June 9, 2009 - 11:14am
From my experience I have noticed that almost every different doc or dentist usually prescribes the same RX for pain every visit. Same brand and the same quantity. Over the years I have seen all five of my local dentists and every time I needed something for pain each one had their brand and amount. One always prescribed 12 Lortab 7.5mg. Another always wrote 15 Vicodin 5mg and another 16 Vicodin 5mg.
With the local doctors I have noticed that one always wrote 12 Lortab 10mg or 8 Oxycontin 20mg. This was before there were 15 and 30mg formulations. A family member was going to a doctor that always wrote 30 Vicodin.
Why is this?? Do they make a deal with the pharmaceutical representatives?? If someone could explain this it would be great. I have been curious about this since I realized it aout 10 years ago.
June 9, 2009 - 11:23am
#2
if your talkin about the type
if your talkin about the type of pill then its just because some pills time release different so they prefer lortab. they dont make money off of the brands because its illegal if they do. also you can get different brands of lortab generic or name brand.
June 9, 2009 - 11:30am
#3
misunderstanding
I think that you are misunderstanding my post completely.
All formulations of hydrocodone/apap are basically instant release. There is no time released hydrocodone.
June 9, 2009 - 11:56am
#4
its the release of
its the release of hydrocodon. norco has less acetaminophen the regular vicodin hp. like lortab has alot more than vicodin hp.
June 9, 2009 - 11:59am
#5
it does make the release
it does make the release different. more acetaminophen helps the lortab last longer then vicodin. when i was on norco it was a great at once where hp will last longer.
edit/g
June 9, 2009 - 12:24pm
#6
Hydro
It's just their "protocol." It's what they've become comfortable prescribing over years of practicing medicine. Personal preference.
Imagine how many Vicodin scripts an oral surgeon has under his belt? =)
There are no deals with the pharm companies, except with the newer drugs....maybe Opana or something 
The reps push that pretty hard.
June 9, 2009 - 12:38pm
#7
Pokuras,
Sorry to tell you, but nothing in any of your replies has any factual basis whatsoever. The amount of acetaminophen has nothing to do with the release of hydrocodone, or the duration of action of the active ingredients. It is there strictly as an adjuvant, because for moderate short term acute pain, the combination of the two usually works better than either does alone. And Hydro is correct in his statement that there is currently no extended-release formulation of hydrocodone. The fact that you think one works longer for you than another does not make it extended-release lol. I do thank you for trying to help though, and for the comic relief.
There was a study conducted 2 or 3 years ago however by Abbott Labs (the makers of Vicodin) on the efficacy of a controlled release combination product named Vicodin CR. I don't remember many details about the study and I cannot post a reference link because it was on a physician member site. A web search for "Vicodin CR" may turn up some basic information on the study or the details of the drug itself. I do know it was a hydrocodone/apap combo and was listed as a C-III at the time.
June 9, 2009 - 5:14pm
#8
most family Dr.s write set amount for bouts of acute pain
while pain management will write a maintaince reguiment.
the denist on the other hand, takes alot more into consideration, not only does he have 5 different anesthesgic s for working for different reasons such as allergies, diabetic s or chronic asthma patients
June 12, 2009 - 7:50am
#9
Kind of what I figured
feliks--Thanks for answering what I actually asked in my post. Thats kind of what I figured. I have never imagined how many Vicodin RX's an oral surgeon has scribed. WOW! Oral surgeons and dentists alone could keep the makers of hydrocodone in business. lol
moorefeen--I remember reading or hearing about the study conducted for an extended release Vicodin. No offense to Pokuras, but I don't think he/she? quite got what I was asking.
PLEASE do not take offense to what I am about to say. It is not a jab at anybody in particular.
I wish that posters would please stop posting statements that they have heard from a friend or elsewhere to be facts. Unless you have read it in a PDR, a medical journal, or a pharmacology textbook or an otherwise non-fiction form of text, don't post it as fact.
Wikipedia doesn't count!!!
Pokuras - Please don't think that I was directing this statement towards you. It's just that, like MooreFeen said, what you posted was a little incorrect. I know you are new to the Pharmer family let me welcome you and say keep coming back.
