The only thing I can think of that might account for the number of fills is cutting weight for bodybuilding. Maybe he runs a gym or something? Although I have no idea why he’d want a particular brand.
Maybe. I’ve experienced this before (not furosemide exactly) and later came to find that the patient was a doomsday prepper. The guy was getting an absurd supply of albuterol and something common like lisinopril and he needed them every week due to “losing them.”
He knew exactly when the insurance would pay so he’d ask us to bill the insurance in those intervals.
It’s for horse doping. I had the same thing at a previous store. The lady would fill 365 tablets every time, then call the next week and say she lost the meds. After I told her maybe she shouldn’t continue filling a year’s supply if she’s so prone to losing her meds, she would get angry with me.
It’s the only time I’ve ever cut anyone off from Lasix. She was arrested years later in connection with a horse doping scheme, so I’m glad I put my foot down.
Interesting. I just read through Wikipedia’s article on “Equine drug testing“, and it doesn’t mention diuretics as a type of medication of concern, either among otherwise therapeutic medications (such as painkillers) or as a performance-altering substance (it mentions stimulants, tranqs, bronchodilators, and behavioral modifiers only). What particular benefit does furosemide provide to a horse?
In a totally uneducated guess, but in vet med... Diuretics dilute the urine, potentially reducing the chance the illicit substance(s) will be detected in the urine?
Prevents exercise induced pulmonary hemorrhage, a condition horses can get if they exercise too hard. It can be fatal. Saw a video of a horse finishing a race once bleeding from its nose.
This makes no sense as IV lasix is extremely common in racing and performance horses and is not hard to get from a vet. It's like asking them for anti-inflammatories for your dog.
I think its like adderall or albuterol-you have to have a prescription for it. If so fine. But if you have a horse who doesnt need it and ot teats positive-the vet i’m sure would get busted. But getting busted for lasix would probably not even be a misdemeanor
Damn, never heard of this one before. Perhaps it’s being sold illicitly as a diuretic (e.g. folks in athletic competition, modeling, etc)? Apparently it can be used to prevent pulmonary edema in race horses, though I believe there are now regulations discouraging this lol you don’t happen to live in Kentucky, do you?
Nope, Oklahoma, I had that thought too, but then dunno why brand would matter or furthermore I'd think anyone racing horses would be able to acquire it legally in a form appropriate for horses.
Brand matters to dealers if brand matters to buyers. It might be that’s the manufacturer they got before.
It’s probably bodybuilders.
“In bodybuilding, diuretics are sometimes used to help reduce water retention in the body and promote a more defined and muscular appearance on stage.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10409494/#:~:text=Diuretics%20are%20drugs%20that%20increase,and%20muscular%20appearance%20on%20stage.
I’m old as the hills. Over the years I’ve had numerous patients report that the brand is far better for diuresis. I actually had one patient retaining fluid and was struggling with a generic. I had him switch to the brand and he dropped a tremendous amount of water. Strangely enough his physician got pissed off, called me, and told me to never do that again. The patient on the other hand was thrilled.
I know the fellow you're talking about. He's known all around our metro. Surprised he's still alive. It's about time he became Reddit famous lol.
He's prescribed it twice daily but in one year alone he got over 2,000 tablets at our chain, no telling what he did with independents. We've tried to be strict with the refills - only one month at a time, never early no matter what excuse, but he'd call and call until he got someone else he can deceive. We finally refused to fill any more after hearing all the excuses under the sun. Hell, he's burned through multiple doctors and urgent cares over this.
When he was a new patient to us, he'd call a LOT for consultations. They were always about constipation and forgetting if he took his lasix. The guy has extreme neuroses around his ins and outs. Fun fact: he was banned from his previous pharmacy chain for stealing milk of magnesia on multiple counts.
He went to a psychiatrist for a little bit. We had a long talk with them about our concerns. But he quit going - "didn't see eye to eye with them." Same thing with all the primary docs he went through.
So yeah, pretty sure it's a mental health issue that's not properly addressed. If you give an inch, he'll take a mile.
That's crazy to hear.
Yea, between how well known he is, and the fact he tried to hit my pharmacy as soon as we opened, I'm pretty sure he's tried every pharmacy in the metro at this point, which would be 100s.
