Category Archives: Drug Trivia and Rants

Solodyn and the dumbass Dermatologists who write for it

Stupid drugs piss off pharmacists, its a known fact.
Stupid doctors who listen to drug-reps as if they were the second coming of whoever piss off pharmacists.

Combine the two, and you get 2 classes of doctors:
Dermatologists and Dentists.  Notice how they both start with D as well as the word Dumbass and Dipshit.

Take a completely stupid new drug that is out, Solodyn (Website complete with 1 recall!).  That’s right, they took Minocycline, made it 90mg and ER, sucked the FDA off to give it an ‘acne’ indication, and now they are selling it for $1573.82 per bottle of 100.  Thats right, 1500 bucks for minocycline.  Go look at your shelf at that $20 bottle of minocycline 100mg in generic and tell me what 10 fucking milligrams in an “Extended Release” is going to do (and is it worth the 100x price increase).

What gets me are the Dermatologists who write for this shit.  Are you fucking kidding me?  Are you so incredibly stupid to believe that this bullshit will do ANY better than the 100mg they have had on the market for decades?  Why do you believe that 90mg ER is better than 100mg bid?  Is it because the big-titted reps tell you so?  I don’t even know how you can even justify this! What are you going to do? Show me studies that are made BY THE DRUG MANUFACTURER that show this to be better than Minocin 100?  Yeah, I’ll also show you evidence BY CHEVY that MY CHEVY TRUCK is better than YOUR FORD.  That’s okay, I consider Dermatologists to be on the same level as voodoo witch doctors.  No offense to those out there who actually boot drug reps out and use actual *gasp* knowledge, but your fellow colleagues are stupid and make my life difficult.  Most of you guys/gals are more than willing to switch to generic Minocin (especially when I tell you how much this cost, a figure the rep ‘accidently’ left out), however a handful of you need to lay off the Medicis Kool-Aid Crackpipe.

So instead of having this sleazy me-too producing drug company (Medicis, producer of overpriced shit like Benzoyl Peroxide Pads) hand out samples to the doctors, they hand them these trial cards. Yeah, I’m going to stock a 1500 dollar bottle of your shit on my shelf so I can dispense 30 and have the rest rot.  Go fuck yourself.  If you cared about anything other than your profits/what nationality of imported hookers for the next board meeting you would make this shit in unit-of-use bottles of 30.  On behalf of pharmacies everywhere, you make it in 30’s and we’ll stock it.  Until then, I’m sorry but “our wholesaler is out of it/we don’t stock that drug” because its FUCKING STUPID.  Doctors, if you wish to plop down the 1500 beans and carry this shit in your office, oh, I didn’t think so.

This is yet another reason why medication costs so much in this country, because there are STUPID drug companies who will make this shit, and there are even stupider Doctors who gobble up the bullshit studies and actually write for this and get it sold!

Dental drugs are also notorious for being so overpriced and stupid (uh Periostat?).  At least most dentists are so insecure in their pharmacology that you can get them to change it to something that is not going to cost the patient their first born child, but Dr Dermatologist WD (Witch Doctor) and their chicken-bones (Elidel/Protopic) are hard headed.  I’m sorry the other MD’s made fun of you in school, doesn’t mean you need to take it out on the pharmacist and the patient with the bullshit you get from your big-titted friend with the free pens and clipboards.

I can go on for ages about the stupid these these two classes of doctors write for under the all-knowing direction of some clueless PDR using sales rep, but I think you get the point.  If you stock this shit, let me know so we can laugh at you.

On another note, since the economy is taking a nosedive, I’m sure a bunch of these big companies are going to be laying off some drug-reps.  Anyone around want to spearhead a Drug Rep Porn site?  Its like Pharmacy Hotties (NSFW)  but with drug-reps!  There are going to be a ton of hot big-titted reps that are going to be hungry for work to pay off their boob-jobs.

Confusion with the Vico-Dans

Alright boys and girls.  We have seem to have a bit of confusion in the patient/crackhead/doctor worlds as to the proper strengths and naming of various hydrocodone products.

