Table 6.

Adverse events following rejection of pharmacist’s recommendations

High-risk medicine(s)	Pharmacist recommendation	Outcome	Pharmacist preventable?
Age >60 + TCA	Stop/reduce TCA	Fall. Medication considered to be a factor	Yes
Age >60 + TCA	Stop/reduce TCA	Fall. Medication considered to be a factor	Yes
Warfarin + antiplatelet	Review need for combination	Gastric ulcer	Yes
Age >60 + TCA	Stop/reduce TCA	Confusion attributed to TCA	Yes
Triple whammy	Stop NSAID	High INR attributed to NSAID	Yes
Age >60 + benzodiazepine	Stop/reduce benzodiazepine	Day-time drowsiness and headache attributed to benzodiazepine	Yes
Age >60 + hypnotic	Stop/reduce hypnotic	Road traffic accident due to next-day drowsiness	Yes
Age >60 + TCA	Stop/reduce TCA	Fall attributed to TCA. Hospital admission	Yes
Triple whammy	Stop NSAID	Reflux due to NSAID	Yes
Age >60 + multiple antihypertensives	Consider reduction of antihypertensives	Decreased renal function requiring antihypertensive to be stopped	Yes
Age >60 + multiple antihypertensives	Consider reduction of antihypertensives	Low blood pressure	Yes
Age >60 + multiple antihypertensives	Consider reduction of antihypertensives	Falls and low blood pressure	Yes
Age >60 + antipsychotic + TCA + anticholinergics	Stop/reduce TCA	Fall. Medication considered to be a factor. Hospital admission	Yes
Age >75 + PPI no gastroprotection	Start PPI	Gastrointestinal bleeding requiring NSAID to be stopped	Yes
Age >60 + hypnotic +TCA	Stop/reduce hypnotic and TCA	Fall. Medication considered to be a factor	Yes
Age >60 + antipsychotic	Stop/reduce antipsychotic	Fall. Medication considered to be a factor	Yes
Triple whammy and NSAID in reduced renal function	Stop NSAID	Gastrointestinal side effects requiring NSAID to be stopped	Yes
Age >60 + benzodiazepine + TCA	Stop/reduce benzodiazepine and TCA	Falls and confusion attributed to medication	Yes
Age >60 + hypnotic	Stop/reduce hypnotic	Drowsiness	Yes
Age >60 + hypnotic	Stop/reduce hypnotic	Fall. Medication considered to be a factor. Hospital admission	Yes
Age >60 + multiple antihypertensives	Consider reduction of antihypertensives	Fall. Medication considered to be a factor	Yes
Age >60 + multiple antihypertensives	Consider reduction of antihypertensives	Oedema due to amlodipine requiring dose reduction	No

INR international normalised ratio, NSAID non-steroidal anti-inflammatory drug, PPI proton pump inhibitor, TCA tricyclic antidepressant