Ever seen this drug combo? A harrowing cocktail.

[trailerpark]

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Clonazepam BID
Lorazepam 1 mg TID prn
Lunesta @HS
Nuvigil 400 mg AM
Gabapentin 1,800 daily
Cymbalta 120 mg daily
Abilify daily

I don't remember all the doses, about midrange on the klonopin. All from the same Dr, pt is new to us but she has been on all these for a while- years with no change (I was looking for any indication of trying to taper down when I called). I didn't fill all of them.

Why would you put a pt on a Z drug for sleep when they're already on 2 benzos and then the high dose stimulant in the morning after the pt has been on downers all day?

 

[Cee-two]

Which ones did you not fill?

 

[CetiAlphaFive]

Clonazepam BID
Lorazepam 1 mg TID prn
Lunesta @HS
Nuvigil 400 mg AM
Gabapentin 1,800 daily
Cymbalta 120 mg daily
Abilify daily

I don't remember all the doses, about midrange on the klonopin. All from the same Dr, pt is new to us but she has been on all these for a while- years with no change (I was looking for any indication of trying to taper down when I called). I didn't fill all of them.

Why would you put a pt on a Z drug for sleep when they're already on 2 benzos and then the high dose stimulant in the morning after the pt has been on downers all day?

Hahah, Holy cow.

I would've sent her right back out the door.

I bet she had NDC demands, too

 

[BigBoss]

Walking zombie

 

[RxPreceptor]

Throw in some phentermine, cyproheptadine, oxybutynin, cevilimine, midodrine, doxazosin....what other body functions does she need controlled with drugs?

 

[BidingMyTime]

Whoa! That is harrowing! Not only the mix of drugs, but such huge dosages. Like you, I wouldn't want to fill all of them, but who knows which ones to fill and which ones not to fill! I wonder if her current doctor inherited her from someone else, or was the current doctor the guilty party who put her on all of this stuff. I suppose there won't be any pleasant way for her to get off of all of this, the patient really needs someone trained who can wean her dosages down/or get her completely off this stuff. And psychological support to do so. I don't believe any human benefits from being on such a combo.....but of course if they've been on this combo for a number of years, it's going to seem normal to their body.

 

[quickpic007]

Walking zombie

I could see this pt easily hustling the lunesta, clonazepam, and nuvigil and living fairly normally off the rest.

Tax dollars at work!

 

[Sabril]

Clonazepam BID
Lorazepam 1 mg TID prn
Lunesta @HS
Nuvigil 400 mg AM
Gabapentin 1,800 daily
Cymbalta 120 mg daily
Abilify daily

I don't remember all the doses, about midrange on the klonopin. All from the same Dr, pt is new to us but she has been on all these for a while- years with no change (I was looking for any indication of trying to taper down when I called). I didn't fill all of them.

Why would you put a pt on a Z drug for sleep when they're already on 2 benzos and then the high dose stimulant in the morning after the pt has been on downers all day?

The closest that I have is a pt on, among other things, adderall xr, diazepam, alprazolam, and lunesta. and she is a young girl with autism, intellectual disability, mood disorders etc. living in a facility. And the DEA lady already had a massive erection over this. Yes I used those two words in the same sentence. Hopefully they can at least keep it in their pants in your case.

 

[Dred Pirate]

I heard that our long range bombing pilots during the war would be hyped up on adderal - flying their 20 hour round trip mission, hit the barracks, zonk out on ambien for 10+ hours, then wake up, hit adderal and fly again

 

[CetiAlphaFive]

Which ones did you not fill?

@trailerpark pls answer

 

[ExpressMaiL]

Clonazepam BID
Lorazepam 1 mg TID prn
Lunesta @HS
Nuvigil 400 mg AM
Gabapentin 1,800 daily
Cymbalta 120 mg daily
Abilify daily

I don't remember all the doses, about midrange on the klonopin. All from the same Dr, pt is new to us but she has been on all these for a while- years with no change (I was looking for any indication of trying to taper down when I called). I didn't fill all of them.

Why would you put a pt on a Z drug for sleep when they're already on 2 benzos and then the high dose stimulant in the morning after the pt has been on downers all day?

Because daytime hangover isn't real. Not.

What if the patient has spinal cord injury and refractory phantom limb and is suffering from major PTSD with GAD and MDD s/p MVA?

 

[BidingMyTime]

Because daytime hangover isn't real. Not.
What if the patient has spinal cord injury and refractory phantom limb and is suffering from major PTSD with GAD and MDD s/p MVA?

I think TrailorPark would have mentioned if any of the above were present in their patient.

 

[CountBy5s]

I have patients like this as well. Other than calling the doctor documenting. Do you try to limit to quantity dispensed at one time. I have doctors who write for cocktails at high dosage and high quantities. #180,#240 #360. Way more than a months supply. Do you dispense these quantities or do you limit it to a month at a time?

 

[Claydoe]

I had a patient that I turned away who sees this idiot NP who was on
Xanax 0.5mg QID
Klonopin 1mg BID
Ritalin 30 mg QID
Is there an actual rationale behind prescribing 2 benzos baseline other than the patient thinks you're great because they're high all day?