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Pharmacist being sued over lamotrigine induced SJS
Started by WVUPharm2007
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What's the counseling requirements in Colorado?
Wonder if it was dispensed with the required med guide.
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If it’s not standard lamotrigine titration dosing that nearly fits guidelines, I would always call. Too many stories like this. Counsel your patients. A lot of prescribers have no business prescribing this medication as they haven’t a clue how to titrate safely as evidenced by this same issue coming up again and again.
This is the reason i always counsel on lamotrigine, regardless if new or refill. If theyve missed more than 5 doses, time to retitrate. Also I will refuse to dispense a quicker titration than whats listed in the package insert, it's just not worth the risk. There are more stories like this with the pharmacist being sued, for example:
Woman's skin 'melts off' after medication error
Woman's skin 'melts off' after medication error
Lawsuits suck. There needs to be a shift in our culture.
Its not strictly required but if a patient asks or a pharmacist believes it could help a patient then they should consult. If he didn't get the med guide (rash 1st point) then its also misbranding.
Yeah agreed. So does greed, entitlement, and lack of personal accountability.
I understand about failing to catch the dosing errors, but I don't think I can mention SJS for every drug that can cause it or every single black box warning of every drug. There is also no mention that the pharmacist gave the guy any med guide though it must have been there. It sounds like the lawyer is going after the RPh because she did not verbally tell the patient about SJS.
Well, I think the dr will be defending himself saying how depressed the patient was warranted the increased dosage escalation. This won't fly because I don't think lamotrigine is used in acute depressive episodes and I believe they will get experts to say this technique is outside usual practice. If he was that sick, why did he not get admitted? The pharmacist seems to be claiming that the black box warnings are for prescribers not dispensers but this won't fly either. On this one I think its just how big the settlement will be
In terms of our own jobs everyone likes to say how much money they make, but isn't the best if we can do that AND warn patients?
Therein lies the problem.
In my state we are required to document that we counseled the patient.
However, no one will every be able to prove what was or was not said during counseling.
All we have, as pharmacists, are the Rx Notes and the "Counseling Accepted / Declined" box.
In my area it is not uncommon to get a lamotrigine 200 mg QD script out of the blue after months and months of not being on it. In a few cases the pt said they were in jail or in a psych hospital where they were maintained on that dose. But are you gonna take them at their word?
Yes. And document that you confirmed with them that they havent missed doses and they are aware of the risk of SJS.
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Sounds like we shouldn’t ever dispence any medications since they all have risks.
I don't get your point. If you confirmed with the patient that they didn't miss any doses and you counseled them on the risk of SJS, and then you document that you provided the counseling, how is that merely documenting? If you think the patient is lying to you or isn't able to comprehend what SJS is, then call the prescribing doctor to voice your concerns and ask the doctor to provide documentation confirming the patient was receiving the drug while incarcerated. If they aren't able to provide such documentation, insist on retitrating the drug. But again, that is probably unnecessary, since I am not sure why the patient would lie to you about not missing doses, especially if you explain to them that missed doses and taking the full dose without retitrating increases the risk of an extremely painful and life threatening rash in which their skin peels off, and if it doesn't kill them it might leave them blind and disfigured for the rest of their life.
"are you gonna take them at their word?" was meant to be rhetorical. My point, actually in response the post right before my initial one, is every pharmacist draws their own lines, or cuts corners if you will if you really want to be blase about it, when it comes to the uncertainty or ambiguity surrounding the prescriptions they come across, which happens tens if not hundreds of times a day in retail
I document everything even if I spoke to no one, am I safe to do anything I want?
When I was an RPh, I always counseled on every black box warning for the dispensed medication. I would do this on all refills as well.
lol...sure ok
How many times did you counsel on synthroid’s black box warning? Thousands? Or zero? I’m guessing zero.
“If you get any kind of abnormal rash while you’re taking this, let your doctor know right away.” You don’t need to get into specifics or show them pictures of skin sloughing off.
Really? I always informed patients that synthroid is not to be used for weight loss.
What would you do if the patient said they are using it for weight loss but when you call the doctor they tell you it's for hypothyroidism. They only told the customer that so they would take it but the actual reason is for weight loss and the doctor lied just to get you to fill it?
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Why? If you think their doctor is writing for thyroid hormones based on anything other than TSH/T4 levels, you need to talk to the doctor or medical board. The patient is just going to smile and nod and trust their doctor over you.
Not in my experience
Do you tell people receiving prednisolone eye drops that it may weaken their immune system?
In this scenario how would you know the doctor was lying? Also if a patient told you they were taking it for weight loss why would you even bother calling the doctor?
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I am sure all your male patients on lisinopril appreciate knowing they shouldn't take it during pregnancy.
This statement is so blatantly absurd I can only assume it is a joke. There are what, thousands of drugs with black box warnings?
There was essentially no point to my post.
However I've never told a Synthroid customer this shouldn't be used for weight loss.
Real question is at what age do you stop warning about meds and pregnancy?
To be honest it never occurred to me when dispensing Synthroid that it would have been prescribed for anything other than thyroid needs. Although I have always been an easy mark so that shouldn't surprise anyone.
Is there precedence for this? Any cases where pharmacists were sued for not giving black box warnings?
Probably not.
Pharmacists usually get the "You too!" lawsuits whenever a patient gets harmed by a prescribed medication.
Based on your comment, it seems as if there should be precedence then
where did you work that you had time to do this???
Does that mean you are no longer an RPh?
Am I the only one here wondering why a doctor put this lady on lamotrigine after she went to him because she was depressed? Wouldn't be my first choice for depression.
It is required in my state to counsel on all new rxs. However, I’d like to hear how you guys know what’s really a new rx. It can be a new rx number but meanwhile it is for a med a patient has been taking. At cvs i know it says counsel on top of the label if its a new rx but that doesn’t necessarily mean its completely new in their profile and wasnt filled before under another rx number, does it? How do u ensure u counsel on all new rxs esp if ur busy? U cant be standing over the tech at pickup making sure whats new or old etc
Have out window ask the patient if it's a new medication?
True, then lets say if other rph didnt put a note on the bag (we dont have force counsel option at independent), how would i be expected to know what ddi’s exist to counsel the patient on? Most i could do is counsel on that drug itself
Do you do a DUR analysis at pick up for whatever is being rung out, that’s basically like re-verifying LOL.
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The state of Texas actually defines what a "new prescription is". New prescriptions include orders that haven't been dispensed to the patient in the same strength and dosage form within the last year, transferred prescriptions, and discharge orders. If you have been getting metformin from CVS for the last 20 years and you bring it to our outpatient pharmacy, we are required to counsel you on it.
