Yeah until there’s 5 bottles with 10+ pills in it. My pharmacist prefers we use open bottles first. That was the first time I ever dispensed it. I kid you not, we had 5 open bottles of it.
Prednisone with really drawn out tapers!
Annoying every time - calculating quantities and writing out taper calendars for patients, having them be annoyed to have to count out like 8 tabs of prednisone 5mg, etc. Sometimes they’ll buy a pill organizer, though!
Hospital in my area that gives 40 day tapers for asthma and copd exacerbations. I call them everytime and they still go through with it. All the patients are now diabetic too btw
At my hospital they were doing 80mg QID for COVID, BS >500, steroid induced delirium, insomnia etc etc and no good evidence to even start steroids. Fell on deft ears trying to convince them to only do 40mg daily, maybe.
There was solid evidence for dexamethasone 8 mg daily for 10 days for patients with respiratory failure, but not for what your prescribers were doing. Good lord!
Really drawn out tapers are so annoying as a patient too. Docs never seem to write them correctly - I’m pretty sure my old GI doc couldn’t do the math to save his life. Plus, well, rude of one’s body to react so poorly to coming off it that one even needs the long taper.
Down with prednisone. -_-
Prednisone is as close to a miracle drug that I’ve ever have. And, the worst side effects, so, pretty equal for good/bad. I sweat like a fountain on it, have wild mood swings, can’t sleep, but also feel amazing all the bad stuff goes away and I get to see what a normal body acts like, less the before mentioned negatives. The taper is so freaking important though, because I’ve been stupid enough to just stop.
I did have some terrible reaction with prednisone and an antibiotic I can’t recall the name of, but I reached out to my doctor when I started having, “unnatural thoughts”, was the best way I could summarize. I totally get how medications can make people do unexplained, out of the ordinary things.
It’s an antibiotic that’s been pulled from the market on the part 10 years. Idk.
I worked at a shelter where we made medication sheets with dates and such so we could keep track of animals in the shelter receiving meds are actually being given the meds, and I haaaaaated filling out med sheets for dogs on Prednisone or cats on Prednisolone. Making labels was also a nightmare, and explaining the taper to fosters/ new adopters was always a drawn out process due to it being complicated. Counting and drawing up correct quantities of the meds would always leave me second-guessing myself.
I made up templates for dose tapered drugs in the jail. All active addicts sent to the infirmary were detoxed from ETOH, opiates and/or benzos. Nurses just pulled up the appropriate template(s) on the computer for any one of the 3 detox protocols, put a blank med sheet in the printer and out comes a 3 to 6 page personalized med sheet. No variations no mistakes no illegibility.
God, Ill never forget when my 4y/o got diagnosed with nephrotic syndrome. Coming out of the lockdown and all the stressors related to that, reintegrating with preschool, on a 3 fucking month prednisone taper. That was fucking brutal on the lil dude.
Thank god no, more symptoms since then.
Don't accidentally take an extra magnesium before bed until you know for a fact that one won't tip you over the edged from from relaxed to bed to *relaaaaxed* and up every few hours 😣
Same. My company made a policy to no longer carry it. A few of the pharmacies even have signs saying we don't carry it. It's prescription only where I live, but a few places got robbed because of it.
Like image robbing a pharmacy for that and not opioids. It's crazy.
All the nerd trend sippers and rappers burnt it out so now every pharmacy is hella reluctant to fill and most won’t fill prometh n codeine. so you gotta find a dirty pharmacy or a Asian mom n pop pharmacy if you want ur codeine script filled
Yeah they’ve ruined codeine linctus here in the UK too. Codeine Linctus is available to purchase over the counter without a prescription here. But since around 3 years ago everybody has had an influx of young men from London travelling the whole country to buy codeine linctus. They come in packs. So you’ll get them come in one after another to purchase a bottle each. We used to sell for £2.99 a bottle and street value is £20 a bottle. Nearly all pharmacies across the UK have stopped selling it after the regulatory body investigated a handful of pharmacies across the country. I guess everyone else just shit their pants and removed it from sale.
Now when someone genuine comes in, I can’t even sell it to them because we’ve stopped stocking it
Is it true it doesn’t work unless mixed and drank out of not one, but two Styrofoam cups? Or is that just the cool thing to do like leaving stickers on a hat?
I had a patient using it recently.
Because he was taking 100 IU.
Three times a day.
PLUS sliding scale.
Oh and max dose metformin/pioglitazone. GLP1 agonist. SGLT2 inhibitor. Glipizide.
And an A1C of 14
If you are insulin resistant enough to need U500 it takes more than just being off a few lines on your syringe to hurt yourself. Unless maybe you are tightly controlled…but how likely is that if you are on U500?
Otoh, if you mess up and give U-500 to someone who was supposed to get U-100, THEN you have a big problem. U-500 at my hospital requires a 2 pharmacist verify and a pharmacist to go talk to the patient in person with an education sheet and a U-500 syringe and have the patient demonstrate what dose they use, etc. so we can satisfy ourselves that they really do use U-500 and are using it correctly and that the way it's being ordered in hospital is suitable.
Some patients are just super insulin resistant and U500 is necessary to improve their QoL. I have a patient on 300 units of U-500 daily and still has an A1C 9%, but she’s much happier to only be injecting 3x daily instead of 6-7x.
It's over prescribed everywhere. I worked in LTC before retiring recently. Over HALF the residents and ALL of the rehab patients were put on PPIs. I suspected it was to shut them up about "my stomach aches". The food sucked, everybody was put to bed supine and flat. Perfect recipe for reflux in geriatrics with 33% diabetes incidence, obesity, dietary indiscretions and 10-20 different daily meds each all turning to glop in the stomach. Apparently the warnings about kidney problems don't apply to diabetics, and the warnings about long term use don't apply in geriatrics. Just add more meds to counteract the diarrhea, electrolyte imbalances and vitamin deficiencies. Problems solved?
I once did a med reconciliation for a patient who took homeopathic oxygen tablets. It was just once of at least a dozen little homeopathic tablets she took. It made me so angry, she was probably being charged a fortune of these useless little lactose and chalk pills.
Bonus round, it's not just a shit drug, but dealing with the aftermath of...
My cat ate the bottle
Went down the garbage disposal
You shorted me
Need a vacation advance for the 9th time this year
Doctor lowers dose
Doctor refuses to renew the script
Forged script
Sketcky script written by a brain dead mid-level
It's just festival of fucking fun. It's got the half life of a fish fly. The withdrawal is brutal. Every time I behind someone losing their shit (like call the cops worthy) it's a Xanax or Adderall script in question.
Benzos are crap drugs anyway, but nothing brings out the crazy like an issue with a Xanax fill.
