Sunday, September 27, 2009

About that drug interaction thing.

So... remember how my doctor prescribed me both Savella and Ultracet? And remember how after looking it up I was all, nuh uh, no way that doesn't make sense? And how when I questioned him on it he was all, oh no really it's fine? And how when he said that I was all, uh, what are you talking about that's crazy I'm still not taking it?

Well. You're gonna love this.

Now, let's back up just a lil' bit. When I started on the Savella, I didn't have a prescription for it. Why? Because I needed to do a titration, gradually easing up to my full dose. For this, the drug company that makes Savella is kind enough (ha ha) to provide docs with sample packs. So after the visit where he prescribed both drugs, I filled an Rx of Ultracet, but *not* of Savella.

OK. So fast forward one month. I've been taking the Savella, have figured out I should NOT also be taking the Ultracet (and subsequently have not taken a single pill; still have the entirel bottle of SIXTY sitting in my nightstand drawer), and have had the second visit to the doc wherein I question him and get confusing answers. He has now written me an actually scrip for Savella so that I can continue taking it, because it seems to be working for me. I head to the drugstore.

Well, you know, drugstores do this thing, right? For people like me, who take lots of different medications. They check for drug interactions. And wouldn't you know? They see that they've already filled me up this bottle of 60 Ultracet, and then here I am waltzing in asking for Savella. RED ALERT! RED ALERT! MAJOR DRUG INTERACTION! Basically they tell me that unless they speak with my doc (or, given that of course it's Saturday, because when the hell else do I have time to go to the drugstore? at least the on-call guy) there is no way on god's green earth that they are giving me these pills.

How did I feel at that moment? Well. Unlike the SNAFU with my birth control pills the other month, where my rage was split between Walgreens and my health insurance company, I felt (feel) that this particular event sits squarely on the shoulders of one person. And that person is my doctor! Not only did he tell me to take these drugs together. But he continued to tell me it was alright after I questioned him for a good five minutes on it, explaining to him everything I'd found to the contrary! And fine, OK, the internets is not always the most valid source. But I think this little drugstore experience is proof enough that I was right and he was wrong. And fer serious, I don't want that to ever be the case between me and my doc when it comes to the medication he's prescribing me! It is, to say the least, unnerving.

You'll want to know how it worked out, eh? Well, it goes like this. At the Walgreens pharmacy, you basically have two kinds of people. There are the "pharmacy techs" who work the counter and essentially read the script. So when the kid I was talking to saw the interaction problem on his computer screen, the little light blinked on in his head, and he said "Oh there's a drug interaction we can't fill the prescription until we speak with your doctor." I explained to him that I'd figured it out for myself, that I hadn't taken even a single pill of the Ultracet, and that anyway clearly my doc wasn't in as it was Saturday. I got back: "There's a drug interaction we can't fill the prescription until we speak with your doctor." I asked if I could just have four pills to get me through till Monday, because if I stopped taking them suddenly it would make me sick. I got back: "There's a drug interaction we can't fill the prescription until we speak with your doctor." Ahh, corporations.

Don't get me wrong. He was a nice kid, and I'm sure he would have liked to help me. But assuming he had the mental ability to find a way to help me, company policy had done everything in its power to keep him from doing so.

Luckily, there is a second type of employee at the Walgreens pharmacy: actual pharmacists. When they choose to, they can think and make judgment calls. Front counter robot man started trying to get an on-call doctor on the phone, but by that time the pharmacist on staff was already on hold doing the exact same thing. She finally got one of the sort of operator people on the line and left a message, which was a bit of a trial - clearly these folks are used to taking restaurant reservations or something, because she had to say "serious drug interaction" about six times.

When she was done on the phone I sort of flagged her down. I told her what I'd told the kid at the counter, as he clearly had not done so: that I had figured out the problem for myself and hadn't taken any of the Ultracet. Her eyes sort of brightened. "You haven't taken any of it?" She filled the prescription.

She told me in no uncertain terms that I was NOT to take ANY of the Ultracet EVER while still taking the Savella. She even wrote it on on the bag: DO NOT TAKE WITH TRAMADOL!

So people, if you're reading this and have been taking these drugs together and having nasty side effects, please please please call your doctor right now. This is nothing to mess around with. This can cause Serotonin Syndrome, which always makes you quite ill and in its most severe instances can actually kill you. Medications are serious stuff and should always be approached carefully. Doctors, clearly, do NOT always know what they're doing. They have drug representatives shoving things down their throats, and in turn they shove things down ours. There is so much on the market these days - I imagine that even for the most conciencious docs it's very difficult to keep up with, and most of us real sickies have more than one doc anyway. Which is precisely why drug stores check for interactions in the first place.

Take care. And always look up your medications before you take them.


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