Par, generic Toprol XL, and getting even.

Unless you live in a box, you all are well aware that we are in a nationwide Metoprolol Succinate (Toprol XL) shortage.  This is caused by Ethex getting spanked by the FDA and not allowing to sell drugs in the US.

Now what makes me angry about this, is that the only other manufacturer of generic Toprol XL is Par.  Par, upon Ethex biting the big one, decided to jack up the price about 75-100% THEN back-order us to kingdom come.  You know, Fuck you Par.  It would be one thing if you would of kept the price the same and been back-ordered, that’s understandable.  However you totally screwed us over both price-wise (since most insurance companies were reimbursing based on the OLD MAC price) AND you cannot supply!  I’m not sure if this shortage is intentional so they can squeeze some extra bucks out of us (if so, go fuck yourself), or why they would need to raise the price as high as they did (other than “because they can”).

So here is a big TAP fuck-you to you Par.  Since you can’t supply to us, I’m getting everyone switched over to another product, and when your shitty product does come back in stock, I’m not going to switch them back.

Brain between your ears, not in the palm of your hand

This entry is dedicated to all of the PA’s and NP’s out there who use a hand-held device (palm pilot, iphone, whatever) to dose medications.


Lets be completely honest here. We are both professionals so we can have this conversation.  Do you really think a welfare mother of 4 is going to have the mental horsepower to measure anything other than what is clearly marked on a measuring spoon?  Do you think they can comprehend the idea of anything smaller than 1mL?  Do you really believe in their ability to use a dosing syringe and draw up liquid to a big black line which I draw on there with a sharpie?


If you cannot use some common sense and round up or down dosages of amoxicillin or Prelone to either 1/2 or 1 full teaspoonful, then please save us both the trouble and write for something else which can.  Seeing dosages of 435mg tid of amoxicillin suspension just makes me wish that you didn’t have prescriptive authority.  I’m just going to round up to 500mg, and when you call me to bitch, I’m just going to tell you to use a little common sense and less calculator.  I’m also going to tell you that the idiot mother in front of me (who has yes to realize that penis + vagina = kid) doesn’t have a snowballs chance in hell in measuring what dose you initially wrote for.

Idiots who write super-precise dosages like that are the retards in college that score 100% on the tests, but can’t apply that knowledge to any real-world situation to save their life.  Unless you are dealing with a hospital staff with very narrow therapeutic drugs, whats the point of writing dosages like that?  Are you proud that you can do math using mg/kg units?  Are you proud that you have a program that figures out the dosages for you?  Have you ever in your life seen the thick pink amoxicillin death that you wish to be dosed out to .004mL digits?

When you write for those dosages, think for a whole 2 seconds knowing that amoxicillin comes in 125mg/5cc (1 cc = 1 mL in case you didn’t know), 250mg/5cc, and the ever not-used 400mg/5cc.  Now, use your math skills and shoehorn the dose that the stupid palmpilot program gives you into one (1) of those dosage bottles so the twatmuffin mother will give 1/2 or 1 teaspoon.  If you can’t, then just round up.  If some kid dies from getting an extra 25mg of amoxicillin, then obviously your diagnosis was so far off you shouldn’t be practicing.

Finally, please, when the pharmacist comments on your dose over the phone, don’t just blow him/her off with a “uh huh” and proceed to write again for stupid dosages.  That just makes us angry (and you get a rant written about you).

DTC Advertising

DTC Advertising – Direct to Consumer Advertising.  Everyone has seen the “Ask your doctor about whocares, a new drug to help you sleep/screw/be-happy” commercials on the TV.  These are the steaming turd in the diaper of medicine.

Lets take a stereotypical patient.  While he/she is sitting around leeching on the taxpayer dollar watching Judge Judy and Maury (“You are NOT THE FATHER”), he sees a commercial for a new drug.  The commercial is happy, wonderful, and promises a new life (in very vague terms) if you take this drug.  “ASK YOUR DOCTOR ABOUT THIS”.  So the idiot does.

Idiot goes to his doctors office, and after signing his name with drug-branded pens on a drug branded clipboard and gets seated in a drug-branded chair while looking at drug-branded posters on the walls, he sees the doctor (who has a drug-branded clipboard and a drug-branded stethoscope).  He asks the doctor for the drug which he saw on the TV.

Now here is where I have the issue.  You see, in a perfect world the patient wouldn’t have advertisements bombarding him that he SHOULD be on this, because in a perfect world someone with medical knowledge would make the judgment call on what medications the patient should be on due to the symptoms presented.  The patient should have zero say in what he/she should be on, because he/she really doesn’t know enough to get the “whole picture”.  The patient shouldn’t say “I WANT TO BE ON THIS BECAUSE THE TV SAYS SO” but “I am experiencing symptom X, what do you think”.

Its now NOT the doctor making the decisions on what drugs a patient should be on, but the patient and the TV.  If the doctor says no, the patient will find another doctor who will say yes.  Now I’m not one to turn down business, but there is a huge problem with most modern trade-name drugs:

  1. Insurance companies (if they pay for it) reimburse $2.50 on that $200 Rx.  Its not even worth my time to even carry it.
  2. Most of the new trade-name only drugs are just “Me-Too” knock-offs because patents are expiring left and right.  I really don’t give a rats ass that a once-daily drug is coming out with a new XR formulation that is…. ONCE DAILY.  Seriously, who cares?
  3. All of the new and novel trade-name drugs aren’t the ones that are advertised on TV, only the shit patent-expiring crap.
  4. What the fuck is wrong with the generics that save the patient AND an overstressed health care system money?  Oh, not advertised on TV.

If the generic drug companies didn’t have their heads up their asses, they would advertise on TV.  “Watson Pharma! Bringing you quality generic Vicodin and Soma!”.  However I really wish they would just shitcan all of the DTC marketing crap and leave the selection of drugs to the people with the education to do so.