Any pharmacist here to answer a question?

laura_li

Hi all,

Is there any pharmacist here who could answer me this:

I have been really seriously injured by a prescription medication. I'm unable to work for months already.

Stupid enough, the doctor didn't warn me about any potential side effects. The pharmacy attendant just handed me a bag with a blister of pills, no leaflet, no information. She had gotten that bag from the pharmacist who stayed behind the counter and didn't tell me anything.

It didn't even occur to me that the medication could be so dangerous. When I got a hold of the leaflet after I was injured, everything was clear. This medication could kill an elephant. I complained to the pharmacy who claim they have given me the leaflet and information. That's not true of course.

Do pharmacies have to record the information given to you and if a leaflet was reprinted?

Thanks a bunch!

Laura

laura_li

Someone asked which medication it was. I got an email notification but can't see the post now (strange..).

The medication was Venlafaxine. It has the nickname "The devil's tick tacks".

palmcut

laura_li wrote: »

Someone asked which medication it was. I got an email notification but can't see the post now (strange..).

The medication was Venlafaxine. It has the nickname "The devil's tick tacks".

That was me. When I read the other thread my question was answered so I deleted my question. No strangeness intended.

laura_li

Ah, ok! I thought Boards.ie had swallowed your answer

Pookla

laura_li wrote: »

Do pharmacies have to record the information given to you and if a leaflet was reprinted?

I'm not a pharmacist but I've worked in the area and no, to my knowledge, they don't.

I'd be very surprised if they actually hadn't given you one though. Especially for a newly prescribed medication.

laura_li wrote: »

The medication was Venlafaxine. It has the nickname "The devil's tick tacks".

A quick search online shows that no reputable source calls it that.

I'd advise seeking professional advice when it comes to medication issues tbh. Boards.ie does not count in that respect.

locum-motion

laura_li wrote: »

...
The medication was Venlafaxine. It has the nickname "The devil's tick tacks".

Pookla wrote: »

...

A quick search online shows that no reputable source calls it that.
...

Agreed. "The Devil's Tic Tacs" is Vicodin. Completely different drug.

laura_li

Pookla wrote: »

I'm not a pharmacist but I've worked in the area and no, to my knowledge, they don't.

Thanks, that's good to know. A pity, because I can't prove that they didn't give me the leaflet or any advice.

Pookla wrote: »

I'd be very surprised if they actually hadn't given you one though. Especially for a newly prescribed medication.

They really didn't. They just put the blister in a paper bag sealed with a sticker, so I didn't notice until I was home. They also didn't give any advice. I think it was a screw up. They must have thought it's a repeat prescription or something.

Pookla wrote: »

A quick search online shows that no reputable source calls it that.

It's a nickname used in some forums.

Pookla wrote: »

I'd advise seeking professional advice when it comes to medication issues tbh. Boards.ie does not count in that respect.

I'm not asking for medical advice, for that it's already too late. I was just wondering about the documentation best practices in pharmacies.

Pookla

laura_li wrote: »

It's a nickname used in some forums.

I'll accept that it might be called that in some circles. Sounds very like an anti-psychiatry movement term tbh, which is something I'd advise everyone to run a mile away from, as it's generally nothing more than half-truths and outright lies that they peddle.

laura_li wrote: »

Thanks, that's good to know. A pity, because I can't prove that they didn't give me the leaflet or any advice.


They really didn't. They just put the blister in a paper bag sealed with a sticker, so I didn't notice until I was home. They also didn't give any advice. I think it was a screw up. They must have thought it's a repeat prescription or something.

No, you can't prove that they didn't. Do bear in mind that there is a good evidence body that even if you knew that there was a risk of a particular side effect, you may well have taken the medication anyway,depending on how severe the condition you were taking it for is.

I'm sorry that you've suffered from a side effect, but in and of themselves, they're not normally someone's fault per se.