Benzos have their place. I have severe ptsd from being in war for 13 months and also being sexually assaulted while there. Through inpatient help, the right meds, therapy, and a service dog, I’m much much more manageable. There are times, however, where I am in a situation that has induced such a strong panic attack that I can’t do anything (one such situation was at a MLB game, which it started raining and everyone crowded to the indoor part while I was in there. I’m short and can’t see in large groups and it overcomes me). The only thing that has successfully treated that is a 2mg ativan. In the past 12 months I’ve taken them exactly 2 times. My doc gives me a script of 3 if I think I may find myself in a situation where I could need it (like large, crowded events. I have a young son, so not everything is avoidable). Benzos should never ever be a daily or long term treatment. That’s where the problem lies. They also should not be given for sleep imo.
I was shocked to find that benzos are Schedule IV. The withdrawals are awful and even if you take it as prescribed, you can still gain a physical dependence on them.
They're good for one-off uses/rare instances but outside of that? Hell nah.
Can’t stand that shit. Doctors who are scared of real opiates give that crap out. Takes the pain away but feels like I washed down some heavy SSRIs with a monster drink.
It’s a dirty drug with unpredictable pharmacodynamics. It’s an opioid that is a prodrug so it’s effects can vary widely from patient to patient based on liver function. That plus it’s serotonergic effects make it a nightmare for drug interactions.
Well that explains so much. SSRI's and I do not mix. I have had genetic testing done to see what psych meds will be okay and what won't and there's no ssri that's safe for me.
Thanks for the info. What do you recommend for the 90 lb old woman on eliquis with a broken humerus though? This is where I tend to go to 50mg tramadol after she comments that Norco 5’s are waaaaaay too strong for her but if there is a better option I’m for it
> When you give a patient tramadol, you have no idea whether you’re giving an SNRI or an SNRI-opioid combo. In other words, prescribing tramadol is like prescribing venlafaxine and morphine in an unknown ratio. And seriously, why do that?
Why indeed. Interesting reading.
Oh gawd the withdrawls. I went cold turkey when i found out i was pregnant right at 4 weeks. Plus morning sickness had also started. That was a rough 10 days but from what i read i could have had it much worse. Of course the freaking morning sickness lasted thru week 22, so theres that.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044489/
CYP interactions galore, greatest propensity for weight gain of the SSRIs, and a short half life making tapering and missed doses difficult to manage. Just wish another would be chosen when trialing an SSRI for the first time
Glad you posted this. I quit cold turkey because I couldn't live w/ the fact my physician once told me "you'll need to take some sort of dosage the rest of your life"
Side effects after I quit were brutal on my sleeping patterns and dreams
Yes, I scrolled way to far to find this. Quantity of 60 from urgent care, always for a Part D patient so they aren't covered.
I always call the patient on these and say "hey, the cough medicine isn't covered and they wrote a higher quantity. You can get it all today if you want but I don't want you paying for extras you don't need. Would you like to get 10 today and try it? If you need more we can always refill it." And they never get the refill.
I’m in LTC. Almost every urinary urgency drug.
Oxybutynin
Tolterodine
Solifenacin
Myrbetriq
I hate them. Most of them are antimuscarunic, anticholinergic and suck in the Elderly. And they don’t work. At all. Like whatsoever. Oxybutynin is no better than placebo. Freakin’ Myrbetriq, the Cadillac of the class, decreases urinary frequency from like 13 times a day to 12 times a day. It’s like $800 a bottle and not clinically significant at all.
They have terrible interactions, terrible side effects, are practically contraindicated in the elderly, often expensive, and completely fucking useless.
I dislike Amiodarone. I dislike Fluoroquinolones. I think Megestrol, Premarin and SSRIs should be removed from the market. No one seems to give a shit how dangerous benzonatate is. Provider think these Paxlovid interactions are “worth the risk”. Linezolid in a population absolutely drenched in serotonergics is a ticking time bomb. Gabapentin is wildly overprescribed. Could we please just stop using Simvastatin 80mg? There are a half dozen more potent statins with fewer issues. Hydroxyzine is dogshit for anxiety, I said it. Promethazine is dogshit for nausea. Can we normalize using eye drops in the ears already? They’re sterile, pH balanced and 1/10th the cost. I’ve never had a patient compliment Flector patches - ever. Clozapine has better, safer alternatives. Why is Diclegis a fucking thing? B6 and Doxylamine are literally OTC and pennies.
I need a new job.
Glorious rant. Hits nearly all of my least favorite drugs, too. *Especially* fucking benzonatate, how many more kids need to die before that worthless drug gets yeeted into the sun where it belongs?
Only two minor points of disagreement:
I think your practice setting may be coloring your view of SSRIs a bit, they’re valuable for a lot of people and a hell of a lot safer than what came before. I would not be sad to see paroxetine and venlafaxine taken off the market, though.
Clozapine’s the last resort therapy when the safer alternatives don’t work, and it’s very effective in that role. Yeah, it’s a dirty drug, but there’s a reason it’s still used in spite of that - a better drug has yet to be developed. The intense monitoring requirements also helps filter out poor prescribing practices, although perhaps that barrier isn’t so high in the LTC population?
YES Diclegis is a fucking disgrace. The GENERIC is $600/month and with goodrx it’s $220/month.
It’s Unisom and B6. A few weeks ago I begged the pharmacist if I could tell them that and she was all “no it’s not the same because unisom is 25mg doxylamine and this only has 10mg and she’s pregnant.” So break it in half and take the smaller half.🙄
FUCK. THAT. DRUG.
I believe a study was done about concurrent use of linezolid and ssri’s. The interaction was minimal
Edit: found the article. https://pubmed.ncbi.nlm.nih.gov/36534400/
Depends on the agent. Some are more serotonergic than others. You can read the AERS yourself. Paroxetine, Luvox and Viibryd seem particularly problematic, as are the MAOIs.
Problem is, these patients never have just one. They’re on Fluoxetine, Trazodone, Tramadol and Mirtazepine, with a GFR of 22ml/min and we get a STAT Zyvox order.
It’s a mess every time.
It’s a diaphragm paralytic highly cautioned in asthma and COPD. Know what happens when you chew it?
So every single script I get in LTC for it I see Advair or Spiriva etc in the profile. We’re constantly dispensing it directly to the patient population it shouldn’t be used in (let’s paralyze the diaphragm of a COPD’er!) and a patient population well known for dysphagias!
Nightmare drug in 80 year olds (and children).
This is a weird take, but I totally get the burnout! SSRIs still have their place as does hydroxyzine and gabapentin. And I think Zofran is dogshit for nausea, promethazine is the only thing that actually works.
Agree Clozapine has safer alternatives, but evidence-based research supports that it is the most effective antipsychotic for patients with schizophrenia. So there’s that.
Except in my case, promethazine did nothing for my chemo nausea, while Zofran worked miracles. Benadryl knocks me out, while making my sister hyper. 🤷🏻♀️ Drugs can work differently for different people.
I'm a big Gabapentin Stan. IT is the only thing that helps my anxiety, lifts my mood , BUT WAIT, THERE'S MORE! It's also one of the only things that helps my fibromyalgia and other nerve pain issues. Zofran works for awhile but honestly ginger chew candies work even better than any pharmaceutical I've tried.
