We got pills, they're multiplying, and they're losing control...

[PharmDstudent]

Why are patients getting so many scripts? We filled 10+ scripts/person for three people yesterday. I find this to be excessive. There were moderate interactions between the scripts too.

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[firefighter9015]

I agree people are getting more scripts. Maybe this is because people are living longer, or because doctors are getting more slap happy with prescribing, due to all the known risk factors for heart disease. Who knows, but it is happening.

 

[collegegirl247]

people filling just one script at my old pharmacy was so unusual we called them "oners"..it almost never happened- just a few patients a day....thats sad
it was not uncommon for people to have 12+ meds filled as maintenance medications monthly

 

[PharmDstudent]

I know. We have statins, ACE inhibitors, beta blockers, ARBs, diuretics, alpha agonists, niacin, cholestyramine, low dose aspirin, digoxin, and anti-platelets. There's so much more too, which is crazy.

It seems like every condition requires at least two or three medications.

People aren't just depressed anymore, you know? They're depressed with mild anxiety and ADD/ADHD. They might even need a little cyproheptadine for their appetite.

Do people really need a separate script for every single symptom?

 

[njac]

I guess I'm part of the problem. At 24 I'm on 4 maintenance meds.

My boyfriend at 29 is on 3.

Although 2 of his are lifesaving and none of mine are.

 

[medicalCPA]

Why are patients getting so many scripts? We filled 10+ scripts/person for three people yesterday. I find this to be excessive. There were moderate interactions between the scripts too.

10+ scripts/person???? That's...wow.

 

[pharmdinfl]

This is obviously not the case for every health condition ....but, in regards to certain health conditions, it seems that some people rather swallow a pill every day instead of giving a chance at spending 30 minutes walking around the block and eating healthier.

 

[medicalCPA]

This is obviously not the case for every health condition ....but, in regards to certain health conditions, it seems that some people rather swallow a pill every day instead of giving a chance at spending 30 minutes walking around the block and eating healthier.

Well, duh. Who wants to waste 30 minutes when swallowing a pill takes less than 10 seconds?

 

[collegegirl247]

some doctors are prescription writing happy...plus I heard that certain drug companies offer bonuses to doctors depending on the (high) number of scripts they write for certain drugs

 

[YapYap6]

some doctors are prescription writing happy...plus I heard that certain drug companies offer bonuses to doctors depending on the (high) number of scripts they write for certain drugs

Yep, I've started getting a lot scrips for Xyzal. As usual, drug companies decide to put out a "new" version of the same drug after the old one goes off patent or OTC. Ooooo, LEVO-Cetirizine! Way more effective than racemic cetirizine! Right....

 

[pharmdinfl]

Well, duh. Who wants to waste 30 minutes when swallowing a pill takes less than 10 seconds?

ME! I personally don't consider it time wasted either.

 

[Fenderplayer108]

The most scripts i have ever had to verify and consult a patient was about 22, we counted them several times to make sure we had them all typed. A local hospital around here has discharge sheets that have 10 block spaces on them, and this patient had two full sheets, and a paper script from a family doctor.

I do agree that this seems to be becoming very popular. Alot of the ones I notice seem to follow each symptom they may have. Heck, going to the doctor for a sore throat seems to require at least two scripts to get the patient out of the office.

Good topic.

 

[medicalCPA]

ME! I personally don't consider it time wasted either.

There really should be a sarcasm emoticon. What I am trying to say is that people (me included) are lazy, and will take the route of least resistance. If advertising by pharmaceutical companies leads them to believe that they can simply pop a pill and lose weight for example, you can bet there will be people who will pop that pill (not me though, I'm still too skinny). They want to lose weight without putting in the effort.

eg. Lipozene...the powerful pill that burns fat without liposuction. Anyone see that commercial?

 

[AggiePharmer]

There really should be a sarcasm emoticon. What I am trying to say is that people (me included) are lazy, and will take the route of least resistance. If advertising by pharmaceutical companies leads them to believe that they can simply pop a pill and lose weight for example, you can bet there will be people who will pop that pill (not me though, I'm still too skinny). They want to lose weight without putting in the effort.

eg. Lipozene...the powerful pill that burns fat without liposuction. Anyone see that commercial?

Speaking of sarcasm emoticons...

Awww shnapps, you mean those 1.5gram tablets won't decrease my overall bodyweight by an average of 3.82lbs over a span of 8-10 weeks?!

Oh-N0z0rz!

On topic: What's the avg # scripts you all do per patient?