Might be time to channel your energies into getting better rather than looking at the healthcare services?

laura_li

Pookla wrote: »

I'll accept that it might be called that in some circles. Sounds very like an anti-psychiatry movement term tbh, which is something I'd advise everyone to run a mile away from, as it's generally nothing more than half-truths and outright lies that they peddle.

I'm not going to get into this discussion with you since this is not the purpose of this post, but if you had any idea how much people suffer who either go through a difficult withdrawal or suffer the type of adverse reaction that I suffered, you would not make a statement like this.

I sincerely hope for you that you never have to go through a situation like that, although it might be an eyeopener.

Pookla

laura_li wrote: »

I'm not going to get into this discussion with you since this is not the purpose of this post, but if you had any idea how much people suffer who either go through a difficult withdrawal or suffer the type of adverse reaction that I suffered, you would not make a statement like this.

I sincerely hope for you that you never have to go through a situation like that, although it might be an eyeopener.

Please don't pretend that you know enough to predict what I would or would not say (or subtly wish ill will and ill health upon me for that matter).

I've had my own difficulties with antidepressants. Would take them again if needs be though.

And I stand very firmly behind my feelings towards the anti-psychiatry movement. These people are dangerous. They both ruin and take lives.

laura_li

I'll jump out of this discussion now. It's pointless and not what I was looking for.

Pookla

laura_li wrote: »

I'll jump out of this discussion now. It's pointless and not what I was looking for.

Yes, I suppose trying to gather "evidence" so that you can try and sue your pharmacist and/or doctor for something that's not their fault is pointless. :rolleyes:

Luke92

I've been on loads of different medications. I've always asked about side effects and always read the label. It says it on the pack to read the label. Don't go blaming the doctor and pharmacy that you didn't read the information leaflet. There's always an information leaflet.

Stheno

Luke92 wrote: »

I've been on loads of different medications. I've always asked about side effects and always read the label. It says it on the pack to read the label. Don't go blaming the doctor and pharmacy that you didn't read the information leaflet. There's always an information leaflet.

I've had prescriptions dispensed without information leaflets usually repeat ones

NomadicGray

Stheno wrote: »

I've had prescriptions dispensed without information leaflets usually repeat ones

The onus is still on you to know what your putting in to your body though

Stheno

NomadicGray wrote: »

The onus is still on you to know what your putting in to your body though

Agree 100% if I don't have an information leaflet I look up the info

Luke92

Stheno wrote: »

I've had prescriptions dispensed without information leaflets usually repeat ones

Did any of these medicines have potentially life changing side effects?

Stheno

Luke92 wrote: »

Did any of these medicines have potentially life changing side effects?

Some were pretty strong with rare side effects and a warning to seek medical attention if you suffered them, one had a side effect on the liver, can't remember the name

Another was tylex which is a fairly powerful painkiller.

Pookla

Stheno wrote: »

I've had prescriptions dispensed without information leaflets usually repeat ones

We all have (I'd wager). They're not a particularly helpful thing tbh. On a personal note, I've always asked my pharmacist my questions as I've these leaflets to be next to impossible to understand and usually full of far too much information that's not even possibly going to be personally relevant.

Also, they don't protect from recognised (or even unrecognised!) side effects particularly well.

Being alive is a risky business. Taking things to make you better is not completely safe (hell, even eating is dangerous) and bad things do happen.

Pharmacists check every medication that they dispense but they can't offer an absolute promise that it's perfectly safe and will definitely work. That falls outside the limit of modern pharmacology.

Pookla

Luke92 wrote: »

Did any of these medicines have potentially life changing side effects?

Every single medication has this potential btw. Even over the counter ones.

Stheno

Pookla wrote: »

We all have (I'd wager). They're not a particularly helpful thing tbh. On a personal note, I've always asked my pharmacist my questions as I've these leaflets to be next to impossible to understand and usually full of far too much information that's not even possibly going to be personally relevant.

Also, they don't protect from recognised (or even unrecognised!) side effects particularly well.

Being alive is a risky business. Taking things to make you better is not completely safe (hell, even eating is dangerous) and bad things do happen.

