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Old 08-22-2008, 04:20 PM   #1
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How long [on average] does it take for your body to get used to a new dose?

A few questions tied to my thread on generics [I also just curious and am thinking about an increase in meds that I don't think will be helpful] Since generics, in theory, can vary by as much as 40% [OTH, I doubt many generic manufacturers are putting *more* medication in their generic product than the brand manufacturer, so it's probably not more than a 20% difference - I defer to the resident experts on this though -Ex, for ex.), I'm wondering how long it takes for most people [I realize it's individual and will vary somewhat from person to person] to "get used to" a higher dose. Some people have mentioned that they experience withdrawal when they switch to a poorer quality generic - With high doses, I assume the effect is even more significant.

So, my question is, if you switch to a "better" generic [or even a higher dose of the same med], how quickly does your body get used to the new dose? Is it a matter of days, weeks, or months? Is the adjustment time related to the amount of increase or is it independent of this?

I'm also curious because my doctor has talked about trying a relatively small increase in one of my medications, but I don't think this increase will make any difference b/c I don't have a very good response to the medication. I'm willing to try it, but would prefer not to go up [permanently] if it isn't going to make a difference. Would it work to try going up for two weeks and then return to the previous dose if it didn't make any difference in the pain level?

The question also applies to changing generic brands. What, if any kind of time window is there for returning to a previous dose [or a previous generic that is lower quality] without going through a withdrawal? If you switch to a better quality generic but it's only available at one store, are you risking withdrawal if you have to switch pharmacies and generics, or if the store changes it's policy?]

I imagine there is a relationship between the amt. of time, the % increase in your dose, and the duration and strength of any withdrawal [on average].

I realize these are somewhat complicated questions - if anyone knows from experience or reading how quickly the body acclimates to a higher dose, I would be interested in knowing. Also curious if there is substantial individual variability. Thanks.

Last edited by Confused089; 08-22-2008 at 04:22 PM.

 
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Old 08-22-2008, 06:56 PM   #2
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Confused089 View Post
Since generics, in theory, can vary by as much as 40% [OTH, I doubt many generic manufacturers are putting *more* medication in their generic product than the brand manufacturer, so it's probably not more than a 20% difference - I defer to the resident experts on this though -Ex, for ex.)
Yes, technically speaking there could be that big a spread, but in reality, it's probably not more than 20% as you say. Putting less med in a pill, patch, or whatever, cuts cost for the generic company, and that's their objective. Adding med would push their profit equation in the wrong direction. It's my experience that most generic companies are going to take advantage of the difference. For those brand companies that make the generics, it's almost a 100% certain because they can "protect" the brand by ensuring a measurable difference (to the consumer).


Quote:
I'm wondering how long it takes for most people [I realize it's individual and will vary somewhat from person to person] to "get used to" a higher dose. Some people have mentioned that they experience withdrawal when they switch to a poorer quality generic - With high doses, I assume the effect is even more significant.
Unfortunately, this is almost impossible to answer. It does vary greatly person to person, and it also depends on the base strength of the med, the dose increase, and the length of time taking that med, and others.


Quote:
The question also applies to changing generic brands. What, if any kind of time window is there for returning to a previous dose [or a previous generic that is lower quality] without going through a withdrawal? If you switch to a better quality generic but it's only available at one store, are you risking withdrawal if you have to switch pharmacies and generics, or if the store changes it's policy?]
I think one would be more likely to have issues with dose decreases than increase....For example, a 10% could result in a lot of discomfort while a 10% would be noticed, but not to the same extent.

Quote:
I realize these are somewhat complicated questions - if anyone knows from experience or reading how quickly the body acclimates to a higher dose, I would be interested in knowing. Also curious if there is substantial individual variability. Thanks.
Yes, it is complicated...I think it's highly dependent of the med and the person. For example, it may not take much time to get used to a higer dose of Lortab, but with the patch, a dose increase could take 2-3 weeks, or more.

Regards,

Ex

Last edited by Executor; 08-22-2008 at 06:57 PM.

