Dispense as written....

Nurses General Nursing

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Ugh!!! Anyone else have a problem with this? My husband takes Levoxyl for his hypothyroidism. Our doctor was adamant that he stick with this namebrand, he didn't want the namebrands changed. He writes the script for Levoxyl, dispense as written. So I pick up my husband's medication the other day and bring it home. I never looked at the medication in the bottle. My husband went to take his med last night and he brought the med to me. He said this isn't Levoxyl. (levoxyl has a distinctive bowtie shape). I called the pharmacy and they said they didn't have Levoxyl when they filled the script so the filled it with Levothyroid instead. I told them that the doctor did not want him changing brands once he was established on this med. So, my husband went to get the correct med today. We usually get the generics when they are available, but I really feel that since the doctor specified a name brand we should stick with that....

Originally posted by Mimi Wheeze

My levoxyl bottle says it is generic for synthroid....(?)

Is is really true that generics have to only be 80% effective?

Do your pills look like this? (Levoxyl comes in different colors depending on the dosage)

levoxyl1a.jpg

This is what the brand name for Levoxyl looks like. Like little bow ties. Levothroid is round-also in different colors and has the dosage imprinted on one side and some kind of almost triangular marking on the other. That is also a brand name. Synthroid is another brand name. Levothyroxine is the generic name for all three. Our doctor didn't want my husband switching from one brand to another once he started on one brand.

For some reason, I remember specifically from nursing school that one brand should not be substituted for the other for levothyroxine in particular. I don't remember why that is.

No matter what, the doctor ordered dispense as written. For the pharmacy to fill it with something else is a med error.

According to my drug book - you should not accept brand change as differences in bioequivalence exist among brands. Also, (not applicable in this particular circumstance but important in regards to brand names) Synthroid 0.1 and 0.3 mg contain tartrazine which may cause and allergic-type reaction in certain patients. It is frequently seen in persons who also have aspirin hypersensitivity.

Now in this instance, it's up to you as to whether you think you can trust them in the future with your medications &/or report it. It was probably an honest mistake since most people want cheaper medication and they are probably in the habit of filling with generic without complaints. You may want to point out that the drug guide states that there are significant differences between brand names.

Originally posted by hogan4736

maybe first speak w/ said pharmacist, or the pharmacy supervisor, before going to the board.

geez, and I'm high strung?

If the MD wrote fill as written, the pharmacy can not legal dispense anything else. If the pharmacy dispense anything but the prescribed medication there is no justification. Its practice medicine without a liscence. They should of explained they were out of the drug and given you the option to go else were. By not saying anything to you, they took away your right to make an informed healthcare decision. What ever their motive, they have no right to take the choice away from you and your spouse and they need to be held accountable for their actions. At the very least, the board should come in and do an audit, to ensure this is not a common practice.

Originally posted by montroyal

If the MD wrote fill as written, the pharmacy can not legal dispense anything else. If the pharmacy dispense anything but the prescribed medication there is no justification. Its practice medicine without a liscence. They should of explained they were out of the drug and given you the option to go else were. By not saying anything to you, they took away your right to make an informed healthcare decision. What ever their motive, they have no right to take the choice away from you and your spouse and they need to be held accountable for their actions. At the very least, the board should come in and do an audit, to ensure this is not a common practice.

you've never written and order first, then gotten the actual order later (or gotten the doc to sign for it later)??

that is something I think we've all done at least once...careful montroyal, that's practicing medicine w/o a license...what if you had an overzelous co-worker who witnessed you do that and called the board without talking to you first...wouldn't you at least deserve being confronted before having your livelihood possibly snatched away??

relax...I disagree w/ what happened, but the pharmacist deserves at least hearing about it from his supervisor, before having his case immediately go in front of the board???

what, in Canada one isn't innocent until proven guilty??

what about due process

besides, you're only hearing one side of the story

again, RELAX...you are mistaking the pharmacist for another nurse (you know, nurses eat their young, no questions asked, as THAT'S what you seem willing to do in this case)

Pharmacies make mistakes. So do nurses. Most of the time, they're innocent, as it seems was the case with the Levoxyl. I don't think we should be so quick to crucify pharmacists (a few major pharmacy chains being the exception....).

I take multiple medications for asthma, allergies, and depression. Being a responsible patient, I try to have one doctor (my internist) prescribe all the medications, and I try to fill them through one pharmacy. Even with these precautions, mistakes have been made.

A couple of years ago, I filled a prescription for prednisone. It was supposed to be a tapered regimen--6 tablets every X hours the first day, 5 every Y hours the second day, etc. The prescription I picked up was for the correct amount of tablets (around 50) but the SIG was wildly incorrect. The instructions read something like, take 6 tablets once daily for five days. Hmm.

Even if the SIG had been correct, the # of tablets being dispensed should have set off alarm bells for the pharmacist, right?

It turned out that the pharmacist actually had called the office to check on the SIG, which was called in by my doctor's MA. The MA had supposedly told the pharmacist that the SIG she originally called in was correct--leaving the pharmacist with no choice but to fill the prescription. When I called my doctor the next morning, my doctor told me that her assistant had read the chart notes incorrectly--yet another reason to have only licenced RN's call in scripts--and didn't have the training to realise that the SIG she called in made no sense.

Another time, this same MA called in a script for 300 Tylenol #3 instead of 30!

Also, as far as pharmacists switching patient medication (within a drug class), keep in mind that this might be due to insurance formularies. I don't know the law in this regard, but when I was on an HMO, my pharmacy once had to fill a sleeping medication Rx with trazodone instead of zolpidem; my doctor did approve the change but was not happy about it.

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