TRC Conversation: Keeping Transplant Patients Safer

Jan 15, 2015
Interventions from specialist pharmacists in the Immunology Therapeutic Resource Center® help patients gain a better understanding of their treatment regimen.
  • Transplant

What Happened?

A patient who recently underwent an organ transplant was taking immunosuppressant medications, Prograf® (tacrolimus) and a high dosage of Rapamune® (sirolimus). Tacrolimus was filled through a local retail pharmacy and sirolimus was filled through the Express Scripts Pharmacy.

Clinical Gaps in Care

Immunosuppressants like tacrolimus and sirolimus are typically not prescribed together. If the immunosuppressive therapy is incomplete or incorrect, there is a risk of the loss of the transplanted organ.

Additionally, the prescription for sirolimus exceeded typical doses for maintenance of a transplanted organ. High doses of this medication may result in adverse effects, including kidney disease, high cholesterol, fluid retention and high blood pressure.

Specialist Pharmacist Intervention

A specialist pharmacist in the Immunology Therapeutic Resource Center® (TRC) spoke with the prescriber’s office to inquire if an error had occurred with the prescription. The pharmacist asked if the prescriber intended to continue tacrolimus or change to sirolimus.

The prescriber confirmed that a prescribing error had occurred and intended to prescribe tacrolimus. The prescription was corrected and appropriately filled for the patient.

Why It Matters

Immunology TRC pharmacists are aware of the different medications and combinations used to prevent rejection of a transplanted organ. In this case, the dose of the medication along with a comprehensive medication history provided clues that an error may have occurred. This intervention may have saved the patient from experiencing loss of the transplanted organ.

A strong roster of specialist pharmacists focusing on patients with needs in a specific area, such as immunology, is one of the unique ways Express Scripts helps patients stay on the right treatment and avoid unnecessary, harmful, adverse events. We call it Health Decision Science®: the application of clinical specialization and behavioral sciences combined with actionable data to enable better decisions and healthier outcomes.

Click to download an overview of this conversation.

Author Bio

Lab Staff
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