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Case n°1 :
Prescription on a non-secure prescription form, typed on a computer, of SKENAN â 100 mg for a 47 year-old patient suffering from severe pain due to cancer.
This prescription does not comply with article R. 5194
of the Public Health Code (CSP) which has required the use of secure prescription forms for the prescription of narcotics since 1999.
However, the urgency of the situation and the interests of the patient can, in this case, justify dispensing of the drug, as long as the pharmacist subsequently ensures that the prescription is put in order.
It is therefore appropriate, for regulatory and professional reasons, to issue a Pharmaceutical Opinion in order to have a record of the pharmacist's reaction and to justify it to any authorities.
Prescription example No. 1
Case n°2 :
Prescription by a gynaecologist and obstetrician of NOLVADEX â 20 mg at a dosage of 1 tablet for 5 days from the 4 th day of menstruation in a young 33 year-old woman.
The indication described in the Summary of Product Characteristics (SPC) reserves Tamoxifen for the treatment of breast cancer only.
It is contraindicated in pregnant or breast-feeding women.
The dosage indicated is unusual and is suggestive of treatment of anovular infertility, which is confirmed by the patient. The prescribing physician contacted confirms the use of NOLVADEX®.
Prescription of drugs outside the marketing authorisation indications is possible but only under the full responsibility of the physician and the pharmacist. Moreover, prescription outside the marketing authorisation indications excludes the right to reimbursement
(art L. 162-4, L.162-17 )of the Social Security code giving the right to health insurance cover).
The financial impact may worry this patient and adversely affect her compliance with the treatment.
However, dispensing may nonetheless be medically justified and must lead to harmaceutical analysis of the known negative implications (contraindications, interactions, etc.) of the drug concerned, along with its precautions for use and monitoring required.
By formalising the question and its answer, Pharmaceutical Opinion helps to clarify the terms of the prescription and dispensing of the drug.
Prescription
example No. 2
Cas n°3
A female patient is treated for a bronchial infection with a prescription for ZITHROMAX® .
When she came to the community pharmacy, the pharmacist knew that this patient also took DHE for migraines, which was confirmed by her treatment history (computer tool).
Prescription
example No.3
Case n°4 :
Mr. XY 75 years old, retired – 1.71 m - 65 kg – has had type-2 diabetes since the age of 51. He is still active and a keen gardener..
For the last 5 years, he has been treated with Daonil 2 tabs/day and Glucophage 2 tabs/d, with a normal-calorie and normal-carbohydrate diet, regularly reviewed.
At the time of renewal of this prescription, the pharmacist observed that, without any apparent change in diet, the patient had lost 3 kg, which was worrying his wife.
This pharmacist belongs to a diabetic monitoring network of health care professionals. Recording by the pharmacist of glycosylated haemoglobin levels over the last few months (HbA1c = 7.4%) confirmed “well-controlled” diabetes. However, in the last 3 months, his fasting and post-prandial capillary blood glucose levels have risen (around 1.50 g/L and 2.60 g/L)
His last HbA1c level, recorded a week ago, was 8.9%. Creatinine clearance is 46 mL/min (blood creatinine = 115 µmol/L or 13 mg/L). Urinary micro-albumin levels are 287 mg/24h.
Prescription
example N° 4
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Points
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