How Pharmacists Can Prevent Toxic Combinations

A recent study conducted by Quest Diagnostics showed an alarming number of patients combining toxic drugs, for the most part unwittingly. Specifically, patients are concurrently using opioids and benzodiazepines. Often, they’re unaware that toxic drug combinations can occur with both prescribed and non-prescribed medication use. Pharmacists can be the first line of defense in protecting patients from lethal drug interactions.

Here are three ways that you can protect your patients and prevent toxic combinations.

Proactively Check for Potential Drug Interactions

When filling a prescription for first-time patients, request that they provide you with a list of all medications and supplements they are currently taking, including:

  • Prescription drugs
  • OTC drugs
  • Vitamin supplements
  • Herbal supplements
  • Nutritional supplements

Review all this information for potential toxic combinations.

Utilize Prescription Drug Monitoring Programs (PDMPs)

State PDMPs offer a promising means of intervention for improving oversight on prescription opioid medication. These programs can:

  • Recognize changes in prescribing behaviors.
  • Alert prescribers of patients who are obtaining multiple prescriptions from several providers.
  • Reduce the need for substance abuse treatment by curtailing drug abuse.

Implement Aggressive Patient Education Campaigns

Patient education is one of the best ways to prevent toxic drug combinations from occurring, especially among the elderly. Some ideas for educating your pharmacy patients include:

  • Explaining side effects and potential drug interactions with patients when filling prescription.
  • Encouraging pharmacy patients to have all their prescriptions filled at your pharmacy by offering incentives, such as discount drug programs or coupons good for money off on non-drug items.
  • Having a brown bag day where patients bring in all their prescriptions, OTC medications, vitamins and supplements for review for drug interactions.
  • Offering no-questions asked disposal of expired or leftover medications along with an incentive for doing so.


Drug Shortages Caused by Hurricane Maria

The recent devastation from back-to-back hurricanes Irma and Maria has wiped out most of Puerto Rico’s power grid. With almost 10 percent of the medications that are prescribed in the United States being manufactured in Puerto Rico, there is a strong likelihood that shortages will occur with certain medications, according to FDA Commissioner Scott Gottlieb, MD. This is a significant issue, especially with some products already being in shortage before the hurricanes struck.

Running at Reduced Capacity

While power is still in the process of being restored to the island, drug manufacturers are hobbled with running only one out of five lines and at reduced capacity. Currently it is unknown when they will be able to return to full capacity.

Many of the major drug manufacturers, such as Baxter, Eli Lilly and Co., Merck & Co., Bristol-Myers Squibb, Amgen and Johnson and Johnson have facilities in Puerto Rico, among others. Approximately 40 drugs that are made in these facilities are at risk of shortage. This includes drugs used to treat rheumatoid arthritis, cancer and HIV.

How the FDA is Responding

The FDA is working with drug manufacturers to reduce the risk of these shortages. The agency is assisting with securing fuel and manufacturing supplies, in addition to assisting with logistical support with moving critical products both on and off the island. Reviews and approvals of generic versions of medications and other dosage forms are being performed by the FDA to provide alternative sources of these much-needed medications.

Medical Device and Supply Shortages

Medical supplies needed at hospitals, care facilities and pharmacies are already facing shortages due to hurricane damage in Puerto Rico. IV bags should be conserved whenever possible in order to ensure supplies remain for patients who need them.


Patient Education: Acetaminophen

Acetaminophen is used in more than 600 prescription and OTC medications. As a popular and effective medication, more than 50 million Americans use acetaminophen each week. When it is used as directed, it is effective and safe, but when misused, it can lead to liver damage. But not everyone is aware of the dangers of acetaminophen overuse, and most people who overdose aren’t aware that they’re taking too much.

Prevent Overdoses of Acetaminophen

The U.S. Food and Drug Administration recommends that no one should take more than 4,000 milligrams of acetaminophen in a 24-hour period. It also recommends against regular, long-term use. Patients might not always be aware that acetaminophen is in the various medications that they take. For example, if a patient is taking a prescription pain medication like Percocet or Vicodin and is also taking an OTC medicine like NyQuil, they are at risk of an overdose.

When dispensing medications that contain acetaminophen, it is important to make patients aware of the risk of acetaminophen overdose by:

  • Reminding patients verbally when they pick up their medications of the risk of acetaminophen overdose.
  • Making sure warnings appear in the written materials given when prescriptions are picked up.
  • Labeling prescription bottles to alert patients to not take other prescriptions or OTC medications that contain acetaminophen while taking their prescription.
  • Placing leaflets or hanging posters in waiting areas to warn of the dangers of overdosing on acetaminophen.

For more information on the dangers of acetaminophen overdose and how to alert patients, visit The effects of overdosing are not immediately alarming, but they do produce serious long-term health consequences.