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Alendronate administration — GPhC CRA MCQ

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HardMusculoskeletal TherapeuticsAlendronate administrationGPhC CRA

A transplant patient stable on Prograf twice daily presents a generic prescription for “tacrolimus MR once daily”. The wholesaler offers Advagraf. What should the pharmacist do?

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Correct answer: C — Clarify the intended brand and formulation with the transplant team before supply

Tacrolimus has a narrow therapeutic index, and inadvertent switching between immediate- and prolonged-release products or brands has caused graft rejection and toxicity. MHRA advises prescribing and dispensing oral tacrolimus by brand; an ambiguous generic MR prescription must therefore be clarified with the specialist team. Later monitoring does not make an unplanned switch safe, and frequency changes or alternating products can cause major exposure errors.

Reference: MHRA: oral tacrolimus by brand. https://www.gov.uk/drug-safety-update/oral-tacrolimus-products-reminder-to-prescribe-and-dispense-by-brand-name-only