Scribd Logo
Upload

Welcome to Scribd!

  • 18 views

    Medicines Information Scenario 1

    Uploaded by

    Patrick McClair
    The pharmacist provides recommendations on initiating duloxetine treatment for Mrs. P McLachlan based on her current medications and medical conditions. There are no known drug interactions between pregabalin and duloxetine, but both can cause drowsiness so the patient should be monitored. Duloxetine may increase the risk of bleeding when taken with warfarin, so the patient's INR should be monitored. Duloxetine could potentially cause hypothyroidism as an uncommon side effect, so the patient's thyroid levels should be checked after starting treatment. The pharmacist recommends starting duloxetine at 30mg or higher and monitoring the patient for side effects and potential need for dose adjustments.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Medicines Information Scenario 1

    Uploaded by

    Patrick McClair
    18 views2 pages
    The pharmacist provides recommendations on initiating duloxetine treatment for Mrs. P McLachlan based on her current medications and medical conditions. There are no known drug interactions between pregabalin and duloxetine, but both can cause drowsiness so the patient should be monitored. Duloxetine may increase the risk of bleeding when taken with warfarin, so the patient's INR should be monitored. Duloxetine could potentially cause hypothyroidism as an uncommon side effect, so the patient's thyroid levels should be checked after starting treatment. The pharmacist recommends starting duloxetine at 30mg or higher and monitoring the patient for side effects and potential need for dose adjustments.

    Original Description:

    ..

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The pharmacist provides recommendations on initiating duloxetine treatment for Mrs. P McLachlan based on her current medications and medical conditions. There are no known drug interactions between pregabalin and duloxetine, but both can cause drowsiness so the patient should be monitored. Duloxetine may increase the risk of bleeding when taken with warfarin, so the patient's INR should be monitored. Duloxetine could potentially cause hypothyroidism as an uncommon side effect, so the patient's thyroid levels should be checked after starting treatment. The pharmacist recommends starting duloxetine at 30mg or higher and monitoring the patient for side effects and potential need for dose adjustments.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    18 views2 pages

    Medicines Information Scenario 1

    Uploaded by

    Patrick McClair
    The pharmacist provides recommendations on initiating duloxetine treatment for Mrs. P McLachlan based on her current medications and medical conditions. There are no known drug interactions between pregabalin and duloxetine, but both can cause drowsiness so the patient should be monitored. Duloxetine may increase the risk of bleeding when taken with warfarin, so the patient's INR should be monitored. Duloxetine could potentially cause hypothyroidism as an uncommon side effect, so the patient's thyroid levels should be checked after starting treatment. The pharmacist recommends starting duloxetine at 30mg or higher and monitoring the patient for side effects and potential need for dose adjustments.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Dear Mr XY,

    Re: With regards to Enquiry 1, received 07/11/19, regarding commencing a trial of duloxetine in
    patient Mrs P McLachlan (CHI number 1709669921) for knee pain.

    Many thanks for your query concerning Mrs McLachlan’s treatment. I have looked into this for you
    and am happy to provide you with the following information.

    With regards to your question around whether there is any interaction between pregabalin and
    duloxetine – there is no data available on Stockley’s or the summary of product characteristics to
    suggest any such interaction1,2. However, as these drugs share common side effects of drowsiness
    and dizziness3,4, the patient should be counselled on the additive effect that this may have, and to
    avoid driving or operating machinery should they feel excessively drowsy.

    Concerning this lady’s other medication, Stockley’s states that there is a severe theoretical
    interaction between duloxetine and warfarin5, whereby the addition of duloxetine could increase
    the risk of bleeding. The SPC for duloxetine 30mg capsules2 also states that caution is advised when
    used in patients who take oral anticoagulants, however it is also noted that when initiated in
    patients who were stable on warfarin, there was no clinically meaningful increase in INR. Should you
    decide to initiate treatment with duloxetine, the patient’s INR should be monitored more frequently
    in case a warfarin dose adjustment is needed.

    Furthermore, with respect to this lady’s co-morbid conditions, when looking at the side effects
    according to the SPC for duloxetine 20mg capsules, hypothyroidism is listed as an uncommon side
    effect6 – meaning between 1 in 100, and 1 in 1000 people experience this effect. However, this side
    effect becomes less common with higher strengths of the drug. At strengths above 30mg2, this side
    effect is listed as ‘rare’ – meaning between 1 in 1000 to 1 in 10,000 people experience this. Should
    you decide to go ahead with initiating duloxetine, you may wish to consider starting at a dose of
    30mg or more initially per day, to minimise the risk of hypothyroidism. The patient should be
    informed of this side-effect, and should be informed to report any increasing fatigue, weight gain
    etc. to their GP. I would also advise having TFTs checked at around one month after starting the
    duloxetine to be on the safe side.

    I could find no instances of any issues concerning duloxetine in myotonic dystrophy, however
    Martindale lists rare side-effect of rhabdomyolysis with pregabalin7. As she is already stabilised on
    this, I can only recommend that the patient monitors for signs of any worsening muscle pain and
    reports this to their GP.

    To conclude, I can recommend that you may start duloxetine therapy safely in this patient, provided
    that Mrs McLachlan’s INR is monitored more frequently until she is stabilised on the duloxetine.
    Additionally, she should be counselled around general side-effects, for instance the increased risk of
    drowsiness due to concomitant pregabalin and duloxetine use. You may wish to alert the GP to
    recheck thyroid hormone levels 1 month after starting duloxetine to ensure that no change to the
    levothyroxine dose is required.

    I hope this information helps with Mrs McLachlan’s treatment and please do not hesitate to contact
    me if you need further information.

    Kind regards,

    MI Pharmacist
    1. Stockley's Drug Interactions [Internet]. Medicines Complete. 2019 [cited 8 November 2019].
    Available from:
    https://www.medicinescomplete.com/#/search/stockley/pregabalin%20and%20duloxetine?
    offset=0
    2. Duloxetine 30 mg hard gastro-resistant capsules - Summary of Product Characteristics
    (SmPC) - (emc) [Internet]. Medicines.org.uk. 2019 [cited 8 November 2019]. Available from:
    https://www.medicines.org.uk/emc/product/4984/smpc
    3. British Medical Association, Royal Pharmaceutical Society. (Sept 2017). Pregabalin. In: The
    British National Formulary 73. Pharmaceutical Press. 304.
    4. British Medical Association, Royal Pharmaceutical Society. (Sept 2017). Duloxetine. In: The
    British National Formulary 73. Pharmaceutical Press. 345.
    5. Stockley's Drug Interactions [Internet]. Medicines Complete. 2019 [cited 8 November 2019].
    Available from: https://www.medicinescomplete.com/#/content/stockley/x06-3258
    6. Duloxetine 20 mg hard gastro-resistant capsules - Summary of Product Characteristics
    (SmPC) - (emc) [Internet]. Medicines.org.uk. 2019 [cited 8 November 2019]. Available from:
    https://www.medicines.org.uk/emc/product/1777/smpc
    7. Martindale. (2019). Pregabalin. Available:
    https://www.medicinescomplete.com/#/content/martindale/19950-w?hspl=pregabalimLast
    accessed 08/11/2019.

    You might also like