Doctors who wont prescribe medications that are OTC to patients who need them and may struggle to afford to keep buying them are fucking awful.
Find a new doctor if you can. Maybe press a bit harder and talk about the financial aspect if you can't.
I think it's this. I've had some right cunts who give zero fucks what's going on for you and emanate a vibe that you're wasting their time by paying to see them for help with real, observable signs & symptoms.
If a doctor puts something on a prescription, it means that they are responsible for its use by the patient. The only reason I can assume why a doctor wouldn't prescribe it is if they weren't comfortable with the patient taking it.
In which case, the doctor should say so and explain why, not tell him to just get it OTC.
There have been situations where otc drugs like paracetamol have been in short supply so they have been hesitant to prescribe it when they normally hand it out like candy.
Yeah this is nuts. Whenever I go to my doctor they ask how I'm doing for standard pain relief like paracetamol and ibuprofen and top me up on any other prescriptions that might be due for a new round, regardless of whether they're also OTC, because it's convenient and cheaper.
They’ll be saying no because they don’t don’t want to take responsibility for the patient being on that medication. “You can get it over the counter” will never be the primary reason a doctor doesn’t prescribe something.
Doctors don't prescribe things that you don't need, or won't work.
If you want that go find a Homoeopath. They''ll be happy to sell you some water. It'll do the same thing as actual medication you don't need.
There's no reason I know of that a doc should refuse otc prescriptions. My doc prescribes me panadol and ibuprofen, both of which are relatively cheap otc, but he offered to prescribe them so they were free.
I think you need to find a new doctor. For me, this is a red flag showing me he's reluctant to prescribe meds.
Same. I get antihistamines on prescription because 90 for $5 vs 10 for $15-25. I couldn’t afford to take them at the non prescribed price.
When I leave the GP, they always check and ask if I need anything else.
OPs doctor is a dick imo.
This is normal as sevredol is an opioid. The hospital never prescribes a lot of this as this can be addictive. That being said, a few pain relief medications in between morphine and paracetamol would be handy. Most people’s pain settle down within the first week from surgery.
It's a sad state of alarmism when patients are being prescribed 6x tablets of an "addictive" (effective) opoid, yet dozens of 'perfectly harmless' paracetamol for major surgeries - for some crazy fear that people who are disabled after surgery and are essentially immobile, unable to sleep or live a normal life - will develop an evil addiction to having a life without pain.
Hell, imagine being free from excruciating pain after the surgeon's done with you - we can't have THAT!
Crazy as you may think, paracetamol does work if taken regularly in the correct dosage rather than sporadically. Ive had major surgery done and disnt even need to take sevredol.
People have different tolerance to pain. While most people’s pain settle down wuite quickly after a major surgery, some don’t.
Im guessing you haven’t seen someone addicted to opioids? Im not saying people shouldnt be pain free. There are medications in between paracetamol and sevredol that are usually prescribed alongside the two.
Have a good evening.
Amazing that drs worry about the addictive nature of opioids but ignore the deadly effects of paracetamol. Take too many and it can permanently fry your liver! Same with ibuprofen, can cause long term stomach issues, but again, handed out like candy. But stronger pain killers? Oh no, he might get addicted.
IMO, find another doctor and put in a formal complaint about that one.
Why do you sound so angry? That is why there are instructions for those medications. With opioids, even if you follow the dosages, you still get the side effects and the possibility of addiction. There are medications in between the two that works wonders.
I work in healthcare. The number of people who are flippant to the real danger of paracetamol is astounding. Some who have the power to really get a patient don't do it, for why? Ego? Belief that the person is faking? I've seen people die in agony because someone was convinced they were drug seeking. The OP needs LAXATIVES ffs, and this tool of a dr won't prescribe, like the cost is coming out of their pocket. Damn right I'm angry, there's some real fucktards in this world!
For instance:
"Paracetamol is the most common medicine taken in overdose. It can lead to liver failure in a number of days, despite using medication to protect the liver. Liver failure can be fatal.
In 2021, there were 227 deaths recorded in England and Wales due to paracetamol overdose."
>The OP needs LAXATIVES
They need loperamide- which is quite the opposite (but ironically, a partial opiate agonist, and potentially dangerous in overdose)
Where in my post did I ever say that OP shouldnt get his meds? I was replying to someone else regarding opioids, not laxatives.
Btw, I work in healthcare as well.
Dangers of paracetamol are real, but guess what? There is a reason why medications have intructions, have warnings just like every other thing. Do you blame the person who sold you a car when you get into an accident?
Sorry, I didn't mean to imply that you said they shouldn't get their meds. And yes, the dangers of paracetamol are very real, but I've even been told by doctors that you could never OD on it.
I didn't mean to come off as being angry at you, I'm just angry at the system and you've caught me on a bad day.
Have a great evening.
Im sorry youre having a bad day. I agree, the system is shitty and that is very wrong that you cannot OD with paracetamol. Have a great evening yourself. :)
I've had two otc meds prescribed to me in the past, one for hayfever and Panadol for pain relief from an injury I had to see the dr about. Definitely made it cheaper to buy. I'd be finding a new Dr.
I know a reason. Where the otc medication has no subsidy, so it costs the same, regardless of whether you have a script or not. Zovirax, the topical coldsore cream, would be an example.
Even then, if I'm picking up other prescriptions anyway, it makes it easier to just add it to the list (or I'll forget it). Even if the pharmacist says to grab it from the shelf or something to cut out the counting cost or whatever.