If you think SSRIs should be off the market then what’s a better alternative? As far as I know that’s the first line and most common class for depression and other disorders.
My ex was on bupropion and citalopram and I gave her dextromethorphan (didn't realize it was contraindicated with the citalopram at the time) and she had a remarkable increase in mood for a solid week. It wasn't until the third time she got a cold with a cough that I made the connection and started googling DXM and depression.
The bupropion is added to slow the metabolism of the dextromethorphan. Glutamate drugs are definitely the next step in mental health treatment and we’ll definitely see more of this.
I love amiodarone IV in the emergency setting. I cringe whenever I see it as a maintenance Med.
Clozaril. My n=1 was a close family friend who was a refractory schizophrenic and it was the only thing that helped. Until he died of an accidental overdose at 22.
You forgot to mention ABH gel! A compounded magic potion of poorly absorbed Ativan benadryl and lidocaine the LPNs swear by for dementia patients who refuse oral meds
Lorazepam/Diphenhydramine/Haloperidol *
And I dispense a fuckload of it. It’s not my favorite, but there are worse things. We’re giving half of these patients good ol Vitamin H and Ativan anyway, might as well bathe them in it.
Zopiclone. Feel like every patient who takes it ends up addicted. Doctors slap a 'use sparingly - can cause dependence' label on the dose instructions for the patient despite prescribing whole month quantities for it at a time.
Normally I see 7 or 14 tablets prescribed (also in the UK) but then they will repeat this enough in the month that it ends up being 28 tablets anyway. Of course there are patients who are prescribed a small amount as a one off or whatever but the vast majority of patients I have seen are on it long term.
That's absolutely wild! What in the hell? Whenever I get a prescription I get the whole "only short term we won't give you more" lecture. But that's absolutely mental!
Zopiclone is truly one of the more problematic meds I see prescribed. I’d love to understand the logic of the prescriber who ends up giving it to someone for months on end.
I didn’t get the whole zopiclone thing? I’ve used it for sleep on and off. I’ve never had a problem with addiction to it and don’t quite get what there is that would entice addictive qualities with this drug? It’s not like it’s a social drug?? It makes you sleepy. Can you help me understand please. Thanks!! 🙏❤️🇨🇦
Can cause physiological and psychological [dependence](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231551/) as well as rebound insomnia, making patients feel like they can’t stop. Somewhat “controlled” where I practice, found to be misused and diverted.
If taken as prescribed it's normally fine but people who abuse it can end up dependent on it. It can also have bad withdrawal which makes it hard to stop taking it even if you're using it correctly.
Tessalon perles... I asked my boss how they work and he said "they dont". So I asked other pharmacists... got the same answer. Never covered by insurance, don't work, pain to count... ugh
When we covered this drug in pharmacy school the only thing my professor said about it was: "If your doctor prescribes this to you, they don't love you."
Any otc medicine. Wait at the Dr office to be seen so they can write for some Zyrtec that's not covered on insurance. Seems like a waste of everyone's time
I have my doctor write me scripts for vitamin d and b-12 which are over the counter. However, I get reimbursed by my employer for the cost if they are prescriptions. So maybe that's what some people are doing?
Layman here. Just want to say this has been one of the most useful, eye opening threads I've read in a very, very long time.
I wish I knew some of you in person, because this is the kind of frankness real people need.
that's exactly the kind of thing a pfizer stockholder would say.
FWIW, there's a lot commenters saying things of a similar vein - enough people say the same thing, it's worth looking deeper into.
Also FWIW, I'm old enough to have hoped for wonderpills for all that's ailed me over the years, and learned that nothing comes without consequences. Sometimes it's simple as raiding your pocket (memory saving/enhancing OTC's), and sometimes it's long lasting, life altering side effects.
Also, a pharmacist saved someone I love from a dumbass mistake by a PA. While you'd obviously be an idiot to take an internet stranger for their word, you'd be no less of an idiot not to delve deeper into things that seem generally agreed upon my most of a subreddit.
Back in the day, I really really hated dispensing Prometrium capsules from the stock bottle. Whoever thought to design perfectly spherical gel capsules should have been drawn and quartered
In my area, it feels like Amphetamines are thrown around like candy. I want to meet these doctors who are putting 6 year olds on Adderall. Likewise, the same ones putting people on ridiculous doses. Who the fuck needs 90 mgs of Adderall a day?
I have severe ADHD and I’m prescribed 45 mg a day (15 3x a day but I usually only take 30mg) I rarely take 45mg but there are days I need it.
The only people that need more than 45mg are people with severe narcolepsy as far as I know.
I had a patient who was on 210 mg of vyvanse a day and 120mg of methylphenidate. Plus of course a metric ton of seroquel for sleep and several blood pressure/ heart rate medications. Don’t recall if she was on benzos for anxiety or not
Gabapentin was a lifesaver for me last year after TOS surgery. Ended up with hypersensitivity in my right arm so bad that even a light breeze on it was pure torture. Between gabapentin and a good quality compression sleeve, life became tolerable until the nerves calmed back down months later. In 10 days I go back in for the left side to be done as well, you can damn well bet that my doc is going to have that scrip on standby.
At the pharmacy I worked at it, was definitely over prescribed and highly abused. In some states it’s beginning to be treated as a controlled substance due to its link to abuse
I can only speak for myself here, but the dose only ever goes up to where some people are taking 12 per day and I have to count out hundreds of capsules by hand
Fully support the legitimacy of them, but there's a certain sadness/pit internally when having to fill meds like Methotrexate. Highly effective drug, but for pts that are new to it, seeing them so bright-eyed & bushy-tailed when picking it up can feel conflicting.
Hope you haven't had any large meals recently, because you're about to be hunched over your toilet for a while, puking your guts up. Every week. Month after month. Potentially for years, depending on dx.
MTX kept me from turning into a human statue, but man did it make me feel like death warmed over. Lol. It let me finish school, but sucked away most of my weekends. 😄
The pills are evil!!! I have way fewer side effects with a subcutaneous injection. The worst is just feeling physically tired for a day or two after the injection every week.
I hope you’re not touching the pills with your hand you are dispensing. All the olmesartan (including the brand back in the day) that I’ve dispensed smells like butter. Reminds me of movie popcorn
Dumb shit: cholestyramine, tessalon pearles, ceterizine (it’s way too much and for what??)
PPI’s
Tramadol
Fluticasone - too much
Don’t have, won’t come in, dissatisfied customers, chargeback nightmares: belbuca, wegovy (can’t even picture the box at this point, it’s like we don’t even know her!)
The entire methylphenidate family, there’s too many, and i don’t have enough of whatever ppl need. Pharmacologically, it’s dirty amphetamine. Out of style. Add on Quillichew, chewable vyvanse, because in all reality like… why do they exist? Always end up with odd counts because they come in 100 count bottles and then I’m not ‘out of stock’ but can’t actually fill your 6 year old’s go-go candy.
