Your pharmacist may be switching your meds

http://www.msnbc.msn.com/id/30627962//

By Richard Laliberte
Prevention Magazine
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.

To understand the nuance, think of statins. They constitute a single class of medication because they all lower cholesterol by reducing its production in the liver. But not every statin lowers cholesterol by the same amount or with the same balance of LDL to HDL. So if your doctor orders a brand-name drug but your pharmacist switches it for the cheaper version of a different medication (but still a statin), you may not get the precise benefit your doctor had in mind — and may, in fact, suffer unexpected side effects.

In one way, at least, patients can benefit from substitution — smaller co-pays. But two-thirds of people who reported having meds switched in a National Consumers League survey said they weren't consulted. Of those, 40 percent said the new drug was not as effective, and a third said it had more side effects. "It's not okay for your insurance company or pharmacist to change your drugs without your knowledge," says NCL Executive Director Sally Greenberg.
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... [see article for suggestions on dealing with problem]
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... [see article for common substitutions and their dangers]