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Your pharmacist may be switching your meds

June 2, 2009
From:  Prevention Magazine
By Richard Laliberte. Updated 8:13 a.m. ET, Tues., June 2, 2009

When you hand a pharmacist a prescription, you expect to get the medication your doctor ordered. But because of a perfectly legal loophole in rules that govern how drugs are dispensed, you may not — and the consequences can be dire.

Just ask Amy Detrick of Grove City, Ohio.

For months after the former social worker, 40, was diagnosed with epilepsy, her doctor fine-tuned the precise cocktail of meds that would keep her from having seizures — adding and subtracting drugs, calibrating doses, and carefully tracking how she responded. When her condition was finally under control, she filled a prescription for one of two drugs she took — Tegretol — and shortly afterward had a seizure while riding a bicycle. She fell off the bike, broke her leg, and had a hairline fracture in her left eye socket. While the doctors were treating her, they noticed the blood level of her medication had declined. Her pharmacist, she learned, had exchanged her Tegretol for a generic that worked a little differently. ” Just imagine what could have happened had I been behind the wheel of a car,” she says.

Detrick’s story sounds like a medical mistake, but it wasn’t. Instead, she experienced a potentially deadly consequence of a common practice called “therapeutic substitution,” wherein her pharmacist legally switched a drug prescribed by her doc — but without telling her or her physician. Usually, pharmacists replace a brand-name drug with a generic formulation of the exact same medication. Therapeutic substitution is similar but with one crucial distinction: The new drug is in the same class as the old and treats the same condition, but it’s not precisely the same medication.

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