Doctor told the patient to open Adderall XR capsules...

[Modest_anteater]

Alright that's a lot of responses, I appreciate the feedback. If I would've known the patient would have been instructed to open up the 30mg capsules to divide the contents into three I would've just filled the 10mg capsules. That wasn't explained to me and the prescriber asked me to delete the 10mg script after the 30mg came in so I couldn't go back. I originally thought it would be better for him to get a single dose from one pill then take two considering he takes 5 other meds and admits to me he can't keep track of everything he takes.

I'm not perfect, nor do I have a complex that I must be right or I'm a know-it-all, etc. I made a decision that I thought was right and the patient was good with that decision. I will take everything into consideration the next time a situation like this arises and maybe ask one more question to the provider to see if I can get all the information.

"patient would have been instructed to open up the 30mg capsules to divide the contents into three I would've just filled the 10mg capsules."

" Capsule may be swallowed whole or it may be opened and the contents sprinkled on applesauce. Applesauce should be consumed immediately without chewing. Do not divide the contents of the capsule."

Do not divide the contents of the capsule

Do not divide the contents of the capsule

Do not divide the contents of the capsule

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[rx1983]

Customer service but also health care. On top of that you have the rediculous amount of regulatory burden as a barrier to actually providing good customer service.

Although I actually agree with your basic premise. It’s amazing how once you earn that Pharm.D. “helping people” no longer seems to be your driving force...

Yeah, difficult balance for sure.

 

[CetiAlphaFive]

I'm gonna link both a PDF *and* video of Lorne Michaels giving a Presentation about how it's illegal to divide the contents of the capsule.

 

[Lnsean]

I'm gonna link both a PDF *and* video of Lorne Michaels giving a Presentation about how it's illegal to divide the contents of the capsule.

Bro are you still illegally doing transfers of controls at your store? Lmao

 

[Modest_anteater]

Yeah I just wanted to throw that into someone's face haha.

It's a little less satisfying now.

It does state there are different beads later on. It's under description. Based on that, I wouldn't recommend opening the capsule unless you plan on taking everything, definitely not dividing it.

Anyways, all but two people are in the wrong, the OP and the other person knows who they are.

Yes this. You CAN't divide these pills. At worst this could be considered practicing medicine without a license which is a felony at best the amount of amphetamine in each bead is not uniform at all so some beads may contain a disproportionate amount of ampheaetine.

Come on people. Think!

If a doc says the patient is to open the cap, crush the beads into a fine powder and snort them would you approve that drug with its illegal / non guideline dosage form?

 

[CetiAlphaFive]

Yes this. You CAN't divide these pills. At worst this could be considered practicing medicine without a license which is a felony at best the amount of amphetamine in each bead is not uniform at all so some beads may contain a disproportionate amount of ampheaetine.

Come on people. Think!

If a doc says the patient is to open the cap, crush the beads into a fine powder and snort them would you approve that drug with its illegal / non guideline dosage form?

Breh.

Chill breh

 

[wagrxm2000]

Oh snap, I got schooled. I will shut up now.

Ha, I wasn't talking about you

 

[beautifulrobot]

Yes this. You CAN't divide these pills. At worst this could be considered practicing medicine without a license which is a felony at best the amount of amphetamine in each bead is not uniform at all so some beads may contain a disproportionate amount of ampheaetine.

Come on people. Think!

If a doc says the patient is to open the cap, crush the beads into a fine powder and snort them would you approve that drug with its illegal / non guideline dosage form?

Unless the state has some law that prohibits administering a drug in a way that is contrary to what is described in the FDA-approved labeling (i.e. package insert), there is nothing illegal about dividing the contents of the capsule / prescribing drugs in a way that differs from the administration and dosing described in the drug labeling. Administering the drug in a non-FDA-approved manner may make you more vulnerable to a civil lawsuit if it results in harm to the patient, but there is nothing illegal per se about not following the drug labeling. Off-label use is generally not illegal, unless it is something a reasonably prudent pharmacist would object to (like your drug snorting example). As silly and unnecessary as it was to instruct the patient to divide the contents of the capsule, it doesn't quite cross the line of crushing the beads and snorting the drug. The risk of harm from not having the perfect ratio of IR/ER beads when splitting a 30 mg capsule doesn't really excite me that much.

 

[PolarPop]

Unless the state has some law that says that administering a drug in a way that is contrary to what is described in the FDA-approved labeling (i.e. package insert), there is nothing illegal about dividing the contents of the capsule / prescribing drugs in a way that differs from the administration and dosing described in the drug labeling. Administering the drug in a non-FDA-approved manner may make you more vulnerable to a civil lawsuit if it results in harm to the patient, but there is nothing illegal per se about not following the drug labeling. Off-label use is generally not illegal, unless it is something a reasonably prudent pharmacist would object to (like your drug snorting example). As silly and unnecessary as it was to instruct the patient to divide the contents of the capsule, it doesn't quite cross the line of crushing the beads and snorting the drug. The risk of harm from not having the perfect ratio of IR/ER beads when splitting a 30 mg capsule doesn't really excite me that much.

This has nothing to do with off-label use. While it is not exciting and probably will not cause any harm, you are still adulterating a drug... 1.5 capsules of Adderall XR 20 mg does not equal 1 capsule of Adderall XR 30 mg. Because it's impossible to maintain the correct ratio it ends up being Adderall 80%XR 30 mg or Adderall 120%XR 30 mg and last time I checked, none of those mystery products have been evaluated by the FDA. Anything happens to this patient you are completely ****ed.

