Tuesday, November 18, 2003
Physicians Need to SERIOUSLY Examine They're Prescribing Habits
These are some things that I see happen everyday when I'm at work as a retail pharmacist. To me, they are examples of appalling misuse of expensive medications when cheaper alternatives are available and would work just as well. It is obvious that doctors are prescribing based on what drug rep has been in their office lately or what new commericial they have seen on TV. Medical costs keep rising and the U.S. Healthcare system is in a serious crisis. Things like this NEED to change if we are ever going to get the ever going to get a control on health care spending so that it becomes affordable once again for everyone.
1. Seroquel, Zyprexa, and Risperdal are ATYPICAL ANTIPSYCHOTICS. They were developed to treat serious mental illnesses such as schizophrenia and bipolar disorder. They have some use in things like Obsessive Compulsive Disorder and Refractive Major Depressive Disorder. They are pretty much medications who's prescribing should be reserved for psychiatrists only. A general practioner is not seeing any of these conditions and if they are, they should be at least CONSULTING a psychiatrist. These medications cost between $300 and $700 a month (and that is the WHOLESALE cost, the cost to patients in more, not much because most pharmacies make little profit on these expensive medications). These medications are not first line sleep agents, they are not first line anxiolytics, they are not first line unipolar depression medications, they are not first line OCD medications. Why would ANYONE with a lick of common sense start someone on 25 mg of Seroquel at night to help them sleep, in the absence of one of the above mentioned appropriate uses for these drugs? How about trying a medication that is indicated for insomnia? Benadryl is cheap and non-habit forming, although some of the side effects are undesirable and need to be avoided in some people. Trazodone is a generic medication that has been used SUCCESSFULLY for decades and has been shown to help people restore a normal sleep pattern when it is used. It is also non-habit forming and carries little risk for side effects (except for rare cases of priapism in some men). Ambien and Sonota are two new sleep aids, but they are really only to be used for 7-10 days and are expensive. Benzodiazepines also can help with sleep and are cheap although they pose a large risk of creating drug dependecy with their extended use (so do Ambien and Sonota). Let's compare though a 30 day supply of the following therapies:
#30 Seroquel 25mg (NOT INDICATED FOR INSOMNIA)...................,...............$80 a month
#30 Zyprexa 5mg (NOT INDICATED FOR INSOMNIA)......................................$400 a month
#30 Ambien 10mg (NOT INDICATED FOR USE BEYOND 7-10 DAYS)................$80 a month
#30 Sonata 10mg (NOT INDICATED FOR USED BEYOND 7-10 DAYS)..............$75 a month
#30 Trazodone 100mg...................................................................................$10 a month
#30 Benadryl 25mg........................................................................................$5 a month
#30 Clonazepam 0.5mg................................................................................ $10 a month
Seems like a pretty obvious choice to me. And yet EVERYDAY I have prescriptions called in for Zyprexa and Seroquel and the like for patients who have never tried anything else for sleep and have no indications for using an atypical antipsychotic agent. They are using them soley for their side effect of somnolence. What a waste of money. I mean they could at least TRY a cheaped agent first!
2. Actiq is a immediate release narcotic medication. The medication is Fentanyl and it comes in a lollypop that patients suck on to get immediate pain relief. It is strong, HIGHLY addictive and HIGHLY abused. It is indicated for people with SERIOUS pain (mainly those who are DYING) who need IMMIDIATE pain relief and can no longer get enough relief from other methods of medication delivery (normal tablets, liquids, injections, etc.). The shorter acting a drug is, the more abuse potential it posesses. Unless it is being prescribed for a terminal patient, this medication should NOT be dispensed in an outpatient setting. There is ABSOLUTELY no reason to start an otherwise healthy middle aged adult with fibromyalgia on Actiq. Doctors do it though. A patient who has ONLY taken methadone to try and control her "fibromyalgia pain" is put on Actiq. In addition to all the other drawbacks of the medication, it's easy to overdose and die on narcotics (they simply stop people from breathing at levels not much beyond levels that effectively control pain), and they are EXPENSIVE. #5 Actiq 200mcg lollipops cost over $300. A patient like the above mentioned fibromyalgia patient should at least be tried on other narcotics before going to Actiq. I mean if we're going to use highly addictive pain meds, why not go with cheaper ones? Something even somkething like the highly addictive and very expensive Oxycontin would be much cheaper compared to Actiq. Percocet is generically available and can cost less than $20 a month. #6 Demerol injections cost about $10. Where is the logic in prescribing a medication like Actiq? Practice like this should be condemned!
I have more, but this is enough for tonight.