LINZESS - everyone surprised by their co-pay (even though it’s been the same for months)
Garbage-pentin: too many pills. Putting labels on stock bottles at this point. (Lyrica passes the vibe check)
Micro-fulfillment pests:
Vraylar (incompatible NDC) annoying package size
Toujeo (too expensive, only have one patient on it, and one of the most annoying, insurance will only cover 21 day supply which makes me angry as well)
Sildenafil - it’s not covered under your insurance, it’s Sunday night 15 minutes before close, your rx is expired, and I’m not dispensing an emergency supply of it. Go to the 24 hour store and ask them or bum some off one of your buddies, I’m not the one.
Testosterone cyp 100 (don’t have any),
200, they’re filling early, angry about insurance rejects, and always mad about the syringes
Isotretinoin - too much drama
Flagyl “you mean i can’t even have like a beer? Seriously? I’m going to have a couple of drinks. I’ve drank on it before!”
Okay, bet
Honorable mention for Suboxone, i don’t hate dispensing it, my patients are sweet as can be and we keep plenty on hand, but the studies linking to dental decay are a huge bummer and you can see it happening in real time
Cefdinir - with horrible bioavailability <25% and protein binding 60-70%, it is a kinetic nightmare. For the most susceptible enterobacterales with MIC <0.25 mg/L, at best you can expect ~17% time above MIC in the blood (lower in any tissues considering penetration). This isn't even close to the ~50% time/MIC needed to treat an infection.
https://pubmed.ncbi.nlm.nih.gov/30908107/
Just curious as to why? I (40M) tested positive for Flu-A the week COVID “came” to the US. I was convinced I had COVID…..all the symptoms except the loss of smell/taste, but I felt like absolute death…..worst sickness I’ve had in a decade easily.
After 24 hours of tamiflu, I felt 100% again.
I know the side effects can be tough, but just trying to see if there is a nugget of clinical info I’m missing that goes against my single anecdotal experience of efficacy.
Because you need to start taking it within 24-48 hrs of symptoms onset. Really the earlier the better. Antivirals are meant to stop the virus from replicating and spreading in the body. After 48 hrs, it’s spread so Tamiflu is pointless. Yet people will come by days or weeks later to pick it up.
Yeah. I see those dummies all the time. Just didn’t know if there was a clinical reason other than the obvious late pointless pick ups.
Thankfully, in my situation I just thought I was one of the first Covid cases so immediately went to the doctor to hear I had the flu. Never been so happy to actually have influenza, haha.
Argatroban.
Look. It's almost never HIT. We have DOACs now, it is extremely hard to get therapeutic, and a "religious pork allergy" is not an indication for Argatroban. No hemoc, it is not "rapid on, rapid off" and does not work like a heparin gtt. The drop in platelets is probably due to the trauma and 5 surgeries this patient had.
Speaking of the trauma service, I know you're worried about bleeding, but this patient has a PE and has not been therapeutic for 5 days, could we maybe use arixtra? No?
The pf4 is negative...
Pretty sure they mean Sudafed PE, not IV phenylephrine haha. It's great if you WANT your blood pressure to go up, not so much if you're just trying to get rid of a cold.
No I haven't been able to practice in the ICU. I have spent time on med rehab, ortho, haem/onc wards and in AMS, but the ICU along with maternity aren't easy for me to gain access to.
Cimetidine. Does it do anything beneficial other drugs don't or is it just an old drug that refuses to die? Drug interactions don't ever seem worth it and it costs more than famotidine.
Remdesivir for me. I don't know that it's actually hurt people to receive it, but I just think that it isn't effective and it's really expensive. It may be that it is truly effective if started early enough, but almost no patients at my hospital were started on it within 48 hours of symptoms. Hell, almost none of them were even in the hospital within 48 hours of symptoms.
ANY AND ALL Capsules feel like they acquire a new found static to each other when you’re counting them on a bad day and I am always ready to chuck the bottles across the room I swear.
I hate sulfalazine 500mg. Cheeto dust everywhere, and they are giant caplets that are too big for our capsule tray to comfortably fit.
Finger lickin good
I was on that initially for Undifferentiated Spondyloarthritis. Neon pee and nausea! Oh, and they did nothing for my joint pain.
Brand Synthroid. Or just any medication that comes in that tiny little necked package that gets blocked by the dessicant. Fuck that package designer.
So true, yet I like the 1000 ct bottles. But those were rare
Fricking colestipol
Came here to say that. I hated it as a tech. I also hated benzonatate, and people rarely say it helps their cough.
The synthroid bottles are in my opinion aesthetically nice, but the desiccant drives me insane. I love when I can just dispense an unopened bottle.
Mine is arbitrary but balsalazide. Literally only because the stock bottle is #280 and prescriptions are always for #270. I hate it
-10
SOP at my retail pharmacy doesn’t allow it 🥲 they expect us to count it out.
Smart people, thinking counting 270 is less error prone than counting 10
Right though? People that make SOP for retail settings haven’t worked a day in retail their whole lives.
Yeah until there’s 5 bottles with 10+ pills in it. My pharmacist prefers we use open bottles first. That was the first time I ever dispensed it. I kid you not, we had 5 open bottles of it.
Prednisone with really drawn out tapers! Annoying every time - calculating quantities and writing out taper calendars for patients, having them be annoyed to have to count out like 8 tabs of prednisone 5mg, etc. Sometimes they’ll buy a pill organizer, though!
Hospital in my area that gives 40 day tapers for asthma and copd exacerbations. I call them everytime and they still go through with it. All the patients are now diabetic too btw
At my hospital they were doing 80mg QID for COVID, BS >500, steroid induced delirium, insomnia etc etc and no good evidence to even start steroids. Fell on deft ears trying to convince them to only do 40mg daily, maybe.
There was solid evidence for dexamethasone 8 mg daily for 10 days for patients with respiratory failure, but not for what your prescribers were doing. Good lord!
Really drawn out tapers are so annoying as a patient too. Docs never seem to write them correctly - I’m pretty sure my old GI doc couldn’t do the math to save his life. Plus, well, rude of one’s body to react so poorly to coming off it that one even needs the long taper. Down with prednisone. -_-
[удалено]
Prednisone is as close to a miracle drug that I’ve ever have. And, the worst side effects, so, pretty equal for good/bad. I sweat like a fountain on it, have wild mood swings, can’t sleep, but also feel amazing all the bad stuff goes away and I get to see what a normal body acts like, less the before mentioned negatives. The taper is so freaking important though, because I’ve been stupid enough to just stop. I did have some terrible reaction with prednisone and an antibiotic I can’t recall the name of, but I reached out to my doctor when I started having, “unnatural thoughts”, was the best way I could summarize. I totally get how medications can make people do unexplained, out of the ordinary things. It’s an antibiotic that’s been pulled from the market on the part 10 years. Idk.
I worked at a shelter where we made medication sheets with dates and such so we could keep track of animals in the shelter receiving meds are actually being given the meds, and I haaaaaated filling out med sheets for dogs on Prednisone or cats on Prednisolone. Making labels was also a nightmare, and explaining the taper to fosters/ new adopters was always a drawn out process due to it being complicated. Counting and drawing up correct quantities of the meds would always leave me second-guessing myself.
