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Do we counsel enough?

By Rachael Yim posted 02-18-2011 14:22

  

How much do we counsel?

Recently, Merck won it’s first fosamax (aledronate) trial. Alison Rosenberg, a 67 year old woman from Pennsylvania, sued Merck on the basis of the bisphosphonate causing osteonecrosis of her jaw (ONJ, for short). 

The bisphosphonate class are the pyrophosphate analogues that are taken up by osteoclasts and inhibit resorption.  The more common ones we see, are the second generation ones, (aledronate, risedronate, ibandronate) that both prevent and treat osteoporosis.  And yes, when I learned about it in pharmacy school, there was the rare occurrence it could cause ONJ.

It’s not like it’s ground breaking news. We all learned it at some point during our pharmacy career.  But when counseling on an outpatient basis, I never think about warning patients about the ONJ. It’s more I focus on the basics- it’s poorly orally absorbed, so take 30-60 mins before eating, and don’t lie down 30 mins after taking it, because of the gastroesophageal irritation effect. Sure, we all learned that. But how many times did I really say to that patient “oh, and by the way, there’s a rare occurrence of jaw death that may occur?”

This isn’t the first time that Merck has received drama for their drug. Back in October 2010, in one of the bellwether cases, Merck lost a lawsuit that cost them 8 million dollars. Apparently, the plaintiff was having severe pain and suffering, and enough damage related to fosomax to have part of her jaw removed. There’s been around thousand more different cases.

I’m not arguing that we should start counseling patients on ONJ when put on fosomax (while it is good to keep that in mind). It’s more the fact of, how much detail do we give? As an inpatient pharmacist, most of my questions come from nurses asking me if they can crush a tablet to give it down a NG tube, etcera- where then I’m hurriedly looking it up in facts and comparisons or lexicomp. Are we giving out enough information when we give out or verify medications?

Nonetheless, I believe just speaking to our patients help shield the error (from the USAToday article two years ago!). I mean, Merck did all it could (the FDA had it change its drug insert), and whoever gave Ms. Rosenberg the fosamax hopefully counselled all they could as well. And since Ms. Rosenberg had been taking fosamax for four years, one would only hope she actually said something once she started feeling a little differently in her jaw. Nonetheless, I believe this instance just proves how much we can contribute and prevent error in our careers on a daily basis....

 

 

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