Removing the wool

well what about your patient’s that still want the hydrodiuril. i had one of them today. if she was asthmatic she’d be all over xopenex. the funny thing is that her prescription still says HCTZ, she just wants me to tell her it’s different.

you had a lot of problems with ranbaxy lately? i know the FDA shit, but now customers are asking for accutane which not only fucks up insurance, it guarantees a 30 minute reversal on ipledge
dm

You forgot about PEXEVA - the
newest, brightest in the paroxetine clan–paroxetine mesylate! So it would be the rep from Noven Therapeutics that the doc’s head is buried in……

This is another post all together.
Paroxetine HCl (Paxil) ====> Paroxetine Mesylate (Pexeva)
Zolpidem HCl (Ambien) ====> Zolpidem HCl (Ambien CR)
Venlafaxine (Effexor) 2-3/day ====> Venlafaxine (Effexor XR) 1/day
Metoprolol Tartrate (Lopressor) 2/day ====> Metoprolol Succinate (Toprol XL) 1/day

The latter two, I can understand. Less doses per day could increase compliance. But, going from once per day to once per day, especially in a long half-life drug like paroxetine just stumps me…

“Citalopram (Celexa) is a racemic mixture. Only the Dextro isomer is active….the inactive isomer has been removed. Escitalopram (Lexapro)…”

Don’t you mean only the Levo (S) isomer is active? If D is the only active enantiomer, then Lexapro would not have been called escitalopram (named for the inactive S isomer)…am I missing something?

R and S are different from D and L. R can be D or L. S can also be D or L.
Citalopram = 1-[3- (dimethylamino)propyl]-1-(4-fluorophenyl) -1,3-dihydro[3,4] benzofuran-5-carbonitrile
Escitalopram = S-(+)-1- [3-(dimethylamino)propyl]-1- (p-fluorophenyl)-5- phthalancarbonitrileoxalate

So, for this molecule, S is dextrorotatory and R is levorotatory.

today i had a sensible patient who was willing to listen. i told her to forget about the PA for Xyzal and to go to Costco and buy herself some shitload of citerizine for 20 bucks, i could have sold her my store brand, but i thought it was a rip off (30 tab/~$12).

“He’s too busy with his head buried in some drug rep’s tits….”

…you’re just jealous…. and so am I ;)

Had to argue with my MD to get a RX for Gabapentin instead of Lyrica.

All I want to say is AMEN.

Patients bitching about copays or insurance won’t pay for it, and all pharmacists have seemed to become (at times) is the complaint department for the insurance company!!

The docs don’t understand, we KNOW this. Even when I was working in hospital, you tell the doc we don’t have something on formulary (IE Desvenlafaxine) and what the formulary alternative is (Venlafaxine) and they have a fit or “BUT the patient is on THIS you can’t just SWITCH them”

Um, why not
you’re a doc, just write the damned order.

Hilarious insight but unfortunately true. I wonder if the drug companies are paying for the breast implants? LOL

What is a “fill-call”?

Fill it as if there is a refill or the change is okay and call the doctor the next business day….Rather than front a few tablets to a patient, I sometimes do that. If the doc says no or changes it, I’m out a few bucks. I’d never do it on a narc or drug that is relatively new or frequently titrated.

Also a necessary evil on drugs that cannot be ‘fronted’ like an albuterol inhaler.

Good points…in my small critical access hospital I had a rather new nurse ask me the other day why we didn’t carry such and such on the formulary, so I briefly touched on the whole rigamarole about containment of costs, availability of various drugs, i.e. formulary concept. She seemed to be nodding her head in the right places at the explanation, but then I wondered if she ‘got’ it when she said, ‘but the docs used to be able to get whatever they wanted when they ordered it, right?’ (Yea, and they used to be able to write ‘Do not label’ on scripts, and just how many drugs were available back then?) Generally, I’m under the impression that MDs graduating in last 20 yrs ‘get’ it, unless they learned their art under a toadstool.

So when the new laws go into place about the drug reps not being able to give shit out (pity, I got into Pharmacy was for the pens…)
Think that will stop the drug reps?

No. They’ll find a loophole…a way around…

Don’t forget about Veramyst (Flutiscasone) and generic Flonase (fluticasone). Veramyst is not on many pbm’s formulary’s and yet generic flonase is overlooked for the more common rhinocort, nasacort aq, veramyst, etc. Wake up people!!! Oh and who did nasacort aq have to sleep with to get on medicaids formulary?

Absolutey AMEN
I have never dispensed that Xyzal crap (amazing how the $50 copay make patients believe me when I point to the $6 store brand Zyrtec) I also have a whole little “patient friendly” speech, involving left and right hands and gloves, to explain to people why they are getting screwed. Tinker toys work too.
What I don’t get is why don’t the MD’s understand the concept. When I took Organic chemistry and learned about enantiomers, the rest of the class was almost exclusively pre-med. Why do I still have to pull out my gloves when I try to explain this to a prescriber! It should at least sound familiar when I use words like racemic and isomer.

Hey! I got a black message :) Try again….

“He’s too busy with his head buried in some drug rep’s tits “… you’re just jealous….

…and so am I ;)

I couldn’t agree more. I’m glad you picked Forest as your example; that company makes me angry. I had one of their reps come in one day and push Lexapro as being vastly superior to generic citalopram. He basically answered all my questions with “well, some studies have shown Lexapro is better. Also, the FDA approved it for generalized anxiety disorder.”

I’m sure they could get citalopram indicated for GAD, too, if there were any money in it.

The rep also decided to start talking about Namenda and the apparently overwhelming amount of evidence for giving every patient who might possibly be developing Alzheimer’s Namenda because “why take the risk?” I dunno, dropping another $200 a month to “maybe possibly slow down just a little bit” the development of Alzheimer’s may or may not be everyone’s cup of tea.

O Great One, I am but a pharmacy student to petition your wisdom on a similar matter. Does Trexima and Imitrex have the same situation as this?

Treximet = 85mg Sumatriptan, 500mg Naproxen (Aleve, essentially)
Imitrex = 25mg, 50mg, or 100mg Sumatriptan (Or equivalent Injection/Nasal Spray)

Yes, my dear, they are the same drug. Consider the costs. Aleve is a dirt cheap
drug, available over the counter. Should we really be charging buttloads of money to
add that to the Drug of Choice for migraines? More importantly, don’t most migraine
suffers try the OTC treatments like Aleve, Advil, and Excedrin before they seek help
from a physician and get prescribed Imitrex, Maxalt, etc? Of course they do.

If you knew the first thing about drug metabolism, you would know that in many racemic mixtures, the inactive enantiomer is converted to the active form by the liver. Several types of long acting medications, such a pain relievers, use such a system. The active enantiomer goes to work right away, while the liver more slowly converts the inactive to prolong the effect.

Ohh yes — If I knew anything. Why did you feel the need to use such a bitch fucking tone? I don’t get why people have such a wild hair to be pricks in their comments on the internet. You could have worded that SO much better — to not seem like an asshole.

Okay. Let’s go. Tramadol converted by the liver to the M metabolite which is a weak opioid. Now, you name the rest smartass.

Good article. I may also point out that Xyzal is backwards for “Lazy”X… the drug companies know what they are doing and are snotty enough to put it right into the product naming.

Never saw it…wow…