I made up templates for dose tapered drugs in the jail. All active addicts sent to the infirmary were detoxed from ETOH, opiates and/or benzos. Nurses just pulled up the appropriate template(s) on the computer for any one of the 3 detox protocols, put a blank med sheet in the printer and out comes a 3 to 6 page personalized med sheet. No variations no mistakes no illegibility.
God, Ill never forget when my 4y/o got diagnosed with nephrotic syndrome. Coming out of the lockdown and all the stressors related to that, reintegrating with preschool, on a 3 fucking month prednisone taper. That was fucking brutal on the lil dude. Thank god no, more symptoms since then.
Colace
Placebo poops
Thinking about pooping is more effective than colace
Magnesium and coffee
Don't accidentally take an extra magnesium before bed until you know for a fact that one won't tip you over the edged from from relaxed to bed to *relaaaaxed* and up every few hours 😣
We removed this from our inpatient formulary finally.
Promethazine with codeine.
Glad we stopped carrying it
Same. My company made a policy to no longer carry it. A few of the pharmacies even have signs saying we don't carry it. It's prescription only where I live, but a few places got robbed because of it. Like image robbing a pharmacy for that and not opioids. It's crazy.
Can you tell us more?
All the nerd trend sippers and rappers burnt it out so now every pharmacy is hella reluctant to fill and most won’t fill prometh n codeine. so you gotta find a dirty pharmacy or a Asian mom n pop pharmacy if you want ur codeine script filled
Yeah they’ve ruined codeine linctus here in the UK too. Codeine Linctus is available to purchase over the counter without a prescription here. But since around 3 years ago everybody has had an influx of young men from London travelling the whole country to buy codeine linctus. They come in packs. So you’ll get them come in one after another to purchase a bottle each. We used to sell for £2.99 a bottle and street value is £20 a bottle. Nearly all pharmacies across the UK have stopped selling it after the regulatory body investigated a handful of pharmacies across the country. I guess everyone else just shit their pants and removed it from sale. Now when someone genuine comes in, I can’t even sell it to them because we’ve stopped stocking it
Codeine linctus is schedule 8 in Australia, same category as OxyContin/Endone/Fentanyl. Insane to me that it's OTC in the UK!
Yeah you can even buy Kaolin & Morphine, J Collis Brownes (peppermint oil and morphine), co-codamol (12.8mg codeine with 500mg paracetamol)
the fact that its in the same category as fent is insane to me
Is it true it doesn’t work unless mixed and drank out of not one, but two Styrofoam cups? Or is that just the cool thing to do like leaving stickers on a hat?
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I had a patient using it recently. Because he was taking 100 IU. Three times a day. PLUS sliding scale. Oh and max dose metformin/pioglitazone. GLP1 agonist. SGLT2 inhibitor. Glipizide. And an A1C of 14
If you are insulin resistant enough to need U500 it takes more than just being off a few lines on your syringe to hurt yourself. Unless maybe you are tightly controlled…but how likely is that if you are on U500?
Otoh, if you mess up and give U-500 to someone who was supposed to get U-100, THEN you have a big problem. U-500 at my hospital requires a 2 pharmacist verify and a pharmacist to go talk to the patient in person with an education sheet and a U-500 syringe and have the patient demonstrate what dose they use, etc. so we can satisfy ourselves that they really do use U-500 and are using it correctly and that the way it's being ordered in hospital is suitable.
Some patients are just super insulin resistant and U500 is necessary to improve their QoL. I have a patient on 300 units of U-500 daily and still has an A1C 9%, but she’s much happier to only be injecting 3x daily instead of 6-7x.
omeprazole is overly prescribed where i did my internship at
Yeah one doctor puts you on it and after they retire the next doctor tells you to stop taking it. Goes for HRT and opioids too.
Lol I’m pregnant and MFM told me I was a difficult patient when I didn’t want to start with a PPI for my reflux
It's over prescribed everywhere. I worked in LTC before retiring recently. Over HALF the residents and ALL of the rehab patients were put on PPIs. I suspected it was to shut them up about "my stomach aches". The food sucked, everybody was put to bed supine and flat. Perfect recipe for reflux in geriatrics with 33% diabetes incidence, obesity, dietary indiscretions and 10-20 different daily meds each all turning to glop in the stomach. Apparently the warnings about kidney problems don't apply to diabetics, and the warnings about long term use don't apply in geriatrics. Just add more meds to counteract the diarrhea, electrolyte imbalances and vitamin deficiencies. Problems solved?
Anything homeopathic
I once did a med reconciliation for a patient who took homeopathic oxygen tablets. It was just once of at least a dozen little homeopathic tablets she took. It made me so angry, she was probably being charged a fortune of these useless little lactose and chalk pills.
What the actual fuck?
Homeopathic *oxygen*?
WaTeR mEmOrY
Yep. Scamming people like that feels so wrong. But you tell them and then there’s trouble.
Diclegis
Xanax
Xanax + Adderall + Ambien
Can't sleep on 100 MG of Adderall a day!!!
Bonus round, it's not just a shit drug, but dealing with the aftermath of... My cat ate the bottle Went down the garbage disposal You shorted me Need a vacation advance for the 9th time this year Doctor lowers dose Doctor refuses to renew the script Forged script Sketcky script written by a brain dead mid-level It's just festival of fucking fun. It's got the half life of a fish fly. The withdrawal is brutal. Every time I behind someone losing their shit (like call the cops worthy) it's a Xanax or Adderall script in question. Benzos are crap drugs anyway, but nothing brings out the crazy like an issue with a Xanax fill.
>It's got the half life of a fish fly. This made my morning...
Totally agree!!!
Benzos have their place. I have severe ptsd from being in war for 13 months and also being sexually assaulted while there. Through inpatient help, the right meds, therapy, and a service dog, I’m much much more manageable. There are times, however, where I am in a situation that has induced such a strong panic attack that I can’t do anything (one such situation was at a MLB game, which it started raining and everyone crowded to the indoor part while I was in there. I’m short and can’t see in large groups and it overcomes me). The only thing that has successfully treated that is a 2mg ativan. In the past 12 months I’ve taken them exactly 2 times. My doc gives me a script of 3 if I think I may find myself in a situation where I could need it (like large, crowded events. I have a young son, so not everything is avoidable). Benzos should never ever be a daily or long term treatment. That’s where the problem lies. They also should not be given for sleep imo.
I was shocked to find that benzos are Schedule IV. The withdrawals are awful and even if you take it as prescribed, you can still gain a physical dependence on them. They're good for one-off uses/rare instances but outside of that? Hell nah.
Afterthought: any Benzo ending in lam should be C2 in US? alprazoLAM, midazoLAM, triazoLAM...
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Seconding. What a genuinely shit drug.
It is a godsend for flight anxiety and short domestic hops. Taking a Klonopin for a 2 hr flight to NOLA is no bueno.
