Sometimes you do a Medicines Use Review (MUR) and there's nothing to report - in fact this happens quite a lot - although I believe that the MUR isn't wasted because in these cases  we get to confirm everything is fine. (Remember that a patient adhering to their medication is most likely to get maximum benefit - and less likely to suffer problems)
 
But, just occasionally something jumps out that seems to justify the MUR service really well!
 
This morning I did a MUR on a lady that had been recently prescribed 80mg of furosemide daily for fluid in the legs...and she takes them correctly as prescribed "two daily." I discovered, however, that she started to take them at bedtime with some other tablets - and is up all night going to the toilet - which we might expect!
 
She didn't realise that it was the tablets, and I've reassured her that her frequent nocturnal visits to the bathroom will stop once she takes the medication appropriately again...
 

I had an interesting conversation with a company representative recently.
 
It turns out that the product "Dovobet ointment" will be available only in the 120g pack size in the near future as the 60g pack size will be discontinued.
 
The "gel form" will be available in both sizes.
 
The problem here is that if pharmacies receive prescriptions for 60g of the ointment, once it's gone, they will be able to properly supply the 120g and be paid for it...but the clinical indication for this product is clear - it shouldn't be used in a casual manner. Indeed the BNF states "apply once a day to a maximum of 30% of the body surface for 4 weeks (max of 15g daily); If necessary treatment may be continued beyond the 4 weeks or repeated on the advice of a specialist.
 
Now, we don't know what areas of skin are being treated -and treatment may rotate around the body as different body parts need to be treated - but by giving a larger pack, the temptation to overuse might be great...
 
Perhaps, we should provide patients with a MUR when supplying Dovobet to ensure appropriate use; and more importantly prevent inappropriate excessive application?

I did an interesting MUR the other day on a gentleman who takes blood pressure tablets and uses inhalers for asthma.
 
During the MUR it became apparent to me that he was in denial regarding his medication and really wished to be free of all of it. He had started jogging to improve his health and lose weight - which is admirable and I applauded this; but as he was now feeling fitter, he decided that he would stop his steroid inhaler and only use his blue inhaler when necessary. As he told me this I could hear his chest wheezing...
 
I explained the importance of regular steroid inhaler use to alleviate, and treat, his condition - and we discussed the idea of stepping down (and up) as conditions change; but in a sensible way - preferably with GP approval. He told me that the GP had previously given him similar advice - which he had ignored; but agreed to use the inhaler as prescribed in future after our discussions. 
 
It's easy to be in denial; and in most cases probably occurs because people are ignorant of the consequences of benefit versus risk - good communication is so important.
 
Once a patient understands about the medication, patients are so much more compliant - and MURs are a great tool to get this information across and reinforce good messages!

I did a really interesting MUR on a patient the other day - it was an intervention MUR.
 
A lady called into the pharmacy stating that she had virtually no diazepam left - our computer records showed that she should have some and this triggered the MUR!
 
During the consultation, I was alerted to a huge problem - that she had stopped all her blood pressure medication (lisinopril & amlodipine) and her other heart medicine three weeks ago...
 
Why...?
 
Well, because she had been to the surgery; and the GP had told her that her bloods were a bit low...and he would have to give her a course of injections to bring it up again. Later on, she reflected on what the doctor had said and being confused, assumed her blood pressure was dangerously low and stopped her tablets - whereas the GP was talking about B12 injections for anaemia!
 
I urgently spoke to the surgery, and she has started her tablets again and will be seen soon by the doctor...
 
It just goes to show the importance of good communication during consultations...

When we do a patient service, such as a medicine use review (MUR), we expect minor issues to be raised during the consultation, but every now and again something stops you in your tracks...it happened to me the other day. 

I was doing a MUR on a gentleman and we began discussing his medication...when we got onto his pain relief medicines and reached paracetamol I though he was going to say "yes, I take them as prescribed - Two, up to Four times a day when necessary" but he didn't...He said "I often take Four tablets Four times a day when in pain - sometimes more - I know it's an overdose!" I was shocked...such a toxic overdose is potentially lethal.

 The maximum dose is on all products and labels. I had a stern conversation about overuse of paracetamol and the toxicity of it. He admitted that he obtains extra supplies from corner shops and from family members...We discussed liver toxicity and the risk of paracetamol poisoning, and death, with overdose... I've referred him to his doctor urgently.

 I hope the patient takes my advice, cuts down on the paracetamol and gets his pain control reviewed; or else I fear for the consequences... and, I guess, this just goes to show the benefit of the MUR service - even on what might be thought of as trivial medication...