Dear Pharmacist, Stop Giving Patients Rat Poison Indiscriminately

Prescription only medicines (POM) are medications that need to be prescribed by a doctor prior to being dispensed by a pharmacist. This is in contrast to ‘over the counter’ medications (OTC) that may be purchased without a prescription. For a medication to become OTC, it must demonstrate an immense safety profile such that even when abused, the chances of an enduring adverse is quite slim. Prescription only medicines, on the other hand, don’t have a similar safety profile. Instead, they are often dangerous when taken without proper instruction and oversight. Hence the restriction of its sale only on the order of a doctor.

Within POM’s there are some medications that have narrow therapeutic windows and require extra procedures or regular blood monitoring. A prime example is the blood thinner Warfarin that is used in conditions such as atrial fibrillation and deep vein thrombosis. When warfarin is given, a regular blood test – INR must be done in order to keep warfarin both safe and effective. I’ve known people to die and suffer bad consequences from warfarin overdoses. Thus imagine my shock to have recently observed a pack of warfarin tablets being given out to a young individual without a prescription or advice given to promote its safe use. This practice, unfortunately, leaves a lot to be desired in the area of pharmaceutical care.

Another area of concern within POM’s are medications that don’t necessarily need blood monitoring but still have deadly outcomes, especially when used in the wrong population. An example is the strong NSAID, indomethacin, in the elderly population. I’ve seen situations where people have had cardiac arrests, bled profusely from their gut or ended up in an intensive care unit on renal replacement therapy as a result of inappropriate NSAID use. Again imagine my shock when I observed an elderly gentleman obtain indomethacin without a prescription or much warning regarding its effects. This again falls short of the pharmaceutical care standards pharmacy professionals profess and aspire to.
Requiring a prescription for prescription-only medicines is good practice that your patients will thank you for. Done rightly it demonstrates care and regard for the health and well-being of patients. While there may be resistance initially, your patients will come to love and trust you. In the absence of a prescription as is often the case. It would be important to question the patient at length and spend some time educating them on the medication you’re dispensing. Remember to always keep the lines of communication open and provide them with a contact number they can reach you on if they have any questions (patients forget up to 90% of information giving by health care professionals within 15 seconds).  Situations like this is what prompted us at WellaHealth to build our engage platform that records patient information and delivers drug instructions to their phones. It means they can refer to it when they get home to avoid any mistakes. The SMS carries a phone number they can call with any questions. This is enabling excellent pharmaceutical care for 100’s of pharmacies simply via mobile technology.
So what does rat poison have to do with this? It may interest you to know that both warfarin and indomethacin have been known to share similar active ingredients as some rodenticides (rat poisons). So before you give out any rat poisons (or other poisons/medications) to a human, ensure they have a valid prescription for it and that you educate them appropriately via a platform like WellaHealth’s. You may not want to tell them they’re consuming a poison though.
Ikpeme Neto
Founder Wella Health

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