Phentermine Dosing of 37.5mg BID

[Show Stopper]

Had an interesting situation pop up today when it came to an Adipex prescription where I got a script for 37.5mg BID. Got into an argument with her saying the max doses is 37.5mg which is one per day but she refused and got angry saying that I was the first pharmacist to call her about this. Regardless I refused to fill which throughly made her more upset which ultimately ended up with me hanging up on her. My manager had a similar case on Saturday with a different doctor but apparently they work in separate clinics but within the same Hospital. Same situation for him.

Correct me if I'm wrong but have you all ever heard of BID doing? I have heard of it but not for the 37.5mg and typically the dosages are much smaller and don't exceed the max of 37.5mg. Tried to do a bit more research and hunting but still can't find any data or reputable papers/sites that back up her claim that 75mg daily is okay. I haven't had this problem since starting at this pharmacy a year ago and never had a problem in this office up until just now. If there has been a problem, they have always agreed and have been willing to change. Supposedly my manager said the nurse he talked to said a more local pharmacy in town near them will fill it for them (we are about 30 minutes away) which we are more or less said that is there choice. Just curious if you all had seen anything similar or have any relevant papers on it.

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[Carboxide]

I would not fill. It is one of the most high-risk drugs I can think of regarding long-term use. There is a reason for this. That high of a dose would be far too risky re putting her into an arrhythmia, etc. It's just blatantly unsafe.

 

[Show Stopper]

I would not fill. It is one of the most high-risk drugs I can think of regarding long-term use.

Agreed. I've never heard of dosing like what they were talking about and they wouldn't back down from it either. Apparently they were doing this for "years" although it's the first I've seen of it and my manager says it's been several years since he saw something like this. The nurse didn't even provide any evidence as to why it should be 75mg a day besides that they have been doing it for awhile. Got me fired up at the time and a little annoyed and I'm sure it won't be my last clash with them if this becomes a trend.

 

[Sine Cura]

My usual answer to the "first pharmacist" complaint is so what? They can go **** themselves. There are other pharmacies in town.

No there is no data and there is no justification. "Treating the patient" is bull****. Manage your diet and quit relying on quick fixes.

 

[farmadiazepine]

See it all the time. I fill it and go onto the next one.

If you don't want to fill it, then you don't fill it.

I'm not a fan of Adipex. People should get the f*ck up and exercise, do P90X and restrict calorie intake. People have no fu*king discipline. They need a f*cking slap in the face.

 

[cjb56]

See it all the time. I fill it and go onto the next one.

If you don't want to fill it, then you don't fill it.

I'm not a fan of Adipex. People should get the f*ck up and exercise, do P90X and restrict calorie intake. People have no fu*king discipline. They need a f*cking slap in the face.

That last sentence was also in your post about the generic Adderall complaints in another thread. I agreed with you then, as well.

 

[BidingMyTime]

I'm not a fan of Adipex. People should get the f*ck up and exercise, do P90X and restrict calorie intake. People have no fu*king discipline. They need a f*cking slap in the face.

Man, you are feeling quite violent today, aren't you?

To the OP, I've never heard of such a dosing, but then I guess I don't really fill that much Adipex. I would also want to see preferably justification from the literature before filling such a high dose, or at a minimum, a logical explanation on why this patient requires such a dose. Was this a doctor or a NP who prescribed it (you said the nurse wouldn't give any explanation, but I wasn't sure if you meant the office nurse or the prescribing NP.) I especially wouldn't fill this RX if it was from a general practitioner or NP.....if the RX was from some gastroenterologist specializing in weight loss or something, I'd consider it, but I would also expect the doctor to be able to provide logical justification for the dosage.

That said, I've never understood why people throw a fit when a pharmacist won't fill their prescriptions, aren't there pharmacies on just about every street corner? If someone doesn't want my business, I'm happy to take my business elsewhere. On the other hand, if every pharmacy is turning down filling the prescription, shouldn't that be a clue to the patient that there is something wrong with the prescription?

