PHARMACEUTICAL INCOMPATIBILITY

THERAPEUTIC INCOMPATIBILITY
BY
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

THERAPEUTIC INCOMPATIBILITY

Therapeutic incompatibility may be a

result of prescribing certain drugs to a patient

with the intention to produce a specific

degree of pharmacological action, but the

nature or Intensity of the action produced is

different form that intended by the prescriber.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

Reason for therapeutic incompatibility: 1. Wrong dose

2. Wrong dosage form

3. Contra-indicated drugs

4. Synergetic drug
5. Antagonist drug

6. Drug interactions
7.WRONG drug
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

1. ERROR IN DOSAGE: Many therapeutic incompatibilities result from errors in writing or interpreting the prescription order. The most serious type of dosage error in the dispensing is overdose of a medication.

It becomes the duty of a pharmacist to check the

prescription before dispensing it. Pharmacist is often in a position to detect such error and help to avoid problems.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

Example:
Prepare and dispense the following 10 capsules.

Atropine sulphate
Phenobarbitone Aspirin

0.006 g
0.015 g 0.300 g

In this prescription, the quantity of atropine sulphate in each capsule is more than its minimum recommended dose. So the

prescription is referred back to the prescriber to correct the

overdose of atropine sulphate.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

2. WRONG DRUG AND DOSAGE FORM

There are certain drugs which have quite similar
names and there is always a danger of dispensing the wrong drug. Example: Prednisone and prednisolone, digoxin and digitoxin.

Sometimes many drugs are available in different dosage

forms and hence, if the dosage form is not clearly mentioned on the prescription, it becomes necessary to seek clarification from the prescriber.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

3. CONTRA-INDICATED DRUGS:
There are certain drugs which may be contraindicated in a particular disease or a particular patient who is allergic to it. Example: Corticosteroids are contra-indicated in patient shaving an active peptic ulcer. The penicillin and sulphur drugs are contra indicated to the patients who are allergic to it. Vasoconstriction drug are contra-indicated in hypersensitive patients Barbiturate and morphine should not be given to

asthmatic patients.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

4. SYNERGISTIC DRUGS:
When two drugs are prescribed together, they tend to increase the activity of each other. This is known as synergism. Example: A combination of aspirin and paracitamol increase the analgesics activity
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

5. ANTAGONIST DRUG:
When two drugs are prescribed together, they tend to reduce the activity of each other. This is known as antagonism. Example: Prepare and dispense the following 10 capsules. Acetyl salicylic acid 0.6 g Probenecid 0.5 g Acetyl salicylic acid and Probenecid are used in the treatment of gout, the combination of these lead to neutralization. So refer back the prescription to the prescriber for necessary correction.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

6. Drug interaction:
1.Drug Drug interaction:

The effect of one drug is altered by the prior or simultaneous administration of another drug. The drug

interaction can usually be corrected by the proper adjustment

of dosage if the suspected interaction is detected. Example:

Prepare and dispense the following 10 capsules.

Tetracycline hydrochloride 250mg Direction: Take one capsules every six hours with antacid.

Tetracycline is inactivated by calcium which is present in

Antacid. So tetracycline capsule should not be taken with Antacid.
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

6. Drug interaction:
1.Drug food interaction:

The effect of one drug is altered by the prior or simultaneous administration of food.

Example:
Prepare and dispense the following 10 capsules. Tetracycline hydrochloride 250mg

Direction: Take one capsules every six hours with milk.

Tetracycline is inactivated by calcium which is present in milk. So tetracycline capsule should not be taken with milk. In

this prescription the therapeutic incompatibility is unintentional.

So the prescription may be referred back to the physician to change the direction
K.SAMINATHAN. M.pharm, M.B.A,( P.hD) Allianze college of medical sciences

7. Wrong Drug
The dispensed drug is differ from the prescribed drug. This is due to
the same appearance of the drug and closer spelling and name of the drug. EXAMPLE:

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