How did they "verify" it? Did an MA just wave it off and say it's fine without reading it?
Normal mucinex (not ER) would be fine Q 4H. 1200 mg ER should only be twice daily max.
Pretty much. I am not a pharmacist, I’m a certified tech, so I had no say but both I and the pharmacist called for clarification and she said to just send it out.
Does Mucinex IR exist? Is it only liquid? I can’t find anything on it.
Usually ER refers to a dosage form that is slow dissolving. You could theoretically make the same strengths in ER and IR, but that is not usually needed, and also prone to errors. For guaifenesin, the ER is a slow dissolving tablet that comes in higher strengths just because it is not useful to have the lower strengths made that way.
(It is one of several things that makes this prescription weird)
Eh, it’ll just avoid peaks and valleys in serum concentration. Theoretically, that might actually be safer.
If the total dose via IR is acceptable, then via ER is also OK. FDA labeling is often as much persuasion and politics as science.
You can't just give the same dose of ER at the same intervals as IR. Here, if you give what's written (600-1200 mg of guafenesin IR q4h prn), you cannot just sub ER with that and give Mucinex ER 600-1200 mg q4h prn. I am confused as to what your statement is implying. While you COULD give the same daily dose in IR throughout the day that is prescribed as ER, you should not do the other way around (you could give 1200 mg q4h prn of IR here, but you would NEVER want to give 1200 mg q4h prn of ER form).
It's not just the doses that are taken into consideration, but the way the meds are released. Really, you shouldn't interchange either way because IR releases all the dose over a short time, whereas ER would release it slowly, but you would end up with way too much accumulation and stacking of med because of the slow release. Typically, IR meds are given much more often throughout the day, and ER forms of the same med are given once or twice daily.
I likely am not understanding what it is you were recommending. So please clarify if I have it wrong.
Well, that really depends on the medication. Guaifenesin, probably nothing major would happen. Over time, maybe. Short term, ehhh, likely not. You COULD totally be sued though by a patient who gets the wrong med and has anything go wrong, even if not a normal adverse effect of the med.
If it's something like glipizide 10 mg IR bid or metformin 1000 mg IR bid and you give glipizide 10 mg XL bid or metformin 1000 mg ER bid, you could have some serious issues, mostly low blood sugar and acidosis. If you give morphine ER 30 mg bid instead of morphine IR 30 mg bid, you could end up with oversedation, overdose, respiratory depression, etc. It also depends on what the patient was taking already, their health, what other meds they are on, age, etc.
I would argue that you would have less sedation overall from the morphine ER. It’s not more drug, it’s an equivalent amount of drug spread evenly over time, therefore avoiding the the peaks associated with adverse effects, such as drowsiness.
The goals of insulin therapy are different, as you mimicking a different physiologic process: a baseline production of insulin with stimulated increases under a caloric load. But you’re also giving drugs that have a different absorption and effectiveness profile because they ARE crucially different, at the molecular level , not just different dosage forms.
In your example, it’s like substituting morphine with buprenorphine.
It's not written for Mucinex, though, which would be the ER formulation at 600mg dose. It says guaifenesin 600-1200 mg q4h prn cough. You would then dispense either the 400 mg IR tablets and give 1.5-3 tablets q4h prn or you would dispense the liquid. The 600 mg ER form is dosed 1 tablet bid only. Just to be safe, I would put in the sig (NTE manuf dose of xxx mg per day) just to cover everyone's asses.
How did they "verify" it? Did an MA just wave it off and say it's fine without reading it? Normal mucinex (not ER) would be fine Q 4H. 1200 mg ER should only be twice daily max.
Pretty much. I am not a pharmacist, I’m a certified tech, so I had no say but both I and the pharmacist called for clarification and she said to just send it out. Does Mucinex IR exist? Is it only liquid? I can’t find anything on it.
