For many of the nnrsing home patients for whom an ACE inhibitor was indicated
becanse of their high blood pressure, Monopril/fosinopril was not the "drng of choice." Among
its many adverse side effects, Monopril tends to increase liver function impairment when
compared to other ACE inhibitors. Monopril also has a very high phannokinetic protein binding
rate; therefore, if a patient was, for example, anemic, Monopril was not the "drng of choice." If
a patient had certain heart conditions (such as a heart attack), and was suffering from congestive
ventricular dysfunetion, captopril and trandolapril, not Monopril, were specifically indicated.
During Lisitza's tenure at Omnicare, the Omnicare computer-based pharmacy
system was designed in such a way that it was tillable to flag patients with a medical history
indicating that Monopril was not a preferred medication.
Omnicare compounded these serious complications by failing to monitor the care
of the nursing home patients victimized by the switch. Hence, an Omnicare pharmacist would
not know that a patient was anemic and for his or her health and safety should be switched from
Monopril to another more effective or appropriate ACE inhibitor (or maintained on the originally
impact, the unlawful Market Share Agreements resulted in such patients failing to receive the
physicians, ostensibly the gatekeepers when it comes to prescribing medications, into signing
PALs thinking Omnicare would exercise due diligence to "catch" those instances where a switch
was medically problematic. This did not happen, and elderly patients were put at risk.