Xopenex nebulizer AND inhaler?

[rogerkassob]

Earlier today a patient in his 40s came to the pharmacy with two different prescriptions, one for a xopenex inhaler and another one for a xopenex nebulizer. I have never seen this before in practice and I tried calling the doctor office to try to understand the rationale behind this but they were closed. I ended up dispensing both prescriptions. Now looking back, I am not sure if that was the smart thing to do 🙁 Has anyone here seen a patient prescribed both an inhaler and nebulizer for the same drug?

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[socalpharm86]

Nebulizer for when he's at home. Inhaler for when he's at work, the office, wherever else.

 

[drcrispmd]

Yes it is done. A lot of COPD patients will have both neb and inhaler of albuterol (or xoponex)

 

[rogerkassob]

Nebulizer for when he's at home. Inhaler for when he's at work, the office, wherever else.

Why does he need the nebulizer at home when he can just use the inhaler at home?

 

[Ackj]

Why does he need the nebulizer at home when he can just use the inhaler at home?

I believe he is more likely to get a full dose, since he's able to breathe it in over the span of the treatment, rather than all in one (possibly shallow) breath. Ideally he would always be able to get the nebulized dose, but it isn't convenient and portable.

 

[zelman]

Why does he need the nebulizer at home when he can just use the inhaler at home?

The nebulizer also contains a dose of saline which helps to moisturize and act as an expectorant.

 

[Old Timer]

Earlier today a patient in his 40s came to the pharmacy with two different prescriptions, one for a xopenex inhaler and another one for a xopenex nebulizer. I have never seen this before in practice and I tried calling the doctor office to try to understand the rationale behind this but they were closed. I ended up dispensing both prescriptions. Now looking back, I am not sure if that was the smart thing to do 🙁 Has anyone here seen a patient prescribed both an inhaler and nebulizer for the same drug?

How long have you been a pharmacist? Are nebulized and MDI equivalent in onset and duration of action? If so, why would you ever use a nebulizer? What is the side effect profile? Did you speak to the patient? What were his/her symptoms?

 

[rxsurf23]

I agree, I've seen patients on both nebulizer at home when needed and an inhaler for on-the-go symptoms if needed - for Albuterol. I'm not sure I see the issue. I think maybe you're thinking too much into the fact that it's Xopenex and not albuterol.

 

[ExpressMaiL]

Don't overlook cost.

 

[BidingMyTime]

Yes, convenience, also sometimes people just have severe flares after being exposed to certain allergens or what not, so they will use the inhaler during their normal flairs, but then use the nebulizer when they are having a serious flair.