June 12, 2009 - 8:28am
#10
The answeris this
Most Dentists and Oral Surgeons use what in their opinion works on their patients. I have been to more Dentists, Periodontists and Oral Surgeons in my lifetime than anyone I know. And Endodontists too. My dentist always prescribed 12 -5 mg Percocet. The periodontist, 24 -10 mg Percocet and my endodontist would always give me 30 Vicodin ES. This is what they use on me. Now on other patients they may use the same but maybe not as many. Its just what they find what works for their patients and Hydro and Oxy seem to be the best for oral pain. I have never received Morphine from any of them however, once I got Hydromorphone (Dilaudid) from the Endodontist. You can go to any of these oral care people and always get a script for Hydro whether its in the form of Vicodin or Lortab or anything else. Once you have told them that its not working, they bump you up to the Oxy and give you the 5 mg Percocet. Rarely will you get anything stronger. I am one of the luckier ones and I do get the 10/325 Percocet from my Periodontist. After some sort of surgery. Never more than 24 at a time. Go figure. Anyway, I hope we can put this to rest now. I think that Feliks and I have given you what you were looking for.
June 12, 2009 - 12:17pm
#11
It either personal preference or protocol
Most dentists are part of a practice, and they usually develop specific protocols in terms of dispensing pain medication. I have realized this through conversations with dentists in my area (one office is right across the street from our pharmacy, and the dentist is a customer of ours.) For smaller procedures, he will write for 15 vicodin, 30 amoxicillin for people at high risk of developing endocarditis (a heart infection which can occur via bacteria entering the blood stream through gums damaged during dental work) For more advanced and painful procedures, he will write for 20 percocet and the antibiotic. Nothing stronger. If pain persists, he will usually refer them to an oral surgeon if it is something he cannot fix. Also, dentists are only allowed to write within the scope of their practice. This means a dentist cannot legally write for cholestrol medications. In New Jersey, opthamologists cannot write for pain medications, and we actually discovered a forged prescription when someone brought an RX for percocet in from a opthamologist. It was odd, so I called to confirm and found out his pad was stolen by a patient.
June 12, 2009 - 1:00pm
#12
No deals with the
No deals with the pharmaceutical reps at all, because when you get to the pharmacy you probably get whatever the the pharmacy has in stock that is an equivalent dosage. Doctors write for whatever they are most used to writing for. I write for "Vicoden 5/500, or 7.5/750" and the patient gets some brand of Hydrocodone/APAP in the pharmacy. If acetaminophen is a concern I write for "Norco 10/325" and the patient gets some brand of Hydrocodone/APAP 10/325 in the pharmacy. Some patients swear by Lortab or Lorcet so I occasionally write for those and patients get some brand of hydrocodone/APAP in the pharmacy.
June 14, 2009 - 9:59am
#13
specific drugs
I think I failed to mention in my OP that the specific brands and amounts are the same for most every patient not just me. I live in a small rural community and anyone I have known that has seen any of the dentists or doctors will get the exact RX, if a script is indeed needed.
June 14, 2009 - 3:52pm
#14
I know of only 1 PM Doctor
that has a definable protocol for prescribing opiates, in that I asked him about it when he called to get some information on fentanyl patches. He starts with non-opiate NSAIDS/corticosteroids, Neurontin or Lyrica, and Muscle relaxants first for new patients. If ineffective, he will change to percocet or vicoprofen as needed, along with local treatments if possible (Epidurals, local steroid injections, surgery). If still ineffective, he will go to oxycontin with percocet for breakthrough pain, along with a muscle relaxant if applicable. For patients requiring higher doses of opiates, he will switch to fentanyl with roxicodone for breakthrough pain. He showed me his typed plan, and I was impressed. It was very thorough, and he had extensive research into it. He is the doctor who hasn't made any writing mistakes in the time I've been working there, and we average about 20-50 of his CII's a week, along with about 25-75 non-controlled drugs. Its very impressive, and I commend him whenever I talk to him.
June 15, 2009 - 12:05am
#15
Thats good NJ but seriously,
Thats good NJ but seriously, all doctors should be that diligent. They make the money they do because their job requires great precision and expterise. Its a shame that there are so many doctors who don't pay close attention to important details of their job.