Pharmacists check every medication that they dispense but they can't offer an absolute promise that it's perfectly safe and will definitely work. That falls outside the limit of modern pharmacology.

Agreed

Thu I often find it easier to ask a pharmacist questions or to look up the manufacturers site for info

I will say that the pharmacists local to me are all excellent and will often preemptively bring up side effects

Pookla

Stheno wrote: »

I will say that the pharmacists local to me are all excellent and will often preemptively bring up side effects

In all my years either working with them or getting meds from them, I've actually never met a bad pharmacist (even the ones with significant attitude problems I'd still have to classify as good).

It's a product of their education and regulation. If you make it to practicing stage, you just have to be that good.

laura_li

NomadicGray wrote: »

The onus is still on you to know what your putting in to your body though

It is of course, but it's hard to find the right information without leaflet. There's so much incomplete information out there on those drugs.

Pookla

laura_li wrote: »

It is of course, but it's hard to find the right information without leaflet. There's so much incomplete information out there on those drugs.

Very true. There's a lot of partial and incorrect information about every medication circulating around everywhere.

To get past this, it's best to use a documented reputable source.

Personally the SPCs as prepared by medicines.ie are the best and most thorough.

RobFowl

Mod note
Lets all calm down a little

deepimpact

Pookla wrote: »

Personally the SPCs as prepared by medicines.ie are the best and most thorough.

The SPCs on medicines.ie are only those of the IPHA member companies. Generic medicine manufacturers are not included in the medicines.ie compendium.

For a complete database of SPCs and PILs, the HPRA (formerly the IMB) website is the most useful, see here.

Mrs OBumble

A few years back, my GP and the pharmacist gave totally contradictory advice about how to take a particular medication.

So I looked up the data sheet, and found that what it recommended was different to what both of them said.

Ever since, I've made it a point to always do so. It makes me a lot better informed about potential consequences than any doctor ever has.

monkey8

laura_li wrote: »

She had gotten that bag from the pharmacist who stayed behind the counter and didn't tell me anything.

Do you expect the pharmacist to list the side effects of every drug to every patient?! A pharmacist doesn't have time for that. Its the pharmacists job to check for interactions and let you know if you medication reacts with another you are prescribed, not to list you the side effects of every drug.

AS far as the leaflet goes it was probably given out in a split pack. If a box has 56 tablets and a doctor prescribes 28 then the pharmacist will give out the 28 with the information leaflet so there will be no leaflet for the next person getting the next 28.

If you were so concerned about not getting the information leaflet you could simply have just ask the pharmacist for one or looked it up online.

laura_li

monkey8 wrote: »

Do you expect the pharmacist to list the side effects of every drug to every patient?! A pharmacist doesn't have time for that. Its the pharmacists job to check for interactions and let you know if you medication reacts with another you are prescribed, not to list you the side effects of every drug.

AS far as the leaflet goes it was probably given out in a split pack. If a box has 56 tablets and a doctor prescribes 28 then the pharmacist will give out the 28 with the information leaflet so there will be no leaflet for the next person getting the next 28.

I think the split pack thing is what happened and yes, I think the duty of the pharmacist is to explain the medication to the patient. That's what I have seen happening in other pharmacies. I would also expect the pharmacist to hand out the leaflet to every patient, split pack or no split pack. I didn't ask the pharmacist for the leaflet because the bag was sealed, I didn't look inside and it didn't even occur to me the leaflet couldn't be included.

monkey8 wrote: »

If you were so concerned about not getting the information leaflet you could simply have just ask the pharmacist for one or looked it up online.

I did, but seems like the info I found was incomplete. I think that's the whole point of having the leaflet: Making sure the patient has the right info.

It seems like people think I'm being pedantic here.. Keep in mind what consequences the whole thing had for me:

I've never been so sick in my whole life as in the last four months. I'm about to lose my job because of it. I've suffered pain that I didn't even think was possible before this happened to me.