 
Old 08-22-2008, 08:01 PM   #3
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Executor View Post
Yes, technically speaking there could be that big a spread, but in reality, it's probably not more than 20% as you say. Putting less med in a pill, patch, or whatever, cuts cost for the generic company, and that's their objective. Adding med would push their profit equation in the wrong direction. It's my experience that most generic companies are going to take advantage of the difference. For those brand companies that make the generics, it's almost a 100% certain because they can "protect" the brand by ensuring a measurable difference (to the consumer). Ex
Yes, realize it is all profit driven, which has made me wonder a bit about how companies like Watson survive - you pointed out that large chains can cut deals with companies like Watson b/c of their ability to buy in quantity - I assume that the deal would have to bring the price down pretty close to the cost of the lower generics. Unfortunately, I don't think most consumers are aware of the differences between generics or generics and brand [and, honestly, for most meds, might not really care even if they did know] and as a result, don't exercise enough 'consumer' power to influence prescription drug buying policies - i.e. if a sufficient proportion of prescription customers took their business elsewhere if their pharmacy didn't stock their preferred generic, it would be far easier to get 'quality' generics. I suspect that a very small percentage of customers consider or shop by the type of generic - if they can't "feel" or "see" the difference [in lab tests, etc.], it's unlikely to influence behavior [and they would have to know about the differences as well . . . ]. Knocks it down to a very small number . . .

Hmm, realize I missed a key sentence - "For those brand companies that make the generics, it almost 100% certain because they can "protect" the brand by ensuring a measurable difference." I'm not entirely sure what you meant here - I understand that the brand is protected - were you talking about protecting a generic version made by a brand company? I'm a little confused. It seems like you do think that there is consumer buying power [and I agree that brand name makes a big difference - we wouldn't have an advertising industry if it didn't] but I'm not sure if you're saying that consumers generally notice the difference between generics (and thus influence purchasing decisions].

Quote:
Originally Posted by Executor View Post
Unfortunately, this is almost impossible to answer. It does vary greatly person to person, and it also depends on the base strength of the med, the dose increase, and the length of time taking that med, and others. Ex
Yes, know I have posed a difficult question - especially since the tendency is to go up, not down - at least for CPP patients. I'm guessing that even on the variables you mentioned (and I know there are others [the % of the total dose the increase represents, whether or not the total is comprised of one med or more, the individual's metabolism...etc.etc.], it's hard to say how influential they are...if I were going to hazard a guess here, I would say that the greater the increase, the smaller the time window and that if you've been taking the med for a while, the window is also likely to be smaller [this last guess is more instinct than anything else - I'm thinking the receptor is probably "primed" in some way for the med and locks on to it more quickly - but that is just a guess. Still, wondering about average tendencies - even with multiple variables, averages and means say *something,* tho I suppose they say very little if the standard deviation is high.

Quote:
Originally Posted by Executor View Post
I think one would be more likely to have issues with dose decreases than increase....For example, a 10% [decrease] could result in a lot of discomfort while a 10% [increase] would be noticed, but not to the same extent.Ex
(I added a couple missing words here - hope I got it right.)

I agree - a small increase may not even hit the radar, but going the other direction is another story.

Quote:
Originally Posted by Executor View Post
Yes, it is complicated...I think it's highly dependent of the med and the person. For example, it may not take much time to get used to a higer dose of Lortab, but with the patch, a dose increase could take 2-3 weeks, or more.Ex
I'm curious about this last conjecture. I assume you've hazarded a guess here and am trying to understand your reasoning, or if you might be talking about the topic more broadly. Do you think lortab might be faster b/c it's a SA med and tolerance rises more quickly, and/or were you thinking about the length of time it takes to ready a steady state on the patch? By a "dose increase" here, do you mean adjustment to the increase, or the ability to return to the original dose? I'm thinking you're talking about the time to adjust to the increase - I'm guessing this is different.

I'm thinking about the generic issue at the moment, and how it could tie you to a particular pharmacy if you wound up getting one of the better brands. Not a problem if the pharmacy is highly committed and you don't expect to move, but getting a better generic is tantamount to a dose increase that you don't have quite as much control over....[unless, of course, you can afford brand].

Still hoping that others will contribute experiences, thoughts and hazard guesses on this in spite of the difficulty of the question. . . Thanks for weighing in on this and the prescription drug thread, Ex.

Last edited by Confused089; 08-22-2008 at 08:50 PM.

 
Old 08-22-2008, 09:17 PM   #4
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Re: How long [on average] does it take for your body to get used to a new dose?

