July 28, 2009 -- Imagine going to the pharmacy to fill your prescription only to learn later that the drug your doctor prescribed is not the one you received. The prescription was switched without your knowledge or permission.
Not just switched to a generic version of the prescribed drug, but to a different drug altogether.
That is exactly what happened to Amy Detrick, who said her pharmacist switched her epilepsy medication without her permission.
"When you get to that place where your seizures are under control with a dosage that's correct you don't want to mess with it," she said.
Detrick said the switch ended up sending her to the emergency room with a broken leg and fractured eye socket after she had a seizure while riding her bike.
She said the new medication prompted her seizure.
"Had I been behind the wheel of a car, I could've caused an accident. I could've put my car around a telephone pole," Detrick said.
Detrick's neurologist said the pharmacy didn't inform him of the change either.
"Changes in the blood level because they get a different kind of medication can be a big problem. If it gets too high, she feels badly, too low, she has seizures," said Detrick's neurologist, Dr. J. Layne Moore, associate professor of clinical nneurology at the Ohio State University College of Medicine and Public Health.
Yet the practice of swapping out medications is perfectly legal in most states. It's called "therapeutic substitution" and it happens when a patient is switched from to a cheaper medication in the same class of drugs.
Practicing Therapeutic Substitution
The move may be from a name brand to a generic, but it also can be to a different medicine entirely.
Cholesterol-lowering drugs, antidepressants, epilepsy drugs and medicines that reduce stomach acid are switched the most, according to the National Consumers League.
"We believe that if a patient is switched from one drug to another," said Sally Greenberg, executive director of the league, "that it should not be legal unless the patient and the doctor have been informed and are on board with the switch."
The National Consumers League recently conducted a survey and found two out of three people who had their prescriptions switched never were told.
The organization believes pharmacies make the switch to save money.
"Insurance companies absolutely are putting pressure on doctors to switch people. They're putting pressure on pharmacies to switch people," Greenberg said.
America's Health Insurance Plans, an industry group, told "GMA" that patient safety is top priority and insurance companies push for a switch only so medications will be more affordable for patients.
The American Pharmacists Association said prescriptions only should be switched with the doctor's permission and when it's best for the patient.
"Pharmacists do a lot of different things to protect your safety and your health, but I think the patients, too, need to start realizing that, in some cases it's good to ask questions," said Kristen Binaso,senior director of corporate alliances for the American Pharmacists Association.
Detrick agreed and hopes her story will help prevent other dangerous switches.
"I think the first thing they need to do is to be aware," Detrick said. "Do not be afraid to ask questions and seek information."
How to Make Sure You Get the Right Drugs
It is important to know the size, shape, color and strength of any pills you take routinely. If you are starting a new medication, you can see a picture of it in the physician's desk reference on www.pdrhealth.com.
Ask your doctor to write "DAW" on the prescription, which stands for dispense as written.
And have your pharmacist put a note in your records that says you don't want any prescription switched without your approval.
If you've noticed the pharmacy has switched your medication anyway, you need to get your doctor's office on the phone to explain why you need the specific drug that was prescribed.
If it's a name-brand medication that your insurance company won't pay for, you may have to pay out of pocket while your doctor helps you appeal.
Generic vs. Name Brand
The active ingredients in a generic are the same, but the inactive ingredients used to bind the medicine together may be different and some people have a reaction to those ingredients.
Some name brands may have a dozen different generics that come with them and you could get a different one each time unless you ask for the name brand.
Questions to Ask Your Doctor
Here are the top 10 questions you should ask your doctor about your prescription, according to the American Pharmacists Association.
What is the name of medication, and what is it supposed to do?
When and how do I take it?
How long should I take it?
Does this medication contain anything that can cause an allergic reaction?
Should I avoid alcohol, any other medications, foods and/or activities?
Should I expect any side effects?
Is there a generic version of the medication my doctor has prescribed?
What if I forget to take my medication?
Is it safe to become pregnant or to breast-feed while taking this medication?
How should I store and dispose of my medication?
If your prescription is switched, you should ask your pharmacist these questions.
Is this the exact drug my doctor prescribed?
Will this switch affect my health?
Why are you switching my prescription?
Have you notified my doctor of this switch?
Will the new drug work better?
How will I know if it does or doesn't?
Are side effects different from those associated with the original prescription?
How will it interact with other medications or supplements I might be taking?