PP+401+-+5

=Patient taking contraceptive pill, doxycycline - has diarrhoea with Xenical=

//Kate is a 26 year old woman who has been coming to your community pharmacy for several years. You know little about her, other than the fact that she is a nurse and often comes into the pharmacy just before closing at 9pm. Her last few months of dispensing history is as follows://

Problem
Possible drug interaction between an antibiotic (doxycycline) and the contraceptive pill Patient has diarrhoea from orlistat (possible problem with contraception?)

= =

Questions to Ask
What symptoms do you have? How long have you been experiencing the diarrhoea? //3 days// Do you know what may have caused the diarrhoea (any recent changes to your diet, new medications)? What medications are you currently taking? //doxycycline for 6 months// Are you currently taking any OTC medications or herbal supplements? //very important as they don't consider orlistat (Xenical) to be a medication// When did you start taking the medication?

What to do
- Counsel that orlistat can lead to diarrhoea when taken with a high fat meal - Could try stopping Xenical for a few days (should not affect weight gain very much) and seeing if it is the cause of the diarrhoea. If it is, you can either continue Xenical and put up with the diarrhoea (counsel to reduce fat in meals) or try another option altogether. - Can suggest use of ORT if there is a moderate-large amount of diarrhoea. - Tell the patient that the diarrhoea from the Xenical may affect the ability of the pill to provide sufficient contraception, when diarrhoea occurs within 3 hours of taking the pill. Additional contraception may be required and the possibility of emergency contraception may be considered if intercourse occured during this time.

Questions asked by the patient

 * Can I take Imodium (**Loperamide**) for the diarrhoea?** Probably not appropriate due to the nature of the diarrhoea (caused by oily stools rather than intestinal spasms). Can give if patient needs to be away from the toilet for half a day or something (business meeting or travel), however otherwise not advised.