Can a Pharmacist Prevent the Next Pileup?

By: Moisey Rafailov, PharmD Candidate c/o 2015

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It was early in the morning on New York’s Route 684 when a car hit a tractor-trailer and continued driving without regard. Imagine that, when later stopped by a police officer, the driver said that the accident was her pharmacist’s fault. What if I were to tell you that that she might have a point?

Kerry Kennedy, the daughter of former President John F. Kennedy, was taken to the hospital for this accident last July. Although she did not blame her pharmacist, her prescription sleep medication might have played a role in causing the collision. After the necessary blood tests, the only thing that was found was 14 nanograms of Zolpidem (Ambien®) per mL of blood, which equates to less than 0.1 mg systemically. Though physicians suggest that she might have had a seizure, Zolpidem might have played a role in what occurred that morning.¹

On January 10^th 2013 the FDA made a drug safety announcement regarding this very matter. In summary, the FDA “recommends that the bedtime dose [of Zolpidem] be lowered because new data show that blood levels in some patients may be high enough the morning after use to impair activities that require alertness, including driving.”² In fact, next morning impairment is possible with all sleep aids, especially extended release formulations. The FDA suggests that the dose for women should be lowered from 10 mg to 5 mg for immediate release and from 12.5 mg to 6.25 mg for extended release products. Men, however, can use either strength, but are still urged to use the lowest dose possible. Furthermore, the FDA encourages all healthcare professionals to inform their patients of possible next morning impairment, which may affect patients even when they feel fully awake.²

The purview of a pharmacist’s influence is amazing—with one counseling session, a pharmacist could head off a car accident. Without one, pharmacists may well find themselves liable for situations like Ms. Kennedy’s. It is safe to say that Ms. Kennedy’s situation is not an isolated incident. Broadly speaking, there might be many people unaware of the most common side effects of the medications they are taking. Pharmacists are more than machines that fill, count, and dispense medications. A pharmacist can save others from discomfort, drug interactions, non-adherence, and potentially lethal outcomes.

SOURCES:

1. James, Susan Donaldson. “Kerry Kennedy and Ambien: A Common Med Mix (Up), Say Experts.” ABC News. ABC News Network, 26 July 2012. Web. 28 Jan. 2013.
2. “Drugs.” FDA Drug Safety Communication: Risk of Next-morning Impairment after Use of Insomnia Drugs; FDA Requires Lower Recommended Doses for Certain Drugs Containing Zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). N.p., n.d. Web. 28 Jan. 2013.