Two Gallons of Golytely

[BrightLight]

There is a doc that likes to prescribe two gallons of golytely for colonoscopy. He gets pretty mad when a pharmacist question him about this. I still remember how reluctant the last pt was to take the two tanks home when he saw how much he had to deal with for his procedure next morning. Do you seen two gallons of Golytely being prescribed a lot in your practice? Why would some patients need two gallons instead of one?

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[genesis09]

Never seen that. All our local physicians prescribe one gallon of Go-Lytely or other colon prep.

 

[rxlea]

if you go see a colonoscopy maybe you'll understand why

 

[All4MyDaughter]

I've never seen two gallons at once. Double yuck.

 

[Momus]

Makes sure it's all clear LOL...

 

[rph3664]

Never saw multiple gallons of Golytely used for colonoscopy prep, but at my last job, there was a pediatrician who would order 6 gallons for encopresis treatment. 😱 They would drop an NG tube down the kid, and we would send up the first one, mixed, and leave the others for the nurses to mix if the "return" wasn't clear by the end of the first one. It wasn't a 24-hour pharmacy, and I don't recall that they ever needed to use a second one. This was usually done on boys in the 8- to 10-year age range.

 

[cycloketocaine]

Never saw multiple gallons of Golytely used for colonoscopy prep, but at my last job, there was a pediatrician who would order 6 gallons for encopresis treatment. 😱 They would drop an NG tube down the kid, and we would send up the first one, mixed, and leave the others for the nurses to mix if the "return" wasn't clear by the end of the first one. It wasn't a 24-hour pharmacy, and I don't recall that they ever needed to use a second one. This was usually done on boys in the 8- to 10-year age range.

That's pretty normal for encopresis. Key is they didn't get most of that, usually 1 gallon will do.

 

[KARM12]

Most patients only really drink about half the bottle anyway...

 

[southpharmindy]

Not only do most patients not need 2 gallons but you will most likely end up giving them 1 gallon for free. You will give them 2 gallons because that is what the doctor prescribed and then 2 years later the PBM will audit you and tell you that patients should only have 1 bottle and take the money back.

 

[NateRobinson]

I'd do something very simple if this scenario came up. After the MD told me to fill it anyway, I'd document on the back of the prescription and go up to the patient and tell him/her that in the entire time I've been an RPH/intern, I've dispensed thousands of golytelys and not ONCE have I dispensed two at the same time a single patient.

I'd tell the patient that nowhere in the literature does it state to use 2 gallons at once, that the patient can go ahead do what the doctor says but that I do not recommend doing so.

Easy. Save your ass, do your due diligence with the MD AND the patient, go home and sleep like a baby.

 

[rxlea]

Maybe both people in a marriage are getting colonoscopies and only want one copay??? 😀

 

[All4MyDaughter]

Maybe both people in a marriage are getting colonoscopies and only want one copay??? 😀

I had someone try that with lice shampoo once. It was a mom trying to cover the whole family with an RX for one kid.

 

[rxlea]

I had someone try that with lice shampoo once. It was a mom trying to cover the whole family with an RX for one kid.

I've seen it a couple times with other things too...

And like you mentioned, it was usually for the whole family or the other sibling.... Elidel, nystatin, stuff like that.

Oh and the scabies one. That was a major one. Elimite or whatever. Can't remember.

 

[amox]

I've seen it a couple times with other things too...

And like you mentioned, it was usually for the whole family or the other sibling.... Elidel, nystatin, stuff like that.

Oh and the scabies one. That was a major one. Elimite or whatever. Can't remember.

Yep Elimite (permethrin), and I have seen the same ... 1Rx for 3 children.
Just to never seen two bottles at one time, thats insane...

LD50 for H20 = 90g/kg (in rats) which for me at 100kg = 9000g = 9 Liters = 1.98 Gallons.. Did I do this right?!?

Probably over thinking...

GO LIGHTLY NOT GOLY TELY grrr

Edit
Maximum Dosage Limits
•Adults
4 liters/24 hours PO (Clenz-Lyte, Colyte, GavilLyte, Golytely, Nulytely, and Trilyte); 2 liters/24 hours PO (Moviprep).

Copied from Clinical Pharmacology (Indications/Dosage)

 

[GodsSon2011]

I would just forget what he said and fill one bottle with one refill 🙂

 

[Kwiz]

2 gallons sounds like it would GoViolently not lightly

 

[rxlea]

2 gallons sounds like it would GoViolently not lightly

lol

 

[BrightLight]

I would just forget what he said and fill one bottle with one refill 🙂

No can do. That doc would call back and yell at the pharmacist and threaten to board us to the BOP.

 

[Ackj]

LD50 for H20 = 90g/kg (in rats) which for me at 100kg = 9000g = 9 Liters = 1.98 Gallons.. Did I do this right?!?

That really is an insane amount of volume. What sort of timeframe do they have to ingest all of that? I drink roughly a gallon of water daily, and I feel like I'm constantly sipping on it. Could not imagine doubling that.

 

[Wheresmyaricept]

The doc is obviously trying to dilute the patient's blood and make them 100% water instead of full of s***.

Make sure you document on all of those that you verified with the office that the doctor knows he wrote for 2 and wants 2 dispensed to avoid chargebacks.

 

[rph3664]

Because 50 is beckoning for me, it's only a matter of time before I'll have to do that. I can hardly wait. 😀 😳

 

[amox]

That really is an insane amount of volume. What sort of timeframe do they have to ingest all of that? I drink roughly a gallon of water daily, and I feel like I'm constantly sipping on it. Could not imagine doubling that.

No time frame that I saw! But I assume as fast as one can drink it (15min maybe?).

I weigh more than the general public so it's a lower quantity for most.

No one drinks that much at once, but over 24 hours I your system can handle that quantity.