Archives for February 2013

Working in retail pharmacy for 21 years, I saw the following scenario way too many times. The circumstances and drugs were different, but the result was the same. The patient had been placed in danger due to the pitfalls that can occur when getting a prescription filled. And I’m talking about when the prescription is filled correctly from the first step to the last. These pitfalls go beyond the actual filling of the prescription.

In the busy, prescription-hungry culture we live in, it’s necessary to become our own pharmacist…sort of. (Care to tweet that?)

Consider the following steps we take to get a prescription filled (with a little animation from me):

1. How often do we go to the doctor with the prescription we want already in mind? We are paying. Our doctor typically wants to make us happy, so if the prescription makes sense, we typically get it.

2. When we take the prescription to the pharmacy, do we sit and wait? I don’t know aout you, but the CVS’s, Walgreen’s, and Wal-Mart’s around here are never busy. Right? Ha! I take mine to the drive-thru to be picked up hours later.

3. When we pick up the prescription do we stroll leisurely up to the counter, chat with the pharmacist about the prescription, ask all of our questions, pay, and then leave? Typically not. Often it’s 5:30pm, after work, the line is at least five people deep to the counter, the kids are picking up everything on the shelves, and we just want to get the heck out of there! Are we concerned about the prescription? Only the fact that it will make us better. At the moment, that’s all that matters. Oh…and that it went through on the insurance card of course.

4. We get home, unload the car, take the prescription bottle from the bag and throw everything else away. After all, who wants all that paperwork on the counter? We know we’ll never read it.

5. We look at the directions of the antibiotic and take one. And of course we’ve also taken cough syrup and cold medicine to help us get through homework, supper, and getting the kids to bed.

6. Did we remember to tell the pharmacist that we were on Cymbalta for depression that we got filled at another pharmacy? It was cheaper at Wal-Mart than at our regular pharamacy. But it really has nothing to do with a sinus infection anyway, right?

7. And what about the Imitrex we took earlier for a migraine? We only need it like once a month, so it probably doesn’t even matter.

Did anybody think about what could very possibly and probably happen?

Confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

Would  you have ever guessed? The drug interactions in this particular example caused Serotonin Syndrome. How could this have been avoided?

• IF all of the prescriptions were filled at the same pharmacy
• IF the physician were aware of all the medications currently being taken.
• IF the pharmacist wasn’t so busy with the 100’s of prescriptions they fill daily, they would have caught the interaction.
• IF we weren’t so busy and distracted when we took and picked up the prescription, we might have asked a question or two.
• IF we carefully read the medication insert that came in the bag with the prescription.

Let’s be realistic. No way all of those could actually happen.

With the help of a computer (our loved friend and dreaded enemy), anyone can determine if there are interactions, side effects, if warnings, etc. It is very important to know your source—make sure the website you are using is reputable.

Here’s what you would find on a search of the prescription drugs used in the example above:

When the interactions for these drugs are searched, there are four pretty major interactions found. Then, be sure to scroll down to the section that says, “Other drugs that your selected drugs interact with.” That’s a real eye-opener. And then there are food interactions to worry about too.

Interactions between your selected drugs

dextromethorphan ↔ duloxetine   

Applies to: Tylenol Cold (acetaminophen/chlorpheniramine/dextromethorphan/pseudoephedrine), Delsym (dextromethorphan), Cymbalta (duloxetine)

Talk to your doctor before using dextromethorphan together with DULoxetine. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

sumatriptan ↔ duloxetine  

Applies to: Imitrex (sumatriptan), Cymbalta (duloxetine)

Talk to your doctor before using SUMAtriptan together with DULoxetine. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms while taking the medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

chlorpheniramine ↔ duloxetine  

Applies to: Tylenol Cold (acetaminophen/chlorpheniramine/dextromethorphan/pseudoephedrine), Cymbalta (duloxetine)

Using chlorpheniramine together with DULoxetine can increase the effects of either medication. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

pseudoephedrine ↔ duloxetine  

Applies to: Tylenol Cold (acetaminophen/chlorpheniramine/dextromethorphan/pseudoephedrine), Cymbalta (duloxetine)

DULoxetine may increase your blood pressure and heart rate, and using it with pseudoephedrine may further increase those effects. Your blood pressure should be monitored while you are on DULoxetine. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs that your selected drugs interact with

• amoxicillin interacts with more than 30 other drugs.
• Cymbalta (duloxetine) interacts with more than 500 other drugs.
• Delsym (dextromethorphan) interacts with more than 50 other drugs.
• Imitrex (sumatriptan) interacts with more than 40 other drugs.
• Tylenol Cold (acetaminophen / chlorpheniramine / dextromethorphan / pseudoephedrine) interacts with more than 400 other drugs.

Interactions between your selected drugs and food

duloxetine ↔ food Applies to: Cymbalta (duloxetine)

DULoxetine may cause liver damage, and taking it with alcohol may increase that risk. You should avoid or limit the use of alcohol while being treated with DULoxetine. Call your doctor immediately if you have fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, dark colored urine, or yellowing of the skin or the whites of your eyes, as these may be symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Are  you starting to see why it’s necessary to “sort of ” become your own pharmacist? Time to take some responsibility for your health and don’t just assume it’s in capable hands of others.

This post was just a little precursor to wet your appetite for the screen cast tutorial coming up on Monday. There are way too many prescriptions being filled and consumed these days for you not to know how to inform yourself. So check in Monday for the tutorial and I’ll show you how to check all of this yourself.