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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Phillipa on December 9, 2007, at 12:27:47
Seems a lot of pdocs are prescribing psych meds above the maximum doseage reccomended by the drug company that developed the med. Is this safe and legal? Just a question . Phillipa and why?
Posted by Maxime on December 9, 2007, at 13:56:17
In reply to How Can a Pdoc Rx a med Above the Drug co's Max?, posted by Phillipa on December 9, 2007, at 12:27:47
> Seems a lot of pdocs are prescribing psych meds above the maximum doseage reccomended by the drug company that developed the med. Is this safe and legal? Just a question . Phillipa and why?
If my pdocs had not prescribed over the recommended maximum, I never would have had a response to ANY med.
I was on 100 mg of Prozac, 90 mg of Parnate and now 250 of Seroquel. It's not illegal and it is safe. Everyone metabolizes meds differently. Of course you should be on the least amount of meds as possible.
Maxime
Posted by Phillipa on December 9, 2007, at 14:13:33
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Max? » Phillipa, posted by Maxime on December 9, 2007, at 13:56:17
Wow and I cut the valium to l5mg and tiny up of luvox to 75mg and now sleeping til noon and the new pdoc is cancelled til March. I'll need you guys more than ever. How did you tolerate those high doses no anxiety for you at all? Love Phillipa
Posted by sunnydays on December 9, 2007, at 15:15:48
In reply to How Can a Pdoc Rx a med Above the Drug co's Max?, posted by Phillipa on December 9, 2007, at 12:27:47
Perfectly legal. Just like docs will prescribe drugs so-called 'off-label' for things they know the drug works for but the drug company hasn't specifically gotten approval on. For one thing, Lamictal is only approved for bipolar I and epilepsy, I believe, but is commonly prescribed off-label for help with both bipolar II and unipolar depression. There's nothing wrong with doing that. I suppose there may be some risk, but I wouldn't think side effects would be any different for people, it just may not work as well.
As for why... well, because from their clinical experience the drug has seemed to be safe and effective for whatever purpose they are prescribing it for. I would much rather see a physician willing to prescribe me what was most likely to work rather than running out of options because they stuck strictly to the label.
sunnydays
Posted by bleauberry on December 9, 2007, at 18:33:07
In reply to How Can a Pdoc Rx a med Above the Drug co's Max?, posted by Phillipa on December 9, 2007, at 12:27:47
They are grasping at straws.
A lady had 80mg prozac poop out on her, she was upped to 120mg. That is a fair amount above the max dose allowed. Do I need say it didn't work? She was darn near cured when she discovered she was intolerant of gluten and stopped eating wheat and barley products. She is in remission with 5mg prozac + 25mg 5htp daily, but she can send herself into suicidal depression by eating a pizza.
I could sit here for the next 6 hours and run similar stories one after the other after the other. Gluten, other intolerances, magnesium, candida, thyroid, cortisol, mercury, lead, sleep apnea...
Like I said, the pdocs pushing ridiculous doses are grasping at straws. Nobody's chemical imbalance is THAT far out of whack. I mean, the reuptake receptor sites are already 100% saturated and closed with the drug at doses well below the high doses you are talking about.
Safe? Probably. A ton of side effects though. Legal? I guess so or they wouldn't do it...their number one priority is not the patient, it is avoiding malpractice suits.
Effective? Not likely, except in rare situations where someone is an extremely fast metabolizer. But even in that situation, there is a specific lab test available to pinpoint that so as not to be guessing. If the pdoc didn't order that lab test to justify astronomical doses, then I do not think it is good business or effective therapy.Just opinion, but basically I am saying that a doc pushing megadoses is displaying his/her own inadequacy in the art of diagnosis. They simply do not have any other ideas, even though there are dozens they haven't even looked at that are right in their own medical school books, so they just up the dose.
> Seems a lot of pdocs are prescribing psych meds above the maximum doseage reccomended by the drug company that developed the med. Is this safe and legal? Just a question . Phillipa and why?
Posted by Racer on December 9, 2007, at 18:57:06
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Max?, posted by bleauberry on December 9, 2007, at 18:33:07
>
>
> ...their number one priority is not the patient, it is avoiding malpractice suits.That seems like a gross generalization to me. I do believe that, when I see my pdoc, my well-being is his number one priority -- and I don't think he's unique in that.
Posted by Phillipa on December 9, 2007, at 19:22:41
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Ma » bleauberry, posted by Racer on December 9, 2007, at 18:57:06
I feel almost like I can read the mind of mine when there her attitude is whatever you want then do it. So is that my best interests? Phillipa
Posted by tecknohed on December 9, 2007, at 19:41:25
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Ma » Racer, posted by Phillipa on December 9, 2007, at 19:22:41
> I feel almost like I can read the mind of mine when there her attitude is whatever you want then do it. So is that my best interests? Phillipa
Phillipa, have you ever seen/considered seeing a male pdoc? I dont mean to sound sexist, but maybe a male doc would take a whole different approach with you?
Probably sounds like a bizzare comment, but its just a thought.
And how long have you been seeing her? Maybe she's at the end of her teather with trying to treat you successfully (which is of course COMPLETELY wrong).
teck
Posted by MidnightBlue on December 9, 2007, at 19:58:55
In reply to How Can a Pdoc Rx a med Above the Drug co's Max?, posted by Phillipa on December 9, 2007, at 12:27:47
Mine did because the blood level of the drug was still not in the theraputic range even though I was on the max recommended dose.
MB
Posted by sunnydays on December 9, 2007, at 22:21:38
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Max?, posted by bleauberry on December 9, 2007, at 18:33:07
Sometimes I think it's not grasping at straws, it's wanting to try all the options. I went up on my Lexapro above the max dosage because it had worked for some of my pdocs patients, and since I was already on it, if that had worked it would have been a lot faster than tapering off and up on another drug and waiting for that to take effect. It didn't work, so my pdoc then presented me with 6 options, said which one she thought was best and why, and I made a decision. Doesn't sound like grasping at straws at all to me. Sounds like trying to do what could be best for the patient.
sunnydays
Posted by Phillipa on December 9, 2007, at 22:55:12
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Ma » Phillipa, posted by tecknohed on December 9, 2007, at 19:41:25
Tech yes have seen male pdocs. Good ones and bad ones through the years. My options for pdocs here are used up two big practices and you can't switch docs within and I didn't mix with the one I got so can't go back there. The other one was the one that cancelled so I'm my own pdoc. And I can't treat myself. Love Phillipa
Posted by bleauberry on December 10, 2007, at 20:13:33
In reply to Re: How Can a Pdoc Rx a med Above the Drug co's Ma » bleauberry, posted by Racer on December 9, 2007, at 18:57:06
Not a gross generalization. Sorry it sounded that way. Making sure to avoid potential lawsuit is number one, as it is the essence of survival. The patient is number one after that, assuming the particular doc has more passion for his patients than his paycheck.
What is the doctor's largest expense? The building lease? The license? The secretaries? The computer system? It is the malpractice insurance. It is so astronomical in some parts of the country there are shortages of doctors.
> >
> >
> > ...their number one priority is not the patient, it is avoiding malpractice suits.
>
> That seems like a gross generalization to me. I do believe that, when I see my pdoc, my well-being is his number one priority -- and I don't think he's unique in that.
>
>
This is the end of the thread.
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