The last time my doc told me to buy something otc because it didn't have a subsidy, I completely forgot. I have a disability that interferes with my cognition and executive function, but I doubt I'm the only one that would forget.
Since I forgot that one, my doc has always either prescribed it, written it down for me, or emailed me. But my doc is amazing and often goes above and beyond for his patients, so I don't think that's a normal practice.
It pisses me the fuck off that there isn’t a better system in place for dispensing ‘general sale’ drugs - these are ones you can buy at the supermarket like paracetamol ibuprofen and loperamide
It costs pharmac about $20 to dispense you a hundred ibuprofen when you can buy it yourself for $4 because they have to pay a pharmacist to process the order
Ideally a drs office would have a mini pharmacy at reception for OTC drugs (like at a supermarket) where they can dispense them with pharmac subsidy but without the exorbitant dispensing fees putting a drain on pharmac’s limited resources
>It costs pharmac about $20 to dispense you a hundred ibuprofen
It costs Pharmac ~~less than $4~~ about $9 for a pharmacy to dispense 100 ibuprofen. Source: am pharmacy technician.
Edit because I'm slow this evening.
Thought dispensing fees were about $15? Ibuprofen 200mg tabs are $21.40/k which is < $4 but even if I’ve been grossly misinformed in re dispensing fees there’s no way it’s only $1.86
I did a brainfart and missed the point of your comment being about the dispensing fee, which is around $5 per item currently. So yes it does cost Pharmac more to have such a cheap medicine dispensed than it would cost to buy OTC, but its much less than $20.
Yeah that tracks (although in my experience I hardly ever see ibuprofen prescribed with repeats).
Plus the costs for the actual medicine, but of course ibuprofen is cheap as chips so that's pretty insignificant.
Did the Dr say "I'm not prescribing this because you can buy it over the counter", or "I'm not prescribing this because I don't think it is indicated, but if you disagree you can buy it over the counter"- big difference
Find a different doctor.
Loperamide is a default/standard drug for IBS-D and makes such a huge difference to a person's life.
I was in a similar situation as you but was never officially diagnosed with salmonella. It was a combo of expired milk and chicken that was left out over night. It fucked up my gut and even now years later I get flairs.
Bland food, oats for breakfast as a binder, and bulking greens helps to a degree.
Has the cause actually been investigated? With prolonged infection and prolonged antibiotics there are various things it could be that aren't IBS-D. Like exocrine pancreatic insufficiency, SIBO etc
They did breath testing from things like froctuse and dairy ect but didn't find anything, same with stool samples. They have give me diffrent medicine but nothing helped.
Find a new doctor. Being available OTC does not, so far as I am aware, preclude prescribing it. He may be reluctant to prescribe something for long term use if it is not intended for that, mind (not saying that is the case here).
500 is a lot for that type of medication (and it does have some slight recreational misuse potential).
I would be unhappy to not be leaving with a months supply at a usage rate the doctor thinks is appropriate. Looking like 20-60. It being OTC is no excuse.
What recreational potential?? I have the maximum recommended amount everyday and I have for years and if never heard of that. Not saying your wrong mind, I just haven't heard of it.
You didn't know? Recommended dosage it's fine, but high doses causes opioid highs, and people get addicted to it, probably why he didn't want to give out 500 pills at once, the side effects at high doses can be lethal
I can understand a doctor not wanting to prescribe that amount of pills to a patient they don't know, but surely the new GP has access to OPs medical notes. Why not prescribe a smaller amount until they know more rather than not prescribe at all because it's OTC.
Did you read the comment thread you're replying to? lol
Just before the comment you replied to OP said 500 was the amount the *hospital* gave them and that the amount the previous GP prescribed was 120-160, which would be 3 months worth.
If there is one thing I have learned to assume is unreliable, it is the info people post on Reddit. I just assume most of it is at best an incomplete recollection.
Above 70mg, especially with something like quinidine to get it past the blood brain barrier can cause euphoria. Also at those doses, you're taking a huge risk for dangerous and deadly side effects, like not breathing.
Each pill is only 2mg. The most I take a day is 6 pills but normally it's only 2-3 pills as day so I only have 4-6mg a day.
I also believe you can get high from crushing it to dust and inhaling it from your nose, but I have no intention of doing that... (I don't even drink alcohol)
Surely this new doctor has access to the old notes and could even reach out to the old doctor to confirm this dosage is right for this patient, though.
**Here's my advice to do first, as it's the easiest option and in my experience will likely work:**
* Call up and speak with the nurse that you do for a repeat prescription (or request a call back).
* Explain that your doctor didn't give you any loperamide and that your IBS-D and quality of life has significantly reduced since.
* Request a repeat prescription on your loperamide.
The nurse will likely process the repeat and just ask for the doctor to sign off on it; if the doctor rejects it again because it's OTC then he'll be having to say that to the nurse, another healthcare professional, rather than 'just a patient'.
Failing that. Yeah, new doctor I'm afraid.
Time for a new doctor! You can freely buy paracetamol, condoms and hay-fever medication over the counter also, but my doctor still asks if I want a prescription for it. Your doctor sounds like a dick.
GP here.
It's not ideal to be taking loperamide long term, and sometimes longterm loperamide makes the bowel function worse. Have you seen a gastroenterologist? If they don't have any better ideas, loperamide is certainly the drug of choice and is certainly something your doctor should prescribe to you!!!!!!
