Prevent Mix-Ups With Starter Pack Rxs

You're on the front lines for preventing errors with "starter packs" (Chantix, Savella, etc).

These packs include different doses of meds needed each day or week...to minimize confusion and side effects when starting a med.

Starter packs are often only meant to be filled one time...before the patient switches to the "maintenance" dose.

For example, Eliquis Starter Pack for treating a clot contains two "wallets"...one for days 1 through 14 and one for days 15 through 30. Both wallets contain 5 mg tabs...but are taken differently.

But recently an Eliquis Starter Pack was refilled for several months...instead of the maintenance Rx. Fortunately, the patient took the correct maintenance dose using the tablets in the starter pack.

Stay alert for starter-pack Rxs with refills. These should usually be written as separate Rxs for the starter pack and maintenance dose.

Put maintenance Rxs on hold until they're needed. Filling them at the same time as starter Rxs could lead to patients doubling up.

Pay close attention when selecting packs. For instance, there are 8 different starter packs for Humira...and 9 for Lamictal.

Help clarify "Use as directed" sigs...to prevent patient confusion and issues with insurers. Document details on the hard copy Rx and in the computer...to avoid charge-backs during an audit.

Double-check days' supply...starter packs often contain an odd number of pills. For example, Xarelto Starter Pack includes 51 tablets for 30 days...Namenda Titration Pak has 49 tablets for 28 days.

Take care where you place Rx and auxiliary labels...to avoid covering up any preprinted instructions or storage info on the package.

Get our chart, Dispensing Dose Packs, for more tips on handling starter packs...and other dose packs, such as Medrol Dosepak.

Key References

  • ISMP Med Safety Alert! Community/Ambul Care 2019;18(8):1-4
  • ISMP Med Safety Alert! Community/Ambul Care 2018;17(9):1-3
  • Aust Prescr 2007;30(1):14-6
Pharmacy Technician's Letter. December 2019, No. 351213



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