same drug but 2 different manufactures in the bottle

[missSunshine]

Hi all,

I am a new tech and I just wanted your opinion on this...my pharmacists where I work are constantly mixing 2 different manufacuters of medications and putting them in the patients drug bottles and when I asked them if there could be slight differences in the "ingriedients" of the drug, one of them said yes but are still bio equivalent and aba accepted...is this true and can you guys explanin in detail please?....we constantly get patients that come back so confused and scared to take their meds...


thank you!!

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[g40631]

This is such a silly practice and I really dislike it when other pharmacists do it. First off, to me, it's misbranding. The label states the manufacturer used, and when you bill you select one NDC....so if you're mixing up manufacturers/NDCs, you're technically misbranding, right? Secondly....the vast majority of time pharmacists do this to "save" on inventory by clearing out an older, no longer stocked NDC and combining it with a new NDC. Also saves shelf space? Sounds like a no-brainer right? WRONG. Who has the time to spend 10 minutes with someone who cannot comprehend that even though they look different, they are the same drug? Also, what about the people who won't return to your pharmacy because they think the pharmacist is trying to kill them? Also, the few pennies you save on inventory from combining generics is completely negligible. Most generics tabs/caps are so dirt cheap, you're better off just throwing away the old product.

 

[Praziquantel86]

The drugs are the same in terms of bioequivalence (if AB-rated), but, as mentioned above, it's misbranding. So in addition to being illegal, you have issues with confusing your patients. It's a money-saving practice, but also poor practice. Don't do it.

 

[missSunshine]

Thanks!...but can you please explain bio equivalence...I agree with the earlier post about confusing patients it just not worth it and our customers come back all the time!!! for some reason it just doesnt seem right and the pharmacist never explain that there is 2 diffierent companies, they just put a green sticker on the bag...which clearly everybody misses it!

 

[missSunshine]

Also are there some drugs that can absolutly never be mixed in this way?? because I feel like they do it all the time!

 

[owlegrad]

We do it if we can't fill the order otherwise. We put cotton between the different pills and write on the label that different manufacturers were used. Haven't heard any complaints yet.

 

[owlegrad]

Also are there some drugs that can absolutly never be mixed in this way?? because I feel like they do it all the time!

You need to ask your pharmacist to explain how substitution works. For example you could never mix drugs that are B rated.

 

[Carboxide]

Hi all,

I am a new tech and I just wanted your opinion on this...my pharmacists where I work are constantly mixing 2 different manufacuters of medications and putting them in the patients drug bottles and when I asked them if there could be slight differences in the "ingriedients" of the drug, one of them said yes but are still bio equivalent and aba accepted...is this true and can you guys explanin in detail please?....we constantly get patients that come back so confused and scared to take their meds...


thank you!!

The differences are just in the non-drug parts of the pill, like the binders and coating - things that won't affect how the drug works or its strength. They will not have any issues with taking two different brands - I am sure your pharmacy (like all pharmacies) changes the manufacturer depending on who they have in stock regularly.

We only do this if we couldn't fill the script otherwise - rationale being that you can do an IOU, but when they come back you still may not have that manufacturer and would give them whatever you had with no issues.

If you do this, however, it should be very clear and verbally addressed with the patient to prevent any confusion. All you have to do is say, "Just so you know, there are two different brands in this bottle separated by cotton. They are the exact same drug but look a little different, so don't be concerned - they will both work exactly the same way."

 

[universalcynic]

I have seen pharmacists do it, but they make sure to counsel the patient and explain that it is the same drug from different manufacturers.

 

[Transformer]

Hi all,

I am a new tech and I just wanted your opinion on this...my pharmacists where I work are constantly mixing 2 different manufacuters of medications and putting them in the patients drug bottles and when I asked them if there could be slight differences in the "ingriedients" of the drug, one of them said yes but are still bio equivalent and aba accepted...is this true and can you guys explanin in detail please?....we constantly get patients that come back so confused and scared to take their meds...


thank you!!

I used to be a tech too. What we do with the same medication with 2 different manufacturers is to separate them into two different bottles, and consult/inform patients about the different manufacturer and explain that although the tablets may look different, and contain different colors,etc, they are the same drug. Separating the tablets into two different bottles (with the same labels) and rubber banding them together helps remind patients about the manufacture issue.

