So I go pick up my anti-biotic prescription refill, and its half the expected dosage

[progree]

Last edited Thu Jan 28, 2016, 02:40 PM - Edit history (2)

This has happened twice in the last three times.

I've had a deep skin infection of my foot (Cellulitis) for a month now. Anyway, I had been taking 500mg of the anti-biotic Cephalexin (Keflex) 3 times daily. So I was surprised to pick up my refill and find it 250mg 3 times daily. I figured the Dr. knew what he was doing, and I took it for a week. But my foot progressed very little during that week (very little reduction in the swelling).

But the next office visit I mentioned that it had been 500mg, and he said something like "how did that happen?" and prescribed 500mg.

Fine. When I was done with that, I asked for a refill by phone. The person from the Dr.'s office who called back an hour later, "Ann", said my prescription has been renewed and sent to the pharmacy. I asked, "is it the same thing as before, 500 mg Cephalexin?" She said yes. Well, she was either lying or too lazy to actually look, because when I went to the pharmacy, a prescription for 250mg was waiting. [font color = red]On Edit: To be clear, I later checked "mychart" at the clinic's website and found that 250mg was prescribed on the refill. So it wasn't the pharmacy's mistake - they filled the prescription they were sent.[/font]

Finally the big question: it could be the same mistake again, or the doctor could have had his reasons for reducing the dose to 250mg. If the latter case, leaving Ann's fib aside, should I be mad that I wasn't informed that my dosage had been cut by half? So that I could appeal the decision? Before showing up at the pharmacy?

Anyway, I'm taking two 250mg pills 3 X daily (i.e. 500mg 3X daily as before)... will call the doctor's office tomorrow.

Should I make a huge stink about the surprise reduction and not being informed until I pick up my prescription at the pharmacy? Am I being naïve and stupid to think that I have the "right" to be informed (or just out of courtesy) when my refill is going to be different than what I had before?

Thanks

[font color = red]On Edit: just to clarify: the pharmacy didn't get it wrong. The doctor prescribed 250 mg on the refill, I don't know if intentionally or not yet. My question is: what if he did it intentionally (cut the dose in half), shouldn't I be informed?

ANOTHER EDIT, Update 1236 pm CT: It was a mistake, not intentional. See #14 for more. Thanks all for your input, I'm glad to hear that its not common to intentionally switch doses without telling the patient. But as #14 says, I've had bad experiences with that clinic including something similar that was intentional, so I just wanted to be prepared if what I'm experiencing now turned out to be intentional.[/font]

4 votes, 0 passes | Time left: Unlimited
	It's just the way things are, don't expect them to tell you in advance your prescription was changed. They are very busy you know.
	0 (0%)
	It is entirely reasonable to expect them to tell you they've changed your prescription
	4 (100%)
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[valerief]

1. I think you need to get a prescription in writing and then make copies of it

so when the pharmacy gets it wrong yet again you can point to the copy.

[progree]

2. The pharmacy wasn't the one making the error

I checked the clinic's website (later) and the Dr. did prescribe 250mg. It was just a refill over the phone.

[valerief]

5. Oh, then the doctor needs to say why s/he told you 500 and prescribed 250. nt

[progree]

6. The doctor didn't tell me 500mg. It was an office assistant "Ann" that called me later,

to tell me my refill had been approved and sent to the pharamcy, and who when I asked if it was the same -- 500mg of Cephalexin, said yes (too lazy to check I think, just wanted to get me off the phone)

But yes, I feel strongly that somebody should have told me my refill is 250mg, rather than the 500mg as previously.

[valerief]

7. I see. You still need to speak with the doctor to find out why the dosage changed.

But the next office visit I mentioned that it had been 500mg, and he said something like "how did that happen?" and prescribed 500mg.

It changed and you don't know why and Ann won't tell you.

[progree]

8. Yup. Tomorrow is the big phone call. (I run out of pills Saturday)

[elleng]

3. Right, and that would answer who made the mistake,

MD or pharmacy.

[progree]

4. The pharmacy didn't make the error. They filled the prescription as prescribed

[font color = red]On Edit[/font]I'm just wondering IF it wasn't an error -- IF the doctor intentionally cut the dose in half -- then do I have a reasonable expectation of being informed of the change?

[synergie]

9. You should call your doctor immediatly, and make sure

that your dosage is correct before you leave the pharmacy. There might be just a human error mistake, as in the outer package says something but what's inside the envelope is different. With antibiotics, keeping the right and constant level in your body is very important, not only for efficacy but also to prevent resistance from forming.

More than likely the doctor did not change your dosage on purpose without talking to you about it, check, double check and then if you're still not sure you have them call the office and triple check.

You are the patient, you have the right to know what you're taking, why you're taking it and what the correct dosage is, and if that changes why it has been changed for you. It's all about being an informed patient and the best advocate for yourself and your own health, don't just assume that your doctor or your pharmacist are infallible (also, cut them a bit of slack, since they are human and make mistakes), but be vigilant.

