Actually Coumadin and Warfarin aren't typically interchangeable due to the narrow therapeutic index. Like levoxyl and levothyroxine, same thing but not interchangeable.
That's not that uncommon or dumb. From what limited experience I have dealing with patients in family med, most of them can't tell me the names of half the drugs they're on. Oftentimes when they say they're taking X they'll say they don't even know what it's for.
When i was an intern in the early 70's we could prescribe "Esotcal", prepared in the pharmacy in impressive large yellow capsules. A remarkably effective drug for a variety of indications! We could also prescribe Guinness, which was probably a lot more effective than Zolpidem. Now with informed consent forced down patient's throats, a patient demographic mix that includes a lot more potential folk with lactose intolerance and oversensitivity about alcohol dependence, none of that is possible. Has patient care improved? Well, we ain't using barbiturate hypnotics any more for one thing.
Dr. Grumpy, I'd love to see an Ed the Office Fish webcam. Live updates hourly- or at least a daily "How's Ed doing today" picture. We never get to hear enough about Ed. :-)
I only sleep with Prince Ambien. Just sayin.' he he.
Same concept with my MIL... she never believes me when I take her BP. Because the real nurse (I'm an RN) at the office takes it (med assistant) and it is much lower.
Actually, anonymous 11:50, please, don't confuse the uninitiated among us. As a pharmacist in an anticoagulation clinic and a personal user of externally sourced levothyroxine I like to think Coumadin and warfarin are carefully interchangeable as well as levothyroxine for any number of the various brand name entities. We, in pharmacy, have a carefully researched reference known as 'Orange Book'.
I'm a clinical research assistant and I enter patient data from doctor dictations...anyway, I have to enter conmeds but use generic names, I think i'm going to have all the generic and market names memorized by the end of this semester...omeprazole/prilosec, warfarin sodium/coumadin....they should all just have one name!! lol
I wish I had a dollar for every patient who told me "that's not my 'Brand Name' medicine" when I was giving them the generic that the hospital stocked. No amount of telling them the little white pills were exactly the same as their little blue ones at home.
Your patient has another take on the Branding conundrum :)
...and all my little old ladies in Home Health that had syncope and hypotension because Dr. A had them on Lasix and Dr. Z. added furesomide and no one noted because of the pharmacy hopping for the $25 rebate check of the month!
Only noticed because like all good home health nurses, my pre-admission speech is "Get every single medicine you get from a doctor or GNC, and everything you rub on you, insert anywhere, get from a dropper.....and put it on the kitchen table before I get there tomorrow!"
Yes, there is ALWAYS a kitchen table, usually with a little plastic bin of "his and hers" drugs. It is some sort of AARP law, I think...
My personal favorite was Protonix. When it first came out, there was an authorized generic (brand sold as generic). We had so may people insisting that the generic did not work that we called the mfg (brand and generic) and confirmed that it came off the same presses - just put in diff bottles. I also love the people who insist on all brands...until the ins wises up and suddenly the copay for DAW Xanax is $250 instead of $5. "Well...I guess I could try that generic!" Whatever...
Had one just the other day. Took an OD and rocked up with two boxes of Z drugs. Could not believe that they were the same drug, even after I showed her the writing on the packaging!
Ahh, the placebo factor, wedging it's way into generic-land. "Ibuprofin is so much better than Motrin!"
ReplyDeleteDo you sometimes wonder if your patients will find a kick to the left butt-cheek better or worse than a kick to the right butt-cheek?
May I offer you some naproxen? I find it's superior to Aleve.
ReplyDeleteWe usually see the opposite at the pharmacy. The generic never works and the name brand is so much better. Such a mind game and placebo factor.
ReplyDeleteActually had a patient argue with me about how they couldn't take Coumadin and could only take Warfarin instead.
ReplyDelete~facepalm~
Makes me wonder if pharmacies can bring back snake oil to make a few extra bucks. The things people believe...
ReplyDelete-Flavius
Actually Coumadin and Warfarin aren't typically interchangeable due to the narrow therapeutic index. Like levoxyl and levothyroxine, same thing but not interchangeable.
