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    Thursday, July 19, 2007

    Making My Job Harder: One of my patients received this note from Rite-Aid when he picked up his lisinopril and metformin the other day:

    "Metformin HCl Oral Tablet 500mg is contraindicated in Cardiac Failure. Since Congestive Heart Failure (which is a proxy medical condition based on the use of Lisinopril Oral Tablet 5mg) is a more specific form of Cardiac Failure, the same precaution may apply." and "Metformin HCl Oral Tablet 500mg is not recommended in Myocardia Infarction, which is a proxy medical condition based on the use of Lisinopril Oral Tablet 5mg." and "Lisinopril Oral Tablet 5mg should be used cautiously in Diabetes Mellitus. Since Type 2 Diabetes Mellitus (which is a proxy medical condtion based on the use of Metformin HCl Oral Tablet 500 mg is a more specific form of Diabetes Mellitus, the same precaution may apply."

    This was tucked into his bag with his medication. Now, I think I'm fairly good at reading comprehension, and I've been to medical school to boot, but I had to read this over a couple of times to understand the message. And I only understand it because I'm a doctor. They're telling my patient that sometimes lisinopril is used to treat congestive heart failure and heart attacks, and if he has had either of those conditions, maybe he shouldn't be taking metformin.

    They're also telling him that diabetics shouldn't take ACE inhibitors (in this case lisinopril), and this advice they should just leave out. ACE inhibitors are a drug of choice for treating high blood pressure in diabetics with normal kidney function. The precaution comes for those who renal failure or renal artery stenosis as a complication of their diabetes.

    There's no way the pharmacist could know whether or not my patient has any of the above conditions that illicited this dire-sounding note. It's my job to know these things and to make a medication choice based on them. It's not the job of the pharmacist or the software engineer who wrote the program that spit out that note. The note served absolutely no useful purpose. I had to provide the interpretation for the patient, and I'm not sure he believes me. I've now got a patient who suspects his medication may be doing more harm than good. Thanks, Rite-Aid!

    posted by Sydney on 7/19/2007 01:30:00 PM 3 comments


    Thank you. I had to read it THREE times to figure out what the heck it said. Kinda reminded me of the time a nurse told me I couldn't write clonidine TID. Told me.

    By Anonymous Anonymous, at 2:49 PM  

    RiteAid and others are facing a difficult problem, made worse by the fact that any problems will be solved by involving lawyers and bureaucrats. If everyone was sensible and had time, the notice would say something like "There can be problems related to X, y, z. Check with your physician to be sure that they are aware of this if you have one of these problems."

    It gets messy because none of those involved have enough time to talk. There are lots of patients who have multiple doctors making independent prescriptions, and those doctors are not fully informed. The pharmacist sees the integrated prescriptions, but often knows nothing about the physician or patient conditions. Handling this sensibly requires both have time for discussions. If any party is not sensible, things get bad.

    By Anonymous rjh, at 2:04 PM  

    "The note served absolutely no useful purpose."

    It didn't?

    You mean if there is an adverse reaction that balloons into a class-action suit managed by a John Edwards-type, the manufacturer of the drug won't cite that warning in their defense?

    Seems to me that is the useful purpose of the bafflegab insert.

    By Anonymous Anonymous, at 5:48 PM  

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