I’m tired of seeing Rx’s for Vicodin 7.5/500 or Lortab 7.5/750.  Quit making yourself look like an idiot in front of your local pharmacist and heed my words of wisdom.  Here is the chart, print it out and keep it with you (or just write Hydrocodone/APAP <strength> and make it easy on yourself.

First off, Vicodin 5/500 and Lortab 5/500 are THE SAME FUCKING THING.  Don’t give me this bullshit as to Vicodin upsets your stomach while Lortab doesnt.  To be honest, both come from the SAME generic bottle (yes, the Watsons) so that just tells me how full of shit you are.

Now, the breakdown (hydrocodone/APAP):

  • Vicodin
    • 5/500
  • Vicodin ES
    • 7.5/750
  • Vicodin HP
    • 10/660
  • Lortab
    • 5/500
    • 7.5/500
    • 10/500
  • Lorcet
    • 10/650
  • Norco
    • 5/325
    • 7.5/325
    • 10/325

Now, for those at home who actually aren’t on this stuff, you may notice that LORTAB always has 500mg of Tylenol and NORCO always has 325mg of Tylenol.  Amazing!  Learn the rest or print this out so you can get it right on the Rx. 

You may also notice that Lorcet and Vicodin HP only have 10mg difference in Tylenol in them.  If you call me up, and get pissy with me over 10mg of Tylenol for dispensing Vicodin HP vs Lorcet I will drive to your office and kick you square in the teeth.  There is NO point in stocking both over 10 piddly mg of Tylenol.  Thats almost as stupid as getting pissy at me for dispensing Prinivil over Zestril (back in the day when they were both trade name).

This has been a public service announcement from The Angry Pharmacist(tm).  No Doctors or Addicts were harmed in the making of this public service announcement.

Drug Reps, 30 Day Free Cards and Hatchet Murder

What could make drug reps even more annoying and obnoxious?  Arm them with little plastic coupons for free drugs, that’s how.

I want to go on record to say that I hate 3/7/10/30-day one-time-use drug freebie cards.  These bane of my profession entitle the member to a free fill of a certain drug.  We input all of the data into our system as if its their insurance, run a set quantity of tablets through, and after cost + $2.50 their “insurance” magically covers whatever the rep is pimping out.

The intention is to replace the act of the doctor getting samples and giving them to the patient.  However there’s a huge reason why I hate these cards and why the drug companies/reps absolutely love them.  In fact, there are a few huge reasons.

Take a bottle of the latest and greatest drug.  Runs in the neighborhood of about $400 for #100.  Now give the patient a coupon for 5 free days.  Who gets to have $380 (or #95 tablets) sitting on their shelf wasting money rotting until they expire (and only get about $150 when they are outdated and returned).  Me.  Not the patient, not the doctor, I get to eat the entire cost of the bottle minus what the stupid fucking coupon paid for.  Sure, maybe if hell freezes over someones insurance may cover this drug, but unless you’re on the state tit (Medicaid) no sane insurance company will cover the latest and greatest without a prior auth.

Now, this brings me to my second point.  Doctor gives them a free month of this shit because some big-titted drug rep sweet talked him.  Completely eludes the doctor that what they are pushing is just two existing (probably generic) drugs that cost pennies shoved into one tablet and given a cool name like CADUET or EXFORGE.  Cool trade names give better results (ask your local drug rep).  Anyway, patient is on this new and greatest drug for an entire month because the doctor gets his/her drug information from walking whores (like getting sex advice from pimps, but I digress) only to (surprise) have the patients insurance NOT cover the drug after the 30 day coupon is used up.  So not only did you piss off the pharmacy by making them stock a medication they will never dispense ever again, but now you need to alter your patients therapy because that little coupon didn’t magically buy them a prior auth. Big Pharma – 1, Doctor/Pharmacist – 0, Patient – 0.

So the take-home message to doctors is to just give the patient samples from your office.  If for some reason the drug company will not furnish you samples (and just these stupid coupons) then throw him/her out of your office (which you should anyways).  That way, if the drug isn’t covered you only screw the patient and not your local neighborhood pharmacy (but call us so we can tell you what IS covered or what we can do to help you continue therapy).

The take-home message to the patient is that these coupons are evil.

