Wednesday, May 6, 2009

Some People Grossly Overestimate the Importance of Their Medication

Early today, a woman called in a refill for her Allegra ODT 30mg. We do not usually stock Allegra ODT. We have one patient who gets it, so we do not keep it on the shelves. If the woman orders a refill, we will order it for her, but we will not keep it on our shelves as long as no doctor is writing for it.

Of course, the woman came into the pharmacy in the evening looking to pick it up. We informed her that it had to be ordered, and it will be ready tomorrow.

"BUT I NEED IT!!!!," she exclaimed. "What am I supposed to do now?"

Not wanting to bring up some obvious points that I knew wouldn't get me anywhere with her, I apologized for not having it in stock, explained that we don't usually carry the medication, and assured her that it will be in tomorrow.

What I wanted to say to her (other than to ask her why she waited until she was out of her "necessary" medication before calling in a refill) was, "no, you certainly do not NEED Allegra."

Perhaps some people don't understand the definition of the word "need." You "need" something when you can't possibly live or you put your health at risk without out. For example, I need to eat food and drink water. A patient who had an organ transplant needs his anti-rejection medications. An HIV patient needs his antiviral drugs. A patient with pneumonia needs antibiotics.

No one NEEDS Allegra. Missing one dose of your antihistamine is not an emergency. The very worst thing that can happen is you get some itchy eyes and sneeze a bit more than usual. You will survive and with no long term adverse effects. Furthermore, if your allergy symptoms do get really bad, there are plenty of over-the-counter options available that will provide relief.

Sometimes I think that people must marvel at me. I haven't taken a prescription medication since 2001. It must be a miracle that I survived for so long without at least a course of antibiotics. I must be extremely lucky to never get sick.

I do get sick though. I get sinus infections. I get sore throats. I get chest colds. I don't get them often, but 2 or 3 times per year, I will get some kind of cold. Despite this, I don't take antibiotics. Why? BECAUSE YOU DO NOT NEED ANTIBIOTICS FOR 99.9% OF ILLNESSES. Sinus infections are almost always viral. Bronchitis is viral. The common cold is the rhinovirus. A Zpak or any other antibiotic does absolutely nothing against a virus. I know this. This is why I don't take them.

I'm also not a germophobe. Not at all actually. I don't shy away from contact with people. I don't wash my hands 7,000 times per day. It makes absolutely no sense to be afraid of germs. NEWS FLASH! You're constantly surrounded by germs. All day long, every single day you have bacteria on you. You can't get rid of it all, nor do you even want to. The harmless bacteria that is on floors, counter tops, and people's hands helps prevent more dangerous bacteria from growing.

I had a conversation on this very subject with one of our technicians. She said that she's so afraid of germs that she won't even use her sister's chap stick because she doesn't want to use something that touched her mouth. In response, I asked a simple question, "You would kiss someone though, right?"

She, of course, said yes, she would kiss someone. What's the difference??? Is the mouth not the most bacteria infested place on someone's body? People are afraid to shake someone's hand, but kissing a stranger they just met in the bar is no problem. It's fucking retarded.

You have an immune system for a reason: TO KILL GERMS! I promise that it does a pretty good job of this if you just let it. I'd like to think that I'm living proof of this.

I kind of got off on a little tangent, but the moral of this post is that a lot of people think their medication is much more important than it really is. Antihistamines are not necessary. Nasal steroids are not necessary. That Zpak for your cold is not necessary. Don't act like you're going to die if you have to wait an extra 12 hours to get it. To my knowledge, no death has ever been averted from taking Allegra.

**Of course, all these people who think they need far more medication than they really do ultimately pay my salary. I guess I shouldn't complain.**


The Ole' Apothecary said...

Unfortunately, the public is so trapped in idol-worship that they won't listen to you.

Prescription drugs have that tantalizing cache. You have to get permission to use them, and you have to bring your written permission to someone to get them. There is enough placebo effect in that very act of restricted availability. Tell someone they can't have something, and it morphs into a higher order of thinking. Oh, my gosh, tell them that it is a CONTROLLED SUBSTANCE and, even though such is a man-made concept from 1971, they would still think that Lortab is the food of the gods!

Wanna bet that if all these things were for sale next to the Pepcid AC, that many fewer people would care?

4th Year Pharm Student said...

I completely agree with you on most of this post. However, when my sister doesn't take her antihistamine (forget which one she takes, I think its generic zyrtec), she breaks out in hives on her hands. They are so bothersome that when this occurs she can't do anything until she gets a dose. Of course, since this is OTC, its no problem

My point is that while not taking an antihistamine for a day won't kill someone, it could potentially make them very miserable (though that problem could easily be solved with an OTC med).

P2 said...

I doubt she automatically breaks out in hives if shes misses a dose. She would have to come in contact with the trigger.

Nate said...

Chronic Idoiopathic Urticaria, my good chap!

Anonymous said...

Totally agree with you.

And never mind that you, like most of the rest of us probably, try to remind patients to give us 24-48 hours notice on refills for this specific reason. If they DO run into an issue and need something ordered, they won't run out.

My personal favorites are those with their own little cocktail of painkillers and muscle relaxers who panic every month when we have to contact the doctor for refills. "But I NEED them!" And when you explain that three is the most they ought to take in any day, they say "but it says as needed, and I NEED it." Yup. Bet you do.

Anonymous said...

I'm not a pharmacist but who are you to play GOD and decide how people should take their medicine. My daughter takes Allegra and one missed dose wrecks havoc on her little body. A day without it and she is a walking red itchy mess. AND NO, OVER THE COUNTER MEDICINE DOES NOT WORK ON HER! You are not GOD and you don't know everything that people go through.

Pharmacy Mike said...

For one, I would bet my life you are greatly exagerrating her reaction to a missed dose. I mean, what in the world would have happened to your daughter if Allegra wasn't created. I guess she would have spent her entire life a red itchy mess.

Secondly, if that is the case, and once again, I HIGHLY doubt it, then wouldn't you think to take extra care in reordering the medication? Wouldn't you call it in a few days ahead of time? Wouldn't you call the pharmacy to make sure there were no problems filling it? Wouldn't you monitor the remaining refills carefully? I know if I was the one who "needed" that medication, I'd take a very active role in making sure it was filled on time.

Thirdly... You're right. I'm not GOD. I wish I was though. I'd do a hell of a lot better job with this world than HE has done. There's one diety who has apparently been calling out sick for the last 4.5 billion years or so. If I were God, I'd get shit done.

Michael said...

I have to disagree somewhat.

For about six months, I lived with a roommate who had a cat. For the first week, I tried every OTC antihistamine I could (and since I've been a CPhT with a chain for 3 years, I've no problem figuring out what to try or getting advice).

Loratadine helped somewhat, in the sense that it decreased my difficulty breathing to merely feeling miserable. I tried an Allegra sample at one point, and it was night and day difference. I felt exactly like I did before I moved into the apartment.

I was in my doctor's office two days later and, for the remainder of those six months, never had a problem again unless I didn't use my Allegra. If I didn't use it, I'd be unable to breath without extreme difficulty within a matter of 20 minutes.