 

[missSunshine]

Ok that's good to know. We don't separate with cotton just put both meds in the bottle.

 

[Carboxide]

Ok that's good to know. We don't separate with cotton just put both meds in the bottle.

IMO, that is not acceptable.

 

[missSunshine]

Well this is what my pharmacist do... Ill suggest to them the cotton spacer but in sure they will be annoyed!

 

[kvl1027]

Ok that's good to know. We don't separate with cotton just put both meds in the bottle.

Definitely not good. We do it all the time with a cotton spacer and explain to patients. Nothing wrong with it.

 

[Ackj]

The drugs are the same in terms of bioequivalence (if AB-rated), but, as mentioned above, it's misbranding. So in addition to being illegal, you have issues with confusing your patients. It's a money-saving practice, but also poor practice. Don't do it.

Not misbranding if you have both manufacturers listed. The label prints out with one, but you have to write the other one in.

If patients are confused when some of the pills look different, imagine how they will react when 100% are changed? When you switch brands, you need to green sticker and explain it anyway. This is no different than that case.

 

[kwakster928]

Not misbranding as long as information on manufacturer, lot number, expiration date are clearly visible and labeled.

That said, I would still counsel the patient on two different manufacturer, two different looking pills. I am not a fan of such practice. If I have no choice, I would label them separately, dispense them in separate bottles.

 

[crazybob]

What about two different labels and bottles in the first place?

For example, for a refill of #30 tablets, 10 comes from Jack and 20 comes from Jill. The first label and the first bottle has 10 tablets and gets the lot number and expiration date from Jack, the second label and the second bottle has 20 tablets and gets the lot number and the expiration date from Jill.

I dunno if that would just add to the confusion though.

 

[kwakster928]

What about two different labels and bottles in the first place?

For example, for a refill of #30 tablets, 10 comes from Jack and 20 comes from Jill. The first label and the first bottle has 10 tablets and gets the lot number and expiration date from Jack, the second label and the second bottle has 20 tablets and gets the lot number and the expiration date from Jill.

I dunno if that would just add to the confusion though.

I find that acceptable. Thanks to many drug shortages, the pharmacist process the prescription may have no option but to dispense drugs from two different manufacturer. Like I stated before, when I was in the retail world (very short) I avoided this at all costs.

What you are describing above should be the last resort.

 

[gotgame740]

I am also a new tech (at Walgreens) and I just ran into this yesterday. It was my first day on the job. At first I put them both in the same bottle but then the pharmacist told me to put them in 2 different bottles with labels. I don't think the patient would be confused this way like you guys said.

 

[MindOverMatter]

I'll split up manufacturers, but I always use two bottles with the labels indicating the correct manufacturer and rubber-band them together with a note to explain it to the patient.

For those that use the cotton spacers, where do you get the cotton? From other bottles? What if someone is allergic to whatever that drug is that the cotton came from? To me it's not worth the risk and IMO it looks unprofessional to put two manufacturers in one bottle.

 

[Ackj]

What if someone is allergic to whatever that drug is that the cotton came from?

You alcohol and scrub down your counting tray after every single rx, right? 🙄

Most of the time the cotton comes from the 2nd manufacturer's bottle, so it's a non-issue anyway.

 

[LizzyBusyBee]

Also I take dilantion, my neurologist told me to watch for this! She said once I get with a certain manufactures, dont change. I take mylan and it is fine, but she thinks there is a difference if how it is absorbed or something. Why does she suggest this?? 😕

My best guess is because it can cause serious brain damage to someone that always are having seizures and any possible means she can educate the patient to stop this will help her care for patiences??

Please add if you have any thoughts

 

[Ackj]

Also I take dilantion, my neurologist told me to watch for this! She said once I get with a certain manufactures, dont change. I take mylan and it is fine, but she thinks there is a difference if how it is absorbed or something. Why does she suggest this?? 😕

My best guess is because it can cause serious brain damage to someone that always are having seizures and any possible means she can educate the patient to stop this will help her care for patiences??

Please add if you have any thoughts

SDN is not for medical advice.













Some people claim with NTI drugs like phenytoin, levothyroxine, etc, that having one manufacturer will keep your levels more stable as there will be less variation from rx to rx. All of the generics must be bioequivalent to the branded product, so it's really not an issue.