This practice is designed to deliver a different level of patient care.
Due to changes in the regulatory environment, including changes in Federal oversight of drug manufacturers, wholesalers and pharmacies, we have made the following policy changes:
- If a patient is only taking Immediate Release medications (IR), these can be prescribed to take each 4 hours, which is the duration of benefit. This is in accordance with current best practices for opioid prescribing and conforms with CDC guidelines. This means that 6 doses a day will be prescribed which equals 180 tablets a month. In general, we will no longer write for tablets to be taken 8 times a day (#240 a month).
- There is no good rationale for taking two different IR tablets to be taken together. Immediate release (IR) can be dosed as the lone opioid product, taken at regular intervals. In this case, a different IR product will not be prescribed.
- If patients are taking a long acting (LA)/Extended Release (ER) tablet to provide for 24/7 pain coverage, they may take an IR product for breakthrough/activity pain. In this case, the IR medication can be taken up to 3 times a day (90 tablets a month). This provides an adequate amount of “as needed” coverage for daily pain accelerations. The regulatory environment is such the four times a day dosing is no longer countenanced, and the policy is this practice will be to write for no more than 90 tablets a month for breakthrough.
- As a rule, we avoid writing prescriptions for the same medicine to be taken as both the long and short acting products. For example, as patient on long-acting oxycodone (such as Xtampza or OxyContin) should not also be on Percocet or oxycodone IR. A breakthrough medicine that is different from the ER/LA component should provide better clinical efficacy.