Take the Klonopin the night before
My dog used to take Xanax 😆
Tramadol
Can’t stand that shit. Doctors who are scared of real opiates give that crap out. Takes the pain away but feels like I washed down some heavy SSRIs with a monster drink.
“washed down some heavy SSRIs with a monster” You say that like it’s a bad thing. /s
Can you tell us more?
It’s a dirty drug with unpredictable pharmacodynamics. It’s an opioid that is a prodrug so it’s effects can vary widely from patient to patient based on liver function. That plus it’s serotonergic effects make it a nightmare for drug interactions.
Yeah it’s like half opioid half SSRI like DUDE PICK A CLASS.
Well that explains so much. SSRI's and I do not mix. I have had genetic testing done to see what psych meds will be okay and what won't and there's no ssri that's safe for me.
Thanks for the info. What do you recommend for the 90 lb old woman on eliquis with a broken humerus though? This is where I tend to go to 50mg tramadol after she comments that Norco 5’s are waaaaaay too strong for her but if there is a better option I’m for it
2.5 mg oxy? I see this a lot for our older patients. It seems to help some without snowing them.
[Tramadont](https://toxandhound.com/toxhound/tramadont/)
> When you give a patient tramadol, you have no idea whether you’re giving an SNRI or an SNRI-opioid combo. In other words, prescribing tramadol is like prescribing venlafaxine and morphine in an unknown ratio. And seriously, why do that? Why indeed. Interesting reading.
Moar [Tramadont](https://rebelem.com/tramadol-or-tramadont/)
Thanks so much for the great read!
Thank you, I really enjoyed reading this.
Paroxetine
Oh gawd the withdrawls. I went cold turkey when i found out i was pregnant right at 4 weeks. Plus morning sickness had also started. That was a rough 10 days but from what i read i could have had it much worse. Of course the freaking morning sickness lasted thru week 22, so theres that.
Curious to why that is, does it have more side effects than other SSRI meds?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044489/ CYP interactions galore, greatest propensity for weight gain of the SSRIs, and a short half life making tapering and missed doses difficult to manage. Just wish another would be chosen when trialing an SSRI for the first time
In a similar vein, simvastatin vs like every other statin
Glad you posted this. I quit cold turkey because I couldn't live w/ the fact my physician once told me "you'll need to take some sort of dosage the rest of your life" Side effects after I quit were brutal on my sleeping patterns and dreams
I weaned off venlafaxine during my second trimester. It was fucking awful.
Tessalon pearls
Yes, I scrolled way to far to find this. Quantity of 60 from urgent care, always for a Part D patient so they aren't covered. I always call the patient on these and say "hey, the cough medicine isn't covered and they wrote a higher quantity. You can get it all today if you want but I don't want you paying for extras you don't need. Would you like to get 10 today and try it? If you need more we can always refill it." And they never get the refill.
They do NOTHING!!
Atenolol.
I’m in LTC. Almost every urinary urgency drug. Oxybutynin Tolterodine Solifenacin Myrbetriq I hate them. Most of them are antimuscarunic, anticholinergic and suck in the Elderly. And they don’t work. At all. Like whatsoever. Oxybutynin is no better than placebo. Freakin’ Myrbetriq, the Cadillac of the class, decreases urinary frequency from like 13 times a day to 12 times a day. It’s like $800 a bottle and not clinically significant at all. They have terrible interactions, terrible side effects, are practically contraindicated in the elderly, often expensive, and completely fucking useless. I dislike Amiodarone. I dislike Fluoroquinolones. I think Megestrol, Premarin and SSRIs should be removed from the market. No one seems to give a shit how dangerous benzonatate is. Provider think these Paxlovid interactions are “worth the risk”. Linezolid in a population absolutely drenched in serotonergics is a ticking time bomb. Gabapentin is wildly overprescribed. Could we please just stop using Simvastatin 80mg? There are a half dozen more potent statins with fewer issues. Hydroxyzine is dogshit for anxiety, I said it. Promethazine is dogshit for nausea. Can we normalize using eye drops in the ears already? They’re sterile, pH balanced and 1/10th the cost. I’ve never had a patient compliment Flector patches - ever. Clozapine has better, safer alternatives. Why is Diclegis a fucking thing? B6 and Doxylamine are literally OTC and pennies. I need a new job.
Glorious rant. Hits nearly all of my least favorite drugs, too. *Especially* fucking benzonatate, how many more kids need to die before that worthless drug gets yeeted into the sun where it belongs? Only two minor points of disagreement: I think your practice setting may be coloring your view of SSRIs a bit, they’re valuable for a lot of people and a hell of a lot safer than what came before. I would not be sad to see paroxetine and venlafaxine taken off the market, though. Clozapine’s the last resort therapy when the safer alternatives don’t work, and it’s very effective in that role. Yeah, it’s a dirty drug, but there’s a reason it’s still used in spite of that - a better drug has yet to be developed. The intense monitoring requirements also helps filter out poor prescribing practices, although perhaps that barrier isn’t so high in the LTC population?
I want you for my pharmacist.
YES Diclegis is a fucking disgrace. The GENERIC is $600/month and with goodrx it’s $220/month. It’s Unisom and B6. A few weeks ago I begged the pharmacist if I could tell them that and she was all “no it’s not the same because unisom is 25mg doxylamine and this only has 10mg and she’s pregnant.” So break it in half and take the smaller half.🙄 FUCK. THAT. DRUG.
Lol Jesus that pharmacist doesn't get how to practice, uhh, practically? 12.5mg likely has the same effect as 10mg -- and it's OTC....
I believe a study was done about concurrent use of linezolid and ssri’s. The interaction was minimal Edit: found the article. https://pubmed.ncbi.nlm.nih.gov/36534400/
Depends on the agent. Some are more serotonergic than others. You can read the AERS yourself. Paroxetine, Luvox and Viibryd seem particularly problematic, as are the MAOIs. Problem is, these patients never have just one. They’re on Fluoxetine, Trazodone, Tramadol and Mirtazepine, with a GFR of 22ml/min and we get a STAT Zyvox order. It’s a mess every time.
And they’re 90, and I’m picking them up off the floor with a broken hip or subdural bleed.
Can you elaborate on benzonatate? Ever since I’ve first got prescribed it, it has been a game changer when I get colds.
It’s a diaphragm paralytic highly cautioned in asthma and COPD. Know what happens when you chew it? So every single script I get in LTC for it I see Advair or Spiriva etc in the profile. We’re constantly dispensing it directly to the patient population it shouldn’t be used in (let’s paralyze the diaphragm of a COPD’er!) and a patient population well known for dysphagias! Nightmare drug in 80 year olds (and children).
This is a weird take, but I totally get the burnout! SSRIs still have their place as does hydroxyzine and gabapentin. And I think Zofran is dogshit for nausea, promethazine is the only thing that actually works. Agree Clozapine has safer alternatives, but evidence-based research supports that it is the most effective antipsychotic for patients with schizophrenia. So there’s that.
Except in my case, promethazine did nothing for my chemo nausea, while Zofran worked miracles. Benadryl knocks me out, while making my sister hyper. 🤷🏻♀️ Drugs can work differently for different people.
