypotension
Female91Nitrofurantoin50 mg ×125 mg ×1Chronic cystitisRisk of insufficient treatment
Female52Omeprazole20 mg ×220 mg ×3UlcerRisk of side effects
Female79Esomeprazole40 mg ×120 mg ×1UlcerRisk of insufficient treatment