The Patient

A 62-year-old male patient calls the pharmacy to ascertain pertinent information about his new medication for his chronic inflammatory skin condition (Hidradenitis suppurativa). The physician prescribed adalimumab, to be started per the dosing regimen.

His current medication includes:

  • adalimumab: new start weekly 40 mg/0.4 ml dose option
  • metformin 1000 mg daily (anti-diabetic)
  • insulin 40 units at bedtime
  • lisinopril 20 mg daily (ACE inhibitor)
  • hydrochlorothiazide 25 mg daily (diuretic)
  • statin 40 mg at bedtime
  • pregabalin 100 mg three times daily
  • ibuprofen 400 mg every 4 to 6 hours as needed for pain
  • acetaminophen 650 mg every 4 to 6 hours as needed for pain
  • oxycodone 15 mg every 4 to 6 hours as needed for severe pain

This patient contacted the pharmacy after years of hesitation in starting a new biologic medication for his hidradenitis suppurativa, which he stated was diagnosed about 3 years ago. The patient informed the pharmacy that he had postponed taking the medication due some adverse events experienced by some of his friends and family members on the same drug, including one who took the medication for ulcerative colitis.

Over the past year, the patient experienced an increase in very painful abscesses and nodules around different areas of his body (armpits, groin, and buttocks). He shared that his abscess legions had been draining fluid and emitting a very foul order, which was hard for his family to deal with. His symptoms had gotten worse overall and he decided to get his condition under better control. He hopes to start adalimumab and, in turn, perhaps cut down on some of his daily pain medications.

The Consult

I went over the new medication with the patient in detail to clarify how it would help treat his skin condition. I explained that Hidradenitis suppurativa produces an overabundance of an inflammatory protein called TNF alpha and that the inflammation and lesions on his body were the result of these processes. I explained the mechanism of how adalimumab would actually target his condition by blocking the TNF alpha protein, which is thought to contribute to the detrimental inflammatory effects that are seen in individuals with the condition.

The dosing regimen for hidradenitis suppurativa is:

  • Day 1: 2 x 80 mg pens (total 160 mg)/ or 1 pen (80 mg) each consecutive day for 2 days total
  • Day 15: 1 x 80 mg pen
  • Day 29: 1 x 80 mg pen every other week, or 40 mg pen weekly

I demonstrated administration of the biologic injectable pen, advising the patient not to inject the pen into skin that is sore, bruised, or scarred. (Proper injection sites include the front of the thighs and abdomen, and it is important to rotate the injection site.) I also reviewed common side effects to watch for, such as injection site reactions, rash, headache and infection.

Finally, I informed the patient that the medication would be helpful for his chronic inflammatory skin condition and to reach out to his primary care provider and our pharmacy team for any other inquiries regarding this new medication therapy.

The scenario described above is a common encounter among community pharmacists. One of our primary jobs is to disseminate drug information to patients in ways that will be easy for them to process. We take complex medication concepts and break it down in order for the patient to get optimal understanding of the medication therapy they have to take for their chronic condition.

PPM Survey on New Prescription Counseling

It is worth noting that PPM polled its clinician audience, asking: How much time do you typically spend educating a patient about a new prescription?

  • 20% said 6 to 10 minutes
  • 16% said 3 to 5 minutes
  • 19% said 1 to 2 minutes
  • 45% said they leave it to the pharmacist

As pharmacists, we have to make sure that we take the time to properly counsel our patients and ensure that they feel comfortable to better manage their chronic condition.