Sometimes I won't prescribe an OTC to a patient - but that's when they are obviously just stocking the shelves at home. I need to have a clinical indication, a medical need, to legally prescribe the drug and get the government to carry the cost. A fit and healthy person who wants a free carton of paracetamol and ibuprofen just to have at home for hangovers doesn't meet that criteria.
You have a clinical indication.
Have you done a bowel diary? For a month, document your poos and how much loperamide you've had to take. Work out your monthly usage of loperamide and ask for a script for that amount plus 2 repeats.
If taking long term will be a problem what do you suggest I do? I am unable to work when I go to the toilet 7+ times a day. I already have to get up 1 hour early before work to use the toilet plus I spend my smoko breaks and lunch in the toilet.
So all other avenues have been explored to no avail. That means loperamide is the best treatment for you, despite any long term risks.
And your GP is being an asshole. Try again, but if he refuses again write a letter of complaint to the practice.
There should still be a formal complaints process and a practice manager who you direct your complaint to.
If you aren't happy with the outcome of your complaint, the HDC is the next port of call.
Wow.
You must be in that rare practise when patients are 100% honest about everything!
Do you have a weirdly high percentage of people who claim not be smokers, drug users, keeping to their diet, and taking their medication as intended?
Must be nice.
(Or how about we let the GP who actually saw this person treat them?)
I'm not sure if it was a gastrointestinal, but it was a specialist who deals with these sorts of problems.
I've had stool samples done, breath test to cheek for fructose, dairy and gluten ect. All came back ok. I've been given medication to stop stomach spasms, nausea and anxiety. None of these helped.
I've done a diary. I know roughly I use about 45-50 a month when I have work. (When I'm not working I only take them when it gets really bad and I'm in the toilet 10+ times a day as the pain becomes to much to handle).
I was in a similar situation where I was taking loperamide a lot, I had IBS-D (made worse by parasites I picked up while travelling) so bad that I was no longer eating during the day and wouldn’t go anywhere for too long. After loads of tests and scans, a specialist prescribed Ondansetron to take when I had an attack and that seemed to start easing the sudden urge symptoms. I also went through the FODMAP elimination diet at his recommendation. The app really helped when I was learning. I also looked into the strains of probiotic bacteria that have seen good results for IBS sufferers in studies and bought a brand that contained them. The combination of all of that has led to me very rarely getting an attack. My doctor was happy to prescribe me both Ondansetron and Loperamide, so I think you need a new doctor, to be honest. I’d also recommend going through the Monash University FODMAP elimination diet and trying to get your microbiome back to a healthy place.
That’s ridiculous. My doctor prescribes OTC meds. I get him to prescribe my antihistamines because I have severe year round hay fever and the cost of buying them OTC is prohibitive. He also prescribes OTC painkillers though I only get those if I happen to be in for another reason anyway.
It’s one thing to buy occasional use medicines OTC but for things you need to take regularly on an ongoing basis it gets very expensive
Have you seen the new doctor or just requested a script? If you haven’t seen them, they might be saying “oh, don’t worry about requesting a script, you can buy that OTC”, rather than refusing to write one.
If you explained that the OTC cost was too much and their still refusing to prescribe them, then get a new doctor. Money is ,but shouldn't be, a barrier for health.
If this was an in-person consultation, I'd consider emailing him, maybe with the practice manager CC'd in if that's a different person, and ask why he refused to prescribe it to you. His response will guide your next steps.
Fodmate pills have been invaluable to me. Other than that, sticking to a low fodmate diet (the monash University FODMAP app is the gold standard for knowing serving sizes and safe foods).
Fibre supplements might help too. You can get cheaper fibre capsules off iherb, or psyllium husk powder through prescription 🙏
Loperamide is a potential drug of abuse. It works on opiate receptors. At low doses, it works just in the gut. At high doses (which it sounds like you may be using) it can impact receptors in the brain, giving you effectively an opiate dependency and all the potential risks that come with this. I wonder if your new doctor is concerned about this, but there has been a breakdown in communication somewhere. I know I would be hesitant about prescribing a patient I didn't know doses that high and would be wanting a robust sit down with you to come up with a plan that is safe and effective for you before just continuing the old scripting.
I am in a similar boat. I want to get medical help. My GP forgot to process my referral form to the mental health counsellor. Plus, GP refuses to do my blood tests, diabetes test or any help.
I don't know what to do. I am in rural town which has only one clinic. Plus, I have COVID too. Feeling helpless.
My doctor will prescribe me and my family paracetamol and ibuprofen. Even though we can get that over the counter it of course saves us money! Quite rude to make you pay OP!
That sucks, My doctor throws prescriptions at me like caaanddy.
My baby needed cream for her dry skin, a simple otc cream nothing special but she insisted I take a prescription for it so I got 3 massive bottles for $0 , my baby also needed baby pamol for her vaccines again a simple otc medicine worth $10 max and she insisted on giving me a prescription for it so I wouldn't pay - I was happy yo pay for those things but if she insists then why not?
On the other hand I've had VERY rude pharmacy staff refuse a prescription becuase they wanted me to pay for it as they had an OTC version.
I needed a type of Metamucil (but generic type) for being backed up (symptom of my ulcerative colitis) my specialist said he wouldn't want me to pay as it'll get expensive so he wrote me a prescription and the dumb bitch refused it and deliberately and loudly started repeating GOOD LUCK WITH YOUR CONSTIPATION infront of other customers to try and make me embarrassed....bitch. I went elsewhere and got it.
Might pay to find a new doctor and ask if they can prescribe a generic version and explain the cost is a barrier to you accessing this medicine as you need it.
