D1F507CE-3D45-41A1-8CEE-2B48ADDDF9BC.jpegHighlighting a drug interaction isn’t a pharmaceutical opinion. It’s an insurance fraud.

I often see a fax back of notification that the new prescription for ciprofloxacin has a drug interaction with the patient’s quetiapine. Or a patient’s new prescription for fluconazole will be dispensed, only to be told that the patient should contact the prescriber what to do with her current methadone dose, knowing that fluconazole has an interaction with methadone.

This isn’t a pharmaceutical opinion. This is professional tardiness, or passing the buck or fail to live up to your professional responsibility. Honestly, how can a pharmacist be charging a fee for professional opinion when there is no opinion given for the drug interaction noted?

Suggest few options if feasible, or identify risk factors that may render the drug interaction relevant or more significant.

In the case for drug interaction between ciprofloxacin and quetiapine, the minimum suggestion is to see if there is a recent ECG to assess for baseline QTc interval. Also review any relevant risk factors such as electrolyte abnormalities or cardiac arrhythmia. If one feels the management is beyond his or her scope, say so!

As for the interaction between fluconazole and methadone, the single dose treatment is likely for a vaginal yeast infection for which topical option could easily avoid the issue. Why ask the patient to take the dose and consult the physician how to manage the interaction?  What if the patient cannot contact the prescriber in time to manage the interaction?

A pharmaceutical opinion should have the following components:

1) Identify the drug therapy problem

2) Describe the significance and relevance of the problem. Sometimes it is irrelevant and should clearly state this if it is the case.

3) Provide some suggested management options.  Sometimes it only entails  monitoring with symptoms; other times, it may require lab investigations. In significant issues, identify alternative treatment options or dose reduction.

If a pharmacist isn’t willing to provide a complete pharmaceutical opinion, then don’t bill for the associated fee because it is an insurance fraud. It is also a professional disgrace.

Maybe my tone is a little harsh. But do you agree with me?

Thank you for reading my post.