 

[beautifulrobot]

This has nothing to do with off-label use. While it is not exciting and probably will not cause any harm, you are still adulterating a drug... 1.5 capsules of Adderall XR 20 mg does not equal 1 capsule of Adderall XR 30 mg. Because it's impossible to maintain the correct ratio it ends up being Adderall 80%XR 30 mg or Adderall 120%XR 30 mg and last time I checked, none of those mystery products have been evaluated by the FDA. Anything happens to this patient you are completely ****ed.

I am not opening the capsules and dividing the content and telling the patient that it's the same as the unopened capsules, so I haven't adulterated or misbranded anything.

"Your doctor told you to divide the capsules? It's not advised, since you may not get a consistent effect, but you probably wont notice it."

Do i expose myself to a bit more liability? Maybe. But we are talking about treating ADHD with relatively low doses of amphetamines. This isnt some kind of life threatening condition or a high-risk drug with a narrow therapeutic index...

Eta: i still think it was silly and unnecessary to split the capsules, i just dont think it is illegal or all that big of a deal.

 

[owlegrad]

OK, well first of all even if the pharmacist was opening the capsules and repacking them into new capsules, that would be "compounding" and last time I checked that was not considered "adulterating" (yet).

But that isn't even what is happening here so that example is irrelevant.

 

[CetiAlphaFive]

Yup.

The doctor could tell the patient to empty the capsule, put the beads into a firework, then light it in his backyard.

A.) Nowhere will it say that on anything your initials are on

B.) Who cares

 

[beautifulrobot]

Pharmacists making up laws is one of my top ten pet peeves about this profession.

 

[owlegrad]

Pharmacists making up laws is one of my top ten pet peeves about this profession.

Only in the top ten?

How many pet peeves do you have about this profession?

 

[wagrxm2000]

Pharmacists making up laws is one of my top ten pet peeves about this profession.

Only in the top ten?

How many pet peeves do you have about this profession?

Yes I would like to see this top 10

 

[RxPreceptor]

Another vote for @giga 's 10 pharmacy commandments/thought shall not...

 

[beautifulrobot]

Oh my... I'm flattered.

So as I was putting together a list of specific pet peeves, I realized it just comes down to different manifestations of the following five things:

1. being dishonest
2. judging others/lacking compassion and empathy
3. lacking humility/willingness to accept you don't know everything
4. on the flip side, lacking self-esteem and willingness to recognize that you do have expert knowledge and something of value to offer
5. playing the victim and complaining about problems without providing solutions

Even though these things get on my nerves, I'm not implying that I am by any means perfect. In fact, I fail at avoiding some of these on a daily basis.

 

[wagrxm2000]

Oh my... I'm flattered.

So as I was putting together a list of specific pet peeves, I realized it just comes down to different manifestations of the following five things:

1. being dishonest
2. judging others/lacking compassion and empathy
3. lacking humility/willingness to accept you don't know everything
4. on the flip side, lacking self-esteem and willingness to recognize that you do have expert knowledge and something of value to offer
5. playing the victim and complaining about problems without providing solutions

Even though these things get on my nerves, I'm not implying that I am by any means perfect. In fact, I fail at avoiding some of these on a daily basis.

Wait where is pharmacists making up laws?

 

[thinkblue]

I'm gonna link both a PDF *and* video of Lorne Michaels giving a Presentation about how it's illegal to divide the contents of the capsule.

Jesus, just stop responding to the ***** already! You know it’s useless with the guy. If you tell him it’s a circle, he’ll call it a square.

 

[CetiAlphaFive]

Jesus, just stop responding to the ***** already! You know it’s useless with the guy. If you tell him it’s a circle, he’ll call it a square.

Do you have video evidence of me responding to him ?

LOL. Jk

 

[beautifulrobot]

Wait where is pharmacists making up laws?

Roughly falls under number 3.

 

[874700]

They're's an edit button.

You meant there is not they are is

 

[wagrxm2000]

You meant there is not they are is

Well that joke went over your head didn't it?

 

[Sparda29]

Seriously, I don't even know OP and his post made me mad. How can you be such a freaking robot and not use your head to think? Jesus christ...talk about making mountains out of molehills.

I've met a lot of pharmacists who think like robots and can't think out of the box. And when you do something out of the box around them, they get confused or start lecturing you about not following proper procedure.

It could be a personality type thing, I've been told that most pharmacists would be ISTJ on the MBTI chart. I'm an INTP/ENTP (the N part is not very common with pharmacists, it means I trust gut feelings and intuition over senses)

 

[rx1983]

I've met a lot of pharmacists who think like robots and can't think out of the box. And when you do something out of the box around them, they get confused or start lecturing you about not following proper procedure.

It could be a personality type thing, I've been told that most pharmacists would be ISTJ on the MBTI chart. I'm an INTP/ENTP (the N part is not very common with pharmacists, it means I trust gut feelings and intuition over senses)

1000% yes!! Will never understand these pharmacists who think it's illegal to use their brain!

 

[BC_89]

Oh my... I'm flattered.

So as I was putting together a list of specific pet peeves, I realized it just comes down to different manifestations of the following five things:

1. being dishonest
2. judging others/lacking compassion and empathy
3. lacking humility/willingness to accept you don't know everything
4. on the flip side, lacking self-esteem and willingness to recognize that you do have expert knowledge and something of value to offer
5. playing the victim and complaining about problems without providing solutions

Even though these things get on my nerves, I'm not implying that I am by any means perfect. In fact, I fail at avoiding some of these on a daily basis.

**Side-bar** :::: Reasons of how the military-culture in the health corps just drains me to the core...maybe I should exclaim these points at my next “resiliency” meeting.