I had a dream last night that I was talking on the phone. Keep in mind that when I say "night" I am referring to the period between approximately 5am and 2 in the afternoon.
"Drugmonkey" Said the voice on the line, "I'm sorry to bother you, but I have a question about this Vicodin prescription I got the other day. I know you always used to complain how doctors don't know how to dose Vicodin, but I can't remember how many you used to say you could take a day. My tooth really hurts but I don't want to take too much."
What a boring dream. Not only totally PG rated, but no flying monkeys, falling off cliffs, or monsters chasing me of the sort that put a little spice into the body's downtime.
I do constantly bitch about doctors not knowing how to dose Vicodin though. There are 500 milligrams of acetaminophen (Tylenol) in each Vicodin tablet. The maximum daily dose of acetaminophen is 4000 milligrams. At least 5 times a day I see a Vicodin prescription with instructions of "Take 1 to 2 tablets every 4 hours as needed for pain" Do the math. Doctors will also do this with Darvocet, which has 650 milligrams of acetaminophen per tablet. If you're a doctor and you have ever written a prescription with these instructions for Vicodin or Darvocet, please hit yourself in the nuts and set fire to your medical license.
Back to my dream though. When I woke up I had my cellphone in my hand, and a check of the call log showed that I had just talked to a restricted number for a minute and a half.
Thing is, I don't remember what I said in my dream. I hope I said eight tablets a day, because that's the answer.
At least they didn't ask why their copay was so high.
18 comments:
Drugmonkey, you rock. This is exactly why I ask for Vicoprofen instead of Vicodin (or Percodan vs. Percocet) -- my poor liver can't handle the APAP on top everything else I throw at it. We need more pharmacists like you.
Wow. Last night I dreamed about Firefox extensions.
I have never called my pharmacist at home, but I have gotten scripts for 1-2 vicodins every 4 hours. The pharmacist even put it on the label with a warning about not taking more than 6 per day. Don't MD's know any better? My reg MD gives it as 1 every 4 hours PRN, the ER dude gave me 1-2 every 4 hrs. LOL
I'm one of the few unwashed masses that knows why you need to take your shoes and socks off to keep track of your tylenol intake.
Lifts shirt (don't get all excited), showcases impressive liver transplant scar a la Carol Merrill -- not Tylenol but that 'little of' lady' of the anti-seizure meds: Carbamazepine. Yes, really. I slipped on a figurative medication banana peel and voila~ one 10-day coma later, a kick ass scar.
Enough about me (sigh) on to the morons...
I have never heard of a doctor letting their patients know about COUNTING ALL THEIR SOURCES OF TYLENOL! I can't tell you how many times I have had to set straight people who I thought had a brain.
Frigtard: "Well I took 2 vicodin I had from when I hurt my knee, some Alka Selzer PLUS Cold Medicine, and a couple Tylenol. I've been doing this for days"
Me: Hey frigtard, you like my scar? Cuz if you don't wise up you're gonna get one too -- if you are lucky. Every friggin' thing you are taking has Tylenol in it! You need to keep track of it.
Frigtard: "It doesn't have Tylenol. The label said Acetaminophen."
Nevermind.
@pemdas -- That's provided, of course, you get the n-acetylcysteine in plenty of time to be effective vs. the agonizing, drawn-out death that could result. So very few people realize that Tylenol is one of the most dangerous things over the counter. I avoid it as much as possible, and use scored children's Tylenol (325mg) chewables when I just absolutely have to switch off ibuprofen temporarily.
Can you tell us more about the shoplifter in your next post? It sounds like a good story.
yeah, so that was me calling and frankly, phone sex is not your forte.
of course NSAIDS are no walk in the park either...but it is pretty rare to see a script written for over the max dose of 3.2 g. Still, taking a 800 mg TID (our most frequently seen dose) every day is probably not a good thing long term
[quote]Frigtard: "It doesn't have Tylenol. The label said Acetaminophen."
Nevermind.[/quote]
Another indication that sometimes, just sometimes, maybe it's best if we let natural selection take it's course.
I had a dream a few weeks ago that I woke up, tested my blood sugar, and was high. So I reached for my insulin pump to bolus. I woke up and my pump really was in my hand at the "confirm dose" screen. I luckily woke up enough to realize I hadn't really tested and wasn't really high and didn't give myself insulin.
People do weird things in their sleep, that just happens to be my most recent.
@fattunesy -- Agreed. Extremely rare that I'd even hit 1.6g ibuprofen in a 24h (although I've been told the max is 4g, not 3.2g), or for more than 3-4 days consecutively. In such cases, I switch off to piroxicam 20mg BID (not that it's any better -- but at least in my mind it's less). And I always (and I mean always) take NSAIDs with food. The bigger problem, that I haven't solved yet, is mixing the ibuprofen and piroxicam with my SSRI -- "we got a bleeder!"
If there are any rx techs that work in hospitals.. check me out at rxtechatflhosp.blogspot.com..
Drugmonkey.. it might make you laugh too!
Ah, Vicoprofen. Finally got a hold of that after trying to explain to bloody MDs that I probably shouldn't be taking 2 grams of ibuprofen a day, but my period makes me want to sell my car and shell out for an elective hysterectomy.
Oh, but drugmonkey? Why is my copay so high? It's completely your fault, isn't it?
In the Hospital you would be amazed at the disregard for maximum dosing of tylenol. we get orders for darv n 100 1-2tab every 4-6hrs as needed and vicodin 1-2 tab every 4-6hrs as needed. on top of the usual tylenol 500-1000mg every 4-6hrs prn. they specify a max of 4g in 24hrs but here is the catch.
do you really think a nurse is paying close enough attention to keep track of every single med that every single one of her 10 patients is taking? I'll give you a hint. HELL NO. they chart it but usually call you after they've gone over for the day and want to know what else to give for pain.
Talking about going over the limit, here is what some idiot nurse did at my hospital:
Back in the day, when we still had crappy Sure-Med cabinets, we had to store more than one narcotic in each drawer. Well the patient is getting Oxycodone 20 mg (4 5 mg tablets for each dose). The Vicodin 5/500 is in the same drawer but separated. See where I'm going with this? She pulled 4 Vicodin 5/500 tabs instead of 4 Oxycodone 5 mg tabs and gave it to the patient! She couldn't figure out why I was looking at her like she was such a freakin' idiot!! How can you freakin' mix up a combination hydrocodone/acetaminophen 5/500 with a single product oxycodone 5 mg tablet?? I mean really!!!
Oh god. I'm just a dilettante psychopharmacologist, and that still sends shivers up, down, through, and across my spine. I freakin' hate combo narcotics. But at least with Vicoprofen, taking 4 of them will zap you with the hydrocodone (30mg) before it will the ibuprofen (only 200mg each -- 800mg ibuprofen, still an acceptable dosage) vs. 500mg or 650mg of APAP in each Vicodin, Lortab, Norco, what-have-you.
is there a vic that comes in 800mg?? i thought it was just 500...750 and 1000...is there more???
Billfer, I also hate them putting APAP/NSAID's with my opioids, but have you never heard of a CWE (cold water extraction)?.
Most opioids are readily soluble in cold water, while APAP by comparison is not. Crush/chop any number of pills into powder, dump into cool water, and then pour the ensuing combo through a paper filter, usually on top a funnel into another container. Squeeze solid white goo dry, toss, and keep the liquid to drink- with the right technique this will eliminate the vast majority of the undesirables, while retaining the scheduled goodies. Even with the 10/325's I have been forced to do this for years.
Google CWE if you need more info, happy hunting, save your liver for drinking
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