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    Old 05-06-2009, 05:52 PM   #1
    10sox
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    pharmacist commented on my pill usage.....

    I just read another thread about a pharmacist and it got me thinking.

    I recently switched pharmacy's because my old pharmacy could not get my hydrocodone strength (10/325). I literally had to wait 2 weeks one time (thank goodness I had some left over from previous months).

    Anyway, Monday morning was the 3rd month (3rd fill) from this new pharmacy. As I was paying, the pharmacy assistant told me the pharmacist wanted me to know that I should not be taking any more than six per day. My script is written so I can take up to 8 per day. He said the pharmacist was concerned about my liver.

    I told him my doctor and I are well aware of the risks and thanked him and left. The thing is, I don't take 8 per day very often. Only when my pain levels are out of control. I also just had an epidural injection, so my pain has decreased some. What the pharmacist does not know is that I just came off a LA narcotic due to terrible GI issues and until that is straightend out, I will be on the hydrocodone....and possibly a SCS this summer.

    Is this normal for pharmacists to instruct patients about how to take their medication? Besides this incident, I really like the pharmacy. THey fill my scripts in 10 minutes and they use a different brand than my old pharmacy. I didn't realize how crappy the other brand was!

    I guess I am being hyper-sensative now about filling my scripts and having people look over my shoulder. I have NEVER ran out early, never tried to doctor shop or anything. My PM and I have a great relationship and I would hate for anything to tarnish that. Oh....I have permanent nerve damage and live in pain every single day. My condition is not going to improve any time soon.

    10sox

     
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    Old 05-06-2009, 06:34 PM   #2
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    Re: pharmacist commented on my pill usage.....

    I think right now things are just kind of "hot" in the pain management area. I was just reading an arcticle where they are trying to pass a bill where pharmacists are responsible for "watching" if someone seems to be getting excess amounts of pain meds. Apparantly a woman on tons of pain meds killed someone by accident and all the pharmacies were alerted to her "abuse". So now they want to make the pharmacists responsible for doling out the pain meds. Things are going to get a lot worse with things like this going on. I think many of us are going to find checks and balances on our usage where there wasn't any before.

    Without getting on my soapbox, I will just say that I have no problem with some of the things we must do in order to have pain management, but it is getting WAY beyond what I believe is justified.

    Melissa

     
    Old 05-06-2009, 08:16 PM   #3
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    Re: pharmacist commented on my pill usage.....

    Quote:
    Originally Posted by 10sox View Post

    Is this normal for pharmacists to instruct patients about how to take their medication? Besides this incident, I really like the pharmacy. THey fill my scripts in 10 minutes and they use a different brand than my old pharmacy.
    Basically yes...It's the pharmacist job to let patients know about major risks, or important instructions....Like taking a certain med with food or if a med may interact with some other med that you also had filled recently....That kind of stuff. They're also available for general questions, or questions about certain meds and etc.

    The amt of safe Tylenol consumption per day is highly debated. The amt of Tylenol in your med (325) is relatively low compared to other Tylenol based pain meds....Many come in the 500 range...Some even higher. I'm sure your Doc is giving you the lowest Tylenol makeup on purpose. If you took eight per day, then your daily consumption of 2,600 mgs is in the "gray" area for sure, so the pharmacist was just giving you a general warning....Probably popped up on the computer screen and even if not, it was very prudent on his part. However, to your point, you don't take that many very often, so your actual consumption is lower. However, you Rx permits you to take up to eight, if needed.

    In all honestly, if your condition is chronic, then your Doc should probably look at moving you to another med at some point in the near future. The problem for you is that there is no 100% hydrocodone product on the market. Your lowest possible Tylenol dosage would be if you went to a compounding pharmacy and they made something specifically for you.

    The next move up in med, would be some type of Oxycodone product....And there is a 100% Oxy product, Oxy IR (no Tylenol), but it's more potent and doesn't permit refills. Also, you may react differently to it....So, moving to another med isn't always as easy as some think.

    You may have seen some of my prior posts where I'm a very big advocate of independent pharmacies, and more importantly, developing a relationship with your pharmacist. I would bring him/her under the tent a bit and explain a bit about your condition and your instructions from your Doc....This way, the pharmacist is aware of your situation and you aren't just some script or number on the computer screen. It certainly couldn't hurt. A good relationship with one's pharmacist can pay off in spades.

