APAP/Codeine Contraindication

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MV777

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Since APAP/ Codeine is contraindicated in children <12 years old now, has anyone refused to fill this for this age group? There have been two occasions when I have talked to parents to let them know it is now contraindicated in their child’s age (one child was around 8 and the other 10) because of fatal reports. Both times the parents insist that their child just had dental surgery and are in pain and assure me they will give the prescribed dose, if not less. I have let them walk out the door after warning them again, but I don’t know if I should be doing this or in the future, refuse to fill. Has anyone had similar experiences? I ask them to try just APAP for the pain first and the parents insist basically. I know I have the right to refuse but haven’t done so yet... Getting worried I am not making the right call in these situations. Thanks for any advice
 
I have filled a T3 for 11 years old, RX from an local ER , double check with Dr let them know abt your concerns , do your due diligence, if the physician still insist, then document on RX whom you spoke with time date etc.
 
MV777 said:
Since APAP/ Codeine is contraindicated in children <12 years old now, has anyone refused to fill this for this age group? There have been two occasions when I have talked to parents to let them know it is now contraindicated in their child’s age (one child was around 8 and the other 10) because of fatal reports. Both times the parents insist that their child just had dental surgery and are in pain and assure me they will give the prescribed dose, if not less. I have let them walk out the door after warning them again, but I don’t know if I should be doing this or in the future, refuse to fill. Has anyone had similar experiences? I ask them to try just APAP for the pain first and the parents insist basically. I know I have the right to refuse but haven’t done so yet... Getting worried I am not making the right call in these situations. Thanks for any advice
Click to expand...
You are absolutely making the wrong call.

Do you understand why it's contraindicated?
 
CetiAlphaFive said:
You are absolutely making the wrong call.

Do you understand why it's contraindicated?
Click to expand...
we removed it from formulary for this very reason. and ya - it is not the dose that is the issue like cetialphafive said - I heard a perfect analagy - ask the parent - if there was a concert at a local large arena - and two kids were going to die at the concert - would you still let your kid go to the concert? risk is low- but it is obviously there for those that are fast metabolizers - you give the correct dose and kid can still die - I would never fill it - if something does happen - the best lawyer in the world can't help you against an absolute contraindication - especially if a kid dies.
 
Nope. Hard no for anyone under 16 where I work. I rarely have to turn anybody away as it is nonformulary for that age group for the major prescriber in town due to the risk for peds.
 
When I was retail, I denied it for a really young pt (forgot the exact age) and got cussed out by both the doctor and the mom. Still would do it again if I have to...
 
Had a physician prescribe this for an 8 year old for post-op tonsillectomy pain. :eyebrow: We outright refused to fill of course.

Though I'm still seeing this being filled for pediatric patients (except for when it's used in post-op tonsillectomy or adenoidectomy).
 
Greeney said:
Had a physician prescribe this for an 8 year old for post-op tonsillectomy pain. :eyebrow: We outright refused to fill of course.

Though I'm still seeing this being filled for pediatric patients (except for when it's used in post-op tonsillectomy or adenoidectomy).
Click to expand...

Jesus wept
 
Sine Cura said:
You guys don't carry Hycet?
Click to expand...

Most pharmacies I've worked at do carry Hycet, but we can't simply call to change the script via phone. The parents can go back to the MD office and pick up the hardcopy, but many times the script is from the hospital/ER...and we all know how that plays out when trying to get a drug change.
 
Thanks for all the replies. I won’t hesistate next time to be confident in turning the script away / call for drug change.
 
I got cussed out by an old MD and name called for not filling it for a 6 year old last year. I just told him no I'm sorry can't do it/please consider an alternative therapy or I'd simply have to refuse to fill it...the risk here is death so I don't mess around with this one. Most parents understand when explained to them.
 
What do yall recommend them changing it to instead?
 
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