Expansion
Prescribed, over the counter, herbal, recreational, and the allergy detail
Expansion
What to ask about
- Prescribed medicines, with dose, route, frequency and duration
- Recently stopped or changed medicines, including short courses
- Over the counter medicines, especially non-steroidal anti-inflammatories and proton pump inhibitors
- Herbal and complementary remedies, notably St John’s wort, a potent enzyme inducer
- Recreational drugs, alcohol, tobacco
- Contraception and hormone replacement
- Vaccinations where relevant
- Compliance: do they actually take them, do they know what each is for, are there practical barriers such as packaging, swallowing or cost
- Sources: the patient, the repeat prescription slip, the boxes, the community pharmacy, the general practice record, the dosette box and family
Characterising an allergy
- The drug and the exact reaction
- Timing relative to the dose
- Severity: rash alone, angioedema, bronchospasm, anaphylaxis, Stevens-Johnson syndrome
- Whether the drug has been taken since
- Distinguish allergy from intolerance and from a predictable side effect. Nausea with an opioid and diarrhoea with an antibiotic are not allergies
Why the detail matters: labelled penicillin allergy leads to broader spectrum antibiotics, more Clostridioides difficile, more resistant organisms and worse outcomes, yet fewer than one in ten labelled patients are truly allergic on testing.
Medicines reconciliation at every transfer of care is where most avoidable harm is prevented.