Somedays I scratch my head more than others…today was one of those days. Seeing Senna and loperamide scheduled together made me scratch it REAL hard. A 77-year-old male was complaining of constipation and Miralax PRN was added to help. As I started reviewing the medication list, I realized that this patient was on both Senna and loperamide. Sometimes finding drug therapy problems can be challenging and take a strong knowledge of pharmacology and pharmacotherapy. Other times, like this instance, simply knowing what the medications are used for should at least lead you to ask why we would use them together?
To be fair, I do see both of these medications on patient lists all the time. They are usually standing orders and only available PRN. Maybe this was one of the reasons why it was overlooked prior to adding the Miralax as needed.
Summing up this situation, using Senna and loperamide scheduled doesn’t make a lot of sense and was a catalyst for polypharmacy. The loperamide was discontinued and this also allowed for a reduction in the Senna-S dosing from 2 BID to an eventual dose of 1 tablet once daily. Miralax PRN use was seldom necessary and eventually discontinued.
What other common mistakes like this have you seen in your practice? Leave a comment below!
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I often see Adderall scheduled simultaneous with anxiolytics. It may not be a mistake but it confuses me.