    We can talk in more detail on this subject if you'd like.

    Regards,

    Ex

     
    Old 05-06-2009, 10:21 PM   #4
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    Re: pharmacist commented on my pill usage.....

    Hey 10sox,

    I can understand your sensitivity here. I too believe that the pharmacist would have been thinking about the tylenol (paracetamol to us in Aus) and possible effects to your liver. My pharmacist, the one that I like and trust, always asks if I'm having any symptoms and which, if any OTC medications I'm taking. He just likes to be safe rather than sorry and does it to everyone. I do take OTC paracetamol sometimes and although none of my meds have any added, he likes to double check. Everytime I've heard him give tylenol (paracetamol) to a patient he goes through the same routine although he does try and keep the conversation as private as possible in the pharmacy atmosphere. The first time I experienced this I was a bit offended but now I know he just cares.

    I hope that this is the way your pharmacist was thinking. Is it possible, as Ex suggested, that you could take a SA oxycodone rather than the percs? That way you get the oxycodone by itself, no liver damage to worry about. I'm glad that the epi helped

     
    Old 05-07-2009, 03:16 PM   #5
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    Re: pharmacist commented on my pill usage.....

    Thanks guys!
    I honestly wasn't offended but after reading some recent posts about pharmacists throwing up red flags , it made me start to worry a bit. I really think (and hope) he was just offering his concerns about the tyelonol after filling this for a second time.

    Ex-
    I tried a LA narcotic, OpanaER, and it did nothing for my pain and disrupted my GI tract badly. I ended up with a bad bacterial overgrowth in my GI tract that was partially caused from the Opana. I was on an aggressive form of antiobiotics for a month. Also, I didn't realize how crappy I felt on the Opana until after I stopped taking it. I took it every 12 hours, and after the 10th hour, i swear I began going into minor withdrawals. I cannot explain this very well, but I just felt like CRAP emotionally. I would watch my favorite TV shows and not laugh. I would feel like I had PMS times 1,000. Even my husband noticed my mood. I also felt like I wanted to jump out of my skin. I could not just sit and watch TV. I felt like I wanted to scream. It was the worst feeling ever. All this makes me very scared to try another LA medication, but I know it is in my future. Right now my game plan with my Pain doctor is to try my series of epidurals and take it from there. I just had my second injection and my pain is stil there. Not as intense obviously but still enough that I am taking my pain pills. I have an apt with him next week and ask him about what our next plan is. He's mentioned a SCS many times, so I have a feeling that is where we are going.

    Thanks again everyone,
    10sox

     
    Old 05-07-2009, 03:52 PM   #6
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    Re: pharmacist commented on my pill usage.....

    Its defintley good the pharmacist mentioned this to you. I wouldn't take it any other way other than he is generally concerned about your liver and your health. I am sure he sees people on much higher doses of narcotics that 8 hydro's a day.. and its true long term use can do damage to the liver. I would much prefer a LA med any day over the short acting kind, as it keeps your pain at bay for 24 hours and your not popping pills as much as your BRL is at constant level and you don't have the ups and down of pain spikes and irritability that SA meds can cause. I also tend to sleep better as it helps my pain at night when my back can just ache and wake me up out of a dead sleep.

    It sounds like maybe Morphine didn't agree with you as that is what Opana has in it. there are so many other meds you could try should you need something down the road that is LA, I hope just because one med didn't agree with you that you don't feel scared to take another LA med because if you turn out to be a CP patient you wouldn't want to live on SA meds . Even oxycodone would be better than hydrocodone as it doesn't effect your liver at all and it does last longer and provides better pain relief by far. but hopefully you won't need to be on this medication long term and that your injections will work and fix you right up... where you will just need it very in frequently. I will be rootin for yah!

    I think your pharmacist is being genuine and isn't trying to be nosey or acting like a pharmacy police in monitoring your pill intake because honestly its not a big deal, its just the tylenol he is worried about.
    take care, SS

     
    Old 05-07-2009, 03:59 PM   #7
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    Re: pharmacist commented on my pill usage.....

    10sox, I take Percodan instead of Percocet b/c it has aspirin rather than acetaminophen; recent studies indicate that aspirin can actually help heal the liver from over-use of acetaminophen and other damage. I had a serious bout with Hep A some years ago, so I try to be as careful as possible.