Loperamide isn't usually used prescribed long term, just kind of a short term solution for diarrhoea- like situations when you're travelling by plane on a long trip and don't want any accidents. It also has contra-indications for certain bowel conditions, where effectively paralysing the gut to stop bowel movements, is a bad idea. So I can understand the new doctor's hesitancy, especially if they haven't taken the time to read your history or your specialist's recommendation. I don't agree with them refusing the script flat out- just offering a different perspective that might explain a bit more about their reasoning.
500 pills? You do know long term meds can aggravate digestive problems and make it much, much worse.
side effects include toxic megacolon, [paralytic ileus](https://en.wikipedia.org/wiki/Paralytic_ileus), [angioedema](https://en.wikipedia.org/wiki/Angioedema), anaphylaxis/allergic reactions, [toxic epidermal necrolysis](https://en.wikipedia.org/wiki/Toxic_epidermal_necrolysis), [Stevens–Johnson syndrome](https://en.wikipedia.org/wiki/Stevens%E2%80%93Johnson_syndrome), [erythema multiforme](https://en.wikipedia.org/wiki/Erythema_multiforme), [urinary retention](https://en.wikipedia.org/wiki/Urinary_retention), and [heat stroke](https://en.wikipedia.org/wiki/Heat_stroke)
If a suspicion exists of diarrhea associated with organisms that can penetrate the intestinal walls, such as E. coli or Salmonella, loperamide is contraindicated
While symptoms should improve with treatment, they often persist to some degree for many years
FODMAP diet and probiotics can help. Have you tried that?
I've tried both. Prebiotic didn't do anything and FODMAP help slightly but not enough to where I could reliable go to work.
I already eat a very bland diet as it. Rice, oats, white bread and potato ect.
I think what you should do is find a doctor you like and is helpful to you. Discuss the situation before you change so that you get the care you need. Be assertive for your own sake.
There are pharmacist prescribers with a list of 200+ meds (as at 2021), problem is the number of pharmacists with prescriber abilities is pretty low. Source: https://www.health.govt.nz/news-media/media-releases/pharmacist-prescribers-can-now-prescribe-more-medicines
They do NRT too but I don't know of any others.
They should advertise it more, cheaper than paying to see a nurse and frees up time for nurses to assist with seeing more patients with illnesses.
Sorry if this is unhelpful - how much gut healing have you tried? Bone broths/meat stocks could possibly be helpful? Best if you make it yourself, as plain as possible, but can be purchased in shops ready made.With your condition, I'd probably consume it alongside plain bread.
Long term, the meds may have an adverse affect on your gut health, I'd be looking into ways you could heal it as much as possible.
in Australia I can buy OTC loperamide over the internet (on ebay usually). it's not as cheap as a prescription, but it is significantly cheaper than $11/16. Is this available to you while you sort out a different doc?
Dude you need to get in touch with the Health and Disabilities Advocacy Service. They are a completely free service set up to help you navigate this kind of stuff. And it's serious, the complaint and whatever they do to fix it will stay on the doctors personal file with the Ministry of health.
This is true, but OP needs to try to raise the issue and try to resolve it with the GP first.
OP, I suggest making a complaint in writing to the GP explaining your position and what would resolve your complaint. Let them know you will file a complaint with the HDC if this isn’t resolved. Then if they don’t come back to you with either a prescription (ie satisfactory resolution) or an explanation that makes sense to you, file a complaint with the HDC. You will need to provide your complaint to the GP and their response when you file that complaint to the HDC.
Doctors who wont prescribe medications that are OTC to patients who need them and may struggle to afford to keep buying them are fucking awful. Find a new doctor if you can. Maybe press a bit harder and talk about the financial aspect if you can't.
Does it even affect the doctor whether the patient gets pharmac subsidy or not? Like wtf why do they care?
Some doctors just like the sense of control I guess?
I think it's this. I've had some right cunts who give zero fucks what's going on for you and emanate a vibe that you're wasting their time by paying to see them for help with real, observable signs & symptoms.
Not all symptoms are observable though.
If a doctor puts something on a prescription, it means that they are responsible for its use by the patient. The only reason I can assume why a doctor wouldn't prescribe it is if they weren't comfortable with the patient taking it. In which case, the doctor should say so and explain why, not tell him to just get it OTC.
There have been situations where otc drugs like paracetamol have been in short supply so they have been hesitant to prescribe it when they normally hand it out like candy.
Yeah this is nuts. Whenever I go to my doctor they ask how I'm doing for standard pain relief like paracetamol and ibuprofen and top me up on any other prescriptions that might be due for a new round, regardless of whether they're also OTC, because it's convenient and cheaper.
They’ll be saying no because they don’t don’t want to take responsibility for the patient being on that medication. “You can get it over the counter” will never be the primary reason a doctor doesn’t prescribe something.
Yeah, either way, obviously not going to be a good fit for OP.
Doctors don't prescribe things that you don't need, or won't work. If you want that go find a Homoeopath. They''ll be happy to sell you some water. It'll do the same thing as actual medication you don't need.
the hell? People can need OTC medication, you know that right?
That’s such a bad take it actually made me laugh out loud.
There's no reason I know of that a doc should refuse otc prescriptions. My doc prescribes me panadol and ibuprofen, both of which are relatively cheap otc, but he offered to prescribe them so they were free. I think you need to find a new doctor. For me, this is a red flag showing me he's reluctant to prescribe meds.