ReplyDeleteThat's not that uncommon or dumb. From what limited experience I have dealing with patients in family med, most of them can't tell me the names of half the drugs they're on. Oftentimes when they say they're taking X they'll say they don't even know what it's for.
ReplyDeleteWhen i was an intern in the early 70's we could prescribe "Esotcal", prepared in the pharmacy in impressive large yellow capsules. A remarkably effective drug for a variety of indications! We could also prescribe Guinness, which was probably a lot more effective than Zolpidem. Now with informed consent forced down patient's throats, a patient demographic mix that includes a lot more potential folk with lactose intolerance and oversensitivity about alcohol dependence, none of that is possible. Has patient care improved? Well, we ain't using barbiturate hypnotics any more for one thing.
ReplyDelete**snort**
ReplyDeleteI'm still waiting on my scrip for Fukitol. ;-)
ReplyDeleteDr. Grumpy, I'd love to see an Ed the Office Fish webcam. Live updates hourly- or at least a daily "How's Ed doing today" picture. We never get to hear enough about Ed. :-)
So much of who we are and how we feel is all in our mind.
ReplyDeleteWhat's the generic name for Viagra? Micoxafalin.
ReplyDeletedrlaura,
ReplyDeleteI heard the new generic for Cialis was mydixatricklyn.
Soon-to-be-PharmD: Sorry, but Mydixatricklyn is the generic for Vesicare.
ReplyDeleteI only sleep with Prince Ambien. Just sayin.' he he.
ReplyDeleteSame concept with my MIL... she never believes me when I take her BP. Because the real nurse (I'm an RN) at the office takes it (med assistant) and it is much lower.
Whatever.
Norco... lortab... whateva!
Actually, anonymous 11:50, please, don't confuse the uninitiated among us. As a pharmacist in an anticoagulation clinic and a personal user of externally sourced levothyroxine I like to think Coumadin and warfarin are carefully interchangeable as well as levothyroxine for any number of the various brand name entities. We, in pharmacy, have a carefully researched reference known as 'Orange Book'.
ReplyDeletewell as long as it works for him, he doesn't need to know the truth, right? :)
ReplyDeleteI'm a clinical research assistant and I enter patient data from doctor dictations...anyway, I have to enter conmeds but use generic names, I think i'm going to have all the generic and market names memorized by the end of this semester...omeprazole/prilosec, warfarin sodium/coumadin....they should all just have one name!! lol
ReplyDeleteI dunno - I think I'd sleep better knowing I'm paying generic price vs. brand price ... :-D
ReplyDeleteI wish I had a dollar for every patient who told me "that's not my 'Brand Name' medicine" when I was giving them the generic that the hospital stocked. No amount of telling them the little white pills were exactly the same as their little blue ones at home.
ReplyDeleteYour patient has another take on the Branding conundrum :)
...and all my little old ladies in Home Health that had syncope and hypotension because Dr. A had them on Lasix and Dr. Z. added furesomide and no one noted because of the pharmacy hopping for the $25 rebate check of the month!
ReplyDeleteOnly noticed because like all good home health nurses, my pre-admission speech is "Get every single medicine you get from a doctor or GNC, and everything you rub on you, insert anywhere, get from a dropper.....and put it on the kitchen table before I get there tomorrow!"
Yes, there is ALWAYS a kitchen table, usually with a little plastic bin of "his and hers" drugs. It is some sort of AARP law, I think...
Pattie, RN
My personal favorite was Protonix. When it first came out, there was an authorized generic (brand sold as generic). We had so may people insisting that the generic did not work that we called the mfg (brand and generic) and confirmed that it came off the same presses - just put in diff bottles. I also love the people who insist on all brands...until the ins wises up and suddenly the copay for DAW Xanax is $250 instead of $5. "Well...I guess I could try that generic!" Whatever...
ReplyDeleteIf Urdixatricklyn you may need some IM Benzathine penicillin. Just sayin'
ReplyDeleteHad one just the other day. Took an OD and rocked up with two boxes of Z drugs. Could not believe that they were the same drug, even after I showed her the writing on the packaging!
ReplyDelete