MEDICATIONS: HEARTBURN MEDICATION IS DISPENSED REPEATEDLY WITH CONTRAINDICATED MEDICATIONS BY THE SAME PHARMACIES

Pharmacies Could Be Important Intervention Points To Prevent Contraindicated Drug Use

October 2, 2001 — Cisapride, a medication formerly prescribed for nighttime heartburn, and medications that were contraindicated for use with cisapride were frequently co-dispensed by the same pharmacies, according to an article in the October 3 issue of The Journal of the American Medical Association.

Judith K. Jones, M.D., Ph.D. and Suellen Curkendall, Ph.D.,of The Degge Group, Ltd, in Arlington, Va., and colleagues studied 131,485 prescriptions for cisapride that were dispensed after warnings were issued about co-dispensing cisapride with certain medications. The authors found a total of 4,414 (3.4 percent) of cisapride prescriptions dispensed overlapped with at least one contraindicated drug — 50 percent (2,190) of the overlapping prescriptions were prescribed by the same physicians for the same patients, 89 percent (3,908) were dispensed by the same pharmacies for the same patients, and 765 (17 percent) were dispensed on the same day.

According to background information in the article, cisapride was approved for use in the United States in 1993 and voluntarily removed from the market in 2000 after more than 270 cases of seriously irregular heartbeat (70 of which resulted in death) were reported among U.S. patients. Most of these cases involved concurrent use of cisapride with drugs that interact with it. Four label changes and physician notifications about the potential adverse reactions were issued between 1995 and 1999.

The authors examined managed care claims database records from July 1993 through December 1998 (after three of the label changes and physician notifications were issued) to determine instances of contraindicated co-dispensing and co-prescribing involving cisapride. The study included 38,757 adult and pediatric patients. Each co-prescribing or co-dispensing, including refills, was counted as a separate incident.

Of the 4,414 instances of overlaps with contraindicated drugs, the overlaps involved 2,657 patients, 3,301 physicians and 1,715 pharmacies. "Throughout the study period, most patients with overlapping contraindicated dispensings had obtained both drugs from the same pharmacy," the authors state. "This suggests that a pharmacy-based intervention to prevent co-dispensing of contraindicated medication pairs could be accomplished without involving complicated communications among different pharmacies."

"Because the present study was based on dispensings, we were unable to determine how many contraindicated medication pairs were successfully identified by pharmacists and not dispensed or how often the pharmacists called physicians to questions the prescriptions," the authors acknowledge. Pharmacists also may have instructed patients to stop taking one medication when the other was dispensed.

The authors state that while most pharmacies have computer-based warning systems, these do not always work to prevent co-dispensing contraindicated drugs. "We found that 89 percent of the contraindicated co-dispensings were associated with the same pharmacies that also dispensed the prescriptions for cisapride, vs. 50 percent that occurred when the same physician wrote both prescriptions," the authors conclude. "This suggests that the pharmacist, who is focused solely on the therapy, more often has the opportunity to apply critical information necessary to prevent contraindicated co-dispensings."

Editors Note: Support for this study was funded by the Janssen Pharmaceutic Research foundation; see the article for authors' individual financial disclosures.

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