If I make a complaint about my GP refusing to prescribe medication

[Sconesandgravy]

My neurologist asked the GP to prescribe a medication to help with a medical condition. The medication is one can cause birth defects. I spoke to the pharmacist this morning who called to say she was putting the request through to the GP. The pharmacist messaged that afternoon to say the GP has refused to prescribe unless I go on hormonal contraception or the copper coil. He has claimed that guidelines say he can't prescribe if I refuse the above types of contraception.

I want to complain about this for several reasons:

• My husband is completely infertile. He had multiple samples of testicular tissue biopsied and it was confirmed he has a condition that means his sperm count will always be 0. The only way I'm getting pregnant is with a sperm donor. I obviously can't do this by accident. The pharmacist made the GP aware of this because she called me this morning and said contraception is recommended, so I said I'm not on contraception and disclosed about my husband.

• I checked the guidelines myself. NICE guidelines state the need for effective contraception must be expressed. The BNF says effective contraception must be advised. On gov.uk there is a 2022 safety review of the medication that states health care practitioners "should fully inform the patients of the risks and advise them of the need to use highly effective contraception". Nowhere specifies what contraception should be used, and none of the above bodies specify that medication should not be prescribed if long term contraception is refused. The only thing I can find is that alternative medications can be offered if the medication is long term and the patient doesn't want to use any form of contraception.

• Condoms and abstinence are also effective forms of contraception. If I were a man these would be recommended as they're the only available form of effective male contraception. It seems discriminatory to suddenly decide they're not considered effective contraception just because I have a vagina.

• I'm an adult with full capacity. I have the right to make an informed decision about what I put into my body.

In all honesty it just feels a bit like the GP has refused my prescription and intentionally given me misinformation about the guidelines to try and coerce me into going onto a contraceptive that he deems the most effective, rather than allowing me to make an informed decision based on my own personal circumstances. I know this is dramatic and I won't put that in my complaint but I just needed to get that thought out of my system

AIBU if I complain?

That's incredibly sad, but not relevent to me as it's not the medication he's been asked to prescribe me

I'm glad you disagree, but equally all guidance for topiramate says I must be informed of the risks and strongly advised to use effective contraception.

I haven't been informed of the risks, I haven't had any conversation other than "the risk is too high as it can harm foetus'".
Other than that been told my husband being infertile doesn't reduce risk as I could have an affair. Oh and that it's still too risky, even though my husband has spina bifida himself, and I support him and care for him when he's unwell.

Other people seem to be prescribed it fine, and have reasonable conversations with their GPs. Mine just seems to think I should be allowed to suffer because if I have a uterus I'm clearly going to sleep with any man that moves.

And to be honest, even if the guidance or the law said I must be on contraception, it is utterly unacceptable to tell someone who has just disclosed their husband is infertile that they could sleep with another man.

Going on the pill will help stop the migraines if the are linked to your hormones.
Cerelle & topiramate are a good combination for migraine and stop the risk of pregnancy so allowing the topiramate to be prescribed - I did this and the migraines reduced dramatically 🙂
Good luck (we also were infertile but just tick that box)

Unfortunately I can't take Cerelle - or any other progesterone only pills. Or the implant, or the depo injection for some reason progesterone only medications administered in those ways make me bleed constantly. I was advised by the gynaecologist not to use them. She also advised not to have the copper coil due to the risk of heavier periods, as I struggle with anaemia

My BMI is over 30, so I would need a medical assessment before being prescribed a combined pill due to the risk of clots.

I can just about tolerate the mirena coil, although I felt so much better mood wise after it was out, and managed to lose weight. That's by the by though because even if I was willing to go on it, the GP says it's not effective enough.

The above is half my annoyance and part of my reason for making a complaint. I don't think it's good practice to agree to prescribe, or insert things without seeing the patient or at least checking their medical history. All of the above is clearly detailed in my records.

I recognise the risks to a foetus have to be taken into account. But putting everything about my husband to the side, I've been left feeling like my health doesn't matter because the GP didn't even look at my own medical history, and was going to prescribe a pill that would either make me bleed heavily every day, or potentially give me blood clots. A foetus that may never exist shouldn't have more rights to safety than the adult who is alive and breathing.

I complained yesterday.
I complained about:

• The lack of direct communication
• The insensitive comments about infertility
• The fact it's detailed in my records that a gynaecologist previously advised against the coil and one type of pill he previously "approved" due to the way I react to it and guidance advises against the other due to my high BMI and the risk of clots.

-that the GP would only consider alternatives if they could look at my husband's records to prove he's infertile. But wouldn't look at my records or consider alternative options due to the documented risks of adverse effects in my medical records.

• The fact that throughout the entire situation, I was left feeling like the only thing anyone was bothered about were risks to a foetus that will likely never exist. Risks to me were completely overlooked.

It's being investigated and the complaints manager is going to go through the recorded phone calls so she can listen to the full interaction and act accordingly.

I'm going to stop following this thread now as the complaint is made and I can't take it back, and wouldn't if I could.

I've just been reading through and couldn't see if anyone has actually told you that the whilst Toperamite for prevention of migraines is actually contraindicated for use unless the patient is on an effective contraceptive.

"For migraine prophylaxis, topiramate is contraindicated in pregnancy and in women of childbearing potential if not using a highly effective method of contraception. As such, topiramate should not be prescribed for migraine prevention in a patient who is pregnant."
You can read about the drug safety update here:
https://www.gov.uk/drug-safety-update/topiramate-topamax-start-of-safety-review-triggered-by-a-study-reporting-an-increased-risk-of-neurodevelopmental-disabilities-in-children-with-prenatal-exposure

So in your situation it could potentially be prescribed to you without a contraceptive/informed shared decision if it was for treatment of seizures, but not for migraines. The GPs solution of reviewing your partners records to confirm that the risk of pregnancy is nil or of a similar low risk to using an effective contraception sounds like a sound sensible/defendable decision making and by refusing this (as is your partners right) then you'll have to manage without the medication as you have done so far.

Of course it sounds like this hasn't been properly communicated to you/not done so very well and quite bizarre that they've not just booked an appointment/call to discuss this with you directly.

I have been on Topiramate since I was about 20 (I’m 31 now) and the only break I’ve had is whilst pregnant and a short time after giving birth.
Medical professionals were well aware before me getting pregnant as I had to be under specialists for another condition.

When I was put back on the topiramate after having my son it wasn’t under any conditions of having to go on contraception. I have the depo injection now but that is for endometriosis management.

I understand the GP being careful but you seem well aware of the risks. I would complain, you shouldn’t have to jump through unnecessary hoops for your meds.

• Leafbuds Is it fexofenadine? That used to be prescription only but you can now buy lower doses over the counter.

Yes it is, I tried the lower dosage and it didn't help at all. My symptoms are so bad I end up on the prescription dose of fexofenadine, prescription creams, inhalers, montelukast tablets and at least one course of steroids to control the symptoms. I do buy the other stuff like sprays and eye drops otc. It's purely the fexofenadine that was put on my records*

In that case, you can still buy it over the counter, you just take a higher dose than stated on the box

(Just for future reference if you're in the same position)