Confused,

I thoroughly believe that each person has to assess their med regimine on an individual basis. There are way too many unknowns and differences from person to person and I don't believe that any two people have the exact same experience with the exact same meds. I really don't see how they could, unless they were the same height and weight, had the same exact metabolism, lived in the exact same environment, ate the same foods, etc.

I know that over the years, I've learned quite a bit about my pain and how my body responds to it. I've also learned a lot about how my body responds to the specific meds that I've taken.

I generally try to give any new meds or any increases in dose, at least 60 days. This gives me an opportunity to assess how the meds are working (or not) in pretty much any given situation. If the change is not allowing me to function at the same level that I was, at the height of the last successful dose or regimine, then I know it either isn't the right dose or the right med.

Also, if a specific med has been known to take a certain amount of time to reach it's full potential, I will give it the suggested or recommended time, before I make any decisions or judgements.

As far as the percentage of increase....... I've had some small increases with certain meds, that made a significant difference (for the better), but I've also had larger increases of some meds do absolutely nothing. So, again, it's more about the person themselves and the specific med. It has certainly made me understand why PM docs have such a difficult job. There is no real consistancy from patient to patient.

I don't know if this is helpful or not. I'm not as well versed in the statistical part of meds and PM, but thought I'd give my perspective. Take care and good luck with your decisions. CMP/MM

Last edited by cmpgirl; 08-22-2008 at 11:25 PM. Reason: sp

 
Old 08-22-2008, 10:22 PM   #5
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Confused089 View Post
I suspect that a very small percentage of customers consider or shop by the type of generic - if they can't "feel" or "see" the difference [in lab tests, etc.], it's unlikely to influence behavior [and they would have to know about the differences as well . . . ]. Knocks it down to a very small number . . .
The thing we have to remember here is that difference between generics and brands is perhaps much more of an issue with pain meds for the obvious reasons....Thus, we will shop around for certain brands or generics. For most other med classes, any generic will do just fine...And consumers aren't going to go to the length to research the differences like we do. Obviously, when it comes to transplant meds or other really critical meds, the "brands" are a must.....But, pain mgt folks will "feel" the differences more so than other categories.

Quote:
"For those brand companies that make the generics, it almost 100% certain because they can "protect" the brand by ensuring a measurable difference." I'm not entirely sure what you meant here - I understand that the brand is protected - were you talking about protecting a generic version made by a brand company? I'm a little confused.
Yes, that's what I mean. Say for example I'm brand A and I make branded widgets. Those widgets are made to high specifications. However, the same company also makes off brand widgets. These widgets work ok, but aren't nearly the quality of the branded widgets...They look a tad different, they work differently, they don't last as long, & etc. Because company A makes both, they can ensure that they protect the branded product by making sure there are differences between the two. As a branded company, you don't want to de-value your branded product. If they made the off brand / generic widget as good or almost as good as the brand, no one would pay the premium for the branded product.

Quote:
I added a couple missing words here - hope I got it right.

I agree - a small increase may not even hit the radar, but going the other direction is another story.
Yes...Sorry for any confusion.


Quote:
I'm curious about this last conjecture. I assume you've hazarded a guess here and am trying to understand your reasoning, or if you might be talking about the topic more broadly. Do you think lortab might be faster b/c it's a SA med and tolerance rises more quickly, and/or were you thinking about the length of time it takes to ready a steady state on the patch? By a "dose increase" here, do you mean adjustment to the increase, or the ability to return to the original dose? I'm thinking you're talking about the time to adjust to the increase - I'm guessing this is different.
Partly, because the patch is a LA med, but my main reasoning was the difference in potency or overall strength. Because Lortab isn't that strong of a med, most people will adjust fairly quickly. However, because the patch is fentanyl, and delivered around the clock, it could take quite a while for a person's body to adjust. In fact, some don't fully adjust. I've read stories of where people have to change because they just couldn't handle it, or they slept all the time. It's not unusual for patch patients to take 60 days like Cmpgirl said. On the other hand, side effects of Lortab will probably subside within days...Week @ the most.

