Somewhere in the United States between December 22, 2025 and February 27, 2026, an Amneal pouch labeled magnesium sulfate 4 g/100 mL went out the door with a bag of tranexamic acid inside it.
That's the kind of mix-up that ends a career, a pregnancy, or both.
It's also one of four FDA actions this quarter that touch drugs you actually push. In order of how badly each can hurt you on shift:
The mag-sulf-is-actually-TXA recall
On March 24, Amneal voluntarily recalled Lot AH250162 of Magnesium Sulfate in Water for Injection 4 g/100 mL because somebody found a TXA bag inside a magnesium pouch. The FDA's risk language is unusually direct: a delay in mag therapy carries "a reasonable probability" of life-threatening morbidity in preeclampsia or eclampsia.
Translation: an OB patient seizes because she got the wrong drug from the right-looking bag.
The other direction is worse than it sounds. Inadvertent TXA into a hypertensive pregnant patient buys you potential thrombosis, seizures, and hypersensitivity, in someone whose chief complaint was already a 170s systolic. Check your OB jump bag and your L&D-transfer stash. NDC 70121-1720-3, lot AH250162. If it's there, it shouldn't be.
The epinephrine you can inject but really shouldn't
The Endo recall of Adrenalin Chloride Solution nasal 30 mg/30 mL dropped in late 2024 and the FDA is still working it because the problem hasn't gone away. The non-sterile nasal vial looks like the sterile injectable 1 mg/mL vial.
Per Respiratory Therapy, the FDA has logged more than 25 confusion reports since 2016, including a 2024 case where someone actually injected the nasal product. Into a person. In an emergency.
If your ED, ICU, or rig still has any BPI Labs or Endo nasal epi in a Pyxis pocket or a code cart drawer, it doesn't belong in the same zip code as your injectable.
Scopolamine patches are cooking people
The FDA's June 18, 2025 safety communication on Transderm Scōp identified 13 global hyperthermia cases. Eight in kids under 17. Four in adults over 60. Four hospitalizations. Two deaths, one a child, one an older adult. Onset was usually within 72 hours of application, often with mydriasis, disorientation, and urinary retention.
Read that symptom cluster again. That's every altered-grandma call you've ever run, and the patch is behind her ear where you're not looking.
The label now tells patients to remove the patch if they overheat or stop sweating, but absorbed scopolamine keeps working for hours to days after removal. Pull the patch on scene anyway. Then keep cooling.
Parkinson's patients, high-dose levodopa, and seizures that don't break with benzos
On March 20, 2026, the FDA required new warnings on every carbidopa/levodopa product (Sinemet, Rytary, Duopa, Crexont, Dhivy, Stalevo, Vyalev) for vitamin B6 deficiency-associated seizures. Fourteen cases reviewed, all on levodopa doses above 1,000 mg/day. Most of those seizures didn't respond to traditional anti-seizure medications.
They responded to B6.
That's the part to file away. A Parkinson's patient on a high levodopa dose, status epilepticus, two rounds of benzos, nothing. The neuro team is going to ask about pyridoxine before you finish your handoff. Have the home med list and the dose ready.
The opioid labeling update from July 31, 2025 is worth knowing too: the FDA finally put in writing that long-term therapeutic opioid use is itself an overdose risk, especially stacked with benzos and gabapentinoids. Nothing in your protocol changes. The conversation with the family at 0300 about why grandpa stopped breathing on his prescribed regimen does.