Question for practicing pharmacists on therapeutic duplication

[MARX22]

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hello folks!

I got an rx for aspirin 81 mg and aspirin 325 mg 1 t po prn from the same dr. One would be for cardioprotection and the other most likely for pain? It seemed odd to me bc I’ve never really seen both, so I wasn’t sure what to do. As per lexicomp, aspirin can be used 325-650 mg
Po q4-6 like acetaminophen, and has a daily max of 4g.... so technically it would be ok to dispense both the 325 and 81 mg without calling or clarifying? The doctor never returned my call nor picked up.

Thanks 🙂

 

[steveysmith54]

hello folks!

I got an rx for aspirin 81 mg and aspirin 325 mg 1 t po prn from the same dr. One would be for cardioprotection and the other most likely for pain? It seemed odd to me bc I’ve never really seen both, so I wasn’t sure what to do. As per lexicomp, aspirin can be used 325-650 mg
Po q4-6 like acetaminophen, and has a daily max of 4g.... so technically it would be ok to dispense both the 325 and 81 mg without calling or clarifying? The doctor never returned my call nor picked up.

Thanks 🙂

Was it an e-script? Most likely intended to prescribe acetaminophen with same dose. Did u try asking the pt?

I personally would not dispense the ASA 325mg bc it doesn't have a real frequency, also it's PRN so proly not critical.

 

[MARX22]

Hey! Yes both erxs! It was 81 mg qd and 325 one tab qd prn.

If the max for aspirin is 4g, what reasoning do we really have not to dispense the 325? I ask only because I’m trying to figure out how to approach such therapeutic duplication scenarios since I ended up not dispensing 325 but would like a clearer idea of why not if it’s technically not exceeding the max

Was it an e-script? Most likely intended to prescribe acetaminophen with same dose. Did u try asking the pt?

I personally would not dispense the ASA 325mg bc it doesn't have a real frequency, also it's PRN so proly not critical.

 

[Lnsean]

hello folks!

I got an rx for aspirin 81 mg and aspirin 325 mg 1 t po prn from the same dr. One would be for cardioprotection and the other most likely for pain? It seemed odd to me bc I’ve never really seen both, so I wasn’t sure what to do. As per lexicomp, aspirin can be used 325-650 mg
Po q4-6 like acetaminophen, and has a daily max of 4g.... so technically it would be ok to dispense both the 325 and 81 mg without calling or clarifying? The doctor never returned my call nor picked up.

Thanks 🙂

what's the problem here? I don't see anything major. Talk to the patient and tell her that the 81mg is important to take everyday and to only take the 325mg as needed. You could also ask her how many times her doctor told her to take it in a day and if he did not specify, give her a hard daily max on it. IF she finds herself using more, she should talk to her doctor again. There are many reasons why a 70 yo can't take tylenol or the MD does not want tylenol.

 

[Abby Atwood]

I’m pretty sure that the 325 mg tab was an error. The dosing doesn’t really make sense for pain (only one tablet daily?). The doctor probably selected the 325 mg tab by accident (the e-scribe software likely defaults to PRN for that tablet strength). He/She then sent through the correct script for the 81 mg dose. Did the 325 mg script arrive first?

It would have been nice if they had called or even just called back :/

 

[headortail]

No... because in my 4 years working as a tech in retail, I never once saw ASA on an Rx used for pain (this could also be because save for insurance purpose, ASA is obtained OTC so no rx was needed. On the other hand, I saw plenty of ASA 81mg). It's not incorrect, but people don't really use it anymore. That coupled with the 81 mg makes me think they didn't intend to send the 325 mg.

Yes, technically it'd be ok, but on the perspective of being a conscientious pharmacist, I would call (like you did). Just like it's ok to dispense levofloxacin 750mg qday for a 92 y.o. F. You don't have her labs, there's no way you would know what the dose should be. On the other hand, logic would tell you that, at 92, most people likely will not make the cut off for that dosing.

 

[Apotheker2015]

hello folks!

I got an rx for aspirin 81 mg and aspirin 325 mg 1 t po prn from the same dr. One would be for cardioprotection and the other most likely for pain? It seemed odd to me bc I’ve never really seen both, so I wasn’t sure what to do. As per lexicomp, aspirin can be used 325-650 mg
Po q4-6 like acetaminophen, and has a daily max of 4g.... so technically it would be ok to dispense both the 325 and 81 mg without calling or clarifying? The doctor never returned my call nor picked up.

Thanks 🙂

Did you look at the fill history?

 

[steveysmith54]

Hey! Yes both erxs! It was 81 mg qd and 325 one tab qd prn.

If the max for aspirin is 4g, what reasoning do we really have not to dispense the 325? I ask only because I’m trying to figure out how to approach such therapeutic duplication scenarios since I ended up not dispensing 325 but would like a clearer idea of why not if it’s technically not exceeding the max

Doesn't matter what the max is. Reasoning for me is that PRN without a max dose written on the RX represents insufficient information to fill an RX, especially one that I am quite sure is written in error. Technically PRN could indicate a frequency of hourly, weekly etc, plus you don't even know what the indication is. I'd tell the pt, listen the SIGS are incomplete I got to call the doctor. You call the doctor and ask him/her is this what you're giving, what's the frequency, and what is the PRN for?

 

[Corpseman]

Just because a medication is under the MDD doesn't mean it is appropriate.

 

[MARX22]

81 mg came first!
I checked history, pt has been on 81 mg. Why would it be inappropriate even if it isn’t exceeding the max dose, if u have no capability of speaking to the doctor? As long as the patient knows not to exceed a certain amount per day, wouldn’t that be ok? Sorry I’m a newbie here just looking at it from different perspectives!!

Just because a medication is under the MDD doesn't mean it is appropriate.

 

[MARX22]

Did you look at the fill history?

Yes, pt was on 81

 

[spacecowgirl]

Ask the MD and/or patient. Makes no sense.

 

[owlegrad]

81 mg came first!
I checked history, pt has been on 81 mg. Why would it be inappropriate even if it isn’t exceeding the max dose, if u have no capability of speaking to the doctor? As long as the patient knows not to exceed a certain amount per day, wouldn’t that be ok? Sorry I’m a newbie here just looking at it from different perspectives!!

Personally I just would have told the patient that I think there had been a mistake at the doctors office and there’s no reason to be on both. Then I would’ve asked the patient what they wanted me to do do they want me to fill it or do they want to clarify with her doctors office first.

In this particular case I don’t see much potential for harm and if the patient wanted me to fill both I would have and moved on with my life.

 

[MARX22]

Thanks everyone!

 

[MARX22]

Lol... they never picked up nor called back despite multiple attempts

Why not call and ask?

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Lol

Why not call and ask?

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[radio frequency]

If I had to guess...the 81 mg is standard cardioprotective and the 325 mg is intended to be a temporary post-ortho thing to prevent blood clots. But I would definitely call to check before dispensing. I have a lot of prescribers who like to write prn ud because it’s easier than writing the actual prescription correctly for them...

 

[Farcus]

That an error 325 1 tab po prn, 325mg qd or bid is really only like post op ortho pt, I don't even think the existing literature points to 325 is better than 81mg in cardioprotective effect, and definitely more bleeding. I hardly see asa being used for pain clinically (one or twice ever), though I'm not saying it wouldn't work.