Quote:
I'm thinking about the generic issue at the moment, and how it could tie you to a particular pharmacy if you wound up getting one of the better brands. Not a problem if the pharmacy is highly committed and you don't expect to move, but getting a better generic is tantamount to a dose increase that you don't have quite as much control over....[unless, of course, you can afford brand].
This is why I highly recommend that PM patients develop a relationship with a good independent pharmacy. They will almost always special order meds for their patients. I can't tell you how many stories I've read where an independent pharmacy will stock a certain med just for one patient, or write a patient's name on a supply bottle for them only. You just aren't going to get this kind of service from a chain...I'm sorry, but you won't. Chains can't deviate from the cost driven systems. Conversely, independent guys own the store and can do whatever they want. My guy is great and has built up quite a following in our area.

But, fundamentally you're right....Switching to a preferred generic is tantamount to a dose increase (from an inferior generic). The other thing you have to remember is that if you don't settle in on one generic or brand, you could experience inconsistencies because the pharmacy switches around between all sorts of generics on it's own...Due to cost issues. Again, I use an independent who has agreed to stock a med just for me.

Hope this helps, and good luck.

Regards,

Ex

Last edited by Executor; 08-22-2008 at 10:30 PM.

 
Old 08-22-2008, 11:27 PM   #6
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Executor View Post
..But, pain mgt folks will "feel" the differences more so than other categories. Ex
Yes, realize this. I think CPP patients are too small a proportion of prescription buyers to have a consumer impact. And, as you obviously know, there are some meds that have such a small therapeutic window that ins. companies will pay for brand.

Quote:
Originally Posted by Executor View Post
Yes, that's what I mean. Say for example I'm brand A and I make branded widgets. Those widgets are made to high specifications. However, the same company also makes off brand widgets. These widgets work ok, but aren't nearly the quality of the branded widgets...They look a tad different, they work differently, they don't last as long, & etc. Because company A makes both, they can ensure that they protect the branded product by making sure there are differences between the two. As a branded company, you don't want to de-value your branded product. If they made the off brand / generic widget as good or almost as good as the brand, no one would pay the premium for the branded product. Ex
LOL - sorry, widgets just bring up old old memories....

Quote:
Originally Posted by Executor View Post
Partly, because the patch is a LA med, but my main reasoning was the difference in potency or overall strength. Because Lortab isn't that strong of a med, most people will adjust fairly quickly. However, because the patch is fentanyl, and delivered around the clock, it could take quite a while for a person's body to adjust. In fact, some don't fully adjust. I've read stories of where people have to change because they just couldn't handle it, or they slept all the time. It's not unusual for patch patients to take 60 days like Cmpgirl said. On the other hand, side effects of Lortab will probably subside within days...Week @ the most.Ex
Interesting. I don't think I've ever "felt" it take 60 days to adjust- closer to two weeks probably but I realize that people are different. Cmpgrl's observations are certainly very relevant. I still didn't quite understand if you thought someone could return to the lower dose relatively easily during the adjustment period. Again, talking averages, not individuals [tho it may be useless to talk about averages and taking the individual out of the equation [for the purposes of discussion]. If you throw a couple standard deviations in however, it should account for most of the range of individual variance - average is probably not very helpful...

It's a bit like insisting each patient conform to the conversion tables for meds. Some docs seem to place way too much faith in these tables and get frustrated when they don't work. It's much harder, of course, to titrate the dose to the individual patient.

Quote:
Originally Posted by Executor View Post
This is why I highly recommend that PM patients develop a relationship with a good independent pharmacy. They will almost always special order meds for their patients. I can't tell you how many stories I've read where an independent pharmacy will stock a certain med just for one patient, or write a patient's name on a supply bottle for them only. You just aren't going to get this kind of service from a chain...I'm sorry, but you won't. Chains can't deviate from the cost driven systems. Conversely, independent guys own the store and can do whatever they want. My guy is great and has built up quite a following in our area.Ex
For some reason, there is a dearth of independents in my area. Not sure why. I assume independents [like all independents] have a tougher time making it (and are therefore more eager to please customers.

Quote:
Originally Posted by Executor View Post
But, fundamentally you're right....Switching to a preferred generic is tantamount to a dose increase (from an inferior generic). The other thing you have to remember is that if you don't settle in on one generic or brand, you could experience inconsistencies because the pharmacy switches around between all sorts of generics on it's own...Due to cost issues. Again, I use an independent who has agreed to stock a med just for me.

