Terbinafine and Metoprolol Interaction

[pharmalt82]

I'm floating for one day at this pharmacy at my chain. I have a 2 hour overlap with the pharmacy manager.
I took in an Rx for Terbinafine 250mg QD #30. The patient was also on a total daily dose of 200mg of Metoprolol from a different doctor.
The manager (been at this store for 10 years, total time of 17 years with the company) just cleared the interaction and told me that he doesn't care about any interactions unless they are Level X or so on any of the major databases.
Now, my normal course of action would be to contact the Dr who prescribed the Terbinafine and get an OK from the Dr.
What is the correct thing to do here?
I've seen these types of scenarios too many times now. Interactions I don't think should be overridden without more details are being completely ignored. One staff pharmacist just gave me a completely cavalier attitude. She knew that she may end up overriding something serious but she said that she doesn't have the time to care and she only watches out for the most important offenders (warfarin, amiodarone, digoxin, HIV meds, known level X interactions) etc.
My friends tell me that they think interactions are ironically a more frequent issue in retail than hospital because hospitals can monitor more closely and have direct access to some prescriber in the hospital or on-call.

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[waiter]

that is not an actionable interaction

 

[pharmalt82]

that is not an actionable interaction

What am I missing here?
Should I at least warn the patient about hypotension?

 

[Estrace]

If either of the med is new for the patient, you can put a consult to warn the patient about hypotension. This isn't a very serious interaction to be calling the Dr on.

 

[PolarPop]

What am I missing here?
Should I at least warn the patient about hypotension?

I'd be more worried about bradycardia than hypotension. Either way it's a problem that is better solved by talking to the patient not the doctor(s).

 

[zelman]

Since they're on the max dose of metoprolol already, I'd call the MD and document. If they don't call you back before the patient tries to pick it up, I'd counsel them and document. You don't want to be liable for a syncope-related car crash or anything.

And how is it not actionable? One can monitor blood pressure and heart rate. Toprol XL can be cut in half. Seems like we have an opportunity to offset the interaction pretty easily.