How many of those at home have gotten an Rx that looks something like this:
Wellbutrin 150 QD
Depakote 250 QD
Effexor 75 BID
Now how many of those at home after getting these prescriptions felt the urge to slam their face into the counter. For those not in pharmacy (or for those douche-canoe asshat prescribers out there who are stuck in 1990) all of these drugs come in different formulations BUT in the same mg strength. The regular-release is the SAME strength as the extended-release. Its not like Coreg or Paxil which the extended-release dosage form has a different strength than the non-XR form. Hell, in that case its easy. Dr writes for Coreg 20, and we know that he wants the once-daily CR caps (unless he wants the patient to start shaving the IR tablets, which would be rather funny).
Does the MD want Wellbutrin 150 SR given once daily? Or did he/she mean to write the once-daily XL? Depakote comes in a 250 DR and a once-daily 250 ER, but depending on the patient they may want the DR given once daily. I’ve seen Effexor plain given BID as well as the XR given BID. Should I just guess?
Its shitty at best and outright dangerous at worse, and there is absolutely nothing that we can do to prevent this. The only thing that we can do is to call the Dr, be left on hold while the patient gives us the “Why cant you fill it? It says the drug on the prescription!!” face, and be at the mercy of the *sigh* wonderful doctors staff to give us a call back saying “Doctor wants the extended release Wellbutrin” *headdesk* “IT COMES IN 2 WAYS!”. What makes matters worse, is that ALL of these drugs are relatively new (compared to like Theophylline, Cardizem, or Verapamil) thereby removing all shred of hope that we could “guess” what the doctor wanted (since some doctors are stuck in 1990). It requires a phone call/fax, which is just balls for everyone involved because 2 little letters could have solved this. This isn’t something that the insurance doesn’t cover, this is just sloppy Rx writing!
Is there a good solution to this problem? The one time we guess as to the release-mechanism it’ll be wrong, so there is no point doing that. Of all of the examples regarding sloppy Rx writing, this has to be the most annoying for pharmacists. I can deal with not having a quantity. In some cases I can deal with not having a sig if I can tell from the quantity (I mean how many ways can a dentist give 28 amoxicillin caps?). I can deal if you didn’t sign the damn prescription. No IR/ER/XL/WTF designation? Boned-every-time. Saving 2 seconds on your end just cost me (and the patient) 15 to 45 mins.
Just go give us one more kick in the balls, the patient wont understand what the problem is. They see a drug, a strength, and some T’s with dots over them with some letters. They don’t care about the IR/ER/XL/OMFG dosage form, they want the drug on the prescription and they wanted it filled before they handed you the Rx. Short of yelling at the doctor for omitting probably the second-most important piece of information on the Rx (yeah, that’ll teach him! *sigh*), all we can do is just bend over and accept the 30 min phone-call and hateful glares from ungrateful patients.