- 63,817 medication errors tied to biologics in 3 years
- Adults most affected—especially on insulin or blood thinners
- Pharmacists catch most errors before harm occurs
This study reveals where and why drug mix-ups happen—and how to stop them.
It started with a missed dose. A patient with diabetes left the clinic feeling fine—until hours later, confusion set in. Low blood sugar. The cause? A mix-up at the pharmacy between two insulin brands. It’s not rare.
Thousands of similar errors happen every year. And a new study from Saudi Arabia shows they’re more common than we thought.
Biologics and biosimilars are powerful drugs. They treat serious conditions like cancer, arthritis, and diabetes. But they’re complex. Made from living cells, not chemicals, they’re harder to copy exactly.
In Saudi Arabia, these drugs are used more each year. That means more chances for mistakes. From 2020 to 2023, nearly 64,000 errors were reported. That’s over 15,000 a year.
Most errors didn’t cause harm. But they could have. And they show weak spots in the system.
Patients rely on these drugs. But small mistakes—wrong dose, wrong name, wrong timing—can lead to big problems.
The surprising shift
For years, experts thought most drug errors happened in hospitals. Nurses giving the wrong pill. IVs mixed wrong. But this study tells a different story.
Most errors happened before the drug even reached the patient. At the prescribing stage. That’s when doctors write the order.
76% to 79% of errors started there. Not in the pharmacy or at the bedside.
Here’s the twist: most mistakes were caught early. Thanks to pharmacists.
Who’s catching the mistakes
Pharmacists reported 87% of all errors. That’s huge.
They’re the safety net. When a doctor writes “insulin glargine,” but the brand name is unclear, the pharmacist flags it. When two biosimilars have similar names, they double-check.
This shows how vital pharmacists are. They’re not just dispensing pills. They’re preventing harm.
And adults over 18 made up 70% of cases. That makes sense—these drugs treat chronic diseases like diabetes and heart disease, which are more common in adults.
Why insulin and blood thinners stand out
Two drug groups caused the most errors: insulin and anticoagulants like enoxaparin and heparin.
Both are high-alert drugs. That means even a small mistake can be dangerous.
Think of insulin like a gas pedal for your blood sugar. Too much? You crash. Too little? You soar. Either way, it’s risky.
Anticoagulants are like traffic controllers for blood flow. They keep clots from forming. But if the dose is off, the risk of bleeding goes up fast.
These drugs are essential. But they’re also tricky to manage.
This doesn’t mean this treatment is available yet.
What scientists didn’t expect
Brand names are a big part of the problem.
Biologics often have long, confusing names. And biosimilars—very similar versions—can have names that sound alike. Like “Remsima” and “Inflectra.” Easy to mix up.
Also, some doctors still don’t fully trust biosimilars. They may switch brands without clear reason. Or patients get switched at the pharmacy.
That increases the chance of error.
The immune system can react differently to biosimilars, too. Even small changes in the drug can trigger a response. We can’t always predict it.
So when a patient gets the wrong version, it’s not just about the name. It could change how their body reacts.
Researchers looked at real-world data from Saudi Arabia’s Ministry of Health. They reviewed every reported medication error linked to biologics and biosimilars from 2020 to 2023.
They used a national electronic database. No patients were contacted. The data was already collected.
They counted how many errors happened, when, and why. They also looked at who reported them and which drugs were involved.
63,817 errors in three years. That’s more than 21,000 each year.
About 70% were non-harmful. These are mistakes caught before the patient got the drug. Like a wrong dose caught by a pharmacist.
But even near-misses matter. They show where the system is weak.
The prescribing phase was the weakest link. That’s when the doctor writes the order. Maybe the brand isn’t clear. Maybe the dose is off. Maybe two similar drugs get confused.
Insulin and anticoagulants were involved in the most errors. Together, they topped the list.
That’s not the full story.
Just because an error didn’t cause harm this time doesn’t mean it’s safe.
One missed insulin dose might be okay. But repeated errors? That’s a pattern. It could lead to hospitalization.
And not all errors are caught. Some slip through. Patients may not even know.
The real number of mistakes could be higher than we see.
This study is a wake-up call. It’s the first national look at biologic drug errors in Saudi Arabia.
It shows where to focus: prescribing, insulin, anticoagulants, and brand confusion.
Experts say this isn’t just a Saudi issue. Countries with growing use of biologics may see similar trends.
Better training, clearer prescribing rules, and electronic alerts could help.
If you take insulin, a blood thinner, or any biologic drug, pay close attention to the name and dose.
Make sure your doctor and pharmacist use the exact brand name every time.
Ask questions. “Is this the same as what I took before?” “Are there look-alike names?”
Don’t assume a biosimilar is identical. It’s very similar—but not 100% the same.
And if you’re switching brands, talk to your doctor. Know why it’s happening.
This isn’t about fear. It’s about being informed.
The limits of the data
This study only includes reported errors. Not all mistakes get reported.
It also doesn’t track whether patients were harmed later. Or how many errors were repeated.
And it’s only from Saudi Arabia. Other countries may have different patterns.
Still, it’s a strong signal. The system needs fixes.
Next steps? Fix the prescribing process. Use electronic systems that flag risky drugs. Train doctors and pharmacists on biosimilar names.
Test new tools—like barcode scanning or automatic alerts—for high-alert drugs.
This study gives a clear target: insulin and anticoagulants. Now, it’s time to act.