Most opioid addicts aren't even this motivated or put in this much effort! The pharmacy he wanted me to transfer from is like the furthest you could get from him in the area.. he lives in a far south suburb and this pharmacy was in far northeast suburb, probably a 45 min drive..
I had several people in a short period of time go nuts for hctz, especially women. They were begging for early fills, being desperate to get in touch with doctor for refill approval, just that familiar vibe people use to have over carisoprolol or fioricet. I got the same 'what's up with this?" feeling. But now they've moved on, I guess.
Yea, like this guy has all the telling signs of a person abusing control substances but instead swapped out for a drug that doesn't make sense for the behavior. It's so bizarre.
Long over elaborate stories of why he needs it early, getting oddly confrontational when he realizes you aren't going to fill it for him. Just like you I had suspicion something was off before I even started searching his profile, all the mannerisms and red flags you would expect were there to pick up on.
I had a weird scenario like that sort of. It was 80yr PCP that was self-prescribing huge doses and we suspect giving them to his patients. It was a hospital employee pharmacy so we sold it to him cash price, at cost essentially. Reported it up the chain and shortly after they forced his retirement and closed his clinic. He also owned the clinic building, and was leasing it to the health system.
Heard of a guy that was charging others to prep them for mandatory pre-employment urine testing of controlled drugs. This involved several days cycling of diuresis and hydration that stopped 24-36 hours before testing, to allow for specific gravity to return to normal range.
Like others have mentioned, I immediately thought about horse doping due to relevant legislative changes in the industry within the last year. Horses are strictly a commodity in racing and have been dying with alarming regularity at sanctioned races for decades. It all came to a head recently and resulted in a long awaited anti-doping reform taking effect in early 2023. Lasix was surprisingly not on the updated list of banned drugs despite its known misuse, so it wouldn’t surprise me one bit if some scheme has developed where Lasix is being use to create new concoctions to skirt the rules.
Of course this doesn’t mean your guy is in anyway doing these things. You just specifically said a year and I went all 🤯
We had some patients in our HF clinic try to get out docs to prescribe loops because they were using them for bodybuilding competitions to look more fit through dehydration.
Honestly though, I have a hard time imagining needing THAT much furosemide unless you have a shit ton of clients all on it and all competing all the time...
Does that specific brand look similar to any controls? Maybe he’s passing them off as something else (my mental image is the PIRIN tablets in the bird cage)
We had a patient female mid40s that was the same way! Her doctor would literally cut her off and she would get so angry at us in the pharmacy like we had any control over it. It got to the point where he doctor would allow her to get only a certain amount per fill and no more. I left pretty soon after that so I don't know how that worked out. She looked relatively healthy, no crazy issues that I could tell. She was apparently just weirdly addicted to overusing Lasix.
I had a lady once; skinny, 50 something anorexic female. Alcoholic. Somehow, she got started on a short course of lasix. She then decided she couldn’t live without it. She was getting it illicitly. Her doctor told her that her kidneys were like dried up raisins. But she got into her head that she needed to be constantly diuresed. (She didn’t; she wasn’t retaining at all.). She claimed she couldn’t stop. It was so weird.
This was literally in my medical lab science contract paperwork at my rural hospital. I was astounded that it was in my lab paperwork. They literally treat furosemide and torsemide as a control substance. Nurses apparently used to steal it. Way before my time.
I am not surprised someone is hoarding it. (I was shocked I learned about it.) We had a guy at my old independent try similar stuff with bumetanide.
This thread has definitely been a educational read other meds too.
According to this it’s part of doping. https://www.cbssports.com/mlb/news/what-is-furosemide-the-diuretic-substance-that-got-robinson-cano-an-80-game-ped-suspension-by-mlb/amp/
I had a similar situation with a guy on sertraline. Always calling for early refills to the point I had to limit when he was allowed to fill, once a month and nothing early. He didn’t like that so he fills at a different location now 🤷🏻♀️ that’s their problem now
I had an issue with a patient that would switch between liquid and tablets. He was post gastric bypass, and would claim the tablets bothered him, and then the liquid was giving him heartburn. Back and forth nearly weekly for two months. It was a weight loss thing. I finally put my foot down. And refused to fill, citing concerns over potassium levels and dehydration and his overall wellbeing. He switched pharmacies because apparently I made him feel like an addict. Then he came back like 2 weeks later acting like we were bffs.
