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Prescription of medication contraindicated in pregnancy (14HDC01058)
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General practitioner ~ Medical centre ~ Practice nurse ~
Medication ~ Hypertension ~ Pregnancy ~ Contraindications ~
Communication ~ information ~ Rights 4(1) and 6(1)
A woman, aged 35 years, was on the statin cholvastin (a
cholesterol reducing medication) and the antidepressant fluoxetine.
The woman saw her general practitioner (GP) to discuss whether she
should recommence taking cilazapril for hypertension. The woman
said that she told the GP she was considering becoming pregnant.
The GP prescribed cilazapril for the woman, which is
contraindicated in pregnancy. The GP did not discuss with the woman
whether the other medications she was on were safe in
Over the following seven months, the woman obtained repeat
prescriptions for fluoxetine, cilazapril and cholvastin from the
medical centre on three occasions, but at no time was her blood
pressure checked. Approximately nine months after she was
prescribed cilazapril, the woman had an appointment with the GP.
During the appointment, the woman advised the GP that she was
pregnant. The GP discussed the woman's diet and exercise. The
medication the woman was taking was not discussed.
A couple of weeks later the woman had her first appointment with
a midwife. During the appointment the midwife called a secondary
obstetrics unit to discuss the woman's medication with an
obstetrician. The obstetrician agreed that the woman should not be
taking cilazapril and cholvastin, and recommended the woman return
to her GP for different prescriptions.
The following day the woman spoke to a nurse at the medical
centre. The RN put an enquiry through to the GP, asking about the
safety of the woman's medications in pregnancy. The GP responded
that the woman should continue taking cholvastin and cilazapril but
should consider coming off fluoxetine. This information was relayed
to the woman. That same week the woman was seen at a secondary
obstetrics unit where she was advised to stop taking cholvastin and
cilazapril. The woman was given a prescription for a blood pressure
medication not contraindicated in pregnancy. The woman continued to
By failing to identify that cilazapril and cholvastin were
contraindicated in pregnancy and ensure that the woman's blood
pressure was monitored appropriately, the GP did not provide
services to the woman with reasonable care and skill, and breached
Right 4(1). Furthermore, a reasonable consumer in the woman's
circumstances would expect to receive information about the risks
and benefits of continuing cilazapril, cholvastin and fluoxetine in
pregnancy. By not providing that information, the GP breached Right
Adverse comment was made about the RN's management of her
telephone conversation with the woman. Adverse comment was also
made about the medical centre's policy on repeat medication, as
well as the communication between the GP and RN.