In Ontario, pharmacists have the ability to make changes to prescriptions in four helpful ways. Let me explain each one to you in more detail.
The first way is by adapting the route of administration. This means that if a medication is normally taken as an oral tablet, but it’s difficult for the patient to swallow, the pharmacist can adapt it to a suppository form instead. This makes it easier for the patient to take the medication and get the benefits they need.
The second way is by adapting the dosage form. For example, if a cream is not suitable for a patient’s skin condition, the pharmacist can change it to an ointment or even a different form like a liquid or gel. Similarly, if a patient has trouble swallowing tablets, the pharmacist can adapt it to a liquid form, making it easier for them to take.
The third way is by adapting the directions. This means that if the original instructions say to take the medication in the morning, but it causes drowsiness, the pharmacist can adapt the directions to suggest taking it in the evening instead. Similarly, if the instructions say to take the medication once a day, but the patient needs it more frequently, the pharmacist can adapt the directions to suggest taking it two or three times a day for better effectiveness.
The fourth way is by adapting the dose. Let’s say a patient has been prescribed 100 milligrams of a medication, but they usually take only five milligrams for their condition. In this case, the pharmacist can adapt the dose back down to five milligrams, ensuring the patient gets the correct amount that works for them. Conversely, if a patient’s medication isn’t working well, the pharmacist can adapt the dose up to see if a higher amount is more effective. Likewise, if the patient experiences unwanted side effects, the pharmacist can adapt the dose down to minimize those effects.
It’s important to note that adaptations do not involve swapping one medication for another. For example, a pharmacist cannot replace a medication like Pantoprazole with Esomeprazole, even if they both belong to the same class. Additionally, certain monitored drugs, including narcotics, controlled substances, and targeted substances, cannot be adapted by a pharmacist.
If a pharmacist makes a clinically significant adaptation, meaning it has an important impact on the patient’s treatment, they should inform the prescriber. If the prescriber is a specialist, it’s also a good idea to notify the primary care provider, whether that’s the family physician or nurse practitioner, to ensure coordinated care. If changing the dose of a medication has a significant effect on its effectiveness, it’s considered a clinically significant adaptation. In such cases, the pharmacist should obtain consent from the patient or their authorized representative, and make a note on the prescription that consent was obtained.
I hope this explanation clarifies the ways in which pharmacists can help adapt prescriptions to better suit patients’ needs in Ontario!- and don’t forget…. MisterPharmacist™ makes patient care easy!
