Hello! Interesting, niche, question from one of our safety-minded outpatient pharmacists regarding the medication Trikafta (elexacaftor, tezacaftor, ivacaftor) for management of CF.

Curious if anyone else has come up with a solution to safely / accurately prescribe and document this medication when dose adjustments are indicated.

This med is supplied as 2 separate products packaged together in a blister card package containing 21 tablets: elexacafter/tezacaftor/ivacaftor (orange capsule-shaped tablet) in fixed-dose combination and ivacaftor (blue capsule-shaped tablets)

Since retail pharmacies likely end up needing to dispense the full blister card package…. when dosing is modified to omit tablets or adjust dosing frequency, prescribers are running into hiccups with dispensing pharmacies / insurance providers leading to potentially inaccurate administration instructions / med lists in the name of simplifying prescribing. (i.e., prescribing the full blister package and capturing dosing recommendations / changes just in notes) (also potential for inaccuracies during med reconciliation, in and out of hospital, etc.)

Curious if others have any experience with this issue and have identified any recommendations around prescribing approach. Or if there is concern about the packaging being inflexible.

thanks in advance!
Emily