Magazine article Drug Topics

Calling Doctors about Drug Interactions

Magazine article Drug Topics

Calling Doctors about Drug Interactions

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In my experience, most doctors don't seem too happy to hear that a pharmacist is calling to point out a drug interaction. They too often interpret this as a turf battle or an implication that they are not sufficiently knowledgeable about interactions among the drugs they prescribe.

Pharmacists are overwhelmed with prescriptions, yet some doctors think we have nothing better to do than call about interactions. One doctor told my partner we were calling his office too often. I told this to another pharmacist, who suggested we request written permission from the doctor never to call him again about drug interactions. I doubt that would relieve us of liability in the event of a lawsuit.

One Saturday I called a doctor about his prescribing of erythromycin for a customer who was on carbamazepine from a different doctor. This is a "Level 1," or "most significant," interaction. When the doctor finally called back, he said rudely, "I'm making a long distance phone call for this? The interaction is extremely mild!" He finally said (as if only to please me), "All right! Change the erythromycin to Duricef!" I told the patient her doctor had changed her antibiotic, but not about the potentially serious nature of the interaction or how angry the doctor was that I called him.

Here is what the United States Pharmacopoeia says about the interaction between erythromycin and carbamazepine (USP-DI, 1997, p. 1351): "Erythromycins may inhibit carbamazepine metabolism, resulting in increased anti-- convulsant plasma concentrations and toxicity; it is recommended that erythromycins be used with caution if at all in patients receiving carbamazepine."

On a different occasion, I called another doctor's office about another Level 1 interaction. I wanted to make sure I should dispense the drugs as written. When the receptionist called me back, she said, "I checked with the doctor, AND HE SAID IT'S OKAY!" Her attitude implied that I was an idiot for calling. I assume that is because the doctor was irritated that a pharmacist had called about yet another drug interaction and took out his anger on her.

Pharmacists are put in the impossible position of having to decide which patients will experience clinically significant effects from drug interactions. In any large statistical sample, some people will end up with adverse consequences from a drug interaction, others will not.

I believe the doctor should be the one to weigh the statistical probability, not the pharmacist. …

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