The take-home message to drug-reps is that you need to whore out the real goods instead of just pimping plastic cards.  You still may have the wool pulled over the eyes of the doctors, but we’re all onto your bullshit and scam tactics to make us stock expensive shit that nobody will cover.  If you made a GOOD product and sold it at a REASONABLE price, then maybe insurance companies would cover it.  Think about that next time you’re at your million dollar corporate parties.

If first you dont succeed…

luvox.jpgAs I was taking my customary pharmacy-dookie this morning, I was flipping through the latest Drug Topics when I saw a nice little advertisement for Luvox CR.  Like Disco and bath-houses, someone is trying to bring back Luvox.  Luvox is one of those red-headed stepchildren SSRI’s that never really caught on.  Paxil, Prozac, Celexa, Zoloft all managed to get the ball rolling in the PR department.  Luvox however sank in the shadows and never really caught on.  It only got a little bit of press that one of the Columbine shooters was on Luvox.

Now, why someone would want to market Luvox CR is beyond me.  Luvox is dead! Deal with it! Why don’t we just bring back Reserpine?  Here you have a market of SSRI’s that cost pennies (Paxil, Prozac, Celexa) and you’re bringing a Continued Revenue formulation of a drug that did not catch on back in the day?  The company making this must be hiring Vegas Hookers as their drug reps to go deep throat every doctor in town to get him to write this shit.

What gets me is the whole “THERE IS NO GENERIC ALTERNATIVE” warning on the advertisement.  You’re right, but a quick phone call can give the patient a generic alternative that does the SAME thing and doesn’t have the trade name copays.  You know, if it came in bottles of 30 and the insurance would cover it, I might of just dispensed it and moved on, but since you had to point out that there IS NO GENERIC ALTERNATIVE like I’m some 4th grader who pooped his pants; it will be my duty now to switch everyone OFF of Luvox CR to either plain generic Luvox or some other generic SSRI.  Fuck you very much.

“But Angry Pharmacist, Luvox CR is DIFFERENT! ITS INDICATED FOR Social Anxiety Disease (SAD) and Dripping Anus Syndrome (DAS)”.  I’ll let you all in on a little secret.  An SSRI is an SSRI.  Ford and Chevy both make cars, but both will take you to the exact same spot.  Don’t give me the “This is indicated for this and our competitor is not” bullshit.  Doctors don’t listen to what a drug is “indicated” for (Uh, Neurontin?) just what works.  A $200 drug is not going to magically work better than a $20 generic.  You remember when reps were pushing Celexa? Remember when Lexapro came out the dumbass reps did a 180 and said how BAD CELEXA was? Yeah, its all about the Benjamins, don’t let the reps fool  ya.

So that Drug Topics advertisement? It was tempting, but I threw it in the trash vs using it to wipe my behind.

Perdue, Thai Hookers, and rolled up Benjamins

As you all have heard/read; Perdue, the maker Oxycontin (AKA: Hillbilly Heroin), decided to sue the shit out of all of the generic Oxycontin manufacturers and cease production (or some patent shit.  I really doubt Teva would make a generic knowing full well the patent is still legit).  Not only that, but they are bringing out NEW strengths for easy pharmacy shafting…er..patient dosing!

Hooray for Perdue! Only brand name Oxycontin in pharmacies everywhere!  Addicts Rejoice!  Pharmacists rejoice! Now we get to stock a bottle that costs $600 vs $300! Hooray! I could piss myself from all of the HAPPINESS that is going on right now.  Oh wait, I cant afford a change of pants because I have a fucking rainbow of gun-in-face magnet pills sitting on my shelf costing me a house payment.  Perdue is probably trying to recoup that $634 million in false “oh, this isn’t addicting.. Hey, it worked with Heroin” marketing, why else would they lawyer-up and magically get FDA approval for new strengths as their patent dwindled.  Some Perdue Exec is probably using wet-naps right now after her visit to the FDA office (ha ha!)

