you guys ever heard of adding zolpidem pen to lunesta daily?
you guys ever heard of adding zolpidem pen to lunesta daily?
I have seen it, pt and prescriber claimed they have two different insomnia types and don't take them together... I said ok fine, I will fill 30 tabs of each for a 60 days supply since u don't take them together... pt said no and took it somewhere else lol
if that is true - you need to grow a backbone and say no - or find a new employerat cvs, you're required to fill them both. including zolpidem and xanax/klonopin. even Fentanyl and oxycodone together. while it is duplication therapy, your cvs supervisor will get on your tail for not filling them.... aside from cvs, if u work for any other company then u can use professional judgment.
at cvs, you're required to fill them both. including zolpidem and xanax/klonopin. even Fentanyl and oxycodone together. while it is duplication therapy, your cvs supervisor will get on your tail for not filling them.... aside from cvs, if u work for any other company then u can use professional judgment.
at cvs, you're required to fill them both. including zolpidem and xanax/klonopin. even Fentanyl and oxycodone together. while it is duplication therapy, your cvs supervisor will get on your tail for not filling them.... aside from cvs, if u work for any other company then u can use professional judgment.
There are legitimate reasons to fill those. I don't know if you are even serious.
...Two different insomnia types? WTF does that mean?
Dumb dumb dumb. Good call on your solution, I like that.
there are legit reasons definitely. one of which is the increasing death rate and hospitalization from Fentanyl. why else would they try to limit C2 distribution from warehouse and went as far as calling it an opioid crisis? an epidemic? people on the news are saying the opioid crisis are destroying their communities! and guess what who better to destroy communities than these pharmacists and you?
Overall, it seems like an inappropriate duplication of therapy, and is not something that is supported by ASSM clinical guidelines or any other guidelines I am aware of. But since refractory insomnia can literally drive people mad, I've seen lots of last ditch efforts, like prescribing a z-drug + a benzo. I don't recall ever signing off on dual z-drug therapy specifically, but it's not that much different from combining a z-drug with a benzo, and I definitely have seen that (granted, it's a bit more excusable, since benzos have other indications besides insomnia, but still). It's a tough call, and I don't think it's wrong to refuse to fill both, and I would definitely want to have a conversation with the provider (and document it) if I was considering filling both.
if that is true - you need to grow a backbone and say no - or find a new employer
I hope you are right, but I am pretty sure she isn't -I'm honestly starting to wonder if sosoo is just a tech masquerading as an RPh for fun
Usually the problem is people who can't fall asleep, not people who can't stay asleep.
Increasing the dose or adding a second hypnotic will do nothing to make people fall asleep faster.
They'll only stay asleep longer.
This is a huge distinction that most MDs who want to argue with me (she needs 30mg Ambien!!!) Never even think about.
Adding on a benzo is better if they don't care about getting dementia.
I hope you are right, but I am pretty sure she isn't -
You limit if the scripts are not for legitimate reasons. The crisis is b/c of that. Ambien and lunesta together don't make any sense. A long acting (Fentanyl) and a short acting (oxy) pain medication used together to control pain do make sense. You want to get documentation on what kind of pain and how the patient has been titrated up to that specific combination, sure. But that's not a surprising combination.
I've seen a combo with the following:
3mg Lunesta + 5mg zolpidem
Walgreens' software (IC+) doesn't have very good ways to leave notes like other chains. I called the Doc and he said the patient needs it because of his weight. Seemed like a valid enough reason to me. He had been on the combo for over 6 months.
Usually the problem is people who can't fall asleep, not people who can't stay asleep.
Increasing the dose or adding a second hypnotic will do nothing to make people fall asleep faster.
They'll only stay asleep longer.
This is a huge distinction that most MDs who want to argue with me (she needs 30mg Ambien!!!) Never even think about.
Adding on a benzo is better if they don't care about getting dementia.
Did you not tell the MD the logP of Ambien and Lunesta don't support that bologna reason?
Are you not a drug expert?
Did you think it's ethical for insurance companies to force docs to put their patients on benzos before trying Suvorexant/Balsomra?
Patient weighed at least 300 pounds.
Did you think it's ethical for insurance companies to force docs to put their patients on benzos before trying Suvorexant/Balsomra? I was shocked to see it in rheum clinic. The doctor ran into that issue repeatedly. In Florida, the psych I worked with was under strict orders not to write any new scripts for benzos (granted he was at a public, pay what you're able sort of clinic).