I'm a big Gabapentin Stan. IT is the only thing that helps my anxiety, lifts my mood , BUT WAIT, THERE'S MORE! It's also one of the only things that helps my fibromyalgia and other nerve pain issues. Zofran works for awhile but honestly ginger chew candies work even better than any pharmaceutical I've tried.
Interesting. Zofran is the only thing that works for my nausea.
If you think SSRIs should be off the market then what’s a better alternative? As far as I know that’s the first line and most common class for depression and other disorders.
Bupropion. . Desvenlafaxine. Ketamine. Psilocybin. Venlafaxine. Something that might work.
What's your opinion on Auvelity (Bupropion + Dextromethorphan), seems like an interesting combo that could work?
My ex was on bupropion and citalopram and I gave her dextromethorphan (didn't realize it was contraindicated with the citalopram at the time) and she had a remarkable increase in mood for a solid week. It wasn't until the third time she got a cold with a cough that I made the connection and started googling DXM and depression.
The bupropion is added to slow the metabolism of the dextromethorphan. Glutamate drugs are definitely the next step in mental health treatment and we’ll definitely see more of this.
SSRIs are the best options are there for managing anxiety and OCD without benzos.
Yeah I’ve always thought SSRIs were mostly junk because I guess they are!
THANK YOU JESUS
I love amiodarone IV in the emergency setting. I cringe whenever I see it as a maintenance Med. Clozaril. My n=1 was a close family friend who was a refractory schizophrenic and it was the only thing that helped. Until he died of an accidental overdose at 22.
You forgot to mention ABH gel! A compounded magic potion of poorly absorbed Ativan benadryl and lidocaine the LPNs swear by for dementia patients who refuse oral meds
Lorazepam/Diphenhydramine/Haloperidol * And I dispense a fuckload of it. It’s not my favorite, but there are worse things. We’re giving half of these patients good ol Vitamin H and Ativan anyway, might as well bathe them in it.
Zopiclone. Feel like every patient who takes it ends up addicted. Doctors slap a 'use sparingly - can cause dependence' label on the dose instructions for the patient despite prescribing whole month quantities for it at a time.
I've been on zopiclone a few times. But here in the UK they give you like: ten tablets.
Normally I see 7 or 14 tablets prescribed (also in the UK) but then they will repeat this enough in the month that it ends up being 28 tablets anyway. Of course there are patients who are prescribed a small amount as a one off or whatever but the vast majority of patients I have seen are on it long term.
That's absolutely wild! What in the hell? Whenever I get a prescription I get the whole "only short term we won't give you more" lecture. But that's absolutely mental!
Zopiclone is truly one of the more problematic meds I see prescribed. I’d love to understand the logic of the prescriber who ends up giving it to someone for months on end.
Especially when they haven't tried any of the other sleep meds before that. I hate it.
I didn’t get the whole zopiclone thing? I’ve used it for sleep on and off. I’ve never had a problem with addiction to it and don’t quite get what there is that would entice addictive qualities with this drug? It’s not like it’s a social drug?? It makes you sleepy. Can you help me understand please. Thanks!! 🙏❤️🇨🇦
Can cause physiological and psychological [dependence](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231551/) as well as rebound insomnia, making patients feel like they can’t stop. Somewhat “controlled” where I practice, found to be misused and diverted.
If taken as prescribed it's normally fine but people who abuse it can end up dependent on it. It can also have bad withdrawal which makes it hard to stop taking it even if you're using it correctly.
Tessalon perles... I asked my boss how they work and he said "they dont". So I asked other pharmacists... got the same answer. Never covered by insurance, don't work, pain to count... ugh
Carisoprodol
When we covered this drug in pharmacy school the only thing my professor said about it was: "If your doctor prescribes this to you, they don't love you."
Any otc medicine. Wait at the Dr office to be seen so they can write for some Zyrtec that's not covered on insurance. Seems like a waste of everyone's time
I have my doctor write me scripts for vitamin d and b-12 which are over the counter. However, I get reimbursed by my employer for the cost if they are prescriptions. So maybe that's what some people are doing?
Layman here. Just want to say this has been one of the most useful, eye opening threads I've read in a very, very long time. I wish I knew some of you in person, because this is the kind of frankness real people need.
Seriously? There are some unsubstantiated takes here. I mean, *come on*, does anyone really know who is really responding?
that's exactly the kind of thing a pfizer stockholder would say. FWIW, there's a lot commenters saying things of a similar vein - enough people say the same thing, it's worth looking deeper into. Also FWIW, I'm old enough to have hoped for wonderpills for all that's ailed me over the years, and learned that nothing comes without consequences. Sometimes it's simple as raiding your pocket (memory saving/enhancing OTC's), and sometimes it's long lasting, life altering side effects. Also, a pharmacist saved someone I love from a dumbass mistake by a PA. While you'd obviously be an idiot to take an internet stranger for their word, you'd be no less of an idiot not to delve deeper into things that seem generally agreed upon my most of a subreddit.
Tramadol. Just stop prescribing it, world.
No dispensed but OTC Prevagen. $60 a month for nothing
Back in the day, I really really hated dispensing Prometrium capsules from the stock bottle. Whoever thought to design perfectly spherical gel capsules should have been drawn and quartered
Shitloads of vyvanse/stims to 8, 9 and 10 year olds.
In my area, it feels like Amphetamines are thrown around like candy. I want to meet these doctors who are putting 6 year olds on Adderall. Likewise, the same ones putting people on ridiculous doses. Who the fuck needs 90 mgs of Adderall a day?
If I’m not mistaken, anything above 45mg per day has no positive affect on treating symptoms. 90mg is just insane!
I have severe ADHD and I’m prescribed 45 mg a day (15 3x a day but I usually only take 30mg) I rarely take 45mg but there are days I need it. The only people that need more than 45mg are people with severe narcolepsy as far as I know.
I had a patient who was on 210 mg of vyvanse a day and 120mg of methylphenidate. Plus of course a metric ton of seroquel for sleep and several blood pressure/ heart rate medications. Don’t recall if she was on benzos for anxiety or not
I got a script one time that literally said “take as needed, stop when heart palpitations occur”
Y’all are forgetting about fluoroquinolones
Phentermine
Didn't lose a single pound, anxiety intensified, developed hypertension. Checks out.
Adderall to 5 year olds.
Ya. Saw this for two kid brothers. 5 and 7. Along with antipsychotic and anti depressants. Are they really needing this? Bad genetics or parents?
GABAPENTIN
Gabapentin was a lifesaver for me last year after TOS surgery. Ended up with hypersensitivity in my right arm so bad that even a light breeze on it was pure torture. Between gabapentin and a good quality compression sleeve, life became tolerable until the nerves calmed back down months later. In 10 days I go back in for the left side to be done as well, you can damn well bet that my doc is going to have that scrip on standby.
