Sad image of pharmacy’s US role

A UK pharmacist who fails to intervene when presented with a potentially dangerous prescription is assumed in law to share the blame for any harm that comes to the patient. I was therefore shocked to learn that in the US, in a case arising from the death of a patient, the Arkansas supreme court has ruled that pharmacists have no duty to warn patients about possible drug interactions.

Hearing a malpractice complaint filed by a patient’s family against both the prescriber and the dispensing pharmacy, the court was told that the patient had consulted the doctor about face pain. For this he had been prescribed an astonishing cocktail of drugs: Norflex (orphenadrine), Zoloft (sertraline), OxyContin (sustained release oxycodone), Percocet (oxycodone and paracetamol), Valium (diazepam), lorazepam, methadone, propoxyphene and doxepin.

To make matters worse, the patient was already taking several of these products, plus Ambien (zolpidem), trazodone and Effexor (venlafaxine).

Four days after receiving his drugs the patient was dead. An autopsy report blamed his demise on “mixed drug intoxication”.

If we ignore the paracetamol, which has no significant known interactions with the other drugs, the patient was taking 11 potent drug substances, with a total of 55 possible two-drug interactions. According to one independent online drug interaction checker, 52 of the 55 pairings present a risk of interaction — 17 major, 34 moderate and one minor.  

If that alone was not enough to alert the pharmacist, the doctor was already notorious locally for reckless prescribing and had had his prescription-writing privileges suspended by the state medical board on several occasions.

How can any pharmacist supply such a dangerous assortment of drugs, prescribed by a known maverick, and offer the patient no warnings?

Sadly, the court’s ruling may mean that more will ignore professional integrity and put their patients at risk by offering no more than a mindless supply function.