Only in My Dreams?

A patient presented a prescription this week written for “nifedipine XL 120mg 1 po QD.”

Nifedipine is a calcium-channel blocker used for high blood pressure, heart rhythm irregularities, angina, and a few other things. The highest strength available is 90mg. I’ve never seen it dosed higher than that. Facts and Comparisons states that “titration to doses above 90mg a day is not recommended.”

The patient had been taking 90mg previously and told me the doctor was increasing his dose. I still felt like I had to call and verify it. I would have had to dispense 4 x 30mg tablets or 2 x 60mg tablets and have the patient take all the tablets at one time, once daily.

It made me wish that doctors had a way to note on the script that they know that the dose they are prescribing is a little high/low/weird, and that they are aware of the irregularity and want it anyway. It would prevent me from having to call on all of the funky prescriptions that doctors write - half the time I don’t know if they are getting a blow job when they write the prescription (are distracted and making mistakes) or if they really want that strange dose of X medication.

I should keep dreaming, shouldn’t I?

As for the nifedipine guy, I sent the office 2 faxes requesting them to verify the dose and also left a voice mail message. They have not returned my call or faxed me back, and it’s been 5 days. This is why I hate having to contact them in the first place.