PP+401+-+1

=Patient with insomnia who has developed tolerance to temazepam = Simon is a regular customer in his early 20’s. He has a history of dropping prescriptions off and picking them up several days later. He often declines to wait even if he is told it won’t take long. His dispensing history for the last 3 months is as follows:

Problem
- Patient refuses to wait for medication (social phobia?) - Drug interaction: Temazepam and Salbutamol (benzodiazepine causing respiratory depression) - Drug interaction: Temazepam and Sertraline (temazepam is used for insomnia, whereas sertraline can cause insomnia) - Has been taking a benzodiazepine for over 2 months (concerns for tolerance and dependence, but frequency of use unknown) - Sertraline at 100mg dose (increasing dose over 50mg produces little benefit) - Asthma situation (need to know about his condition)

Patient requests a product to aid sleeping (Valerian etc.) and you need to figure out that this may be due to tolerance from the benzodiazepine or that sertraline is being used at night time

Questions to Ask
- What are you taking the Valerian for? //sleeping problems// - Have you tried anything else for your sleep? //doctor has put me on temazepam, but it doesn't work anymore// - How often did you take the temazepam? //not very often to begin with, but lately I've been taking it everyday and it doesn't seem to be working anymore// - What other medications are you on at the moment? //sertraline and salbutamol// - What time do you take the sertraline? //at night time//

What to do
- Suggest the patient see the doctor to formulate a benzodiazepine withdrawal plan - If Sertraline was found to have taken at night time, encourage use in the morning to reduce sleeping trouble at night, this may reduce the need for a benzodiazepine to be used everyday

Questions asked by the patient

 * - Can you supply me with the Valerian?** Probably supply, under the condition that this isn't a solution to your sleeping problem, but only to help you sleep for 1-2 days before you see your doctor. Otherwise tolerance could build to the Valerian and this can complicate the benzodiazepine withdrawal plan.

Resources
[|Mental Health Association - Social Phobia]