So Perdue, in an attempt to line its own pockets full of gold, have just shafted not the addicts (who just raise their prices when they sell this stuff) but the legit pain management patients.  Thats right, chronic pain patients now have to deal with trade name copays instead of generic copays.  Your grandfather have cancer? Perdue pretty much is saying “hm, that sucks, so sorry!” as they swim in their lakes of gold and snort their products off of the thighs of 17 year old Thai hookers with rolled up 100 dollar bills.  Thats right, I went there.

I’m all for free enterprise, making money, and selling a good product.  However its not cool when there is indian giving with the generics (like Plavix).  I guess 10+ years of “record high profits” with Oxycontin wasn’t enough.

Perdue Pharma Execs, I hope you never get cancer and have to deal with the same assholes that you have become.

Airborne, wasting your money since around 1998

So, it has come to my attention (a few days ago) that Airborne must pay 25 million due to a lawsuit claiming that it didn’t work.

Some highlights include:

  • Airborne not proven to work
  • The “clinical study” was preformed by a couple of random dillholes and probably was just made up
    airborne_200.jpg
  • If you purchased airborne, you can get a refund
  • Making medical claims without FDA approval

Now, I know that any self-respected pharmacist would never ever suggest airborne to anyone that they cared about.  Why? Because it doesn’t work.  We all know this, you all know this.  Its vitamin-C and a bunch of other OTC shit all in a fizzy alka-selzer tablet that makes you feel all warm inside.  Its like donating $0.75 a day (the price of a cup of coffee) to starving African kids when its just going to feed Sally Struthers.  Rich folk do that just so they can get a hard-on by ‘helping people’ as they bitch at me about their $30 copay.

The only person you would sell Airborne to is that retired teacher who always calls you out front for an OTC recommendation only to tell you how wrong you are and buy something else.  Those fucks you are happy to see waste money because they have no problems wasting your time.

Which brings me to another point.  One of the major selling points of Airborne is that it was “CREATED BY A SCHOOL TEACHER!”.  Now just not any teacher, but a 2nd grade teacher.  Someone enlighten me as to why I would trust anything a school-teacher made?  How is that even a half-way valid selling point?  Some of the most ignorant people I know are school teachers (mostly because they think they know everything and are very vocal about it).  If it were made by a pharmacist it might have some basis because at least we know how the body works, but a 2nd grade school teacher?  Is this shit going to work based upon the vast knowledge of social studies? Cursive writing? Multiplication tables? Is this teacher applying their vast knowledge of shit-stupid physical science to prevent my cold?  What qualifications does he/she have (being a 2nd grade teacher and all) that would actually give her some real-world claim to actually know something about medicine?

Victoria Knight-McDowell, please inform us pharmacists what your methods were to determine what does and does not work to prevent colds as well as any relevant research and study data?  What? No I do not wish my name on the chalkboard. What?!? Detention?  Aww!!!  I’m sorry for implying that you are a fraud preying on the stupidity of the uneducated population, can I go to recess now?

I’m confused as to why people waste their money on this shit.  I’m actually shocked that people swear by something that is proven to not work and has every pharmacist in the country saying that it does not work.  Its the “#1 best selling” because people are stupid.  Not because it works, but because people are piss-stupid.

Of course they also buy “Head On” which is chap-stick for your forehead so I guess I should just shut my mouth.

Amoxicillin retardness

So I’ve had just about enough of the boo-hoo bantering about the USA Today article about the baby who received 5x the “normal” amount of amoxicillin and would “writhe in pain”.  Lets look at this from a purely scientific standpoint.

According to Amoxicillin on RxList.com:

A prospective study of 51 pediatric
patients at a poison-control center suggested that overdosages of less than
250 mg/kg of amoxicillin are not associated with significant clinical symptoms
and do not require gastric emptying.3

3. Swanson-Biearman B, Dean BS, Lopez G, Krenzelok EP. The effects of penicillin
and cephalosporin ingestions in children less than six years of age. Vet
Hum Toxicol. 1988;30:66-67.

** DISCLAIMER (I hate doing these, you all should be smarter than this) DISCLAIMER **
Before I go on, the details of what happened are sketchy at best not to mention published by a shitty sensationalist media outlet that just wants ratings and attention.  Like the 14 year old spoiled drama queen playing the rape card after her boyfriend breaks up with her, you have to treat this all with a huge grain of salt and realization that we are making assumptions here about what happened.