Unfortunately this happens with a range of medications to some people (some antibiotics, some nausea medicines etc). People simply do not know this and fall into the trap.

Would you expect that the antibiotic, antidepressant or anti malaria pill you are handed with no comment by doctor or pharmacist could make you permanently disabled? I certainly didn't expect that.

laura_li

laura_li wrote: »

I think the split pack thing is what happened and yes, I think the duty of the pharmacist is to explain the medication to the patient. That's what I have seen happening in other pharmacies. I would also expect the pharmacist to hand out the leaflet to every patient, split pack or no split pack. I didn't ask the pharmacist for the leaflet because the bag was sealed, I didn't look inside and it didn't even occur to me the leaflet couldn't be included.




I did, but seems like the info I found was incomplete. I think that's the whole point of having the leaflet: Making sure the patient has the right info.

It seems like people think I'm being pedantic here.. Keep in mind what consequences the whole thing had for me:

I've never been so sick in my whole life as in the last four months. I'm about to lose my job because of it. I've suffered pain that I didn't even think was possible before this happened to me.

Unfortunately this happens with a range of medications to some people (some antibiotics, some nausea medicines etc). People simply do not know this and fall into the trap.

Would you expect that the antibiotic, antidepressant or anti malaria pill you are handed with no comment by doctor or pharmacist could make you permanently disabled? I certainly didn't expect that.

How are you permanently disabled? What was the medication? I am a pharmacist. Just curious. I'll let you know what I would have done in that instance.

All medications can make you permanently disabled to a greater or lesser extent e.g. Reye's syndrome with aspirin. Anti-malarials can induce psychosis. The point I am making is no medication is "safe".

laura_li

Deleted User wrote: »

How are you permanently disabled? What was the medication? I am a pharmacist. Just curious. I'll let you know what I would have done in that instance.

All medications can make you permanently disabled to a greater or lesser extent e.g. Reye's syndrome with aspirin. Anti-malarials can induce psychosis. The point I am making is no medication is "safe".

I hope I'm not permanently disabled, but I've been for the last four months and there's not much sign of improvement. I'll send you a PM with the thread that describes what exactly happened. I don't want to bore people on here with the details.

Deleted User wrote: »

All medications can make you permanently disabled to a greater or lesser extent e.g. Reye's syndrome with aspirin. Anti-malarials can induce psychosis. The point I am making is no medication is "safe".

Yeah, that's what I learned in the meantime. I had no idea...I completely agree that it's worth the risk in some cases but it totally wasn't in my case.

WealthyVVanker

Can you tell us what kind of 'injury' this medication caused you?

laura_li

Ok, short version for everyone interested:

I'm not 100% clear if it's an adverse reaction or a crazy, prolonged version of the "Antidepressant Discontinuation Syndrome". But essentially my whole nervous system was fried. I could write an endless list of symptoms.

I think what matches it best would be "autonomic nervous system dysfunction".

Sweating, shaking, panic attacks, chest pains, tendon pains, muscle pains, nausea, couldn't move my head, dizziness, brain zaps, involuntary movements. Symptoms change and fluctuate all the time. At the moment I'm stuck with brain zaps, severe headaches, involuntary muscle movements, nausea, dizziness, fatigue, mood swings.

I had none of this before taking the medication. It's rare, but some people really get their system fried when they take antidepressants. Try searching on Youtube, you'll find some terrifying accounts.

WealthyVVanker

laura_li wrote:

I had none of this before taking the medication. It's rare, but some people really get their system fried when they take antidepressants. Try searching on Youtube, you'll find some terrifying accounts.

I'm only interested in your symptoms as they differ greatly from person to person. Have you been to your GP about these symptoms, what has he said or done for you?

laura_li

WealthyVVanker wrote: »

I'm only interested in your symptoms as they differ greatly from person to person. Have you been to your GP about these symptoms, what has he said or done for you?

The GP & neurologist are confused by the symptoms too. Initially they thought it was withdrawal, but according to them it should last only two weeks, which is untrue if you look at recent research.

