Can we fill a rx for norco 5/325 if md wrote for hydrocodone 5/325.
Hydrocodone 5/325
- Thread starter mona2004
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Yes.
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LOL
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I know , it could easily be 325mg of lisinopril, or midazolam, better be safe than sorry
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Another "internet Pharmacist".....
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Yup. And there's not a single MD out there who has no idea what strength Vicoprofen comes in.
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although dentists know for some reason. Another reason I like hospital - they can write for whatever the hell they want and I change it to what I want to give
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Seriously. I can't even believe this is a real question in the world.
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My pet peeve is when they write for Vicodin 7.5/325 or something like that. Vicodin doesn't come in that strength; Norco does. I receive a rx for Vicodin 7.5 and a look on the profile says they have been getting 7.5/325. Of course, I don't have the 7.5/300, and since it is a C-2, I can't change it. The person wasn't happy when I said I couldn't fill it.
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can't you call the MD and change it? I thought you could essentially change any of the "numbers"
would a member of the BOP care if you changed vicodin 7.5/325 to Norco 7.5/325? Would you ever get in trouble,
but I have been out of retail for so long I cannot remember -
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Depending on state you can change the strength just not the name.
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You wouldn't change Vicodin 5/325 to norco 5/325? LOL WUT?
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I am actually lost on this question...
Actually... It depends on your state law. Norco is brand so you can not fill it if the doctor wrote for generic...
jk.
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The issue is that they used the brand name Vicodin. Vicodin has an acetaminophen strength of 300 and Norco has an acetaminophen strength of 325. If they write Vicodin 5/325, I can clarify it to Vicodin 5/300. It cannot be changed to Norco because it is a different brand of drug and you cannot do that with C-2s. In the case above, physician wrote for Vicodin 7.5 and so, there is no grey area. All they can get is hydrocodone/apap 7.5/300. When it was a C-3, it wasn't an issue, but since it is now a C-2, prescribers need to get their Vicodin and Norco straight or just use the generic name. With C-2s, you cannot change the name of the drug. This is not a board of pharmacy issue but a DEA issue.
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Thank god I don't work with you.
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What is up with pharmacists that call and fax about everythingggggg I tried to fill amoxicillin 500 tabs with caps because we only carry the 500 caps and the other pharmacist put it into resolution and called the doctor...
Really. Must be brand new rph
I agree
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You are INSANE. You probably drive doctors offices CRAZY. Talk about freaking doing things to the letter of the law.
How would that phone call to the doctors office go?
"Hi, I'm calling from pharmacy to speak to Dr. Roberts?. Hello doc. I see you wrote a script for John Doe for Vicodin 7.5/325. Vicodin doesn't come in 7.5/325.
Md: Of course it does. I dispense Hydrocodone and apap 7.5/325 all the time!!!
You: aha! But That is Norco. Not Vicodin. You see Doc, the Hydrocodone and apap in Norco and Vicodin are the exact same drug. But since Norco is 7.5 of Hydrocodone and Vicodin is not 7.5/325 but rather 7.5/300, I am afraid you have to re-write this prescription."
What a freaking waste of EVERYONES TIME. NO WONDER EVERYONE COMPLAINS ABOUT the lack of tech help. When you spend 15 minutes of your day doing this ****, you DESERVE TO BE SWAMPED WITH WORK.
I don't know anymore. Some of you RPhs give me migraines just READING what you do on a daily basis.
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It's his/her style. Let's just say the patient took the med and had an adverse reaction that landed him or her in the hospital. The court may very well find the pharmacist ignorant for not clarifying the prescription with the doctor.
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So no one here has had a pissed off md call them because they changed from a capsule to tablets? I've had a pain clinic call because I dispensed oxycodone tablets instead of capsules
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me - never - but 99.9% of the time the MD's could care less - I guess with zanaflex is does matter, and in very rare cases with a specialty MD/Drug such as a pain clinic
Doesn't matter. You are allowed to change the dosage form in consultation with the patient and informing the doctor later. In your case it's a C2, so I guess it would vary state-wise.
