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Letters to the Editor
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Safety
Interactions with other substances
From Mr S. Howshall, MRPharmS
Patients, generally, do not regard substances they consume as capable
of affecting their prescription medicines. I always ask patients about
over-the-counter medicines, herbs, vitamins and minerals when conducting
medicines use reviews. Often, reluctantly, patients give this information
with surprising results.
Last week I conducted an MUR with a patient chosen because she was on
warfarin and had just been prescribed omeprazole. I intended to warn
her to get a blood test because of the interaction of these drugs. I
noticed that she had recently been prescribed two other proton pump inhibitors.
She told me that these had not worked so I recommended a change of time
for taking the drug. We went through the other drugs she was taking again
and I was able to suggest changes to optimise her treatment. At the end
I asked if she was taking anything else; she said paracetamol, for pain
in her arthritic hands. We discussed that she should not take fish oil
because of warfarin but she said that, on the doctor’s advice,
she was taking 1.5g glucosamine daily. I explained this was a high dose
and could be the cause of her stomach problems. She is now going to stop
taking the glucosamine but if I had not asked the extra questions it
would not have come to light.
This is not the first time I have uncovered a potentially dangerous interaction
of prescribed and purchased drugs. Pharmacists conducting MURs should
always be on the lookout for such cases. Incidentally, I have recently
learnt that one litre of ice cream can affect warfarin levels.
Sue Howshall
Wimborne, Dorset
Madopar packaging confusing
From Mrs S. J. Carr, MRPharmS
I recently visited a patient with Parkinson’s disease whose medicines
regimen had been changed by his consultant. He now takes three different
strengths of Madopar. He has, among others, two bottles of Madopar 125.
One is labelled “Madopar 125” and the other “Madopar
100/25”. To us they are the same thing but to a non-pharmacist,
the people who have to take these medicines, they are confusing.
Is there any logical reason that these are labelled differently? For
whose benefit are they labelled differently? Parkinson’s patients
are usually on complicated regimens plus several other (non-Parkinson)
medicines, and it is up to us to try to simplify and clarify things as
far as possible. It would help us and the patients, enormously if the
industry would take some responsibility in this respect and label medicines
clearly, unambiguously and consistently.
Sharon Carr
Specialist Clinical Pharmacist
Brent Rehab Service
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A REPRESENTATIVE from the corporate affairs department,
Roche, responds:
The UK carton and label carries the name “Madopar
100mg/25mg hard capsules”. Some countries within the EU have different
labelling requirements and therefore cartons and labels in those countries
may be
labelled “Madopar 125”. In each case the labelling states
specifically that the capsule contains 100mg levodopa and 25mg benserazide.
It may be that the patient you refer to had a UK/IE Roche pack and a
parallel import pack from another EU country, which does happen. Legally,
the parallel
importer must over-label the imported pack, which does not appear to
have occurred in this particular case, and hence, the difference in
the labelling
of each pack. |
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The
Pharmaceutical Journal