Now, assuming that the child is way premature, say it weighs 1 kg or 2.2 lbs.  Amoxicillin comes in your standard 125mg/5cc, 250mg/5cc, or the oddball 400mg/5cc.  Nobody writes for the 400mg/5cc so we’ll just assume that the strength doesn’t exist for our example.

For a 1 Kg infant (which im sure the child weighed a bit more than 2.2 lbs) to receive 5 times the “normal” dose (which for our assumption the upper limit will be 250mg/kg since thats the upper limit of no clinical symptoms) the parent would have to give the child 5 teaspoonfuls a day.  Thats for a 1kg infant, thats 10 teaspoonfuls a day or 50mL (1/3rd of the bottle) for a 2kg patient (which 4 lbs sounds reasonable for a premature infant).

Now what fucking parent with a fucking premature baby would think that giving 5 teaspoonfuls a day of an antibiotic (or anything) would make sense?  Now don’t get me wrong, the mistake shouldn’t of been made in the first place, but don’t you think common sense would kick in around teaspoon number 3 or 4 of “maybe something isn’t right here”.  Considering the father is a “assistant professor of biomedical engineering at the University of North Carolina” we aren’t dealing with your standard uneducated village idiot here.  How would they know the baby is “writhing in pain” due to the amoxicillin and not just pissed off because its getting over an infection that required IV antibiotics?  Do they have baby brain reading machines?  Hell, have you tasted amoxicillin suspension? It makes me writhe in pain just smelling the dust when I open the bottle.

The /only/ way that I could see this happening is if the doctor wrote 1.5mL and the pharmacist though it meant 1.5 teaspoons.  However 1.5mL’s of the 250/5 is what, 75mg of amoxicillin? For a child that was on IV antibiotics, all that’s going to do is just make the baby spit pink all over the place.  I mean thats about as retarded as when PA/NP’s write for 4.56mL’s tid of amoxicillin because their common sense is in their palm pilot and not in their brains were it belongs. 

Who knows, I may be way off base here, but from the looks of it the USA Today just added the whole Amoxicillin story as purely emotional sensationalism.  Why don’t they write shit about us catching mistakes and saving people vs publically hanging us.

Translated Drug Rep Speak

You will only find this here at “The Angry Pharmacist(tm)”.  It is a smuggled document from the headquarters of a training facuilty (the drug company shall remain nameless) about how to train drug-reps.  This is the secret code! Lets take a look:

  • Doctor, can I speak with you for a min about a new product?
    • Translation: Our patent has ran out on our best selling drug, so I’m going to tell you how much the generic will suck and how our NEWER and BESTER product (which is the same shit just XR after the name) beats the living hoo-hah out of the stuff I was pimping to you as the latest and bestest just 2 weeks prior.
  • Here are some studies for you to read.
    • Translation: You wont read this shit, and we paid for them so what do you think they’ll say you idiot.
  • You know that our new product has 500% better bioavailability and the AUC is 15% higher big-word big-word.
    • Translation: You have no idea what the fuck these numbers mean, and neither do I!  I just memorize them and spit them out to sound smart.
  • I’m going to leave some coupons here so you can trial your patients.
    • Translation: We’re gonna fuck over pharmacies so they’ll have to buy a $500 bottle of 100 to get a whole 7 tablets out for the fucking coupon.  The rest will just rot and outdate on them.
  • All major insurance companies cover this.  Its Tier-4 on their formularies
    • Translation: Which means its not covered without a prior auth.  I know you’re too ‘busy’ to do PA’s so we’ll just fuck over your patients by feeding them samples until they run out, then force them to pay $200/month to continue therapy.  Wait, I think the coke dealer did that same thing to me when I was in college.
  • Do you have any questions?
    • Please don’t be an ex-pharmacist.  Please dont be an ex-pharmacist! SHIT! I NEED A DISTRACTION! IT LOOKS LIKE HE’S GOING TO ASK ME SOMETHING!
  • Oh, I dropped my pens.  Dont worry, i’ll get them.
      • Translation: Yes, they are real. I can make them bounce into each other.  Look into my mind control device doctor.. Loooooook.
  • Here are some pens and notepads for you doctor.  I hope you have a wonderful day!
    • Translation: Sucker!!!! HAHAHA!