MRI is clear. Probably in a couple of years I'll laugh at it, but right now this whole thing is just awful.

WealthyVVanker

laura_li wrote:

The GP & neurologist are confused by the symptoms too. Initially they thought it was withdrawal, but according to them it should last only two weeks, which is untrue if you look at recent research.

laura_li wrote:

MRI is clear. Probably in a couple of years I'll laugh at it, but right now this whole thing is just awful.

My advice would be not to go to court with this (that seems to be what you're getting at, I could be totally wrong) as you will end up paying a hefty price in fees and I'd almost guarantee you will get nowhere. Your situation is unfortunate, but ultimately you're own fault. These symptoms should clear soon after medication leaves your system. 2 weeks sounds about right.

sbsquarepants

laura_li wrote: »

Sweating, shaking, panic attacks, chest pains, tendon pains, muscle pains, nausea, couldn't move my head, dizziness, brain zaps, involuntary movements. Symptoms change and fluctuate all the time. At the moment I'm stuck with brain zaps, severe headaches, involuntary muscle movements, nausea, dizziness, fatigue, mood swings.

.

Hi Laura, what's a brain zap?

laura_li

WealthyVVanker wrote: »

My advice would be not to go to court with this (that seems to be what you're getting at, I could be totally wrong) .

I had contemplated that but I think you're right in that I will get nowhere with that.

WealthyVVanker wrote: »

These symptoms should clear soon after medication leaves your system. 2 weeks sounds about right.

This was the original belief about antidepressant withdrawal and is still quite widespread among doctors. Now it has been shown that it can last longer. Check out the product leaflets or any of these:

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review
Fava G.A.a, b · Gatti A.a · Belaise C.a · Guidi J.a · Offidani E.c

New insights on the antidepressant discontinuation syndrome.
Harvey BH, Slabbert FN.

Playing the Odds: Antidepressant ‘Withdrawal’ and the Problem of Informed Consent
By STUART SHIPKO, M.D.

sunshine and showers

Withdrawal symptoms from Venlafaxine can and do last longer than two weeks. The brain zaps in particular are horrific. I tried to explain them to a psychiatrist, who said he'd never heard of them before. They're very much an issue with this medication, though. Some people can be so sensitive to this medication that they get "withdrawal" symptoms if they take their next dose at a slightly later time than normal. AFAIK, it's because of the short half life of the pills. There does seem to be a lack of understanding of these pills and their negative side effects amongst some healthcare professionals - I had to do a lot of my own digging about them and show it to doctors/psychiatrists.

OP, you need to go back to your doctor if you still have discontinuation issues. Did you wean off them correctly? Going cold turkey is a terrible idea. Have you discussed bridging the tablets with Prozac to wean from them more effectively?

Venlafaxine works for some people. It worked for me for a few months before it gave up. It's a properly horrible drug that I don't think anyone should be put on unless they've tried all other options.

laura_li

sbsquarepants wrote: »

Hi Laura, what's a brain zap?

It's an awful feeling of electric discharge in your brain. It's different for everybody but in my case it sometimes makes my whole body twitch. It doesn't hurt much but it's very uncomfortable.

sunshine and showers

laura_li wrote: »

It's an awful feeling of electric discharge in your brain. It's different for everybody but in my case it sometimes makes my whole body twitch. It doesn't hurt much but it's very uncomfortable.

Mine felt like my brain physically jolting in my head. Horrible things that are so upsetting and disorientating.

laura_li

sunshine and showers wrote: »

Withdrawal symptoms from Venlafaxine can and do last longer than two weeks. The brain zaps in particular are horrific. I tried to explain them to a psychiatrist, who said he'd never heard of them before. They're very much an issue with this medication, though. Some people can be so sensitive to this medication that they get "withdrawal" symptoms if they take their next dose at a slightly later time than normal. AFAIK, it's because of the short half life of the pills. There does seem to be a lack of understanding of these pills and their negative side effects amongst some healthcare professionals - I had to do a lot of my own digging about them and show it to doctors/psychiatrists.

