Hello Steve I’m writing to ask for some clarification on a problem I had today. I went to fill a prescription for my wife who is afflicted with PTSD, rapid cycling bipolar, and BPD. despite being on the medication for a month and the risks of going without the medication the pharmacist refused to fill the medication due to a possible interaction between two drugs. Now one of these a had already been filled so we were unable to fill her mood stabilizes which had her so distraught that having been without it for a week, due to a mishap with her doctor not the pharmacy, that she was afraid she was going to need her 6th hospitalization in 5 years. I drove to the Dr’s office and had him call and force the prescription through, and I talked with the pharmacist about the issue. She informed me she had a right to refuse the medication and I subsequently informed her that the ADA provided her certain rights including getting her medication since the prescription was due to be refilled and was her not one but two conditions explicitly mentioned by the ADA. I spoke with two RNs as well as a LPN and they said they saw no reason for it not to be filled. I was hoping you might be able to offer some insight about the conflict between these two conflicting laws from your unique and experienced point of view.
The typical pharmacy computer system throws out so many “potential interactions warnings” that most pharmacists come NUMB to all the warnings that require a override… that all to many get into the habit of not really paying attention to the warnings and just hitting the “OVER RIDE KEY” and keep going… after all the chain headquarters is always watching over your shoulder on how many prescriptions you are filling/verifying per hour – in the industry referred to as “METRICS “.
Here is a survey done in Chicago about one year ago where it was alleged that pharmacists missed about 50% of serious drug interactions when presented certain medication combination that was used in the test. http://www.chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-pharmacy-met-20161214-story.html
The most serious drug to drug interaction is classified as a LEVEL ONE… and those you really should pay attention to… those tend to be ones that you don’t just hit the “over ride key” and keep going… but apparently this pharmacist claimed that there was a POTENTIAL INTERACTION, but since the pt had been taking these two medications for some time.. would suggest that the POTENTIAL is really not there. There is often a VERY WIDE GAP .. between a “potential text book interaction” and an “observed clinical interaction”
The job of a pharmacist is to talk to the prescriber and work out any concerns about the potential drug to drug interaction.. I can think of only a few times in my decades of practicing pharmacy do I remember just flat putting my foot down and saying NO..
IMO …What should have been done… is call the prescriber… if you can’t get the prescriber to change one of the meds to avoid the potential interaction… the pharmacist should document the conversation and make the pt aware of what the potential interaction is and what to be on the lookout for and discontinue the medication and contact the prescriber if symptoms appear.
Filed under: General Problems
Abrupt interruption of mood stabilizers is EXTREMELY dangerous. My son went through hell when he was weaned from Abilify (an atypical antipsychotic that the FDA approved as an “add-on” to antidepressants). He was weaned from a very low dosage. I can’t imagine the pure hell this lady went through. Does anyone in healthcare have even an ounce of compassion left within them??