June 15, 2009 - 7:35am
#16
Many doctors just have
Many doctors just have certain pain relief medication preferences. Many do not know every single generic and every single pain med available. Most doctors prescribe what they are used too and what seems to work for most patients. Dentists especially seem to be fond of hydrocodone meds. offer suggestions discretely if the medicine does not seem adequate to you but don't ever tell a doc what you need.
June 15, 2009 - 9:22pm
#17
in my experience
I once asked my dentist why I always get the same Rx--12 Darvocet. He said it was simply that he wrote the same Rx for everyone unless there was an allergy to an ingredient. Every pharmacy in town knows what he writes for regularly. This way if someone tries to forge a script the Pharmacists know right away if it is anything different at all. Much like the PM you spoke of NJRx242.
Kitty
June 15, 2009 - 10:09pm
#18
Exactly
I know his handwriting, its very distinct and unique. Plus, I know how he writes, and if anyone tried to forge a stolen rx pad from him, I would spot it in a heartbeat. Most dentists use hydrocodone products because it is great for the moderate pain experienced with dental work.
June 16, 2009 - 9:17am
#19
odd
I just found it odd that most of the time each doc/dentist, PM's excluded, will write the exact same script for every patient.
June 17, 2009 - 3:15am
#20
Hydro, hope you don't mind
I have a couple generic questions for anyone and the a couple specific ones.
I've never heard of vicoden hp. What is the strength? Also, the strength of vicoden ES. I've heard of this one but unsure of the concentrations of the two meds in it.
Woodstock, you mentioned earlier that dentists use 5 different anesthetics. What 5 are they? Also, which ones are specifically for diabetics and chronic asthmatics? Why that particular one for those specific disease processes? I've taken some time to research those and can't seem to find answers to match your posts. If it's too difficult to type out and explain, please just post a link to your site with the information. I never mind clicking on links and going straight to the source. Plus it's so much simplier and quicker for the poster.
Thanks in advance Woodstock an anyone else that responds.
June 17, 2009 - 7:51am
#21
its been a while
lidocaine, novacaine, are the only two i can remeber as of now
novaicaine is used ythe most, one is used for patients with heart conditions, one is used for blood disorders as freebleeders, an best that memory serves me one is for pateint that are allergic to reg. novaicaine
My dentist was a boss of mine while taking dental school in Tennessee at ETSU, he work the mines during the day an surry to classes that where over 2 hours away, H e made one fine dentist
I ll try to find out all the numbing agents for you
edit: lidocaine, xylocaine,novaicaine,procaine,septocaine, an marcaine
nitrous oxide is used to help you walk out of the dentist chair on your ^*#% cheeks while he s working on you
I m no Dr , just a hillbilly
June 17, 2009 - 9:05am
#22
scrubnursek
Vicodin HP is a 10/660 combination. Vicodin ES is 7.5mg of hydrocodone and I think 750mg of acetaminophin.
July 3, 2009 - 11:21pm
#23
If you have bad dental pain
If you have bad dental pain over here they prescribe ibuprofen ( that you ca buy over the counter )
If it does not go away they might try paracetomol or more ibuprofen ( you can buy paracetomol over the counter aswell )
If it gets worse / does not go away they prescribe difene.
But you can buy fairly cheap ibuprofen/codeine paracetomol/codeine and aspirin/ codeine combinations over the counter.
I have very rarely heard of anyone being prescribed an opiate for dental pain over here.
There was a great drug for dental / soft tissue inflammation and pain called Aulin ( nimuliside ) but they pulled it off the market after some elderly people died from liver failure after taking higher end doses.
You really have to be in screaming rag order to get a opiate painkiller over here, and even then you may not get one , let alone a script, they only get the morphine out when you have a week or so left. They are giving people with cancer ( that have no private health insurance ) tramadol, about as useful as an ashtray on a motorbike!!
July 4, 2009 - 1:25am
#24
milo
I always appreciate the unique perspective you bring to the board. I am very interested in monitoring the state of heathcare programs abroad, and you always offer great information.
The "ashtray on a motorbike" joke was good too. I'll go to bed with a smile on my face.
