GPhC warns pharmacy teams over emerging safety issues

Warnings have been issued to pharmacy teams about emerging safety issues across multiple areas of practice in a letter from the General Pharmaceutical Council (GPhC) .

In an open letter to pharmacists, pharmacy technicians and pharmacy owners, chief pharmacy officer Roz Gittins highlighted specific concerns around:

• dispensing and supplying methotrexate;
• supplying higher risk medicines including propranolol;
• interactions, contraindications and counselling;
• antibiotic stewardship with fluoroquinolones; and
• utilising IT systems to support safe prescribing and dispensing

Methotrexate

The GPhC said it had recently received a concern involving methotrexate dispensed with a label instructing patients to take it once daily rather than once weekly.

The regulator urged pharmacy teams to take particular care when dispensing and supplying high-risk medicines, emphasising the need to counsel and remind patients on once-weekly administration, the specific day of the week for dosing, and the risks of potential overdose.

The GPhC said pharmacy teams should ensure patients receive and understand resources that support safe use, including the 'Methotrexate Information Book' from Specialist Pharmacy Services.

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Propranolol

The GPhC said it was 'saddened to hear of further deaths and harm' resulting from propranolol toxicity.

According to the regulator, pharmacy teams should provide clear counselling highlighting the risks of overdose and when to seek urgent help, discourage stockpiling, and be alert to overdose risk in vulnerable patients or those at risk of self-harm.

They should also consider avoiding supplying large quantities and increasing dispensing frequencies with smaller amounts where appropriate.

The GPhC emphasised the need for pharmacist prescribers to ensure robust safeguards, especially when prescribing remotely, including independently verifying clinical information rather than relying solely on online questionnaires.

Interactions and contraindications

The GPhC said it had received concerns indicating that important interaction checks and contraindications were not being fully considered as part of clinical checks before medicines were supplied.

One example involved the supply of antibiotics through the NHS Pharmacy First service in England to a severely immunocompromised patient taking methotrexate, which can increase the risk of toxicity and myelosuppression.

Another incident involved a patient who was routinely prescribed a long-term medicine and was provided with an antibiotic where an interaction was present.

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'In some cases, such interactions can result in serious patient harm and, rarely, life-threatening outcomes,' the letter said.

While acknowledging that pharmacy teams might not always have access to a patient's complete medication history, the regulator urged them to take all reasonable steps to ensure a safe and appropriate supply, including consultations, checking records where possible, providing counselling, and communicating with other healthcare professionals.

Fluoroquinolones

The GPhC said it had been made aware of instances where fluoroquinolones have been prescribed despite not being the recommended first-line option.

The MHRA issued a drug safety update in January 2024 restricting the use of systemic fluoroquinolone antibiotics to situations where other commonly recommended options are inappropriate.

The regulator urged pharmacy teams to remain vigilant when encountering fluoroquinolone prescriptions, ensuring their use is clinically justified, and providing clear counselling so patients understand the potential risks.

IT systems

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The regulator asked pharmacy owners and superintendent pharmacists to consider how IT systems and prompt functionalities can be utilised to optimise patient care, especially in online settings where automated prompts can alert prescribers to repeated or early ordering of medication.

'We urge pharmacy teams to recognise the importance of these messages and to engage with them thoughtfully, using their professional skills, knowledge, and judgement to ensure IT systems support safe practice, enhance patient care,' Ms Gittins wrote.

The GPhC also reminded pharmacy professionals of the importance of reporting suspected adverse reactions through the MHRA Yellow Card scheme, highlighting that patients can also submit reports themselves.