Table 2 Examples of prescription changes due to prescription inquiries related to laboratory data.
Nature of prescription inquiry | Drug | Laboratory data | Prescription inquiry | Result |
|---|---|---|---|---|
To avoid exacerbation of adverse drug reactions | Glycyrrhizinate | Potassium 2.3 mmol/L | Serum potassium level decreased from 3.1 mmol/L to 2.3 mmol/L. Blood pressure is elevated. Pseudoaldosteronism is suspected, suggesting need to stop glycyrrhizinate or add an aldosterone antagonist | Medication added |
Eplerenone | Potassium 5.3 mmol/L | Since serum potassium level increased from 4.8 mmol/L to 5.3 mmol/L, eplerenone dose should be lowered | Dose lowered | |
Diclofenac | CCr 9.7 mL/min | Diclofenac is contraindicated in severe renal dysfunction. Change to acetaminophen or tramadol is recommended. Prescribing physician decided to follow up without prescription change. However, creatinine clearance is impaired at next visit. Drug change is recommended again | Medication changed | |
Voriconazole | Alkaline phosphatase 5368 U/L | Alkaline phosphatase value 2 weeks earlier is high and is still increasing. Liver dysfunction caused by voriconazole is suspected, but there is no blood test data for that day | Dose lowered | |
Distigmine | Cholinesterase 154 U/L | Cholinesterase level is decreasing, the medication should be stopped | Medication stopped | |
To avoid adverse drug reactions | Dabigatran | CCr 25.9 mL/min | Contraindicated in severe renal dysfunction. Proposal for change to apixaban | Medication changed |
Olanzapine | HbA1c 9.1% | Contraindicated in diabetes mellitus with original prescription | Medication changed | |
Sitagliptin | CCr 25.1 mL/min | Proposal to start at 12.5 mg | Dose lowered | |
To improve the effect of drug therapy | Amoxicillin | Neutrophil 252/µL | Since antimicrobial drugs that cover Pseudomonas aeruginosa are required for treatment of febrile neutropenia, we suggested a change to levofloxacin | Medication changed |