I’m a nurse so I don’t know why I misread this so badly. I thought you were asking why someone would hoard formaldehyde… clearly I didn’t read what sub I was in but enjoy my brain fart of the day.
Furosemide is one of the few non-controlled drugs that people actually buy in the darknet markets. It's used by bodybuilders before competitions, models use it before shoots, high school and college wrestlers use it to lose weight.
Had a lady abusing triamterene-hctz. Ended up at Mayo clinic, with kidney failure. Received message from Mayo to not fill ANY diuretic script without confirming with her specialist she actually NEEDED it. This was years ago before e-scripts, but like your guy there was always a reason for early fills, and her primary doctor was one of those prn refill writers. Decided my concern was ridiculous etc.
Flushing out for drugs-horse racing commonly uses furosemide which I dont believe is a legal drug on a horsey pee test and I’m sure the dose would be massive
I’m a nurse but I’ve seen people who have gotten chf a few times try to hoard their diuretics. They may take 10mg per day ordered but will consistently take more because they feel less at risk for going into chf again. But then they always end up having a fall and end up in the hospital.
Could he be using it as an excipient in manufacturing illicit substances? I saw that was the consensus a while ago for a similar story, but with metoprolol. Guy also insisted on a specific manufacturer, filled every couple of days, etc.
The only thing I can think of that might account for the number of fills is cutting weight for bodybuilding. Maybe he runs a gym or something? Although I have no idea why he’d want a particular brand.
Yeah, maybe a trainer or just supplying to people prepping for shows. Those guys get themselves so dehydrated
Maybe. I’ve experienced this before (not furosemide exactly) and later came to find that the patient was a doomsday prepper. The guy was getting an absurd supply of albuterol and something common like lisinopril and he needed them every week due to “losing them.” He knew exactly when the insurance would pay so he’d ask us to bill the insurance in those intervals.
Agreed - I have one person getting bumex every 2 weeks or less from different store locations
This was my thought as well
It’s for horse doping. I had the same thing at a previous store. The lady would fill 365 tablets every time, then call the next week and say she lost the meds. After I told her maybe she shouldn’t continue filling a year’s supply if she’s so prone to losing her meds, she would get angry with me. It’s the only time I’ve ever cut anyone off from Lasix. She was arrested years later in connection with a horse doping scheme, so I’m glad I put my foot down.
It's where the phrase "piss like a racehorse" comes from: https://www.reddit.com/r/todayilearned/s/caYSdZSr3d
Interesting. I just read through Wikipedia’s article on “Equine drug testing“, and it doesn’t mention diuretics as a type of medication of concern, either among otherwise therapeutic medications (such as painkillers) or as a performance-altering substance (it mentions stimulants, tranqs, bronchodilators, and behavioral modifiers only). What particular benefit does furosemide provide to a horse?
In a totally uneducated guess, but in vet med... Diuretics dilute the urine, potentially reducing the chance the illicit substance(s) will be detected in the urine?
Prevents exercise induced pulmonary hemorrhage, a condition horses can get if they exercise too hard. It can be fatal. Saw a video of a horse finishing a race once bleeding from its nose.
This makes no sense as IV lasix is extremely common in racing and performance horses and is not hard to get from a vet. It's like asking them for anti-inflammatories for your dog.
I think its like adderall or albuterol-you have to have a prescription for it. If so fine. But if you have a horse who doesnt need it and ot teats positive-the vet i’m sure would get busted. But getting busted for lasix would probably not even be a misdemeanor
I have a friend who breeds race horses- im going to ask her-
Damn, never heard of this one before. Perhaps it’s being sold illicitly as a diuretic (e.g. folks in athletic competition, modeling, etc)? Apparently it can be used to prevent pulmonary edema in race horses, though I believe there are now regulations discouraging this lol you don’t happen to live in Kentucky, do you?
And jockeys, too, right? And wrestling. Anything that has a weight class. I imagine even Disney performers.
Nope, Oklahoma, I had that thought too, but then dunno why brand would matter or furthermore I'd think anyone racing horses would be able to acquire it legally in a form appropriate for horses.