 

[Lnsean]

I also see adipex 37.5mg bid often enough. I wouldn't say it's common but I have seen a lot more of it. If patient has been on it before...no worries...i'd fill it and move on. If this is the first time...I would definitely call the MD up and ask why he would start someone on bid...keep it professional and friendly...

to the people that say "NO NO NO...never." Never say never. Practicing trends change all the time. they're not paying you to be a human scanner...like if something doesnt fit the exact bill you auto reject. Talk to the doctor and use your judgement.

 

[marymartins]

I am not a fan of it all i and giving more than that dose is quit a huge one and can cause some irregularities.

 

[Lnsean]

really old thread

 

[13gunhey498]

Had an interesting situation pop up today when it came to an Adipex prescription where I got a script for 37.5mg BID. Got into an argument with her saying the max doses is 37.5mg which is one per day but she refused and got angry saying that I was the first pharmacist to call her about this. Regardless I refused to fill which throughly made her more upset which ultimately ended up with me hanging up on her. My manager had a similar case on Saturday with a different doctor but apparently they work in separate clinics but within the same Hospital. Same situation for him.

Correct me if I'm wrong but have you all ever heard of BID doing? I have heard of it but not for the 37.5mg and typically the dosages are much smaller and don't exceed the max of 37.5mg. Tried to do a bit more research and hunting but still can't find any data or reputable papers/sites that back up her claim that 75mg daily is okay. I haven't had this problem since starting at this pharmacy a year ago and never had a problem in this office up until just now. If there has been a problem, they have always agreed and have been willing to change. Supposedly my manager said the nurse he talked to said a more local pharmacy in town near them will fill it for them (we are about 30 minutes away) which we are more or less said that is there choice. Just curious if you all had seen anything similar or have any relevant papers on it.

I believe you did the right thing.

“Phentermine hydrochloride 37.5 mg has the potential to be habit forming and must be used with diligence and control so that things don’t get out of hand. Allergic reacts are associated with this medication but, with the help of your managing physician, you will most likely be able to use something else that is similar instead.

Can Someone Develop an Addiction to the drug? Sadly yes, many consumers have reported that they feel as though they are completely addicted to this drug. Many other users have simply made up their own method to help defeat the possibility of addiction before it even begins. Most choose to design a dosage routine while others might pair up the dosage with something else they do every day anyway.

Even “If you forget to take your phentermine one day, do not double-up or increase your next dose. Simply leave the missed dose and start up once again on the regular schedule.” Let alone prescribe a BID for a patient! I don’t understand the reasoning of the doctor who prescribed it in that way!

This page has valuable and accurate info about the drug! And as you read, it discourages doubling the dose, even if the user forgot to take it in time.

 

[maria1oh]

In ohio it's illegal to fill a BID adipex rx. They can only be on it for 3 months and then need a 6 month break from it (ohio rule). Doctor must document weight every month so no 90 day rx allowed.
No such rules yet on belviq or qysmia.

 

[CetiAlphaFive]

In ohio it's illegal to fill a BID adipex rx. They can only be on it for 3 months and then need a 6 month break from it (ohio rule). Doctor must document weight every month so no 90 day rx allowed.
No such rules yet on belviq or qysmia.

Probably because Qsymia is a joke.

 

[farmadiazepine]

Probably because Qsymia is a joke.

Qsymia is the one that makes you dumber, right? Yup.

But in all seriousness, topiramate can make people lose some serious weight. In my psychiatry rotation, we had a patient who was abusing topiramate and she was as thin as a stick. The weight loss is real.

 

[CetiAlphaFive]

Qsymia is the one that makes you dumber, right? Yup.

But in all seriousness, topiramate can make people lose some serious weight. In my psychiatry rotation, we had a patient who was abusing topiramate and she was as thin as a stick. The weight loss is real.

Yeah, I know.
I meant the part where it's expensive AF and has a REMS program.

Someone at the FDA must've thought, "how can I approve this bull**** drug, while at the same time not really approve it"

 

[sosoo]

isn't phentermine chemically related to amphetamine somehow? i remember reading something about it awhile back. hence the nature of addiction? correct me if im wrong.

 

[CetiAlphaFive]

isn't phentermine chemically related to amphetamine somehow? i remember reading something about it awhile back. hence the nature of addiction? correct me if im wrong.

One extra methyl group is the only difference