Beware medication “alert fatigue”

In a US study, more than half of all pharmacists failed to warn patients when presented with dangerous pairs of prescriptions… Do you always check for interactions?

The Chicago Tribune tested 255 pharmacies in seven US cities to see how often stores would dispense dangerous drug pairs without warning patients.

Fifty-two percent of the pharmacies sold the medications without mentioning the potential interaction, which the publication says provides “striking evidence of an industrywide failure that places millions of consumers at risk”.

According the results published this month, independent pharmacies had a higher failure rate than any retail chain, missing risky drug interactions 72% of the time. Chains overall failed 49% of their tests.

Doctors who write the prescriptions shoulder significant responsibility, however pharmacists are uniquely positioned to detect potential drug interactions, says the Tribune.

The question remains: are there similar rates of dangerous dispensing in Australia?

There is a potential that similar issues could arise in Australia, suggests Professor Andrew McLachlan from the University of Sydney’s Faculty of Pharmacy and Centre for Education and Research on Ageing.


“Serious drug-drug and drug-herb interactions have the potential to cause harmful effects and serious injury. There are few drug-drug combinations that should never be co-administered,” explains Professor McLachlan.

“We would hope that [Australian] pharmacists would be alerted during the dispensing process, try to establish a reasonable history (have they had this combination before, did they experience any adverse effects) or call the prescriber to explain the possible risks.”

However he says some pharmacies turn off the drug interaction alerts on the dispensing systems or have “alert fatigue” because the pop-up alerts are not targeted to specific patients groups or relevant to people.

“This can cause complacency in the dispensing process,” he warns.

“I don’t expect that all pharmacists must memorise all serious drug interaction, but knowing some of the high-risk interactions is important. Serious drug interactions in community pharmacy are thankfully relevantly rare, but they do carry a substantial risk of preventable harm.”

Professor McLachlan encourages pharmacists to create a list of selected drugs and herbs that are more likely to be involved in serious interactions, as well as patients at greater risk of harm.

The provision of information, including the CMI, can provide the chance for patients to identify and avoid serious outcomes so they know when to seek help, he adds.

Dr Chris Freeman, a clinical pharmacy lecturer from the University of Queensland has also reminded pharmacists to educate themselves on drug interactions.

“As medicine experts, pharmacists have a responsibility to stay up to date with new information regarding medications and their potential for interactions,” says Dr Freeman.

Pharmacists should remain vigilant when a patient presents with an adverse or an unusual effect which is not commonly attributed to the medicines they are on, he adds.

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