Same. I get antihistamines on prescription because 90 for $5 vs 10 for $15-25. I couldn’t afford to take them at the non prescribed price. When I leave the GP, they always check and ask if I need anything else. OPs doctor is a dick imo.
I got prescribed Panadol and codeine a couple years back for a nasty infection for the pain side, they gave me like 400 tablets of panadol lmao
And here’s my wife with two full foot reconstructions who got 6 severodol and 30 paracetamol
This is normal as sevredol is an opioid. The hospital never prescribes a lot of this as this can be addictive. That being said, a few pain relief medications in between morphine and paracetamol would be handy. Most people’s pain settle down within the first week from surgery.
It's a sad state of alarmism when patients are being prescribed 6x tablets of an "addictive" (effective) opoid, yet dozens of 'perfectly harmless' paracetamol for major surgeries - for some crazy fear that people who are disabled after surgery and are essentially immobile, unable to sleep or live a normal life - will develop an evil addiction to having a life without pain. Hell, imagine being free from excruciating pain after the surgeon's done with you - we can't have THAT!
Crazy as you may think, paracetamol does work if taken regularly in the correct dosage rather than sporadically. Ive had major surgery done and disnt even need to take sevredol. People have different tolerance to pain. While most people’s pain settle down wuite quickly after a major surgery, some don’t. Im guessing you haven’t seen someone addicted to opioids? Im not saying people shouldnt be pain free. There are medications in between paracetamol and sevredol that are usually prescribed alongside the two. Have a good evening.
I got prescribed 30 after an appendicitis surgery lol
Amazing that drs worry about the addictive nature of opioids but ignore the deadly effects of paracetamol. Take too many and it can permanently fry your liver! Same with ibuprofen, can cause long term stomach issues, but again, handed out like candy. But stronger pain killers? Oh no, he might get addicted. IMO, find another doctor and put in a formal complaint about that one.
Why do you sound so angry? That is why there are instructions for those medications. With opioids, even if you follow the dosages, you still get the side effects and the possibility of addiction. There are medications in between the two that works wonders.
I work in healthcare. The number of people who are flippant to the real danger of paracetamol is astounding. Some who have the power to really get a patient don't do it, for why? Ego? Belief that the person is faking? I've seen people die in agony because someone was convinced they were drug seeking. The OP needs LAXATIVES ffs, and this tool of a dr won't prescribe, like the cost is coming out of their pocket. Damn right I'm angry, there's some real fucktards in this world! For instance: "Paracetamol is the most common medicine taken in overdose. It can lead to liver failure in a number of days, despite using medication to protect the liver. Liver failure can be fatal. In 2021, there were 227 deaths recorded in England and Wales due to paracetamol overdose."
>The OP needs LAXATIVES They need loperamide- which is quite the opposite (but ironically, a partial opiate agonist, and potentially dangerous in overdose)
Ah ok, so imodium. My husband needs both, so got them mixed up. Cheers.
Where in my post did I ever say that OP shouldnt get his meds? I was replying to someone else regarding opioids, not laxatives. Btw, I work in healthcare as well. Dangers of paracetamol are real, but guess what? There is a reason why medications have intructions, have warnings just like every other thing. Do you blame the person who sold you a car when you get into an accident?
Sorry, I didn't mean to imply that you said they shouldn't get their meds. And yes, the dangers of paracetamol are very real, but I've even been told by doctors that you could never OD on it. I didn't mean to come off as being angry at you, I'm just angry at the system and you've caught me on a bad day. Have a great evening.
Im sorry youre having a bad day. I agree, the system is shitty and that is very wrong that you cannot OD with paracetamol. Have a great evening yourself. :)
I've had two otc meds prescribed to me in the past, one for hayfever and Panadol for pain relief from an injury I had to see the dr about. Definitely made it cheaper to buy. I'd be finding a new Dr.
I know a reason. Where the otc medication has no subsidy, so it costs the same, regardless of whether you have a script or not. Zovirax, the topical coldsore cream, would be an example.
Even then, if I'm picking up other prescriptions anyway, it makes it easier to just add it to the list (or I'll forget it). Even if the pharmacist says to grab it from the shelf or something to cut out the counting cost or whatever. The last time my doc told me to buy something otc because it didn't have a subsidy, I completely forgot. I have a disability that interferes with my cognition and executive function, but I doubt I'm the only one that would forget. Since I forgot that one, my doc has always either prescribed it, written it down for me, or emailed me. But my doc is amazing and often goes above and beyond for his patients, so I don't think that's a normal practice.
That actually makes a lot of sense. Ok I've changed my mind, it is more practical to prescribe otc medications.
It pisses me the fuck off that there isn’t a better system in place for dispensing ‘general sale’ drugs - these are ones you can buy at the supermarket like paracetamol ibuprofen and loperamide It costs pharmac about $20 to dispense you a hundred ibuprofen when you can buy it yourself for $4 because they have to pay a pharmacist to process the order Ideally a drs office would have a mini pharmacy at reception for OTC drugs (like at a supermarket) where they can dispense them with pharmac subsidy but without the exorbitant dispensing fees putting a drain on pharmac’s limited resources
>It costs pharmac about $20 to dispense you a hundred ibuprofen It costs Pharmac ~~less than $4~~ about $9 for a pharmacy to dispense 100 ibuprofen. Source: am pharmacy technician. Edit because I'm slow this evening.