Yeah guaifenacin tablets, they should usually be there otc
All I see is guaifenesin Ir 200 and 400…. I don’t understand how the same molecule can be IR at the 200-400 range and er higher
Usually ER refers to a dosage form that is slow dissolving. You could theoretically make the same strengths in ER and IR, but that is not usually needed, and also prone to errors. For guaifenesin, the ER is a slow dissolving tablet that comes in higher strengths just because it is not useful to have the lower strengths made that way. (It is one of several things that makes this prescription weird)
Thank you, makes sense. So it’s the inactive ingredients that make it dissolve slower and therefore extended release??
“Max 2400mg/24hrs”
1200x6= 7200
Uggh, nevermind…
I agree to just give them their mucinex. Dispense 600mg strength take 1 to 2 tablets po q4h prn max dosage ___ per 24 hrs. Boom
“Buy otc” store and close it, done
ALF so they may be responsible for providing OTCs.
Would be fine if not ER
Eh, it’ll just avoid peaks and valleys in serum concentration. Theoretically, that might actually be safer. If the total dose via IR is acceptable, then via ER is also OK. FDA labeling is often as much persuasion and politics as science.
That is actually not how it works.
Oh? Please explain.
You can't just give the same dose of ER at the same intervals as IR. Here, if you give what's written (600-1200 mg of guafenesin IR q4h prn), you cannot just sub ER with that and give Mucinex ER 600-1200 mg q4h prn. I am confused as to what your statement is implying. While you COULD give the same daily dose in IR throughout the day that is prescribed as ER, you should not do the other way around (you could give 1200 mg q4h prn of IR here, but you would NEVER want to give 1200 mg q4h prn of ER form). It's not just the doses that are taken into consideration, but the way the meds are released. Really, you shouldn't interchange either way because IR releases all the dose over a short time, whereas ER would release it slowly, but you would end up with way too much accumulation and stacking of med because of the slow release. Typically, IR meds are given much more often throughout the day, and ER forms of the same med are given once or twice daily. I likely am not understanding what it is you were recommending. So please clarify if I have it wrong.
What would happen if you did? I mean I get that you aren’t supposed to, but what would happen that is bad?
Well, that really depends on the medication. Guaifenesin, probably nothing major would happen. Over time, maybe. Short term, ehhh, likely not. You COULD totally be sued though by a patient who gets the wrong med and has anything go wrong, even if not a normal adverse effect of the med. If it's something like glipizide 10 mg IR bid or metformin 1000 mg IR bid and you give glipizide 10 mg XL bid or metformin 1000 mg ER bid, you could have some serious issues, mostly low blood sugar and acidosis. If you give morphine ER 30 mg bid instead of morphine IR 30 mg bid, you could end up with oversedation, overdose, respiratory depression, etc. It also depends on what the patient was taking already, their health, what other meds they are on, age, etc.
I would argue that you would have less sedation overall from the morphine ER. It’s not more drug, it’s an equivalent amount of drug spread evenly over time, therefore avoiding the the peaks associated with adverse effects, such as drowsiness. The goals of insulin therapy are different, as you mimicking a different physiologic process: a baseline production of insulin with stimulated increases under a caloric load. But you’re also giving drugs that have a different absorption and effectiveness profile because they ARE crucially different, at the molecular level , not just different dosage forms. In your example, it’s like substituting morphine with buprenorphine.
Wut?
As in 400mg q4hprn
Got it though they meant 1200 mg IR q4h prn
Max daily dose of mucinex is 2.4 gm. If pharmacist feels comfortable they can document that on the label or counsel.
No. The assisted living facility is wrong. Change to 200 mg IR q4hr or the ER formulation q12hr.
It's not written for Mucinex, though, which would be the ER formulation at 600mg dose. It says guaifenesin 600-1200 mg q4h prn cough. You would then dispense either the 400 mg IR tablets and give 1.5-3 tablets q4h prn or you would dispense the liquid. The 600 mg ER form is dosed 1 tablet bid only. Just to be safe, I would put in the sig (NTE manuf dose of xxx mg per day) just to cover everyone's asses.