    I don't know if I'm a candidate for Oxy IR, but I am going to ask at my next appt. My new PM doctor told me at our first meeting last week, however, that she doesn't think I'm taking enough to do any damage (max 3/day).

    Best of luck to you!
    nancyjo

     
    Old 05-07-2009, 09:24 PM   #8
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    Re: pharmacist commented on my pill usage.....

    hydrocodone i think is a nsaid

    35k every year die from nsaids

    the fake oxycontin scare a few years ago that went up he east coast made news for months,600-850 died for "oxy related deaths". in a car accident,if people died,,,if a passenger in back seat was taking oxycontin for chronic pain, the police were told to mark it up as a "oxycontin related accident or deaths".
    thats one reason them numbers rose so high so fast. if a witness at a store front told cops what he saw and was taking oxy for any reason,it was a "oxycontin related accident".
    check all this up if you like,,,i did.

    when did you last see front page news of nsaids killing 35 thousand in one year much less EVERY year?

    Last edited by Administrator; 05-08-2009 at 11:19 PM. Reason: removed political comment

     
    Old 05-08-2009, 06:18 AM   #9
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    Re: pharmacist commented on my pill usage.....

    Hydro isn't a NSAID. it is a narcotic. Its called Vicadin.

     
    Old 05-08-2009, 08:47 AM   #10
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    Re: pharmacist commented on my pill usage.....

    Quote:
    Originally Posted by slipperyslope View Post

    Hydro isn't a NSAID. it is a narcotic.
    That's correct. Hydrocodone is the active ingredient found in brand names such as Norco, Vicodin, Vicodin ES, Vicoprofen, Lortab, Lorcet, Lorcet plus, Hydrocet, and etc. All contain the active ingredient, hydrocodone, but package it with different amts of Tylenol, Aspirin, or Motrin. There are also generics for each.

    Regards,

    Ex

    Last edited by Executor; 05-08-2009 at 08:57 AM.

     
    Old 05-08-2009, 10:05 AM   #11
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    Re: pharmacist commented on my pill usage.....

    Quote:
    Originally Posted by slipperyslope View Post
    you don't have the ups and down of pain spikes and irritability that SA meds can cause.
    You must have been reading my mind today. I was just telling my husband that about an hour before my next hydrocodone dose, I feel crabby. Nothing like I felt on the Opana, but enough that I don't like it. I am short with my kids and have NO patience. My husband can tell when my meds are wearing off and when I've taken them. I used to think this was a warning that I was becoming "addicted", but several sessions with my pain psychologist has helped me understand this not to be true.....but the nature of SA narcotics and dependence.

    I really think I would like to give another LA med a try before I try the SCS. Does this sound right to you guys?

    I hate having the up/downs all day long from the SA meds (pain wise and emotionally) but I am also scared of having negative reactions like the Opana.

    10sox

     
    Old 05-08-2009, 08:50 PM   #12
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    Re: pharmacist commented on my pill usage.....

    Quote:
    Originally Posted by 10sox View Post

    I really think I would like to give another LA med a try before I try the SCS. Does this sound right to you guys?

    I hate having the up/downs all day long from the SA meds (pain wise and emotionally) but I am also scared of having negative reactions like the Opana.
    Yes, I think another LA med would be prudent. The problem with SA meds is that they are originally designed for 4-6 hr intervals. All the med is released at once (upon taking it) and one's blood plasma level (BPL) spikes and then drops straight off like a cliff. This is fine for addressing short term pain. But, for chronic pain, it's unacceptable.

    Because CPers build up tolerance, what was once a 4-6 hr med, is now lasting 2-3 hrs....Tops....Sometimes less. The "ups and downs" are enough to drive one crazy, not to mention the pain that returns.

    Conversely, a LA med keeps one's BPL stable and any type of flair up, or BT pain can be addressed with BT meds. For example, if you look in the prescribing white paper that accompanies Oxycontin, Purdue Pharma's research says that one who takes 10mg of OC every 12 hours, maintains a higher BPL, then someone who takes 5mg of Oxycodone every 6 hours.

    Best of luck with this.

    Regards,

    Ex

     
    Old 05-09-2009, 09:41 PM   #13
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    Re: pharmacist commented on my pill usage.....

    I also have to add a tidbit about the scs - implanting these things is major surgery and should not be done lightly. They are a last resort option.

     
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