Medication analysis: When fear turns into non-compliance
Fear of side effects is a common reason why patients do not use prescribed medications. / © Getty Images/Isabel Pavia
At the beginning of July, the University of Jena held a seminar entitled "Introduction to Medication Analysis." Pharmacist Stefan Göbel brought anonymized patient cases from his pharmacy . A group of students analyzed the medication of patient CP. The case demonstrated how important adequate adherence to therapy is—and that pharmacists and physicians sometimes have to alleviate patients' concerns to ensure this is successful.
The patient's medication plan was very extensive and the students quickly identified several major problems, as well as minor pharmacological issues.
| drug | indication | remark | ||
|---|---|---|---|---|
| Methotrexate 15 mg | rheumatism | not taken despite prescription | ||
| Folic acid 5 mg | In combination with methotrexate | not taken despite prescription | ||
| Pantoprazole 40 mg | Ulcer prophylaxis due to NSAIDs | not taken despite prescription | ||
| Prednisone 5 mg | rheumatism | / | ||
| Iron(II) 100 mg | Iron deficiency | not taken despite prescription | ||
| Venlafaxine 225 mg | Anxiety disorder | / | ||
| Ibuprofen 600 mg | Pains | possible abuse | ||
| Lorazepam 2.5 mg | Panic attacks | possible abuse | ||
| Potassium iodide 0.262 mg | Goiter | / | ||
| Rosuvastatin/ezetimibe 20 mg/10 mg | Hypercholesterolemia | / | ||
| Salbutamol 0.1 mg | COPD | not taken despite prescription | ||
| Calcium/cholecalciferol 600 mg/400 IU | Osteoporosis prophylaxis | / | ||
| Quinine sulfate 200 mg | Calf cramps | not taken despite prescription |
Medication plan from the case study
Because Ms. CP suffers from rheumatism, she was prescribed methotrexate (MTX), prednisone, and ibuprofen. However, she did not take the MTX for fear of side effects—as only became apparent during a medication analysis consultation at the pharmacy. Instead, she regularly had two doctors prescribe 600 mg ibuprofen for pain relief. She did not take the prescribed pantoprazole as a gastric protector. In addition, prednisone can have a negative effect on the gastric mucosa.
Due to an anxiety disorder, the patient was also taking venlafaxine at the maximum recommended dose of 225 mg for this indication. This can increase the risk of bleeding, including gastrointestinal bleeding. She was also given lorazepam 2.5 mg for panic attacks. The latter was regularly prescribed to the patient by two physicians. The prospective pharmacists suspected addiction.
Another non-adherence was noted: Despite the diagnosis of COPD, the patient did not use her salbutamol spray. Furthermore, an inhaled glucocorticoid (ICS) was missing from her prescription.
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