“You can’t do that,” I said, “You will kill this guy.” I had waited for a good five minutes for this nurse in Omaha, Nebraska. She sounded like your mother’s Aunt Eda. Slow talking. Slow responding.
She giggled nicely though. I was expecting a “Whatever!”
“Mister Frasier knows better than to use Nitroglycerin on the same day that he has used Cialis.” This nurse was very sure of herself.
“Norma, Mister Frasier will be taking the vitamin form of Cialis. Daily 2.5 mg. That means that he can NEVER use Nitroglycerin. Never, ever.”
“He’ll be okay. He has had a nitro prescription for years.”
My question to my readers…Is this kind of prescribing normal…anywhere?
“Norma, I will fill the vitamin prescription, but I am refusing to fill the nitro for him.”
“Just have the doctor phone me about this. But warn her that I am refusing. If another pharmacy does fill these two together and Mister Frazier uses the nitro at a very climactic moment with his wife and has a stroke or worse I will testify for the family.”
“What are you talking about?” There was no giggling now.
“I am setting a precedent. If this guy dies because of Cialis and nitro together, the wife will remember that the pharmacist in Galveston refused to fill. She might tell this to her attorney. The attorney might just pay for an investigator to find me. I get all expenses first class plus a per diem that is more than a pharmacist’s daily wage, plus a four figure consulting fee. Can you hear the judge. ‘Why did you refuse, Mister Plagakis?’”
IT’S A NO-BRAINER. It’s in the literature.
“You are over-reacting.” This nurse wanted to argue with me.
“How can anyone over-react with death? Just have the doctor call me.” I didn’t even say a polite good bye. I just hung up the phone.
I am a package insert directed pharmacist….if I know what the literature says. We have a duty to warn whether we have the time or not. We are supposed to know what is in EVERY package insert. What, are you kidding me, Plagakis? No, every means every. Think about it. There are drugs that warn about sudden death.
How do you warn about that? “Mrs. Jones, you need to understand that sudden death is a side effect of this drug.”
What do we do instead of warning? We oversee the Prescription Mill.
The literature is a mine field. There are bombs all over the landscape. I am only halfway joking when I say that I am surprised that the attorneys that used to be called ambulance chasers are not standing out in front of CVS handing out cards.
The doctor was cheery when she called me back. I asked her about the weather in Omaha and told her about another 90+ day on the gulf coast. Then I was silent.
“Norma said that there is a problem with Mister Frazier’s prescriptions.”
“You can’t use the daily vitamin dose of Cialis and also prescribe nitro.”
Here is what we can call ass-covering. “Oh, no! I wanted the 20 mg PRN for Mister Frazier. Please warn him to never use nitro in that 36 hour window.”
I hate it when I have to correct the doctor and not get dollar one. I hate it when the doctor screws up and escapes Scot-free. I have been covering for doctors for four decades. Not this time. I had already had that good talk with Mister Frazier.
Update from Jay Pee 6-9-09
In other words, after a team of FDA regulators decide on the very best language to describe potential risks of a drug - Joe Six Pack can overrule their expertise and hold the drug company liable for any deficit (as he interprets it) in label language, awarding millions to anyone who experiences harm, no matter how well disclosed that risk is.