Novarel branded hCG "strength" has changed - Get your Rx written correctly

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Or, Another Day at the Circus:
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edit: "Wherever your goal is failure, introduce an excess of complexity to the system"

problem: An incorrectly written Rx gives the pharmacist an excuse not to fill it while also confusing the pt.
solution: Ask your doctor to limit what is on the Rx to the: (1) amount to be dispensed (2) dose (3) frequency pt is to take the dose

good example: "(Dispense) 10,000 IU of Novarel hCG. Generic may be substituted only if branded is unavailable. Reconstitute using 1 ml of included bac water per 1,000 IU of hcG. Inject 500 IU (dose) in the muscle every M W F (frequency)

bad example: "Dispense one vial, 10,000 IU Novarel hCG. Using a 10 ml syringe fitted with an 18 ga x 5/8" needle Withdraw 10 ml of diluent and transfer it to the vial containing the hCG. Draw up 0.5 ml of the reconstituted hCG and inject in the muscle 3x weekly.

How this sets you up for failure: A pharmacist with OCD may refuse to dispense two 5,000 IU vials even if that's all she has and it is the preferred choice. Might refuse to fill if only 1 inch needles are on hand. As obvious as it may seem that the included diluent is to be used the Rx does not so state. Finally, as evidenced on these pages, by not focusing on the dose in IU new patients are often left in the state of the union, confused.
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My ongoing saga of hours upon hours of time wasted over the last year:

old product: 10,000 IU vial, originally Novarel which became temporarily unavailable. Pharmacist refused to substitute then refused to resume Novarel when it once again became available.

new product this week : Novarel is now only available 5,000 IU vial

original Rx: "Dispense 10,000 IU hCG, inject 500 IU every x days" Great. Any brand or pkg size can be dispensed if only the pharmacist did not insist that the MD re-write with added lines of complexity discussing diluent, vial size, volume in ml of reconstituted product.

Pharmacist this week: "The strength has changed to 5,000 IU, You will need a new Rx"

May I speak with the pharmacist? " I AM the pharmacist".
My apologies but I'm unable to believe that I speaking with a pharmacist. The package unit quantity changed not the strength. She was adamant.

"How are you going to reconstitute it?" "The doctor is going to have to calculate that and give you a new protocol"

Really? How about I just continue as I have for the past two years, following the instructions in the package? It's 1 ml of diluent per 1,000 IU. She refused to budge.
"You can't add 10 ml to this. The doctor needs to calculate it and write a new Rx"

Not long ago, with two years dispensing history behind us, this pharmacy decides to phone the MD to find out what diluent I am using to to reconstitute the hCG in spite of the fact that Novarel comes packaged with a vial of Bac water and instructions. Should I omit the part about this "specialty pharmacy" shipping (30) 10 ml syringes to reconstitute every vial, month after month, even after being asked to stop that at least a dozen times? A: Of course! it adds complexity to the saga.

The doctor's nurse called me after the pharmacist called her so I tell her: "Like Emeril I gotta shake it up. Monday it's Roobius tea, Wednesday it's OJ and Friday its Old Crow". The pharmacy then called me. "That was last week. "We have hard water here. Only the commode has a demineralizer. I clean the bowl thoroughly then scoop up 1 cup and run it trough Mr.Coffee using unbleached filters."

The doc called me.

"Doctor, your script could not be more clear. Grateful if you will not allow them to bully you in to writing overly complex scripts specifying vial sizes dilutions and volumes since that inevitably results in nothing at all being dispensed." "Your time and that of your nurse does not need to be squandered and I's like to avoid spending all day every day for a week on the phone with these idiots to get a refill just because the packaging has changed. "

He bowed down to them anyway writing : "Dispense one vial containing 10,000 IU. "Patient to withdraw 10 ml of pH adjusted bacteriostatic water containing 0.9% benzyl alcohol and inject that in to the vial to reconstitute." "Uptake 0.5 ml of the solution and inject it in the muscle every (x) days. " I refused the Rx because it didn't say to refrigerate.

edit: The senior supervising pharmacist called with profuse apologies. No the pharmacist he says should have required such a complex script in the first place and yes she should have substituted two 5k vials for the 10k. As a pharmacist she could have added a note to accompany the new smaller vials so that you would not try to force 10 ml of diluent in to them or simply noted in your file that she spoke with you and you understand how to reconstitute the medicine.

Feel free to post your own "How time and dollars are squandered at my clinic or pharmacy" or "My pharmacist bought his license mail order"
 
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