How well are these supposed to get flagged, absent the patient noticing them?
I’m somewhat curious about this, because I just ran into a minor one that I’m aware of only because I read the inserts. We all know that a large number of people won’t do that.
Specifically, I take one regular medication - cholestyramine (Questran). I went to a sports medicine doc for a lower back problem, and among other things he prescribed me a run of an NSAID, meloxicam. I had mentioned the cholestyramine on his paperwork, and had it filled at the same pharmacy I get the cholestyramine at. When I read up on the meloxicam, I find a specific warning that the former impedes absorption of the latter. Neither the doc nor the pharmacist said anything about it. Should it have gotten noticed? I’m taking it, but spacing it from the cholestyramine as a result.
(Cholestyramine seems to impede the absorption of practically everything. Nonetheless, it seems to work admirably for the off-label purpose it was prescribed for, and probably helps reduce my cholesterol as a side benefit.)
When one of my patients gets prescribed drugs with known interactions, the pharmacy picks it up and does one of 3 things:
If it’s a level 1 interaction (very severe) they generally will not dispense both drugs without direct confirmation of those orders from me or one of colleagues after making us aware of the level 1 interaction.
If it’s a level 2 interaction (not so severe) they will notify me of the interaction and request that I reply to them that I’m aware of the interaction, but will fill the prescription, often with a warning/directions to the patient on what to watch for and how to best safely take each med.
If it’s a level 3 or higher interaction (generally not clinically real relevant) they usually put a label on the rx, directing how to minimize interactions.
Your interaction sounds like a level 3, but I’m not certain. That sort of interaction usually just gets a sticker slapped on the bottle, advising not to take the 2 meds together.
As Qadgop said, it depends on the severity of the interaction. There are many drugs that have interactions but is fine to take as long as you take them a diffrent times. Normally they get flagged on the pharmacy’s system for the pharmacist to take a look at.
Unfortunatly I don’t have any refrence books with me, and I’m on a borrowed laptop so I can’t get to my refrence websites in order to see exactly what type of interactions those two medications have. I do know that cholestyramine is a bile acid sequestraint so it would affect the absorbtion of many things, including anything that would be fat soluable.
If you don’t get a better answer before then, and if you want, I can check my resources tomorrow at school to find out the exact interaction, and if it would be something I would just approve if I was your pharmacist.
Thanks, guys. I didn’t figure it was terribly serious, but it did sound like it would be a bit futile if I were to wash down the anti-inflammatory with the glass of cholestyramine (the stuff is a powder which has to be stirred up as a suspension in a glass of something).
Like Qadgop said, generally the pharmacy will notice this, and notify you or your doctor. Any good pharmacy has computer software that checks any new prescription for you against all your other recent prescriptions, and pops up a flag for any known interactions. (This is one reason why it’s good to stick with one pharmacy.) I’ve worked on some of this software, and it’s very complex & detailed in checking this.
You should be asking your pharmacy (very sternly) why they didn’t notice this interaction and notify you or your doctor. I don’t think it rises to the level of malpractice (especially for a level 3 interaction), but it’s certainly incompetent service. I would be saying ‘Given this poor level of service, why the hell should I continue buying my prescriptions here when I could get them cheaper at Wal-Mart (or CostCo, or whatever local competitor exists)?’ And expecting a pretty good answer!