Hope this helps, and good luck.Ex
Yep, all very helpful. Thank you. Somehow, since the issues are intertwined, I now have two different threads going that touch on the topic of generics and pharmacies. Really meant for this to be more about the average or, to make things far more accurate, but also far more complicated, the question [as I suggested] should be how long does it take for a person's body to get used to a medication [within 2.x standard deviations of the mean? My stats are a little rusty so I can't remember x right now, but close to 99% of the population falls within 2.x standard deviations of the mean, so this would include most individual variation. Average was probably the worst measure I could have suggested however since it's pretty meaningless with so much individual variation and so many variables. Still interested though....

Last edited by Confused089; 09-10-2008 at 09:38 AM.

 
Old 08-23-2008, 06:58 AM   #7
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Confused089 View Post
I still didn't quite understand if you thought someone could return to the lower dose relatively easily during the adjustment period.
Yes, I think....And again, "it depends" on the person, dose, and strength. I think if a person goes up and doesn't do well, or the med is too strong, then returning to the previous does will be quite easy. However, if a person goes up and responds well, then returning to the previous dose would be rough....Let's use Pepper as an example...Not to drag her into it, but if she were to return to her old dose, it would be very, very tough.


Quote:
For some reason, there is a dearth of independents in my area. Not sure why, it could be the cost of living. I assume independents [like all independents] have a tougher time making it (and are therefore more eager to please customers
If there are a bunch of independents in your area then that means they are doing well. Independents buy from "buying groups" and aren't @ that much of a disadvantage.....No different than the local hardware store (Ace or whatever) buy from buying groups.

Regards,

Ex

 
Old 08-23-2008, 09:34 AM   #8
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Executor View Post
Yes, I think....And again, "it depends" on the person, dose, and strength. I think if a person goes up and doesn't do well, or the med is too strong, then returning to the previous does will be quite easy. However, if a person goes up and responds well, then returning to the previous dose would be rough....Let's use Pepper as an example...Not to drag her into it, but if she were to return to her old dose, it would be very, very tough. Ex
Good point - helps me to understand a bit more.

Quote:
Originally Posted by Executor View Post
If there are a bunch of independents in your area then that means they are doing well. Independents buy from "buying groups" and aren't @ that much of a disadvantage.....No different than the local hardware store (Ace or whatever) buy from buying groups.Ex
No, sorry for the confusion - there are very few independent pharmacies in my area. I suppose that the *one* I spoke with [who does not carry CPP meds at all b/c the demand is low and he can't afford to keep expensive meds sitting on the shelves] colored my view. If I could find one, I would give it a try.

 
Old 08-23-2008, 07:24 PM   #9
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Confused089 View Post
No, sorry for the confusion - there are very few independent pharmacies in my area. I suppose that the *one* I spoke with [who does not carry CPP meds at all b/c the demand is low and he can't afford to keep expensive meds sitting on the shelves] colored my view. If I could find one, I would give it a try.
I think you may be surprised...I'll bet there is @ least one thriving independent in your area. Yes, the one independent you reference my not keep expensive drugs sitting on the shelf, but I'll bet he'll order any expensive drug for you assuming you promise to get it, or drop off the script first. Not only do they want to service you, but he'll actually make more profit. A fixed profti margin (say 30%) of a bigger number is a bigger number.

Regards,

Ex

 
Old 08-23-2008, 07:30 PM   #10
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Re: How long [on average] does it take for your body to get used to a new dose?

Ex,

I tried to make that argument with him to no avail - apparently he'd tried working with a couple CPP and had a bad experience - he was left w/ expensive meds he couldn't sell. I *did* call another, but they required you to pay upfront and mail the receipts to your insurance co. for reimbursement.

I know I could drive 20-30 minutes and get to an independent pharmacy, but I was looking for something w/i a 10 -15 minute drive of my home - I can't afford to drive further (!). It actually looks like I will get "good enough" from a small chain for now.

Thanks for the advice and for checking in on the thread - Apparently, no one has been eager to hazard a guess about 2.x standard deviations from the mean . . . ;-)

 
Old 08-23-2008, 08:11 PM   #11
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Re: How long [on average] does it take for your body to get used to a new dose?

He wouldn't even order them if you took the script in advance (and left it with him)? That insures he gets the sale.

