During a prospective drug utilisation review, a technician processes a new prescription for warfarin 5 mg daily for a patient, Tobias Renner, whose active profile already shows fluconazole 150 mg started three days ago. The dispensing software fires an alert. What is the technician's BEST next step?
- AOverride the alert and dispense, because warfarin and fluconazole are commonly taken together without consequence.
- BCancel the warfarin prescription outright and tell the patient the two medicines cannot be combined.
- CReduce the dispensed warfarin dose to 2.5 mg daily to offset the interaction before labelling.
- DRefer the interaction alert to the pharmacist for clinical review before the prescription is dispensed. Correct
Why A is wrong: This is tempting because many software alerts are low-acuity nuisances, but fluconazole is a potent CYP2C9 inhibitor that raises warfarin levels and bleeding risk, so an unverified override is inappropriate.
Why B is wrong: This feels safe, but cancelling therapy and counselling on the clinical decision exceed a technician's scope and may withhold needed anticoagulation; the pharmacist must make that call.
Why C is wrong: Adjusting the dose seems like a proactive fix, but altering a prescribed dose is prescribing, which a technician cannot do, and the magnitude of any change is a clinical decision for the pharmacist or prescriber.
Why D is correct: A flagged major interaction during prospective DUR requires the pharmacist's clinical judgement on whether to dispense, adjust monitoring, or contact the prescriber; the technician escalates rather than resolves it.