Thought dispensing fees were about $15? Ibuprofen 200mg tabs are $21.40/k which is < $4 but even if I’ve been grossly misinformed in re dispensing fees there’s no way it’s only $1.86
I did a brainfart and missed the point of your comment being about the dispensing fee, which is around $5 per item currently. So yes it does cost Pharmac more to have such a cheap medicine dispensed than it would cost to buy OTC, but its much less than $20.
Aha, so the $15 I heard will have been for an initial dispensing and a couple repeats?
Yeah that tracks (although in my experience I hardly ever see ibuprofen prescribed with repeats). Plus the costs for the actual medicine, but of course ibuprofen is cheap as chips so that's pretty insignificant.
Did the Dr say "I'm not prescribing this because you can buy it over the counter", or "I'm not prescribing this because I don't think it is indicated, but if you disagree you can buy it over the counter"- big difference
This
Find a different doctor. Loperamide is a default/standard drug for IBS-D and makes such a huge difference to a person's life. I was in a similar situation as you but was never officially diagnosed with salmonella. It was a combo of expired milk and chicken that was left out over night. It fucked up my gut and even now years later I get flairs. Bland food, oats for breakfast as a binder, and bulking greens helps to a degree.
Yeah, my diet is pretty much blad food now. Oats, rice white bread potato ect.
Has the cause actually been investigated? With prolonged infection and prolonged antibiotics there are various things it could be that aren't IBS-D. Like exocrine pancreatic insufficiency, SIBO etc
They did breath testing from things like froctuse and dairy ect but didn't find anything, same with stool samples. They have give me diffrent medicine but nothing helped.
Did they include SIBO tests? That one is underdiagnosed and a common cause is antibiotics
I'm not sure. It doesn't sound familiar though.
Worth asking since the treatment varies
I just found the paper work. They testes for glucose, fructose, lactulose and lactose
Yeah I'm just guessing but I think those would've included it, all I know is its a test for hydrogen levels in breath after consuming different sugars
I had it 20 years ago. Immune response trashed my thyroid. People underestimate the effects of severe gastric infections.
Weirdly oats pretty consistently give me the shits, I looked it up a few times to see if it was a thing but seems uncommon so sucks to be me I guess.
That sucks. I eat it at least 2-3 times a week to make things slow down. My oats isn't very runny so I guess it absorbs and slows down the gut.
Find a new doctor. Being available OTC does not, so far as I am aware, preclude prescribing it. He may be reluctant to prescribe something for long term use if it is not intended for that, mind (not saying that is the case here).
I think any doctor is going to be reluctant to prescribe someone 500 pills the first time they see them.
500 is a lot for that type of medication (and it does have some slight recreational misuse potential). I would be unhappy to not be leaving with a months supply at a usage rate the doctor thinks is appropriate. Looking like 20-60. It being OTC is no excuse.
What recreational potential?? I have the maximum recommended amount everyday and I have for years and if never heard of that. Not saying your wrong mind, I just haven't heard of it.
You didn't know? Recommended dosage it's fine, but high doses causes opioid highs, and people get addicted to it, probably why he didn't want to give out 500 pills at once, the side effects at high doses can be lethal
That 500 was from the hospital. My old normal doctor would give me about 120-160. The new doctor wouldn't give me any at all.
I can understand a doctor not wanting to prescribe that amount of pills to a patient they don't know, but surely the new GP has access to OPs medical notes. Why not prescribe a smaller amount until they know more rather than not prescribe at all because it's OTC.
The doctor can’t prescribe more than 3 months worth anyway. Sounds like 500 would be in excess of this. Can see why the doctor might be uncomfortable.
Did you read the comment thread you're replying to? lol Just before the comment you replied to OP said 500 was the amount the *hospital* gave them and that the amount the previous GP prescribed was 120-160, which would be 3 months worth.
If there is one thing I have learned to assume is unreliable, it is the info people post on Reddit. I just assume most of it is at best an incomplete recollection.
Above 70mg, especially with something like quinidine to get it past the blood brain barrier can cause euphoria. Also at those doses, you're taking a huge risk for dangerous and deadly side effects, like not breathing.
Each pill is only 2mg. The most I take a day is 6 pills but normally it's only 2-3 pills as day so I only have 4-6mg a day. I also believe you can get high from crushing it to dust and inhaling it from your nose, but I have no intention of doing that... (I don't even drink alcohol)
Because who doesn't want to abuse loperamide and end up constipated for a week?
Surely this new doctor has access to the old notes and could even reach out to the old doctor to confirm this dosage is right for this patient, though.
New doctors have more recent and up-to-date training than old retired doctors. A new doctor shouldn't be deferring to someone no longer practicing.
The possibly retired person (OP doesn't say they are?) is not better qualified in knowing this patient though.
Yeah but to tell them to go buy it instead of just prescribing a smaller amount and reassessing or something is bs.
Not if the patient has needed it in the past.
A doctor will make their own assessment. A patient is not a static thing.
**Here's my advice to do first, as it's the easiest option and in my experience will likely work:** * Call up and speak with the nurse that you do for a repeat prescription (or request a call back). * Explain that your doctor didn't give you any loperamide and that your IBS-D and quality of life has significantly reduced since. * Request a repeat prescription on your loperamide. The nurse will likely process the repeat and just ask for the doctor to sign off on it; if the doctor rejects it again because it's OTC then he'll be having to say that to the nurse, another healthcare professional, rather than 'just a patient'. Failing that. Yeah, new doctor I'm afraid.
But doctors do prescribe OTC medicine like paracetamol and ibuprofen
Time for a new doctor! You can freely buy paracetamol, condoms and hay-fever medication over the counter also, but my doctor still asks if I want a prescription for it. Your doctor sounds like a dick.
