Retail pharmacists' access to patient labs

[a student]

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How is a retail pharmacist ever supposed to catch things like nitrofurantoin prescribed for CrCl < 60?

 

[Rukn]

You just fill

Only time I've ever seen a lab was for Clozaril

 

[hye345]

How is a retail pharmacist ever supposed to catch things like nitrofurantoin prescribed for CrCl < 60?

These sort of things are (supposed to) be handled at the hospital/clinic level.

 

[Ackj]

It's nearly impossible to catch on a single rx, unless the patient is very old and you can assume low clearance. Some regular patients you may know more about them and possibly know their renal status. Seeing other medications with renal adjustments on their profile (cephalexin 250mg q12h, Januvia 25mg, etc) could be a hint to double check as well.

 

[Alby]

You could always ask the patient if they have CKD.

 

[Dred Pirate]

These sort of things are (supposed to) be handled at the hospital/clinic level.

it would get caught IF there was a pharmacist reviewing orders at the clinics - but I can't tell you how often I see people come in on inappropriately dosed meds for their renal function.

On a side note - the liit isn't 60 ml/min anymore of nitrofurantoin - it is more like 40 (or 30) depending on who you ask

 

[Corpseman]

it would get caught IF there was a pharmacist reviewing orders at the clinics - but I can't tell you how often I see people come in on inappropriately dosed meds for their renal function.

On a side note - the liit isn't 60 ml/min anymore of nitrofurantoin - it is more like 40 (or 30) depending on who you ask

Who do I ask?

 

[a student]

Who do I ask?

lexicomp

 

[Dred Pirate]

Who do I ask?

not sure what lexi says -but there was a report in pharmacist letter that said 30 - we had a drug info student do a lit search and I comfortably go down to 40

 

[waiter]

not sure what lexi says -but there was a report in pharmacist letter that said 30 - we had a drug info student do a lit search and I comfortably go down to 40

agree

 

[Corpseman]

not sure what lexi says -but there was a report in pharmacist letter that said 30 - we had a drug info student do a lit search and I comfortably go down to 40

Awesome, thanks for the info.

 

[MindGeek]

Oplinger M, Andrews CO. Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: looking for the evidence. Ann Pharmacother. 2013;47(1):106-11. From the professor who taught me CKD it's down to 40.

 

[bacillus1]

Oplinger M, Andrews CO. Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: looking for the evidence. Ann Pharmacother. 2013;47(1):106-11. From the professor who taught me CKD it's down to 40.

Unless you want to use Macrobid in a man. Then it looks like 60 is still the cutoff, and it should only be used for confirmed gram-negative infections (of course not pyelo). Gram positive and mixed infections require pretty much perfect renal function.
Source: Ingalsbe, et. al. Ther Adv Urol 2015, Vol. 7(4) 186-193
I found this article today when asked what to give PO in a guy with PCN allergy and QT prolongation, no concern for pyelo, grew out E. coli that's sensitive to nitrofurantoin...They didn't do doxy susceptibility so I asked if they can do that. If not, or if he needs to be discharged quickly, they might do the Macrobid...

 

[El Trombopag]

Semi recent off label dosing for fosfomycin in men - 2 grams PO q2-3 days x 3 doses.