Thanks! Just read up a bit and it appears Merck aggressively marketed it without sufficient trials. Surprise, surprise.Yes, because Belsomra is a trash drug that's more marketing than science.
The phase 4 trials aren't living up to the hype.
Just kidding, literally nothing insurance does is ethical.
BUT, not enough prescribers force their people to try trazodone + melatonin for long enough.
Especially the know it all patients who have their prescriptions decided before you walk in
Can you articulate why the dose for Ambien would be different for a 127lb sorority sister and a 782 lb morbidly obese person?
You're a professional, not a frat boy guessing how many shots someone can take.
If you think body fat makes a difference and you accept it as justification from the MD you need to understand why.
I filled alprazolam and zolpidem for someone the other day. I didn't like it, but she had been getting it for months now at the pharmacy I took over, so it put me in an awkward position.
You limit if the scripts are not for legitimate reasons. The crisis is b/c of that. Ambien and lunesta together don't make any sense. A long acting (Fentanyl) and a short acting (oxy) pain medication used together to control pain do make sense. You want to get documentation on what kind of pain and how the patient has been titrated up to that specific combination, sure. But that's not a surprising combination.
yesterday i declined a large and high dose vicodin script. a profile lookup shows they also get Fentanyl, oxy, soma, temazepam in the past. its amazing they're still alive. these pharmacists on this forum and in this district are amazingly "reckless." no wonder many communities are being destroyed.. and it all comes from the same doctor i suspect operating a pill mill from day 1.
Surely you are aware that there are medical reason why a person would be on both of these???? (I'm assuming they are taking them at different times of the day....if they are taking them both at bedtime, then I would agree that is a problem.) Now whether or not everyone on both of these medicines needs them is debatable, but certainly there are cases where some people would benefit medically from both of these drugs.
To be fair, my providers do write for Norco with oxycodone and instruct patients to take Norco for mild to moderate breakthrough pain and oxycodone for moderate to severe breakthrough pain. I see their point, but it rarely works out how they hope it will. A lot of our patients on both scripts just take both of their PRNs as scheduled doses and come in every month for all 3 opioid scripts. Unless the patient has tried every other muscle relaxer, the patient shouldn't be on Soma (my opinion).Have you seen a cancer patient drug list honestly? I mean how long have you worked? I mean from your posts, I wouldn't bring any script to your pharmacy.
You probably won't even fill albuterol inhaler and albuterol solution together b/c they're duplication of therapy for god sakes.
Have you seen a cancer patient drug list honestly? I mean how long have you worked? I mean from your posts, I wouldn't bring any script to your pharmacy..
Short acting and long acting combination isn't that unusual. It's a bit weird to see two types of short acting opioids, but I actually like to see a chronic opioid patient on something long acting and something PRN vs a large number of IR tablets every month.i filled it the other day for a hospice patient. and i confirmed before dispensing. thats the only exception. period. you and your kind can wait until u have cancer before coming to me with Fentanyl and oxy combo. and even then i must have confirmation you'll be dying. otherwise i have no problem declining and assuming you're from a pill mill.
i filled it the other day for a hospice patient. and i confirmed before dispensing. thats the only exception. period. you and your kind can wait until u have cancer before coming to me with Fentanyl and oxy combo. and even then i must have confirmation you'll be dying. otherwise i have no problem declining and assuming you're from a pill mill.
i filled it the other day for a hospice patient. and i confirmed before dispensing. thats the only exception. period. you and your kind can wait until u have cancer before coming to me with Fentanyl and oxy combo. and even then i must have confirmation you'll be dying. otherwise i have no problem declining and assuming you're from a pill mill.
am I missing something here, what is wrong with duragesic with prn oxy on top of it? in general you want a short acting PRN for breakthrough pain (provided it is being used appropriately - which is a big assumption)Yeah, fentanyl with oxy. Are we degreed professionals or order takers for the illicit drug trade...geez. didn't know DFW was that bad.
you are not that heartless are you? You must being dying? wow -
to be heartless is to be a reckless drug dealer. to be the main cause of the opioid epidemic. i just think if i don't give them pills out like M&Ms, then no one will die. in all things ethics, i've done no harm. heartless is when u cause harm, and continue as if theres nothing wrong with reckless dispensing of opioids.