 

[DuocSi2010]

Yep, I've started getting a lot scrips for Xyzal. As usual, drug companies decide to put out a "new" version of the same drug after the old one goes off patent or OTC. Ooooo, LEVO-Cetirizine! Way more effective than racemic cetirizine! Right....

I disagree. I think Xyzal really does work better than Zyrtec. I'm on it for CIU and it's getting me through finals week. It's controlling my seasonal allergies pretty well too. It really is more selective than Zyrtec. Its side effect is pretty potent though because it's been harder than usual for me to get up on time in the morning. Good thing my classes doesn't start till 1pm this semester!

 

[Knipps]

I don't know the last time I was actually on a prescription med...

 

[meister]

I know. We have statins, ACE inhibitors, beta blockers, ARBs, diuretics, alpha agonists, niacin, cholestyramine, low dose aspirin, digoxin, and anti-platelets. There's so much more too, which is crazy.

I don't know if you're suggesting physicians are overprescribing these or not, but I seriously doubt that. Why would someone put a patient on an ACEI or BB if they did not need it? There is a world of difference between these maintenance medications and something like benzodiazepines.

I once overheard a patient telling her friend to stop drinking wine to get a buzz and just get a prescription for Valium to save herself from those unwanted calories. Yeah.

 

[corbomite]

I disagree. I think Xyzal really does work better than Zyrtec. I'm on it for CIU and it's getting me through finals week. It's controlling my seasonal allergies pretty well too. It really is more selective than Zyrtec. Its side effect is pretty potent though because it's been harder than usual for me to get up on time in the morning. Good thing my classes doesn't start till 1pm this semester!

From what I read on the package insert it seems like their double blind study had good results and it really doesn't have as much competitive binding like the racemic mixture does. That being said, it pisses me off that it is roughly five times more expensive than zyrtec. Hell, it was probably only released because of zyrtec going otc.

 

[MountainPharmD]

Why are patients getting so many scripts? We filled 10+ scripts/person for three people yesterday. I find this to be excessive. There were moderate interactions between the scripts too.

Thats job security! You should be happy. I believe its a lack of personnal resposibility by our society. Why take responsibility and change your life style when you can take more pills. If people stopped smoking and lost weight we would be out of a job.

 

[MountainPharmD]

I disagree. I think Xyzal really does work better than Zyrtec. I'm on it for CIU and it's getting me through finals week. It's controlling my seasonal allergies pretty well too. It really is more selective than Zyrtec. Its side effect is pretty potent though because it's been harder than usual for me to get up on time in the morning. Good thing my classes doesn't start till 1pm this semester!

Yeah right. As soon as Claritin went over the counter it stopped working for everyone too. When Allegra goes OTC it will all of a sudden stop woking. Oh yeah, Flonase doesn't work any more either because it has a generic.

 

[Quiksilver]

i think that the reason is quite simple actually; advertising! drug advertisements, in any way, shape or form are all over the place. There are people that know no one in the medical field but yet they have a pen, note pad, clock, or whatever from a drug company advertising some drug. Or even worse the multitude of radio, tv or internet advertisements that fill peoples heads about stuff that they can have.

there actually is a study that backs this up, although at the moment i can't find it. They compared Rxs in the USA and canada, in particular the region around seattle and vancouver. In canada, drug ads are not allowed. they found that the patients were either implying or something along the lines of requested prescriptions of drugs for stuff that the doctors did not think they needed. What is worse is that the patients felt that they should have control over what the doctor could and couldn't prescribe. In other words self medication.

an article that is sort of hitting the head, but not the exact one I am referring to:
http://jama.ama-assn.org/cgi/content/full/284/17/2244

i will look for the article

 

[njac]

I know. We have statins, ACE inhibitors, beta blockers, ARBs, diuretics, alpha agonists, niacin, cholestyramine, low dose aspirin, digoxin, and anti-platelets. There's so much more too, which is crazy.

It seems like every condition requires at least two or three medications.

People aren't just depressed anymore, you know? They're depressed with mild anxiety and ADD/ADHD. They might even need a little cyproheptadine for their appetite.

Do people really need a separate script for every single symptom?

for the example patient you chose I don't see anything superfluous. In fact, for several possible conditions, that looks like a legitimate regimen.

I would be more likely to raise an eyebrow at many other regimens, but the above, while many medications, has data to back it up.

 

[Allure]

Yeah right. As soon as Claritin went over the counter it stopped working for everyone too. When Allegra goes OTC it will all of a sudden stop woking. Oh yeah, Flonase doesn't work any more either because it has a generic.