Thank you Sunshine and Showers! So good to read form someone who understands! I was only on the medication a couple of days. The side effects were so severe that I had to stop it immediately per doctors advice. So there was no chance to wean off.

Right now, I just want the symptoms to pass and never touch an antidepressant again. I think I may be one of the people who genetically are not metabolizing these drugs well enough. That would explain why despite my tiny dose and short duration I get crazy symptoms. It's probably a bit like a CT from a high dose.

laura_li

WealthyVVanker wrote: »

Your situation is unfortunate, but ultimately you're own fault.

I decided to comment on the "my own fault" part. It's very easy to blame the patient for a drug injury. The patient is the weakest and most vulnerable part in the whole drug prescribing game. The patient is also the person with the least experience and information and is desperate for help. He/She is also the one who has to suffer the consequences.

I've heard this a lot recently "You should have known" or "It's your fault", but how could I have known if not even doctors and pharmacists knew / acknowledge.

sunshine and showers

laura_li wrote: »

Thank you Sunshine and Showers! So good to read form someone who understands! I was only on the medication a couple of days. The side effects were so severe that I had to stop it immediately per doctors advice. So there was no chance to wean off.

Right now, I just want the symptoms to pass and never touch an antidepressant again. I think I may be one of the people who genetically are not metabolizing these drugs well enough. That would explain why despite my tiny dose and short duration I get crazy symptoms. It's probably a bit like a CT from a high dose.

I wouldn't necessarily rule out trying any antidepressants ever again if they're recommended for you. I've tried several - had no bad side effects apart from the Venlafaxine/Effexor. You just need to work with your doctor to find one that suits you.

laura_li

sunshine and showers wrote: »

I wouldn't necessarily rule out trying any antidepressants ever again if they're recommended for you. I've tried several - had no bad side effects apart from the Venlafaxine/Effexor. You just need to work with your doctor to find one that suits you.

After this experience, I think it's just too risky. If I can get back to the place I was before all of this happened, I can have a decent life without antidepressants. I just need to make sure I don't overload myself again with too many responsibilities. That's the part I take full responsibility for: I didn't take care of myself enough. That has to change now.

secondrowgal

Hi Laura

I work in the pharmaceutical industry, but I'm not a pharmacist.

You can report your adverse reaction to HPRA directly here:

https://www.hpra.ie/homepage/about-us/report-an-issue/human-adverse-reaction-form

Irrespective of a split pack or not, the pharmacist is supposed to supply a patient information leaflet with your medication. It's actually a bit of a bug bear with me that it seems policy to provide the customer with a sealed bag, probably for privacy concerns, but it means most people don't open it until they get home. It's not always easy to get back into the pharmacy to get a leaflet but you can find them all online:

http://www.medicines.ie/searchresults.aspx?term=venlafaxine&searchtype=AdvancedSearch
(which does include generics by the way, and anyway the leaflet for a particular drug will be mostly the same whether it's the "brand" you have or not)

http://www.hpra.ie/homepage/medicines/medicines-information/find-a-medicine/results?query=VENLAFAXINE&field=ACTIVESUBSTANCES

I know that the patient leaflets can have a lot of information and can be confusing, but they are approved by the government agency (HPRA in Ireland) and are subject to EU law. Basically you get the same information no matter what the drug and whatever country in the EU you are in.

I wouldn't depend on manufacturer's sites at all because they may or may not be promotional, biased towards the US market which have different rules on patient information, and of course are going to emphasise the benefits and downplay the risks.

Never, ever, be afraid to ask for information about a drug from a pharmacist or doctor - even a pharmacist that didn't supply it. They are usually very willing to help.

Your case sounds quite unusual though and, to be fair, in these rare cases it's not likely that any healthcare professional could have predicted your severe reaction to the medicine. I hope that you get better soon!

RobFowl

Mod note
Please refrain from asking or offering medical advice as per forum charter.
Thanks
Rob