I really do dislike drug reps.  However I dislike Medicare Part D salesmen even more!  More on that later!

Lilly – Get with the program

As I have (and we all have) learned in school, a bottle of Humulin R or N is good for 1 month if kept at room temperature or if refrigerated good until the expiration date on the bottle.  Right?

Not according to the Lilly Reps.

They are telling doctors and other retarded janitor-types who can write Rx’s that once a bottle of insulin has been opened, it is good for 28 days upon which it must be trashed.  That really great for the cash customer who is on about 10 units a day and gets to shell out the 40+ bucks a month for a new bottle (as they toss out a 3/4 full one).

This bullshit started about 4 years go.  The formula for Humulin R and N have not changed since god was a boy.  What the hell caused this?

Heres the kicker.  There are no studies to back this data up.  Thats straight from the Lilly mothership.  Turns out that Europe (thanks assholes) have this law that states that all injectables must have an expiration date of one month from the time of penetration (har har har).  HOWEVER if the product was made before 1990 this law does not apply.  Thats why Humalog and Lantus have the warning in the package insert to discard after 28 days.  Humulin R and N do not have this warning (also stated directly from the mothership).  The good ole USA just decided to adopt this standard without any studies to show that its even half way legit.  Yeah, lets just do what Europe does, it worked so well for thalomide didn’t it?

Does this stop Lilly reps from spreading the gospel of ‘discard R & N after 1 month’ to every doctor and nurse out there?  Hell no.  Higher sales for Lilly!  Fancier pens!  Lower tops!  Higher heels!

Lilly, you are fucking retarded.  I hope all of you become cash paying diabetics who are forced to sleep in your own shit.

Everything is my problem

A really frustrating part about retail pharmacy is that everything seems to be “my problem”.  Now I went to college for 7 years, got my PharmD, yadda yadda yadda.  I know about drugs.  I am trained in drugs.  Ask me about a drug and I will tell you everything you need to know about it.

However:

  • I am not your fucking insurance agent.  I don’t know how much your fucking deductible is because ITS NOT MY INSURANCE.  I can guess, but its only that, a guess.  Its YOUR job to know about your insurance, not MINE.  If YOU dont understand something, talk to your insurance company; not your pharmacist.
  • I am not the keeper of your insurance card.  If you go to the store and want to buy something but don’t have your credit card, do you ask the salesperson to call VISA and ask for your credit card number so they can finish the transaction?  NO.  Keep your fucking card on you, and when you get a new one don’t make me fucking ask you 100 times for it before you say “Oh! Yeah! I got this new insurance card last month”.
  • I am not the welfare office.  If you bitch about your $3.10 copay and whine how the government hates the poor, let me charge you the fucking cash price of $150 and see how much you fucking whine.  All the welfare programs have done is create a bunch of fucking ungrateful bastards who think the F in Pharmacy stands for FREE.
  • I’m not your mother.  If your medication got lost/stolen/etc its YOUR job to call the doctor to explain how you are not a fucking addict, not MINE.  If I call I’m going to say “Yeah, he/she lost his medicine.  He told me a story but to be honest I wasn’t paying attention.”  Keep your pills where you can find them, and if you lose them expect to pay cash for the replacements.  Insurance companies do not pay the copay on stupidity.
  • I am not a drug company rep.  You can whine to me day in and day out how pricey the medication is in this country, then turn right around and ask me to sign something on a class action lawsuit over Avandia or Vioxx or something.  You know why medication costs so much in this country? Stupid bastards who sue over side effects inflicted from taking a controlled poison.  Lets sue Clorox because my kid drank bleach and died.
  • And last but not least.  I am not your fucking personal bitch.  I am here to help you, and will do so with a smile on my face, but I am not your bitch.  I am your pharmacist, and if you treat me like your child or someone you think you can just boss around I am going to pee in your promethazine with codeine and shit on your Soma.  Treat me with respect and you will get the same in return.  Treat me like shit and you’ll be waiting 4 hours for your Rx’s at the Walgreens down the road.