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A general practitioner in Scotland (John S Millar.British Journal of General Practice2001;51:570) has told a story which will attract widespread sympathy and cries of “Well, you can't win, can you?”
A man with a chest infection was given a prescription for erythromycin capsules. He pointed out that he had a history of allergy to aspirin and was told that the capsules were safe in that there was no cross-sensitivity between aspirin and erythromycin. Soon after taking the capsules, however, he developed tingling and swelling of his fingers and feet, the same symptoms he had had with aspirin. On reading the patient information leaflet included with the erythromycin capsules the patient's wife discovered a warning to the effect that the capsules contained the colouring agent E110 which could cause allergic reactions, particularly in people allergic to aspirin. Despite the general practitioner's attempts at mollification a formal complaint ensued.
The general practitioner points out that it is difficult for doctors to gain access to the information given in the patient information leaflet since standard sources such as the British National Formulary or the Pharmaceutical Data Sheet Compendium do not mention the problem of E110 in the erythromycin capsules and allergy to aspirin. The information provided about excipients in standard professional sources and patient information sheets is often incomplete. For instance, although the data sheet accompanying the erythromycin capsules warned about E110 it did not warn about another excipient, E104, which is known to cause urticaria in some people. There are nearly 200 licensed medicines containing E110 and, to date, the Committee on Safety of Medicines and the Medicines Control Agency have received some 20 reports of suspected adverse reactions to it. Where the information about cross-sensitivity with aspirin comes from is not stated.
It is clearly impossible for doctors to keep up with all this information in printed form; presumably the answer lies with the computer and in making sure that all relevant information is made available.
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