Pharmacy Errors

[whitekd70]

What is the name of your state (only U.S. law)? Idaho

I have a medical condition called Factor V Leiden and carry both genes. I was put on Eliquis early last year after being on Coumadin for over 9 years. The middle of last year, I was prescribed Tegretol for my Bipolar by my psychiatrists. I have my prescriptions filled at the same pharmacy that I have used for quite a while. Yesterday I was informed that these two medications are never to be taken together due to the fact that anticoagulants don't work properly in conjunction with the Tegretol and still allows for DVT's to form putting me at a high risk for another PE. I have already had 2, my last being a saddle embolism that almost killed me. I am not sure if I have a case against the pharmacy, seeing as they never caught this contraindication before, and it was a new employee that found it and brought it to the attention of my primary care physician. What legal rights do I have if any?

 

[quincy]

What is the name of your state (only U.S. law)? Idaho

I have a medical condition called Factor V Leiden and carry both genes. I was put on Eliquis early last year after being on Coumadin for over 9 years. The middle of last year, I was prescribed Tegretol for my Bipolar by my psychiatrists. I have my prescriptions filled at the same pharmacy that I have used for quite a while. Yesterday I was informed that these two medications are never to be taken together due to the fact that anticoagulants don't work properly in conjunction with the Tegretol and still allows for DVT's to form putting me at a high risk for another PE. I have already had 2, my last being a saddle embolism that almost killed me. I am not sure if I have a case against the pharmacy, seeing as they never caught this contraindication before, and it was a new employee that found it and brought it to the attention of my primary care physician. What legal rights do I have if any?

Did your have your two previous pulmonary embolisms before you started taking Tegretol or after you started taking Tegretol?

 

[FlyingRon]

It is not the pharmacy's job to catch this. Many will do it as an added service, but it's NOT RELIABLE. It's up to the prescribing DOCTORS to make sure the drugs they are prescribing are safe in combination with others.

 

[quincy]

It is not the pharmacy's job to catch this. Many will do it as an added service, but it's NOT RELIABLE. It's up to the prescribing DOCTORS to make sure the drugs they are prescribing are safe in combination with others.

Facts will always matter but I agree with you that, as a rule, it would fall on the physician and not the pharmacist to advise of contraindications.

Here is a link to Morgan v. Wal-Mart Stores, Inc., 30 S.W.3d 455 (2000), with a discussion of a Texas pharmacy's duty to warn:

http://www.leagle.com/decision/200048530SW3d455_1463/MORGAN v. WAL-MART STORES, INC.

And here is a link to how other states around the country look at a pharmacy's duty to warn:

http://www.nacds.org/pdfs/membership/duty_to_warn.pdf

 

[not2cleverRed]

Know about being homozygous for the FVL mutation and sympathize.

In order to sue *successfully*, you have to be able to show that the pharmacist and doctors, knowing all your medications, acted grossly incompetently out of line with professional standards, and that your health suffered as a result. And even then it's iffy.

As some with FVL, especially someone who is homozygous with a history of PEs, you really have to become informed and be your own advocate.

Contrary to previous posters assertions, pharmacists ARE supposed to be more knowledgeable about drug interactions, and with everything now on computer there is no excuses. Switch pharmacists.

(I say this as someone who had a dingbat dr tell me to take an NSAID while on Coumadin, saying "It's not contraindicated" - LOL, I know how to read, and the pharmacist totally agreed that would be a bad idea.)

Also, you should look into one of the online FVL support groups. You would have found out about this more quickly - people frequently ask for advice on medications/treatments there. Or heck, do a google search. http://ww4.mgh.org/Coumadin/SitePages/Drug%20Interactions.aspx

 

[quincy]

... Contrary to previous posters assertions, pharmacists ARE supposed to be more knowledgeable about drug interactions, and with everything now on computer there is no excuses. Switch pharmacists ...

Most states have found that pharmacists do not have a duty to warn of contraindications except under limited circumstances. Liability for adverse drug interactions generally will fall on the physicians and/or the drug manufacturers.

This is despite the fact that most pharmacists are knowledgeable about drug interactions, which is probably why whitekd70's pharmacy was able to notify whitekd70's primary care physician and warn whitekd70.

You can read the information in the links provided to see how courts around the country have looked at this issue. As with everything in law, the specific facts of any one case matter.

 

[not2cleverRed]

Most states have found that pharmacists do not have a duty to warn of contraindications except under limited circumstances. Liability for adverse drug interactions generally will fall on the physicians and/or the drug manufacturers.

This is despite the fact that most pharmacists are knowledgeable about drug interactions, which is probably why whitekd70's pharmacy was able to notify whitekd70's primary care physician and warn whitekd70.

You can read the information in the links provided to see how courts around the country have looked at this issue. As with everything in law, the specific facts of any one case matter.

The link you included indicated for OP's state, Idaho, a “pharmacist has a generally recognized duty to possess and exercise the reasonable degree of skill, care, and knowledge that would be exercised by a reasonably prudent pharmacist in the same situation.” Granted, that's from a Utah case? But if the standard is "reasonably prudent", a medication that shows up on the top 10 list of prescribed drugs that interact with Coumadin, that would seem to be something a "reasonably prudent" pharmacist should know. That said, unless OP had a diagnosed PE during the few recent months that OP was taking the medications together, OP should count his/her blessings and just switch pharmacies.