I wouldn't make an old lady drive back to the office for a new script over it though.
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One of these days.....be careful
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I had a board inspection at my pharmacy two months ago where the board inspector specifically pulled c2 files to see if we changed vicodin to hydro/apap 5/325. I would not take the advice of people on this forum saying its okay to break the law in order to save time (by all means do it if you want, just know that its something that is at the very least being looked at by some governing bodies and is a pharmacy law violation).
Do not forget that this is a profession where you can be docked for your labels saying expiration/discard after/finish by instead of "use by." 99% of the time you will be safe with these minor infractions but you always need to decide if its worth getting caught that 1%
Do not forget that this is a profession where you can be docked for your labels saying expiration/discard after/finish by instead of "use by." 99% of the time you will be safe with these minor infractions but you always need to decide if its worth getting caught that 1%
What state? I haven't heard of anyone having issues with either of those. (Not saying I don't believe you, I have heard equally anal things, just haven't heard those in particular).
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I had a state board inspector going through basically one year worth of C2s (due to a diversion in my previous pharmacy) and she didn't mention it at all.
I haven't met one pharmacist in my years of practice that care about this issue.
But you do have anal pharmacists, so it won't surprise me if you have anal inspectors.
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Some of these threads make me so happy I work in a hospital.
MD residents ordering dumb stuff we don't have, discontinue as "not on formulary" ordering wrong strengths of hydrocodone/APAP, change as "therapeutic substitution".
If I was practicing in the community setting there is NO WAY I'm bugging a doctor over 25mg of APAP. I may send an "information" fax or call just to be like, hey, Vicodin is 5/300 and Norco is 5/325 and since it's a CII now you may find some RPhs/DEA issues if you don't comply.
Anyway, what's stopping you from crossing out the 325 and initialing 300 with the MDs initials?
God this thread and the anaphylaxis thread need to be nuked from orbit. Just to be sure they are dead.
MD residents ordering dumb stuff we don't have, discontinue as "not on formulary" ordering wrong strengths of hydrocodone/APAP, change as "therapeutic substitution".
If I was practicing in the community setting there is NO WAY I'm bugging a doctor over 25mg of APAP. I may send an "information" fax or call just to be like, hey, Vicodin is 5/300 and Norco is 5/325 and since it's a CII now you may find some RPhs/DEA issues if you don't comply.
Anyway, what's stopping you from crossing out the 325 and initialing 300 with the MDs initials?
God this thread and the anaphylaxis thread need to be nuked from orbit. Just to be sure they are dead.
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The 1 in a million chance that you get caught. If the patient has a true codeine allergy and you need to provide a copy of the RX because the MD says they never would have written an RX for hydrocodone for that patient. Suddenly they realize they were in Canada ice fishing on the date your note says you talked to them. Now we've got a pharmacist prescribing and falsifying records. My license isn't worth risking over some MD's ignorance.
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NJ, there were plenty of Vicodin 5/325mg changed to 5/300 which is legal because its not changing the drug name and she didnt seem to have an issue with that. Seemed to be looking for that and sampling if we filled any controls written on the old NJ Blanks instead of the new barcoded ones.
I agree, its a beyond stupid issue but is still a pretty easy to catch violation. Just because of DEA involvment its above the "changing proair to ventolin" or "amoxil tabs to caps" issue that we all do. I just wanted to point out to everyone attacking OP that this is a profession built on nitpicky rules and regulations at all levels from FDA approval, to manufacturing GMPs, to dispensing the meds. So while you almost definitely wont get caught for the switch its still a risk/benefit call for you.
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Negative, it's 1 in 1,000,025 chance. Please correct and resubmit thanks bye.
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You asked why. I told you. The fact that you wouldn't make the same decision doesn't mean that it isn't the case.