I don't know what you're trying to imply, but Claritin never worked for me. That was the first one I tried. Zyrtec worked really well for me in the beginning, it still works, but it would take longer and this was way before Zyrtec went OTC and I still use Zyrtec when I need to.

 

[PharmDstudent]

I don't know if you're suggesting physicians are overprescribing these or not, but I seriously doubt that. Why would someone put a patient on an ACEI or BB if they did not need it? There is a world of difference between these maintenance medications and something like benzodiazepines.

I once overheard a patient telling her friend to stop drinking wine to get a buzz and just get a prescription for Valium to save herself from those unwanted calories. Yeah.

I'm tired today...

Every medication has side effects. That's the nature of the beast. I think it would benefit people more if they had more efficient drug regimens. Instead of taking a separate medication for each problem, they would be able to avoid additional side effects by taking medications that have multiple indications. For example, cholestyramine can be used for diarrhea and cholesterol. Instead of prescribing someone a statin and diphenoxylate, the doctor could simply write for cholestyramine.

I wish there were more drugs that could treat multiple problems, preferably the symptoms that are associated with a specific disease condition.
This is just an analogy, but it's like buying a car piece by piece instead of buying it as a single unit.

I want the magic bullet!!!

 

[PharmDstudent]

Thats job security! You should be happy. I believe its a lack of personnal resposibility by our society. Why take responsibility and change your life style when you can take more pills. If people stopped smoking and lost weight we would be out of a job.

We were talking about smoking at work today. Some people will only stop smoking when they die.

 

[genesis09]

We're actually seeing more disease specific drugs. A can of worms have just been opened with Congress outlawing genetic discrimination. Pharma will know be more inclined to develop drugs which will require a genetic test to see if it will work for you.

 

[PharmDstudent]

for the example patient you chose I don't see anything superfluous. In fact, for several possible conditions, that looks like a legitimate regimen.

I would be more likely to raise an eyebrow at many other regimens, but the above, while many medications, has data to back it up.

This is how I'm thinking about this: Depression has so many different manifestations that it may be superfluous to outline every single manifestation as its own disease state.

 

[njac]

This is how I'm thinking about this: Depression has so many different manifestations that it may be superfluous to outline every single manifestation as its own disease state.

right but your original example was "statins, ACE inhibitors, beta blockers, ARBs, diuretics, alpha agonists, niacin, cholestyramine, low dose aspirin, digoxin, and anti-platelets"

sure, that's a lot of meds, but none of those are uncalled for.

 

[b*rizzle]

From what I read on the package insert it seems like their double blind study had good results and it really doesn't have as much competitive binding like the racemic mixture does. That being said, it pisses me off that it is roughly five times more expensive than zyrtec. Hell, it was probably only released because of zyrtec going otc.

Yeah but how many studies do you think that the manufacturers will conduct of a true head-to-head comparison of cetirizine to levocetirizine? I personally believe it's a "me-too" drug that's good for recouping losses after something goes generic and over the counter.


What about albuterol versus levalbuterol?

Sure, Xyzal might be better in certain populations, but I really don't think we have enough data yet for me to feel confident in going out and telling a patient that one is definitely better than the other. I'd still probably say save the $$ and buy generic OTC cetirizine.

But back on topic: the problem is DTC advertising. We make people believe that they need these things. It's good to have, because it may heighten awareness of a certain condition (i.e. a patient with depression might feel better watching a Cymbalta commercial, since they know they're not the only ones out there who have the problem and might be more willing to open up to their physician) but I'm sorry gentlemen, the inability to have an erection is not life-threatening (even though it's bad for the ego).

You don't see ads for the latest and greatest cancer or HIV drug. It's generally benign stuff that would probably improve someone's QOL short term but won't make or break anything in the long-term. (Except statins.)

 

[b*rizzle]

We're actually seeing more disease specific drugs. A can of worms have just been opened with Congress outlawing genetic discrimination. Pharma will know be more inclined to develop drugs which will require a genetic test to see if it will work for you.

I agree with you, but I think we're still a long way off of that, especially because of the ethical implications, and more importantly, cost. Can you imagine running a genetic test every time you wanted to stick someone on something new? I can only imagine how insurance companies will try to weasel out of paying for that stuff. Though I do occasionally have people tell me that it's worth genotyping someone to optimize their Coumadin dose...

 

[PharmDstudent]

right but your original example was "statins, ACE inhibitors, beta blockers, ARBs, diuretics, alpha agonists, niacin, cholestyramine, low dose aspirin, digoxin, and anti-platelets"

sure, that's a lot of meds, but none of those are uncalled for.

That was a list, not an example. The depression case was an example.