And even if OP had a diagnosed clot, OP would have to prove that the interaction caused it. This is unlikely. OP is homozygous for FVL. OP is taking Coumadin as a prophylactic, not for treatment of a clot. There are people with FVL who clot even when their INR is at therapeutic levels. But there are reasonably healthy people walking around who are homozygous for the FVL mutation and on no medications at all.

 

[quincy]

The link you included indicated for OP's state, Idaho, a “pharmacist has a generally recognized duty to possess and exercise the reasonable degree of skill, care, and knowledge that would be exercised by a reasonably prudent pharmacist in the same situation.” Granted, that's from a Utah case? But if the standard is "reasonably prudent", a medication that shows up on the top 10 list of prescribed drugs that interact with Coumadin, that would seem to be something a "reasonably prudent" pharmacist should know. That said, unless OP had a diagnosed PE during the few recent months that OP was taking the medications together, OP should count his/her blessings and just switch pharmacies.

And even if OP had a diagnosed clot, OP would have to prove that the interaction caused it. This is unlikely. OP is homozygous for FVL. OP is taking Coumadin as a prophylactic, not for treatment of a clot. There are people with FVL who clot even when their INR is at therapeutic levels. But there are reasonably healthy people walking around who are homozygous for the FVL mutation and on no medications at all.

States have viewed differently the duty of pharmacists to warn of drug interactions but most, as a rule, find that it is the manufacturer's duty to inform the physician of possible side effects and the physician's duty to know of and warn the patient of these side effects and drug interactions.

The pharmacist generally has no duty to the patient other than to legally and correctly fill the prescribed drugs as ordered by the physician.

The dates of the previous pulmonary embolisms are important in determining if there is any legal action to consider. If there has been no harm that has come to whitekd70 from taking the drugs together, there are no damages. If a pulmonary embolism occurred because of the drug interaction, however, then additional facts would need to be known to determine who could be held liable - doctor, manufacturer and/or pharmacy. It is unlikely to be the pharmacy unless the pharmacy assumed this duty to warn by advertising to consumers that it would warn of adverse drug interactions.

(as a note: for some reason, I confused states, thinking that whitekd70 was from Texas ... I will try to provide something more relevant than the Morgan case later)

 

[whitekd70]

Did your have your two previous pulmonary embolisms before you started taking Tegretol or after you started taking Tegretol?

I had both embolism before I was diagnosed with Factor V. But have used the same pharmacy with the exception when I moved out of state. I had been on Coumadin since my second PE which was in 2007. I remembered I was on Tegretol and Coumadin while I lived in Texas and used a different pharmacy. I had never been informed of this serious contraindications until just yesterday, not even the physicians noted it. This is highly concerning to me with my history and makes me nervous when filling prescriptions now. These warnings didn't even show on the prescription information handed out with prescriptions from the pharmacies or I would never have taken the medications together.

 

[quincy]

I had both embolism before I was diagnosed with Factor V. But have used the same pharmacy with the exception when I moved out of state. I had been on Coumadin since my second PE which was in 2007. I remembered I was on Tegretol and Coumadin while I lived in Texas and used a different pharmacy. I had never been informed of this serious contraindications until just yesterday, not even the physicians noted it. This is highly concerning to me with my history and makes me nervous when filling prescriptions now. These warnings didn't even show on the prescription information handed out with prescriptions from the pharmacies or I would never have taken the medications together.

Thank you for answering my question about your embolisms, whitekd70.

I see a problem if your prescription did not come with drug manufacturer warnings. But, if you have not suffered any harm from this omission (i.e, if no embolism or other adverse side effect can be tied to a drug interaction), there is probably no legal action worth the cost of pursuing.

I would speak to your physician about the lack of information on drug interaction and side effects provided with your prescription. Although this might be a pharmacy error, it is possible that both the drug manufacturer and your physician failed you. And it is also possible that it was not known until recently that this combination of drugs could have dangerous side effects (I haven't checked on this).

Prescription errors apparently are not as uncommon as most of us would hope. It is important for everyone to read carefully what has been provided by the drug manufacturer, to double check prescribed medicines to make sure the drugs and dosages prescribed are correct, and to know their own medical history well enough so that they can question their doctors on side effects and drug interactions and usage.

And you can check with an attorney in your area for a personal review of your medical history if you want to make sure there is no legal action to consider.

 

[whitekd70]

Thank you all very much for your responses.

 

[quincy]

You're welcome, whitekd70. We all appreciate the thanks.

 

[ecmst12]

So the information that elequis and tegretol should "never be taken together" isn't quite right. It is correct that tegretol can result in lower levels or lower effect of the elequis. This same interaction occurs with Coumadin, by the way. And in some cases, the need for you to take both drugs is going to outweigh the risks. What it DOES mean is that the doctor who monitors your clotting condition should be aware that you are taking tegretol and adjust your dose of anticoagulant accordingly. Have you discussed the situation with that physician? Perhaps he was already aware and adjusted your dose to account for it.