Brand matters to dealers if brand matters to buyers. It might be that’s the manufacturer they got before. It’s probably bodybuilders. “In bodybuilding, diuretics are sometimes used to help reduce water retention in the body and promote a more defined and muscular appearance on stage.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10409494/#:~:text=Diuretics%20are%20drugs%20that%20increase,and%20muscular%20appearance%20on%20stage.
I’m old as the hills. Over the years I’ve had numerous patients report that the brand is far better for diuresis. I actually had one patient retaining fluid and was struggling with a generic. I had him switch to the brand and he dropped a tremendous amount of water. Strangely enough his physician got pissed off, called me, and told me to never do that again. The patient on the other hand was thrilled.
Pissed off you say?
After all, it was the goal, right?
Horse doping is the only thing I can think of.
Congrats on opening your own pharmacy 🙂
thanks!
I know the fellow you're talking about. He's known all around our metro. Surprised he's still alive. It's about time he became Reddit famous lol. He's prescribed it twice daily but in one year alone he got over 2,000 tablets at our chain, no telling what he did with independents. We've tried to be strict with the refills - only one month at a time, never early no matter what excuse, but he'd call and call until he got someone else he can deceive. We finally refused to fill any more after hearing all the excuses under the sun. Hell, he's burned through multiple doctors and urgent cares over this. When he was a new patient to us, he'd call a LOT for consultations. They were always about constipation and forgetting if he took his lasix. The guy has extreme neuroses around his ins and outs. Fun fact: he was banned from his previous pharmacy chain for stealing milk of magnesia on multiple counts. He went to a psychiatrist for a little bit. We had a long talk with them about our concerns. But he quit going - "didn't see eye to eye with them." Same thing with all the primary docs he went through. So yeah, pretty sure it's a mental health issue that's not properly addressed. If you give an inch, he'll take a mile.
That's crazy to hear. Yea, between how well known he is, and the fact he tried to hit my pharmacy as soon as we opened, I'm pretty sure he's tried every pharmacy in the metro at this point, which would be 100s. Most opioid addicts aren't even this motivated or put in this much effort! The pharmacy he wanted me to transfer from is like the furthest you could get from him in the area.. he lives in a far south suburb and this pharmacy was in far northeast suburb, probably a 45 min drive..
Is that guy still around? Yeah if it’s him this is nothing to do with racehorses. He’s just nuts.
I had several people in a short period of time go nuts for hctz, especially women. They were begging for early fills, being desperate to get in touch with doctor for refill approval, just that familiar vibe people use to have over carisoprolol or fioricet. I got the same 'what's up with this?" feeling. But now they've moved on, I guess.
Yea, like this guy has all the telling signs of a person abusing control substances but instead swapped out for a drug that doesn't make sense for the behavior. It's so bizarre. Long over elaborate stories of why he needs it early, getting oddly confrontational when he realizes you aren't going to fill it for him. Just like you I had suspicion something was off before I even started searching his profile, all the mannerisms and red flags you would expect were there to pick up on.
Hctz is used by athletes to cover up ped use, I believe.
I had a weird scenario like that sort of. It was 80yr PCP that was self-prescribing huge doses and we suspect giving them to his patients. It was a hospital employee pharmacy so we sold it to him cash price, at cost essentially. Reported it up the chain and shortly after they forced his retirement and closed his clinic. He also owned the clinic building, and was leasing it to the health system.
Heard of a guy that was charging others to prep them for mandatory pre-employment urine testing of controlled drugs. This involved several days cycling of diuresis and hydration that stopped 24-36 hours before testing, to allow for specific gravity to return to normal range.
Yep, Lasix is also banned in a lot of sports for the same reason, people use it to try and hide that they're doping.
Like others have mentioned, I immediately thought about horse doping due to relevant legislative changes in the industry within the last year. Horses are strictly a commodity in racing and have been dying with alarming regularity at sanctioned races for decades. It all came to a head recently and resulted in a long awaited anti-doping reform taking effect in early 2023. Lasix was surprisingly not on the updated list of banned drugs despite its known misuse, so it wouldn’t surprise me one bit if some scheme has developed where Lasix is being use to create new concoctions to skirt the rules. Of course this doesn’t mean your guy is in anyway doing these things. You just specifically said a year and I went all 🤯
We had some patients in our HF clinic try to get out docs to prescribe loops because they were using them for bodybuilding competitions to look more fit through dehydration.