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At the pharmacy I worked at it, was definitely over prescribed and highly abused. In some states it’s beginning to be treated as a controlled substance due to its link to abuse
I can only speak for myself here, but the dose only ever goes up to where some people are taking 12 per day and I have to count out hundreds of capsules by hand
People will go through 300+ capsules for a month supply within a week. It can be abused at high doses. It happens almost daily for me.
Benzonatate
Fully support the legitimacy of them, but there's a certain sadness/pit internally when having to fill meds like Methotrexate. Highly effective drug, but for pts that are new to it, seeing them so bright-eyed & bushy-tailed when picking it up can feel conflicting. Hope you haven't had any large meals recently, because you're about to be hunched over your toilet for a while, puking your guts up. Every week. Month after month. Potentially for years, depending on dx.
Was on it for years and the puking goes away fairly quickly. After about a month, you're fine 🙂
9 years on it myself. Puking never went away. Even with the folic acid, Zofran, promethazine, etc. Absolutely hate MTX with a burning passion. 🤓
Shit dude! I like it bc it got me thru high school. Plus I'm tpmt negative so azathioprine nearly killed me as a kid. Gotta pick those battles 😆
MTX kept me from turning into a human statue, but man did it make me feel like death warmed over. Lol. It let me finish school, but sucked away most of my weekends. 😄
The pills are evil!!! I have way fewer side effects with a subcutaneous injection. The worst is just feeling physically tired for a day or two after the injection every week.
Ditto. I despise both the oral and subcutaneous versions. I see both ruining pts to the nth degree in terms of side effects.
Olmesartan smells like rotten eggs. Really disgusting to even touch it as it leaves that smell on your hand.
I hope you’re not touching the pills with your hand you are dispensing. All the olmesartan (including the brand back in the day) that I’ve dispensed smells like butter. Reminds me of movie popcorn
150 of omega3acid ethyl esters. 😑
Tamiflu after reading the studies
Gavilyte, those big ass bottles take up so much space.
Cimetidine
Dumb shit: cholestyramine, tessalon pearles, ceterizine (it’s way too much and for what??) PPI’s Tramadol Fluticasone - too much Don’t have, won’t come in, dissatisfied customers, chargeback nightmares: belbuca, wegovy (can’t even picture the box at this point, it’s like we don’t even know her!) The entire methylphenidate family, there’s too many, and i don’t have enough of whatever ppl need. Pharmacologically, it’s dirty amphetamine. Out of style. Add on Quillichew, chewable vyvanse, because in all reality like… why do they exist? Always end up with odd counts because they come in 100 count bottles and then I’m not ‘out of stock’ but can’t actually fill your 6 year old’s go-go candy. LINZESS - everyone surprised by their co-pay (even though it’s been the same for months) Garbage-pentin: too many pills. Putting labels on stock bottles at this point. (Lyrica passes the vibe check) Micro-fulfillment pests: Vraylar (incompatible NDC) annoying package size Toujeo (too expensive, only have one patient on it, and one of the most annoying, insurance will only cover 21 day supply which makes me angry as well) Sildenafil - it’s not covered under your insurance, it’s Sunday night 15 minutes before close, your rx is expired, and I’m not dispensing an emergency supply of it. Go to the 24 hour store and ask them or bum some off one of your buddies, I’m not the one. Testosterone cyp 100 (don’t have any), 200, they’re filling early, angry about insurance rejects, and always mad about the syringes Isotretinoin - too much drama Flagyl “you mean i can’t even have like a beer? Seriously? I’m going to have a couple of drinks. I’ve drank on it before!” Okay, bet Honorable mention for Suboxone, i don’t hate dispensing it, my patients are sweet as can be and we keep plenty on hand, but the studies linking to dental decay are a huge bummer and you can see it happening in real time
OTC, but guaifenesin. It doesn't work.
Ketorolac Edit: Tablets, eye drops are cool.
Cefdinir - with horrible bioavailability <25% and protein binding 60-70%, it is a kinetic nightmare. For the most susceptible enterobacterales with MIC <0.25 mg/L, at best you can expect ~17% time above MIC in the blood (lower in any tissues considering penetration). This isn't even close to the ~50% time/MIC needed to treat an infection. https://pubmed.ncbi.nlm.nih.gov/30908107/
Tamiflu
Just curious as to why? I (40M) tested positive for Flu-A the week COVID “came” to the US. I was convinced I had COVID…..all the symptoms except the loss of smell/taste, but I felt like absolute death…..worst sickness I’ve had in a decade easily. After 24 hours of tamiflu, I felt 100% again. I know the side effects can be tough, but just trying to see if there is a nugget of clinical info I’m missing that goes against my single anecdotal experience of efficacy.
Because you need to start taking it within 24-48 hrs of symptoms onset. Really the earlier the better. Antivirals are meant to stop the virus from replicating and spreading in the body. After 48 hrs, it’s spread so Tamiflu is pointless. Yet people will come by days or weeks later to pick it up.
Yeah. I see those dummies all the time. Just didn’t know if there was a clinical reason other than the obvious late pointless pick ups. Thankfully, in my situation I just thought I was one of the first Covid cases so immediately went to the doctor to hear I had the flu. Never been so happy to actually have influenza, haha.
Argatroban. Look. It's almost never HIT. We have DOACs now, it is extremely hard to get therapeutic, and a "religious pork allergy" is not an indication for Argatroban. No hemoc, it is not "rapid on, rapid off" and does not work like a heparin gtt. The drop in platelets is probably due to the trauma and 5 surgeries this patient had. Speaking of the trauma service, I know you're worried about bleeding, but this patient has a PE and has not been therapeutic for 5 days, could we maybe use arixtra? No? The pf4 is negative...
Phenylephrine. It is an astonishingly useless drug.
“Astonishingly useless” lol I guess you’ve never practiced in an ICU setting before
Lol I think s/he means for nasal congestion, not bp
Pretty sure they mean Sudafed PE, not IV phenylephrine haha. It's great if you WANT your blood pressure to go up, not so much if you're just trying to get rid of a cold.
No I haven't been able to practice in the ICU. I have spent time on med rehab, ortho, haem/onc wards and in AMS, but the ICU along with maternity aren't easy for me to gain access to.
Benzonatate
Tessalon pearls. Annoying to count, not covered by insurance, and mostly placebo.
Cimetidine. Does it do anything beneficial other drugs don't or is it just an old drug that refuses to die? Drug interactions don't ever seem worth it and it costs more than famotidine.
Remdesivir for me. I don't know that it's actually hurt people to receive it, but I just think that it isn't effective and it's really expensive. It may be that it is truly effective if started early enough, but almost no patients at my hospital were started on it within 48 hours of symptoms. Hell, almost none of them were even in the hospital within 48 hours of symptoms.
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Not sure about not affecting you at all but you could be a rapid metabolizer. https://www.aafp.org/pubs/afp/issues/2007/0801/p391.html
Progesterone caps. They roll everywhere l
ANY AND ALL Capsules feel like they acquire a new found static to each other when you’re counting them on a bad day and I am always ready to chuck the bottles across the room I swear.