Doxycycline

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VictorOfHungerGames

VictorOfHungerGames

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If doctor just wrote Doxycycline, which one do you guys typically dispense? Mono or hyclate? is it all about $$?
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Yea.. mono because it’s cheaper. Or, whichever the insurance will pay for

If I remember right, doesn’t hyclate cause more upset stomach?
 
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PL has an article covering this topic as far as the differences between monohydrate + hyclate
In a nutshell, monohydrate is slower dissolving, considered to have fewer GI adverse drug reactions vs. hyclate (ate = carboxy terminal, acidic, faster dissolving). *Daydreaming about A-hole little snot nosed eye-rolling pharm D student asking chemistry teacher how a concept might be relevant...

Vast majority of the time MDs I've spoken with have no huge preference and are okay with whichever one is least costly
 
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I remember that my preceptor and her partners always made me call doc's office to get this clear
 
Ugh hearing people call to clarify which salt form makes me die a little inside. If the prescriber cared they would have specified. No one cares. I honesty wonder what people are thinking sometimes.
 
owlegrad said:
Ugh hearing people call to clarify which salt form makes me die a little inside. If the prescriber cared they would have specified. No one cares. I honesty wonder what people are thinking sometimes.
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Sure... this is a symptom of a sue happy culture though.
 
A big a Medicaid HMO only covered hyclate for the longest time. Now I get to pick.
 
If someone wrote doxy for an h pylori regimen I'd tell them to change it to TCN
 
owlegrad said:
Ugh hearing people call to clarify which salt form makes me die a little inside. If the prescriber cared they would have specified. No one cares. I honesty wonder what people are thinking sometimes.
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This! I'm all about filling exactly as the doctor wants....but yeah, if a doctor just writes "doxycycline", it's pretty clear the doctor doesn't care. Why bother calling? The dr/PA/NP will just say "what's the difference?" and when you say "no practical difference", then they will say, "well, give whatever then, I don't care."
 
Sine Cura said:
If someone wrote doxy for an h pylori regimen I'd tell them to change it to TCN
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Eh...data is mixed on that one, with some data saying it's similar, while other data saying it may not be. I probably would still dispense, as long as it's a complete quadruple H. pylori regimen. With severe renal impairment, doxy might actually be a better choice, since TCN renal adjustment isn't really exact, and doxy doesn't need renal dosing.
 
Yeah it's a mixed bag and no compelling reason to use it over tetracycline if no renal impairment if you are already using bismuth. Maybe there are pleiotropic effects that are never considered by prescribers
 
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Alright - since we are splitting hairs here...

Dr. Writes for Cardizem CD, what do you fill it with? Do you call the doctor?
 
Warning: plenty of "ifs" ahead:

If it's an escribed RX, I'd fill with whatever is stated. If the strength is unusual like a 20mg or 50mg and the patient has no history of it, I'd call to make sure the strength is correct. However, If the insurance doesn't cover the escribed doxy, I would run a few alternatives and see what form is covered and then ask the doc if a switch is ok (99% of doc want whatever is covered and least expensive). If the RX is given verbally/written without a preference, I'll fill with what form is covered and annotate on the rx that the covered product was chosen. If the patient is paying cash or using a generic discount card, I'll offer the least expensive one and ask them if that's what they want filled (it usually is).
 
lillilililillilill said:
I remember that my preceptor and her partners always made me call doc's office to get this clear
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Do they call for a script that says "omeprazole 20mg" that doesn't specify caps or tabs too?
 
I know pharmacists that still try to contact clinics to verify body weight for simple ABX (like you gonna ask is it for OM? LOL) or fax to change Zofran regular to Zofran ODT and this unnecessary phone tag/fax tag is ridiculous
 
I switch doxys, tablets to capsules, and Albuterol inhalers. If I'm not sure I'll just ask the patient, for example a doctor called in levothyroxine caps for a first fill that wasn't covered so I just changed it after the patient agreed. I've worked with pharmacists who call to switch Omeprazole to capsules and it's just embarrassing. I had a pharmacy manager send a PA request for Omeprazole tablets for the technicians disabled son and she was about to just pay cash because she needed it so bad... Unbelievable
 
ldiot said:
I switch doxys, tablets to capsules, and Albuterol inhalers. If I'm not sure I'll just ask the patient, for example a doctor called in levothyroxine caps for a first fill that wasn't covered so I just changed it after the patient agreed. I've worked with pharmacists who call to switch Omeprazole to capsules and it's just embarrassing. I had a pharmacy manager send a PA request for Omeprazole tablets for the technicians disabled son and she was about to just pay cash because she needed it so bad... Unbelievable
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People like that bug me. Use some professional judgment. And then people wonder why we no one takes us seriously. No doctor will ever come after you for making those changes, especially if that means the patient will take the med.
 
the only good thing about calling is that if you don't, and the doc is sending escribe, it will keep sending the wrong way for future fills. might as well tell them once initially to get it right going forward. cause then you never know which pharmacist will run into it next and delay it.
 
grumpyRph said:
the only good thing about calling is that if you don't, and the doc is sending escribe, it will keep sending the wrong way for future fills. might as well tell them once initially to get it right going forward. cause then you never know which pharmacist will run into it next and delay it.
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We shouldn’t have to bend over backwards for the few Idiots. One of the most common questions I ask interns is something trivial like a doc sends for 60mls of some antibiotic suspension. It’s a Friday night at 10pm. You only have multiples of 75ml. Do you call the paging service and have them call you to change the quantity or do you just do 75mls, add discard remainder to the sig and annotate something like “commercially available in multiples of xx” or do you call? It’s my way of conveying the message that you should exercise some judgment in your practice. Not everything needs to be called about.
 
projektreverb said:
We shouldn’t have to bend over backwards for the few Idiots. One of the most common questions I ask interns is something trivial like a doc sends for 60mls of some antibiotic suspension. It’s a Friday night at 10pm. You only have multiples of 75ml. Do you call the paging service and have them call you to change the quantity or do you just do 75mls, add discard remainder to the sig and annotate something like “commercially available in multiples of xx” or do you call? It’s my way of conveying the message that you should exercise some judgment in your practice. Not everything needs to be called about.
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Use your brain & realize prescribers don't give a **** about package size tediousness/nuances
 
The key is to TELL the pt in case they are some hypochondriac who must have Proair
 
projektreverb said:
We shouldn’t have to bend over backwards for the few Idiots. One of the most common questions I ask interns is something trivial like a doc sends for 60mls of some antibiotic suspension. It’s a Friday night at 10pm. You only have multiples of 75ml. Do you call the paging service and have them call you to change the quantity or do you just do 75mls, add discard remainder to the sig and annotate something like “commercially available in multiples of xx” or do you call? It’s my way of conveying the message that you should exercise some judgment in your practice. Not everything needs to be called about.
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Oh god I don't think I've ever made a call to any doctor regarding those reconstituted antibiotic suspensions asking if I could give a slightly bigger bottle cause what they are requesting doesn't exist. The only difference between calling and not calling is you'll be flushing the extras down the sink yourself or you tell the patients to throw it out themselves on the sig. They'd prob get pissed that you called for something so stupid. I remember when I started as an intern and I called requesting change from Amoxicillin Tabs > Caps because insurance won't pay for tablets. I'm pretty sure I heard the receptionist whisper "are you *** kidding me?" while calling out someones name.
 
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