[progree]

10. Thanks. I couldn't wait around at the pharmacy, it was late...

I had to accept the prescription because I was one pill from being out. So now I've just been taking two 250mg pills every 8 hours instead of one 500mg pill every 8 hours.

I just want to be ready, before tomorrow's big phone call, if they (or the Dr. himself) tells me that the Dr. thinks that 250mg is the right dose, should I make a big hoo hah about being informed about that (rather than being surprised at the pharmacy?)

It sounds like you agree that I should be told of a change like that (if it was intentional). Thanks

[Warpy]

11. What happened is the doctor told one of the nurses to call in the scrip

and she saw that the last one had been 250 mg. and called it in. You need to call the office and tell them there has been an error, to check the chart and please call in the full dose.

And make sure you're eating lots of yogurt with live cultures. Keflex can completely wipe out your intestinal bacteria except for the really bad ones that can make you sick.

[progree]

13. Actually, the last one had been 500mg. But the one before that had been 250mg.

So could be a mess-up from that

But yes, definitely I will be calling later this morning during office hours.

Thanks for the info on the Keflex / Cephalexin. Ughhh, I don't like yogurt but will get some anyway. I like cottage cheese though... maybe that's good too for restoring intestinal bacteria? ?

The label warns me of diarrhea, which I definitely had a couple of days of. Not bad since I've taken it since Jan 3.

Starting Jan 3, 10 days of 500mg (3X/day)
then 7 days of 250mg (3X/day)
then 9 days of 500mg (3X/day)
and continuing on with 500mg 3X/day consisting of two 250mg pills 3X/day til that runs out Saturday
Hopefully will be getting the proper refill so can continue beyond Saturday without interruption.

Anyway, have been taking it for 3 1/2 weeks. I'd say the ankle on my bad foot is still about twice the circumference as that on the good foot due to swelling... Its all definitely improved from Jan 3 and even recently, its just been such glacial progress after the first week or so.

Online everything I've seen says antibiotics should clear cellulitis up in about 7 days. Definitely not my experience.

[Warpy]

16. No, you need a cultured milk product with live cultures (read the label)

Others are kefir, sour cream and buttermilk. Acidophilus milk won't do it, I'm afraid.

Dannon is about the best supermarket brand, plus there are a lot of health food brands that are pretty good. I could live on strawberry almond kefir, but it would get expensive. I find I like the regular yogurt but am not fond of Greek yogurt, which has gone halfway to soft cheese.

[progree]

17. Thanks for the great info!

I like buttermilk and sour cream. Will check out your yogurt recommendations.

[sharp_stick]

12. It's reasonable to expect

the right thing. You also have to be careful to check it when you pick it up.
Lots of Dr's offices are big enough that refills aren't directly ordered by the doc anymore. Screw ups are a lot more common than we'd like to think.
I'd definitely let the doc and office staff know what happened but wouldn't make a big stink.

[progree]

14. Update - it was a mistake, not intentional like I thought it might be

I called the clinic today, and they talked to the doctor and confirmed that it should have been 500mg, not 250mg. They phoned in a prescription for a weeks worth of 500mg pills, and I verified that they did it correctly by accessing the clinic's "mychart" app.

Sorry to bother everyone with this hypothetical (of what if the dose change was intentional, and they didn't even bother to try to tell me, but left it to be a surprise when I picked it up at the pharmacy). It's just that I couldn't believe they made the same mistake twice (twice in the last 3 times), so I figured there was a good chance it was intentional.

AND because in the past they did do something similar like this -- prescribed the same medication even after I said I had tried it and that it didn't work. As if I was some dumbass that can't follow directions, and to "try again". (I ended up trying it again anyway, and again, it had no effect. I'm very meticulous too about following the regimen)

Also pissed about that "Ann" who last time phoned to tell me that the prescription had been sent to the pharmacy, and who, incorrectly said yes when I asked, "is it the same as the previous prescription -- 500mg of Cephalexin?". Just too busy to check, busy busy you know. Easier, quicker, and more "efficient" to just say yes.

Anyway, thanks for all the input. I'm happy to hear that its apparently not the practice of changing prescription dosages without telling the patient (becuz that would take too much time, and office visits must be kept to 10 minutes and that sort of thing, and phone calls to a minute). I have a very negative view of the medical profession.

[progree]

15. Another lesson learned - there is a clinic app that lets me check what's been prescribed

and next times I will ALWAYS REMEMBER AND NEVER EVER FORGET to check that before going to the pharmacy (in fact check it as soon as possible after I think its been updated so there's more time to get things straightened out if need be).

The "app", is something called "mychart" that lets me see all kinds of my medical records, prescriptions, office visits, blah blah.