One more drug leads to one big problem

Journal of Family Practice, June, 2009 by Jeffrey L. Susman

A 56-YEAR-OLD MAN WAS HOSPITALIZED WITH PNEUMONIA, for which his physician prescribed fluconazole (supplied by the hospital pharmacy). The patient was taking cyclosporine, prescribed after a kidney transplant 20 years earlier, and atorvastatin. Lab work performed a week later revealed renal function problems. The patient's medications weren't adjusted.

The cases in this column are selected by the editors of THE JOURNAL OF FAMILY PRACTICE from Medical Malpractice: Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information about the cases presented here is sometimes incomplete; pertinent details of a given situation may therefore be unavailable. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation.

The patient's wife had him transferred to another facility, where he was diagnosed with rhabdomyolysis resulting from the multiple medications. After extensive hospitalization and rehabilitation, the patient was left with debilitating muscle weakness, especially in his legs.

PLAINTIFF'S CLAIM The hospital and doctor were negligent in failing to recognize the potential for adverse interaction among atorvastatin, cyclosporine, and fluconazole, and in failing to discontinue the atorvastatin.

THE DEFENSE No information about the nature of the defense is available.

VERDICT $1.63 million gross verdict in West Virginia.

COMMENT Can you remember all those CYP 450 drug-drug interactions? Neither can L So when a patient is on an unfamiliar medication (cyclosporine isn't a regular in my practice), it's worth looking up the drug and exploring potential problems.

COMMENTARY PROVIDED BY

Jeffrey L. Susman, MD, Editor-in-Chief