Med Fillers, Stabilizers, Dyes

[Kooky Korky, BSN, RN]

Some meds contain fillers, coloring, stabilizers and maybe other ingredients besides just the actual medication.

These fillers, etc. can cause SOB, anxiety, maybe a sense of panic or fear of dying.

It is the hardest thing in the world to get doctors to acknowledge and accept this.

For instance: I had a patient who could take Toradol shots and received good benefit from them. But the oral form caused her SOB and chest tightness.

Another could take one generic capsule of melatonin but not a different generic melatonin in pill form, due to SOB and a fear that she would die if she let herself fall asleep (feared she'd quit breathing).

Anyone come up against this before? Please share your experiences. Thanks.

[poppycat, ADN, BSN]

I've had that experience with a few medications I take. The solution was to have my doctor write a letter to my insurance company stating medical need for the brand name.

There can also be differences between generic formulations from different drug companies. The pharmacy I use changes drug companies from time to time & I've had problems a few times with generic meds from different companies. Apparently the fillers are not the same from one company to another.

[KatieMI, BSN, MSN, RN]

Yeah, this is what compound pharmacies are here for.

All large pharm companies have some sort of support for people who cannot tolerate or allergic to certain chemicals. But the chemical needs to be identified first, and things like "i have panic attack every time i take a look on anything which might have been near something with Red#40 in it" won't go. Second, it is not physically possible to administer "just pure acting substance" in milligrams and less. So, people with confirmed severe allergies on components either need to find other manufacturer or insurance will request company to supply a kilo of X hydrochloride to compound pharmacy where it will be made into pills without any wheat/corn/cocoa derived fillers. And then they will charge leg and foot and some more for it.

P.S. difference in action between parenteral and enteral forms of the same med usually caused by different adsorption, bioavailability, presence/absense of first bypass and peak of it and other more real pharmacological reasons. It is especially important for patients with some degree of hepatic injury and/or small intestines disfunction.

P.P.S. parenteral meds can contain stabilizators, antioxidants, easy diluting agents and antimicrobials as well.

[nurseactivist]

Yes, broke out in hives at injection site for IV benadryl. Doc thought it was most likely a preservative in the bendaryl.

[Dogen]

There was a pretty big instance of problems around a Wellbutrin XL generic. This case was interesting because it involved several oddities, one of which was that the 150mg tablet was tested but the 300mg wasn't (and ended up being the problem) and the lab that did the bioequivalence testing may have falsified data. Essentially, the generic tablet released bupropion at a much faster rate, causing a rapid onset and increased side effects.