Also, according to my pharmacist, he can return meds. He gets a couple of RGAs per month. I know this because during my patch fiasco, he was ordering all sorts of combinations to ensure I was covered (during the industry shortage). I had even expressed to him that I was concerned that he'd possibly get stuck with them, but he assured me he could return them.

Oh well....

Ex

Last edited by Executor; 08-23-2008 at 08:13 PM.

 
Old 08-23-2008, 08:28 PM   #12
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Re: How long [on average] does it take for your body to get used to a new dose?

Quote:
Originally Posted by Executor View Post
He wouldn't even order them if you took the script in advance (and left it with him)? That insures he gets the sale.

Also, according to my pharmacist, he can return meds. He gets a couple of RGAs per month. I know this because during my patch fiasco, he was ordering all sorts of combinations to ensure I was covered (during the industry shortage). I had even expressed to him that I was concerned that he'd possibly get stuck with them, but he assured me he could return them.
Ex
No - I was really surprised he wouldn't stock them for a regular customer. I think I described my conversation with him in my first post on the pharmacy/generic drug thread - I asked a lot of questions b/c I was really curious why a. he didn't stock them now and b. why he wouldn't stock them for a regular customer when he could make such a good profit. It seemed odd to me - I mentioned the contract to use one pharmacy, profit, etc...

It may have been that one or two bad experiences caused him to perceive to profit/loss situation differently - don't know - he gave me the impression he was stuck with the meds once he ordered them - I'm not sure I said A LOT more about my talk with him on the other thread, but I may have...memory fades fast . . .

 
Old 08-23-2008, 08:37 PM   #13
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Re: How long [on average] does it take for your body to get used to a new dose?

I'm not talking about "stocking" them, but rather you bring the script in...He holds it, and then orders the meds to be filled. I'm really amazed if he won't do this.....Goes against all aspects of service. Even the chains will order a med if you bring the script in advance....Assuming they stock it @ the warehouse.

Regards,

Ex

 
Old 08-23-2008, 09:30 PM   #14
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Re: How long [on average] does it take for your body to get used to a new dose?

Overstock - he said he was ordering meds for a few CP patients [demand is low in his area or at his pharmacy]. He orders the med, fills the scrip and then there is left over medication b/c the scrip doesn't use everything he ordered. This should be no problem if customer is regular, b/c they use up the rest of the order the following month...but he said the CP patients were "always getting their meds changed" and he wound up with v. expensive meds he couldn't sell. He said he had about 10 meds [and I think he lumped the major CP meds into one] he didn't stock for this reason.

The part that didn't make sense was CP patients "always" getting their scrips changed - I got the sense that he tried with a few people, it didn't work out, and he drew conclusions quickly. We talked for about 5 minutes? I simply asked him why, and explained [more or less using the arguments you stated] that I thought that the "guaranteed" sell of the meds [and the expense, which, to him was a big *disadvantage*] made it a no lose proposition for him. Apparently, he felt he lost out in a short trial...Unique situation perhaps...small pharmacy, small, v. wealthy town, fiscally conservative owner [tho, again, I did point out the contract, using one pharmacy - should be just the thing for a risk averse pharamcist - he didn't like the upfront cost. I think he *may* have said something about patients needing their meds the day they came in w/ the scrips as well...].

It was a bit odd, b/c I'd been in there a year or so before, and thought the owner or the pharmacist was someone else - I don't know if it changed hands in the interim. At any rate, I was grateful that he took the time to explain his reasoning to me and I didn't press the issue - just presented why I thought it was generally a guaranteed good deal for the pharmacy and he told me that it hadn't worked for him.

Now, back to 2 standard deviations from the mean....:-)

Last edited by Confused089; 08-23-2008 at 09:35 PM.

 
Old 08-24-2008, 07:08 AM   #15
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Re: How long [on average] does it take for your body to get used to a new dose?

Ok...I understand now....Sounds like a very small pharmacy. I can see his point if he's true mom and pop operation. Those aren't the kind I recommend. In my area, for example, there are two independents that are thriving....They may not do as much as the chains, but close. To give you an idea, there is never less than 4 techs helping the pharmacist....And on certain days, there are two pharmacists and 5 or so techs....So, they do a lot of volume.

Regards,

Ex

 
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