Contraindications

[Curiousone1111]

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hey everyone,
I searched and came across a post here but got mixed answers. If there are contraindicated drugs you come across in a patient profile, some people just refill. I don’t feel comfortable doing that, but if you call, some doctors say they’re aware and want that. How do you remove liability off yourself if you have the right to refuse, plus the literature/package insert lists it as contraindicated? As pharmacists, we’re the drug experts and last line before the drug goes out. Don’t you think fingers will be pointed at the pharmacist if anything were to happen/lawsuits?

I’d rather avoid dispensing such combinations, but seeing all these different practices make me wonder if I’m doing something wrong.

 

[Sabril]

I’d rather avoid dispensing such combinations/QUOTE]

I don't know if that would mean you won't dispense ISMN to a guy who is taking viagra or not, but from the lawsuit cases i read about, hardly any one of them involves contraindications or anything even near a serious drug interactions. They are more like minor stupid things that many of us don't think a lot about in day-to-day practice. I don't think it's a good idea to focus on "contraindications" as the laws to live by as we may even produce far more disastrous outcomes

 

[Curiousone1111]

Yeah that’s one combo to definitely avoid. I understand what u mean about how lawsuits can be about stupid things, but I don’t see how avoiding dispensing contraindicated drugs can produce disastrous outcomes.

 

[Rouelle]

I think this comes down to judgment. What’s the reason for the contraindication? Some contraindications involve tooth discoloration, some involve death. Very different. Look at the history, have a conversation with the prescriber and/or patient. If the potential harm outweighs the benefit, don’t dispense.

The above is generic...it may be helpful if you present something more specific about what you’re encountering.

 

[Subvisual]

Use your best professional judgement.

If you think the contraindication is pointless, just make sure the prescriber is aware and document on the Rx "Spoke with X, they are aware of contraindication, wish to dispense". CYA documentation at its finest.

If you think the interaction is dangerous then tell them that you wouldn't feel comfortable dispensing this as is and offer them a safer alternative.

 

[Old Timer]

There are ALMOST no simple contraindicated combinations. I didn't say there are none. Here is where as others said, you must use the judgement you were taught in school. You need to give is some examples of what you are speaking about. It's hard to answer such a generalized question. You need to provide specifics....

 

[Sabril]

Yeah that’s one combo to definitely avoid. I understand what u mean about how lawsuits can be about stupid things, but I don’t see how avoiding dispensing contraindicated drugs can produce disastrous outcomes.

I just don't think "avoiding" is the best word. Maybe "managing" is a better choice. Like concurrent use of ACEI and entresto should be "avoided", yes, I see no benefits but a humongous risk. Concurrent use of lithium and diuretics should be "managed." Maybe call the prescriber of the lithium and advise her to monitor the lithium level. Or at least tell the patient to watch out for sign of lithium toxicity. Then document. If you "avoid" by not giving the patient either the diuretic or lithium, this is when a disastrous outcome can happen.

 

[Curiousone1111]

True, I would call the doctor and dispense, lithium and HCTZ aren’t contraindicated anyway. Thank you

I just don't think "avoiding" is the best word. Maybe "managing" is a better choice. Like concurrent use of ACEI and entresto should be "avoided", yes, I see no benefits but a humongous risk. Concurrent use of lithium and diuretics should be "managed." Maybe call the prescriber of the lithium and advise her to monitor the lithium level. Or at least tell the patient to watch out for sign of lithium toxicity. Then document. If you "avoid" by not giving the patient either the diuretic or lithium, this is when a disastrous outcome can happen.