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Allergic reaction to pharmacy-only medicine sold inappropriately (02HDC06951)

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(02HDC06951, 25 February 2003)

Pharmacist ~ Pharmacy-only medicines ~ Information about risks and contraindications ~ Adverse reactions ~ Complaints procedure ~ Rights 4(1), 4(2), 10

A woman complained about the service provided by a pharmacist. When she went to the pharmacy to obtain medicine to relieve her husband's symptoms she was provided with the pharmacy-only medicine Nurofen Plus, which contains ibuprofen, a non-steroidal anti-inflammatory analgesic agent. Outside the pharmacy, she read the manufacturer's warning on the box that it should not be taken by patients allergic to aspirin. She returned to the pharmacy and said that she had forgotten to say that her husband was allergic to aspirin. The pharmacist reassured her that the medicine would be safe for her husband to take. Her husband subsequently presented with signs and symptoms of an aspirin allergy. The entry for Nurofen Plus in the 2001 New Ethicals Catalogue states that special precautions are required with asthmatics sensitive to salicylates (aspirin).

The Commissioner reasoned that even though the man was not an asthmatic, and the pharmacist was correct that the medicine did not contain aspirin, the pharmacist erred because he did not take into account the similarities between the chemical and pharmacological activities of aspirin and ibuprofen. Ibuprofen is contraindicated in patients with a history of hypersensitivity or allergy to aspirin.

The Pharmaceutical Society of New Zealand's Code of Ethics specifies that when supplying medicine, a pharmacist must ensure that the patient is provided with credible, understandable information about its safe and effective use and any significant risk of therapy, to allow the patient to make an informed choice. The pharmacist must also, when asked for advice on treatment involving any medicine, ensure that sufficient information is provided to allow the patient to make an assessment that the medication is safe and efficacious.

It was held that the pharmacist breached Rights 4(1) and 4(2) in that:
1) he did not provide medicine that was appropriate to the man's circumstances as disclosed; and
2) he did not provide accurate information about the risks associated with the medicine, and therefore did not provide services with reasonable care and skill and in compliance with professional standards.

The Commissioner commented that the adverse reaction should have been reported, and recommended that the pharmacist revise and implement an appropriate complaints procedure.