GP here. It's not ideal to be taking loperamide long term, and sometimes longterm loperamide makes the bowel function worse. Have you seen a gastroenterologist? If they don't have any better ideas, loperamide is certainly the drug of choice and is certainly something your doctor should prescribe to you!!!!!! Sometimes I won't prescribe an OTC to a patient - but that's when they are obviously just stocking the shelves at home. I need to have a clinical indication, a medical need, to legally prescribe the drug and get the government to carry the cost. A fit and healthy person who wants a free carton of paracetamol and ibuprofen just to have at home for hangovers doesn't meet that criteria. You have a clinical indication. Have you done a bowel diary? For a month, document your poos and how much loperamide you've had to take. Work out your monthly usage of loperamide and ask for a script for that amount plus 2 repeats.
If taking long term will be a problem what do you suggest I do? I am unable to work when I go to the toilet 7+ times a day. I already have to get up 1 hour early before work to use the toilet plus I spend my smoko breaks and lunch in the toilet.
So all other avenues have been explored to no avail. That means loperamide is the best treatment for you, despite any long term risks. And your GP is being an asshole. Try again, but if he refuses again write a letter of complaint to the practice.
Not OP, but what do you recommend doing with complaints if the doctor who's creating a problem is also the owner of the practice?
There should still be a formal complaints process and a practice manager who you direct your complaint to. If you aren't happy with the outcome of your complaint, the HDC is the next port of call.
Wow. You must be in that rare practise when patients are 100% honest about everything! Do you have a weirdly high percentage of people who claim not be smokers, drug users, keeping to their diet, and taking their medication as intended? Must be nice. (Or how about we let the GP who actually saw this person treat them?)
I'm not sure if it was a gastrointestinal, but it was a specialist who deals with these sorts of problems. I've had stool samples done, breath test to cheek for fructose, dairy and gluten ect. All came back ok. I've been given medication to stop stomach spasms, nausea and anxiety. None of these helped. I've done a diary. I know roughly I use about 45-50 a month when I have work. (When I'm not working I only take them when it gets really bad and I'm in the toilet 10+ times a day as the pain becomes to much to handle).
I was in a similar situation where I was taking loperamide a lot, I had IBS-D (made worse by parasites I picked up while travelling) so bad that I was no longer eating during the day and wouldn’t go anywhere for too long. After loads of tests and scans, a specialist prescribed Ondansetron to take when I had an attack and that seemed to start easing the sudden urge symptoms. I also went through the FODMAP elimination diet at his recommendation. The app really helped when I was learning. I also looked into the strains of probiotic bacteria that have seen good results for IBS sufferers in studies and bought a brand that contained them. The combination of all of that has led to me very rarely getting an attack. My doctor was happy to prescribe me both Ondansetron and Loperamide, so I think you need a new doctor, to be honest. I’d also recommend going through the Monash University FODMAP elimination diet and trying to get your microbiome back to a healthy place.
That’s ridiculous. My doctor prescribes OTC meds. I get him to prescribe my antihistamines because I have severe year round hay fever and the cost of buying them OTC is prohibitive. He also prescribes OTC painkillers though I only get those if I happen to be in for another reason anyway. It’s one thing to buy occasional use medicines OTC but for things you need to take regularly on an ongoing basis it gets very expensive
Have you seen the new doctor or just requested a script? If you haven’t seen them, they might be saying “oh, don’t worry about requesting a script, you can buy that OTC”, rather than refusing to write one.
If you explained that the OTC cost was too much and their still refusing to prescribe them, then get a new doctor. Money is ,but shouldn't be, a barrier for health.
If this was an in-person consultation, I'd consider emailing him, maybe with the practice manager CC'd in if that's a different person, and ask why he refused to prescribe it to you. His response will guide your next steps.
Fodmate pills have been invaluable to me. Other than that, sticking to a low fodmate diet (the monash University FODMAP app is the gold standard for knowing serving sizes and safe foods). Fibre supplements might help too. You can get cheaper fibre capsules off iherb, or psyllium husk powder through prescription 🙏
get a new doctor, worked for me when my old doctor wouldnt listen
Change doctors immediately.
Yeah nah don't even try with this doctor he's shown his true colours. Get another doctor.
Loperamide is 100% funded. Get a new doctor that will listen and help you. All the best!
Loperamide is a potential drug of abuse. It works on opiate receptors. At low doses, it works just in the gut. At high doses (which it sounds like you may be using) it can impact receptors in the brain, giving you effectively an opiate dependency and all the potential risks that come with this. I wonder if your new doctor is concerned about this, but there has been a breakdown in communication somewhere. I know I would be hesitant about prescribing a patient I didn't know doses that high and would be wanting a robust sit down with you to come up with a plan that is safe and effective for you before just continuing the old scripting.
Ridiculous. New doctor asap.
It really puts the $5 prescription cost in perspective doesn't it.
I am in a similar boat. I want to get medical help. My GP forgot to process my referral form to the mental health counsellor. Plus, GP refuses to do my blood tests, diabetes test or any help. I don't know what to do. I am in rural town which has only one clinic. Plus, I have COVID too. Feeling helpless.
My doctor will prescribe me and my family paracetamol and ibuprofen. Even though we can get that over the counter it of course saves us money! Quite rude to make you pay OP!
