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Prescription of medication contraindicated in pregnancy (14HDC01058)

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(14HDC01058, 4 June 2015)

General practitioner ~ Medical centre ~ Practice nurse ~ Medication ~ Hypertension ~ Pregnancy ~ Contraindications ~ Communication ~ information ~ Rights 4(1) and 6(1)

A woman, aged 35 years, was on the statin cholvastin (a cholesterol reducing medication) and the antidepressant fluoxetine. The woman saw her general practitioner (GP) to discuss whether she should recommence taking cilazapril for hypertension. The woman said that she told the GP she was considering becoming pregnant. The GP prescribed cilazapril for the woman, which is contraindicated in pregnancy. The GP did not discuss with the woman whether the other medications she was on were safe in pregnancy.

Over the following seven months, the woman obtained repeat prescriptions for fluoxetine, cilazapril and cholvastin from the medical centre on three occasions, but at no time was her blood pressure checked. Approximately nine months after she was prescribed cilazapril, the woman had an appointment with the GP. During the appointment, the woman advised the GP that she was pregnant. The GP discussed the woman's diet and exercise. The medication the woman was taking was not discussed.

A couple of weeks later the woman had her first appointment with a midwife. During the appointment the midwife called a secondary obstetrics unit to discuss the woman's medication with an obstetrician. The obstetrician agreed that the woman should not be taking cilazapril and cholvastin, and recommended the woman return to her GP for different prescriptions.

The following day the woman spoke to a nurse at the medical centre. The RN put an enquiry through to the GP, asking about the safety of the woman's medications in pregnancy. The GP responded that the woman should continue taking cholvastin and cilazapril but should consider coming off fluoxetine. This information was relayed to the woman. That same week the woman was seen at a secondary obstetrics unit where she was advised to stop taking cholvastin and cilazapril. The woman was given a prescription for a blood pressure medication not contraindicated in pregnancy. The woman continued to take fluoxetine.

By failing to identify that cilazapril and cholvastin were contraindicated in pregnancy and ensure that the woman's blood pressure was monitored appropriately, the GP did not provide services to the woman with reasonable care and skill, and breached Right 4(1). Furthermore, a reasonable consumer in the woman's circumstances would expect to receive information about the risks and benefits of continuing cilazapril, cholvastin and fluoxetine in pregnancy. By not providing that information, the GP breached Right 6(1).

Adverse comment was made about the RN's management of her telephone conversation with the woman. Adverse comment was also made about the medical centre's policy on repeat medication, as well as the communication between the GP and RN.


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