1. Seroquel, Zyprexa, and Risperdal are ATYPICAL ANTIPSYCHOTICS. They were developed to treat serious mental illnesses such as schizophrenia and bipolar disorder. They have some use in things like Obsessive Compulsive Disorder and Refractive Major Depressive Disorder. They are pretty much medications who's prescribing should be reserved for psychiatrists only. A general practioner is not seeing any of these conditions and if they are, they should be at least CONSULTING a psychiatrist. These medications cost between $300 and $700 a month (and that is the WHOLESALE cost, the cost to patients in more, not much because most pharmacies make little profit on these expensive medications). These medications are not first line sleep agents, they are not first line anxiolytics, they are not first line unipolar depression medications, they are not first line OCD medications. Why would ANYONE with a lick of common sense start someone on 25 mg of Seroquel at night to help them sleep, in the absence of one of the above mentioned appropriate uses for these drugs? How about trying a medication that is indicated for insomnia? Benadryl is cheap and non-habit forming, although some of the side effects are undesirable and need to be avoided in some people. Trazodone is a generic medication that has been used SUCCESSFULLY for decades and has been shown to help people restore a normal sleep pattern when it is used. It is also non-habit forming and carries little risk for side effects (except for rare cases of priapism in some men). Ambien and Sonota are two new sleep aids, but they are really only to be used for 7-10 days and are expensive. Benzodiazepines also can help with sleep and are cheap although they pose a large risk of creating drug dependecy with their extended use (so do Ambien and Sonota). Let's compare though a 30 day supply of the following therapies:
#30 Seroquel 25mg (NOT INDICATED FOR INSOMNIA)...................,...............$80 a month
#30 Zyprexa 5mg (NOT INDICATED FOR INSOMNIA)......................................$400 a month
#30 Ambien 10mg (NOT INDICATED FOR USE BEYOND 7-10 DAYS)................$80 a month
#30 Sonata 10mg (NOT INDICATED FOR USED BEYOND 7-10 DAYS)..............$75 a month
#30 Trazodone 100mg...................................................................................$10 a month
#30 Benadryl 25mg........................................................................................$5 a month
#30 Clonazepam 0.5mg................................................................................ $10 a month
Seems like a pretty obvious choice to me. And yet EVERYDAY I have prescriptions called in for Zyprexa and Seroquel and the like for patients who have never tried anything else for sleep and have no indications for using an atypical antipsychotic agent. They are using them soley for their side effect of somnolence. What a waste of money. I mean they could at least TRY a cheaped agent first!
2. Actiq is a immediate release narcotic medication. The medication is Fentanyl and it comes in a lollypop that patients suck on to get immediate pain relief. It is strong, HIGHLY addictive and HIGHLY abused. It is indicated for people with SERIOUS pain (mainly those who are DYING) who need IMMIDIATE pain relief and can no longer get enough relief from other methods of medication delivery (normal tablets, liquids, injections, etc.). The shorter acting a drug is, the more abuse potential it posesses. Unless it is being prescribed for a terminal patient, this medication should NOT be dispensed in an outpatient setting. There is ABSOLUTELY no reason to start an otherwise healthy middle aged adult with fibromyalgia on Actiq. Doctors do it though. A patient who has ONLY taken methadone to try and control her "fibromyalgia pain" is put on Actiq. In addition to all the other drawbacks of the medication, it's easy to overdose and die on narcotics (they simply stop people from breathing at levels not much beyond levels that effectively control pain), and they are EXPENSIVE. #5 Actiq 200mcg lollipops cost over $300. A patient like the above mentioned fibromyalgia patient should at least be tried on other narcotics before going to Actiq. I mean if we're going to use highly addictive pain meds, why not go with cheaper ones? Something even somkething like the highly addictive and very expensive Oxycontin would be much cheaper compared to Actiq. Percocet is generically available and can cost less than $20 a month. #6 Demerol injections cost about $10. Where is the logic in prescribing a medication like Actiq? Practice like this should be condemned!
I have more, but this is enough for tonight.
FluMist is a Danger to the Safety of America
Has anyone stopped to think about this?
We are in the midst of one of the earliest and most widespread influenze outbreaks in all of history. Two states are already reporting epidemic infection levels and it is only the 3rd week of November.
Interestingly enough, this is the first year that the nasal vaccine FluMist has been made available to the public.
FluMist is a LIVE VIRUS VACCINE, which means that it works to provide immunity by actually infecting people with a small amount of living flu virus. People who get FluMist inhale into their nasal passages a liquid that contains live and virulent influenza virus. Not only are they being infected, but by having the live virus in their nasal cavity and being exposed to the live virus, they can pass the living virus onto people around them. If they expose people who are advised to avoid getting FluMist (immunocompromised, people over 50, children under 5, etc.) they can potentially make them very ill, this will result in increased health care costs and spending, and possible deaths.
Because people have already received FluMist, there are people out there now spreading the live virus and possibly infecting people. It's not much of a stretch to think that we may have actually started the inlfuenza season early by intetionally giving people the virus.
DON'T PUT OTHERS AT RISK, SAY NO TO FLUMIST
We are in the midst of one of the earliest and most widespread influenze outbreaks in all of history. Two states are already reporting epidemic infection levels and it is only the 3rd week of November.
Interestingly enough, this is the first year that the nasal vaccine FluMist has been made available to the public.
FluMist is a LIVE VIRUS VACCINE, which means that it works to provide immunity by actually infecting people with a small amount of living flu virus. People who get FluMist inhale into their nasal passages a liquid that contains live and virulent influenza virus. Not only are they being infected, but by having the live virus in their nasal cavity and being exposed to the live virus, they can pass the living virus onto people around them. If they expose people who are advised to avoid getting FluMist (immunocompromised, people over 50, children under 5, etc.) they can potentially make them very ill, this will result in increased health care costs and spending, and possible deaths.
Because people have already received FluMist, there are people out there now spreading the live virus and possibly infecting people. It's not much of a stretch to think that we may have actually started the inlfuenza season early by intetionally giving people the virus.
DON'T PUT OTHERS AT RISK, SAY NO TO FLUMIST