Cheers
July 5, 2009 - 7:39am
#25
my motorbike not only has a ashtray
it has a heater an defroster too
Woodstock
July 18, 2009 - 1:05am
#26
To Scrubnursek
From a dentist's perspective we prescribe what we feel comortable with. Analagesics can be anywhere from acetamenophen to morphine. What usually ends up happening is that we end up falling into a routine and giving the same Rx for each pt's situation. For many extractions ibuprofen alone or in conjuction with acetamenophen has been shown to produce pain relief. If pain is still refractory to NSAIDS/APAP, we then will try an opiate. Vicodin is what we have been around the most (most oral surgeons give this routinely, it was basically hardlined into us in our education), but it is appropriate to prescribe Percocet and even morphine if the situation calls for it. All of this is PO.
So there are not really any different local anesthetics which are designed or called to be used in specific medical conditions. There are, however, medical conditions that we must take into consideration when using locals. For example someone on beta blockers has a different response to local anesthetics than someone who is not on any medications. The anesthetics are lidocaine , mepivicaine, prilocaine, bupivicaine, and articaine. These all come in differing solutions, mostly based on presence or absence of a catecholamine/vasoconstrictor, and we select the anesthetic based on procedural and medical needs. More times than not it is lidocaine 2% with epinephrine 1:100,000. I hope that this helps, at least from a dental point of view.
By the way, Novocaine which you are thinking of has not been used in years. It was marketed as procaine and was a horrible anesthetic, lots of possible allergic reactions to it. Newer anesthetics, which are amine derivatives, do not have much of a allergic profile. If I can recall only to sulfites which is to stablize epi while in solution in the carpule. If someone is allergic we just use one without a vasoconstrictor.
July 18, 2009 - 1:38am
#27
butler 029
Welcome to Pharmer butler 029.
Do you know if more or less dentists are using Nitrous Oxide / Oxygen in their practice now, than say 20 years ago? I am just curious, because when I was a kid the dentist always used it, but now I don't know of anyone that uses it anymore. The dentist I have been going to for the past 10+ years is against the use of it. He coincedentally works with may dad for the same company. I am friends with his daughter and son who I went to high school with. (sorry kinda ramblin, its late) Every time I have to get a filling I wish I were at least a little knocked/numbed out. I have been using a flouride rinse and Sensodyne for a year or so, because my dentist recomended it since my teeth are excessively sensitive. Thanks in advance and welcome again.
Also, what happened to the polls everyone?
July 18, 2009 - 2:40am
#28
I see a new poll posted in
I see a new poll posted in the last 15 minutes....
http://www.pharmer.org/content/are-you-happy-pain-relief-offered-your-dr
July 18, 2009 - 2:48am
#29
oneir
That's my vote.
July 18, 2009 - 2:48am
#30
Oh, mine was the 2nd
Oh, mine was the 2nd then...gosh darnit you beat meh
July 18, 2009 - 12:23pm
#31
In the realm of medications
In the realm of medications there are thousands of individual drufgs yet only hundreds of therapeutic classes, i.e. opiate pain meds includes probably 30 or more different oral tablets including all strenghts etc. Prescribers have to distill this for themselves into a workable formulary, where they pick one or two for each situation based on their comfort, familiarity, and knowledge of each agent and class. They then can evaluate a patient and pick from the one or two they are comfortable with, rather than browse volumes of possible choices each time. Many times within a class there are very little differences among individual agents anyway.
What you have noticed is the result of this practice, where the doctor has decided that 4 days of hydrocodone/APAP is as Vicodin is sufficient for most patients, and can 'quick-draw' this from his personally distilled formulary of drugs.
It's a function of necessity in dealing with the large market of available agents. All of the agents you initially cited, hydro, are all generic and not really marketed to prescibers anyway. No back door deals most likely, just a 'survival tool'. ;) It happens with everything: pain, blood pressure, nausea, etc. You just happen to be acutely in-tune to pain meds.
Marketing practices (Drug Reps) do affect prescibing practices, however, so I won't completely discount that it is a possiblity for some drugs/prescribers. These practices have recently been heavily scrutinized and restricted by the industry though.
every doctor is affraid of being the one to get you hooked. i have a doctor i told i've been taking vicodin from another doctor and he give me 60 vicodin hp with 2 refills every month. as long as they can blame your addiction on another doctor they will give you what you want.