Medication error caused by confusing drug blisters.

Presents a case in which a medication error was caused by confusing blister packs. Case of a 71-year-old woman with chronic renal failure who while under hospital treatment developed hypotension and bradycardia; Review of the medical charts which showed she was mistakenly given a generic acebutolol instead of generic amiodarone; Reasons that the blister packs of medications are often very similar; Underuse of generic drugs in France; Packaging improvements which could reduce the likelihood of serious adverse drug reactions; French agency request that companies producing generic medications modify the packaging and labeling on the blisters.