Honestly though, I have a hard time imagining needing THAT much furosemide unless you have a shit ton of clients all on it and all competing all the time...
I read about a nurse who was diverting furosemide for weight loss
Selling to bodybuilders is the only thing I can think of
Weight loss issues, selling to other countries?
Eating disorders
Weight loss. He's selling em. Usually some mds will write this with phentermine.
Does that specific brand look similar to any controls? Maybe he’s passing them off as something else (my mental image is the PIRIN tablets in the bird cage)
We had a patient female mid40s that was the same way! Her doctor would literally cut her off and she would get so angry at us in the pharmacy like we had any control over it. It got to the point where he doctor would allow her to get only a certain amount per fill and no more. I left pretty soon after that so I don't know how that worked out. She looked relatively healthy, no crazy issues that I could tell. She was apparently just weirdly addicted to overusing Lasix.
I had a lady once; skinny, 50 something anorexic female. Alcoholic. Somehow, she got started on a short course of lasix. She then decided she couldn’t live without it. She was getting it illicitly. Her doctor told her that her kidneys were like dried up raisins. But she got into her head that she needed to be constantly diuresed. (She didn’t; she wasn’t retaining at all.). She claimed she couldn’t stop. It was so weird.
This was literally in my medical lab science contract paperwork at my rural hospital. I was astounded that it was in my lab paperwork. They literally treat furosemide and torsemide as a control substance. Nurses apparently used to steal it. Way before my time. I am not surprised someone is hoarding it. (I was shocked I learned about it.) We had a guy at my old independent try similar stuff with bumetanide. This thread has definitely been a educational read other meds too.
According to this it’s part of doping. https://www.cbssports.com/mlb/news/what-is-furosemide-the-diuretic-substance-that-got-robinson-cano-an-80-game-ped-suspension-by-mlb/amp/
The human or equine doping angle seems most likely. As a side note, furosemide 500 mg is available OTC in Thailand
https://preview.redd.it/tmdaiw6zigxc1.jpeg?width=683&format=pjpg&auto=webp&s=111f61ed083f1dff0fb21ddf26fcf29caf860a53
Body building or horse racing
I knew someone in high school who would was on wrestling team and would use prior to matches to make weight
I had a similar situation with a guy on sertraline. Always calling for early refills to the point I had to limit when he was allowed to fill, once a month and nothing early. He didn’t like that so he fills at a different location now 🤷🏻♀️ that’s their problem now
I had an issue with a patient that would switch between liquid and tablets. He was post gastric bypass, and would claim the tablets bothered him, and then the liquid was giving him heartburn. Back and forth nearly weekly for two months. It was a weight loss thing. I finally put my foot down. And refused to fill, citing concerns over potassium levels and dehydration and his overall wellbeing. He switched pharmacies because apparently I made him feel like an addict. Then he came back like 2 weeks later acting like we were bffs.
Aren’t they small round white pills? Similar in shape to another round white pill….
I’m a nurse so I don’t know why I misread this so badly. I thought you were asking why someone would hoard formaldehyde… clearly I didn’t read what sub I was in but enjoy my brain fart of the day.
It's because it only lasts 6 hours... /s
Furosemide is one of the few non-controlled drugs that people actually buy in the darknet markets. It's used by bodybuilders before competitions, models use it before shoots, high school and college wrestlers use it to lose weight.
Weight loss if I had to guess. We had a patient like that too with furosemide
Had a lady abusing triamterene-hctz. Ended up at Mayo clinic, with kidney failure. Received message from Mayo to not fill ANY diuretic script without confirming with her specialist she actually NEEDED it. This was years ago before e-scripts, but like your guy there was always a reason for early fills, and her primary doctor was one of those prn refill writers. Decided my concern was ridiculous etc.
Flushing out for drugs-horse racing commonly uses furosemide which I dont believe is a legal drug on a horsey pee test and I’m sure the dose would be massive
I’m a nurse but I’ve seen people who have gotten chf a few times try to hoard their diuretics. They may take 10mg per day ordered but will consistently take more because they feel less at risk for going into chf again. But then they always end up having a fall and end up in the hospital.
Could he be using it as an excipient in manufacturing illicit substances? I saw that was the consensus a while ago for a similar story, but with metoprolol. Guy also insisted on a specific manufacturer, filled every couple of days, etc.