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I have a colleague of mine who had an incident where the doctor denied changing a prescription after the pharmacist had verified an unusual dose. MD wrote a certain dose, then called in to change it. Pharmacist was not ok with the change and went over multiple times (with documentation) that MD authorized the change. (Patient ended up being admitted to hospital.) Afterwards, MD still denied and lawyers had to get involved. Anyways, this helped influence the installation of a recording system at my pharmacy because there is no limit as to what patients or doctors/nurses/vendors/clients will say and then deny.
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Another issue you must remember is insurance. I bet you if you fill Vicodin 5/325 as such; and they audit you, they will reject it. As long as prescriber uses the generic names, you can always document a change. If they use the brand names, depending on your interpretation of the law, you may or may not make the decision to change it. Whatever you do document it and sign.
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So, my dear pharmacist friends, as a future prescriber, what should I write to avoid giving you headaches? My inclination would be to always write for generic unless I had a darn good reason to insist on brand specific, thus hopefully giving you the most leeway to fill the script according to your well-developed professional judgement. Is that reasonable?
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There is no easy answer. The best thing you can do is prescribe what you want the person to receive.
Don't prescribe "Sildenafil 100% Powder" because it pops up first in your EMR and then put in the directions that the person should take "one 25mg tablet as directed". You will eventually forget to put a strength or you will put a strength that doesn't exist or you will put a strength that is a different drug (Sildenafil 20mg will require an insurance prior authorization and possibly a specialty pharmacy).
However, do not take this to mean you should enter free text of whatever you want as the drug if you include a strength. You can type "Metoprolol 25mg" all day and I will call you every time to see if you meant Toprol XL or Lopressor.
In the case that started this thread, putting a generic name would prevent problems, but it causes problems just as often. Put a brand name for Adalat CC or Procardia XL or any of the million Diltiazem products, please.
There are countless other examples where ordering things a specific way will create problems or prevent them. Just do your best and learn from the phone calls you get to clarify (you're going to answer phone calls like I said in the CII thread, right?).
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Thanks for the response. I will try to learn from my pharmacy friends as I go and not be a p.i.t.a. as I do so. I'm going to answer calls in the way that I would want them answered if I were making the call. After several years as a nurse, having had to call a lot of docs in the middle of the night, I have had opportunity to think about how I would want to answer.
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I have had cases where:
Patient brought back Tretinoin cream, demanded Tretinoin gel because doctor wrote script as gel.
Patient brought back Fluoxetine capsule, demanded Fluoxetine tablet because she used to take tablet.
With phone scripts, the trick to minimize trouble is: talk in term of pills. I tried asking: tablet or capsule okay right? and some said okay and some said: wait....I have to ask doctor. After wasting time for a few times, I just asked this way:
We are reading back to doctors as:
Amoxicillin pill, 500 mg a pill, 28 pills, right?
If they confirm as Yes, we then dispense capsule or tablet.
Case closed with 1 simple sentence, 10 seconds.
Most doctors or office assistants do not know that some picky patients want specifically tablet or capsule. Most prescribers whom I talked with are easy about giving either tablet or capsule.
We still fill capsule with tablet or tablet with capsule. (We are underwater with workload, just don't have time to call doctors to fix tablet to be capsule.)
You know that the cream and gel are actually different, right? The gel is more astringent and causes increased drying of skin - good for acne patients who can handle it. It basically boosts the effect of the drug.
Yes, but is it clinically significant or even relevant? No.
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This is an exaggeration at best. At the federal level, concerning changes on c2, it is pretty vague. If you consult the state's view on it, it gets even more vague. They were not auditing you for vicodin vs norco substitution. Please stop scaring the kids.
I also work in NJ and went through 2 BOP audits since the change. The main thing they are looking for is the new green scripts instead of blue scripts.
With that being said, your other points stand. Norco and Vicodin are not substitutable.
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