One of your patients, 67-year-old Mark, has been recently diagnosed with congestive heart failure and takes several medications. One of his medicines is furosemide for fluid retention. Mark is aware the medication helps to get rid of excess water in his body but is complaining that since he started the medication he is suffering from adverse effects. Mark says the worst side effect is being kept awake at night, as he constantly needs to go the toilet to urinate. His lack of sleep is quite detrimental to his general well-being.

Upon questioning, Mark is taking the furosemide each morning at the correct dose. Today, Mark tells you he does not want to continue taking the furosemide and does not want the repeat prescription filled. When you express your concerns, he requests that you do not contact his doctor about his lack of compliance, as he feels his doctor “doesn’t understand”. You tell Mark that you will respect his privacy and not contact his doctor. During the discussion with Mark, he is breathless although he is sitting down (‘short of breath at rest’) and when he is leaving the pharmacy you notice his lower legs are severely swollen. You have significant concerns about his apparently worsening heart failure.