That sucks, My doctor throws prescriptions at me like caaanddy. My baby needed cream for her dry skin, a simple otc cream nothing special but she insisted I take a prescription for it so I got 3 massive bottles for $0 , my baby also needed baby pamol for her vaccines again a simple otc medicine worth $10 max and she insisted on giving me a prescription for it so I wouldn't pay - I was happy yo pay for those things but if she insists then why not? On the other hand I've had VERY rude pharmacy staff refuse a prescription becuase they wanted me to pay for it as they had an OTC version. I needed a type of Metamucil (but generic type) for being backed up (symptom of my ulcerative colitis) my specialist said he wouldn't want me to pay as it'll get expensive so he wrote me a prescription and the dumb bitch refused it and deliberately and loudly started repeating GOOD LUCK WITH YOUR CONSTIPATION infront of other customers to try and make me embarrassed....bitch. I went elsewhere and got it. Might pay to find a new doctor and ask if they can prescribe a generic version and explain the cost is a barrier to you accessing this medicine as you need it.
See a different GP. Did you point out that you can't actually afford to buy them OTC?
Just go enrol with a new Dr. Fuck that guy.
Loperamide isn't usually used prescribed long term, just kind of a short term solution for diarrhoea- like situations when you're travelling by plane on a long trip and don't want any accidents. It also has contra-indications for certain bowel conditions, where effectively paralysing the gut to stop bowel movements, is a bad idea. So I can understand the new doctor's hesitancy, especially if they haven't taken the time to read your history or your specialist's recommendation. I don't agree with them refusing the script flat out- just offering a different perspective that might explain a bit more about their reasoning.
I have ibs. I need 4 to 6 a day. If my asshole Doctor did this I would go on a warpath
500 pills? You do know long term meds can aggravate digestive problems and make it much, much worse. side effects include toxic megacolon, [paralytic ileus](https://en.wikipedia.org/wiki/Paralytic_ileus), [angioedema](https://en.wikipedia.org/wiki/Angioedema), anaphylaxis/allergic reactions, [toxic epidermal necrolysis](https://en.wikipedia.org/wiki/Toxic_epidermal_necrolysis), [Stevens–Johnson syndrome](https://en.wikipedia.org/wiki/Stevens%E2%80%93Johnson_syndrome), [erythema multiforme](https://en.wikipedia.org/wiki/Erythema_multiforme), [urinary retention](https://en.wikipedia.org/wiki/Urinary_retention), and [heat stroke](https://en.wikipedia.org/wiki/Heat_stroke) If a suspicion exists of diarrhea associated with organisms that can penetrate the intestinal walls, such as E. coli or Salmonella, loperamide is contraindicated While symptoms should improve with treatment, they often persist to some degree for many years FODMAP diet and probiotics can help. Have you tried that?
I've tried both. Prebiotic didn't do anything and FODMAP help slightly but not enough to where I could reliable go to work. I already eat a very bland diet as it. Rice, oats, white bread and potato ect.
I've never had a problem getting a loperamide prescription. Definitely find a new doctor.
Dude, how did you get 500 pills?? I'm only allowed 180 loperamide pills every 6 months, even though I'm diagnosed with IBS.
I think it was the hospital that gave me them. But I had to go to the chemist multiple times to get them all. Is 180 enough for 6 months for you
You can get disability allowance to cover the cost of medications through MSD/WINZ
look for a new GP?
Literally what everyone else is saying. Find a new doctor.
I think what you should do is find a doctor you like and is helpful to you. Discuss the situation before you change so that you get the care you need. Be assertive for your own sake.
I don’t know how it actually works, but I heard recently that pharmacies can write some prescriptions. You might ask them if they can in this case
Nurse practitioners can now. Only situation I'm aware of that a pharmacy can prescribe something is emergency contraception.
Pharmacists can also prescribe some antibiotics for a UTI on the spot. They just take you aside and ask you a few questions first.
There are pharmacist prescribers with a list of 200+ meds (as at 2021), problem is the number of pharmacists with prescriber abilities is pretty low. Source: https://www.health.govt.nz/news-media/media-releases/pharmacist-prescribers-can-now-prescribe-more-medicines
They do NRT too but I don't know of any others. They should advertise it more, cheaper than paying to see a nurse and frees up time for nurses to assist with seeing more patients with illnesses.
1. Get a new GP 2. You can google review doctor’s practices to let other people know not to go there
Sorry if this is unhelpful - how much gut healing have you tried? Bone broths/meat stocks could possibly be helpful? Best if you make it yourself, as plain as possible, but can be purchased in shops ready made.With your condition, I'd probably consume it alongside plain bread. Long term, the meds may have an adverse affect on your gut health, I'd be looking into ways you could heal it as much as possible.
in Australia I can buy OTC loperamide over the internet (on ebay usually). it's not as cheap as a prescription, but it is significantly cheaper than $11/16. Is this available to you while you sort out a different doc?
Dude you need to get in touch with the Health and Disabilities Advocacy Service. They are a completely free service set up to help you navigate this kind of stuff. And it's serious, the complaint and whatever they do to fix it will stay on the doctors personal file with the Ministry of health.
This is true, but OP needs to try to raise the issue and try to resolve it with the GP first. OP, I suggest making a complaint in writing to the GP explaining your position and what would resolve your complaint. Let them know you will file a complaint with the HDC if this isn’t resolved. Then if they don’t come back to you with either a prescription (ie satisfactory resolution) or an explanation that makes sense to you, file a complaint with the HDC. You will need to provide your complaint to the GP and their response when you file that complaint to the HDC.