I am prescribed Tramadol 50mg written as take 1-2 tabs every 4-6 hours No more than 8 tablets per day.. So if I was to get 80 of them. . That is a 10 day supply. I actually only take 6 per day. Everytime I call for a refill about 20 mins later a nurse calls me and tells me I'm 2 weeks early and that its a 28 day medication. I say its not a matter of days its an as needed medicine and I can take 8 per day! They sit there for a minute get mad and say ok let me ask Doc then but I doubt he will fill it. I say if you look at the history you will see he fills the med as needed and if I been taking 6 per day I will be out tommoro if I was taking 8 per day I would already be out.. I'm out today and its still not filled should I call again and AGAIN until they fill it? Its something the nurses send over to pharmacy themselves not even doc. My doc never has the issue its the nurses. And I want to make a complaint about them at this point.
I am waiting on a call back from my doctor now. I just had a nurse call me back and say " Your doctor wants to know why you are taking more then prescribed?" What?! God knows what there tellin my doctor! I said I am not taking more then I'm prescribed or allowed I am alotted up to 8 tabs per day and I take 6 tops. She says "no no, why are u taking more then you should doctor doesn't understand what your doing? You got them on xyz date. ". 17 days ago! Up to 8 - I asked to talk to him personally because this is out of control. I've spent most of my day gettin calls from nurses claiming I'm taking more then I should, but ladt time I checked 6 is less than 8! I'm complaining to someone there.
Unfortunately, most scripts event those that are written to take on a as needed basis are written as a 30 day supply. I get 90 oxycodone tabs a month and the written script says take 1-2 every 4-6 hours as needed. To do that, I would need 4 times the amount of pills I am given. In actuality, I am alotted 3 pills per day (90 pills divided by 30 days equal 3 pills per day). I often take less on certain days and can therefore flex and take 4 or 5 on the days that I need more but I must balance out at the end of the month. So the nurses are taking the qty and dividing it by 30 days and that is how much you are allowed to take each day. The tramadol is written as a 90 qty supply just like my oxycodone so they expect you to take no more than 3 pills per day.
I know this ***** but this is one of the secret rules that they expect pain patients to figure out. As Dee said, you need to tell your doctor that you need to take 6 per day and therefore need 180 pills for 30 days. Repeated early refills on your prescriptions are going into your medical file and could be used against you in the future. Not trying to scare you in anyway, but I want you to know the truth. I always balance out at the end of the month such that I have never requested an early refill on any medication prescribed since starting pain management. If I am having issues with pain that isn't controlled with my normal dosage and/or frequency I talk to my doctor about it and he both increased the quantity and the dose since I started seeing him at the beginning of the year. He also agreed to a increase in strength but same quantity next month.
Most insurances won't allow you to fill meds before 28 days since the last fill...some are more strict and some are more lenient. It depends on the carrier. So that is what the nurses are referring to when they say 28 days. Since Tramadol is not a scheduled drug, the insurance company is giving you a free pass to early refills. You will run into a brick wall trying to do this with oxycodone or Vicodin even if the doctor gives you the refill...the insurance company or the pharmacist can refuse to fill it. In order to fill it, they may request to speak directly with your physician.
So you just need to talk with the doctor and tell him how many you need to take per day and ask him to make sure you have enough pills to be able to take the same amount every day for 30 days.
There's still a part that doesn't make sense. When I was taking hydrocodone, my prescription said one every four to six hours, not to exceed five in a day, and my prescription was for 150 pills for a month. I think the problem lies in how her doctor has written it. She is following directions, but let's say she only took the minimum of four per day. She would still only have enough medicine to last her for 22 days with 2 pills left over. I would think that at the very least the minimum dosage would cover a full 30 days. Anyone would be confused, or at least I would be. It doesn't sound like he explained that her medicine should last 30 days. We aren't mind readers and I can understand the OP's frustration.
I definitely agree she should schedule an appointment and talk to her doctor because you're right, that many calls and "early" refills will send up warning flags.
I totally understand your frustration and it is very confusing unfortunately that is what is going on in pain management. We shouldn't have to be mind readers nor do other circus type acts in pain management but this is how it is. They do expect us to read their minds or in other words figure out how to make our pills last for a month when the written script says we don't have enough pills to follow the written directions.
Important thing to remember is that if the script says "as needed", most doctors don't expect them to be taken at the maximum amount everyday. Furthermore, they are assuming that some days will be worse than others. So if a patient takes 2 pills 5 out of 7 days of the week and the qty on the bottle balances out to 3 per day for 30 days, the patient on the 6th day of the week has 5 extra pills. If the patient is out in the yard doing yard work and has tons of pain that day and needs to take more, the patient now has 5 extra pills plus the 3 already alotted for that day. This is when the written instructions come into play to let the patient know what is the safe maximum dosage that can be taken. In the case of Tramadol, it is 8 pills per day. So if the patient had 9 pills that could be taken and still balance out at the end of the month, only 8 could be taken safely.
The most important thing out of all of these discussions, is for the original poster to make an appointment and sit down with her doctor to talk about her pain and let the doctor know that she needs a higher quantity of pills so that they last 30 days.
Many have come on this forum in the past complaining about this very same issue except it was percocet or vicodin that they were requesting early refills on and upon the first attempt of requesting an early refill, they were kicked out of pain management because they violated their contract. They were livid and tried contacting the clinic to tell them that they didn't understand that they had to make the pills last 30 days. The nurses at the clinic told them that unfortunately the contract is broken and there are no second chances.
So I just wanted to explain what the issue is and how to get it resolved. Some pain clinics are even strict with Tramadol, others aren't. It seems like the original poster's clinic is not strict as she has been able to get early refills previously on several occassions. But one day, the original poster may need vicodin, percocet, or a long acting opioid medication to effectively manage their pain. It is best to start following the rules now to prevent problems later on down the road.
I don't think this is fair at all. I agree with you on that 100%. But pain management isn't fair. Many have been thrown out over faulty drug tests and other ridiculous reasons that I think should have warranted a second chance. But with the DEA breathing down many doctors necks, second chances are very hard to come by.
I definitely agree that pain management isn't fair. I also agree she should definitely schedule an appointment and talk with her doctor about this. It's just that the dosage instructions are so convoluted. How is the average bear supposed to know these rules? Like I said, even at minimum dosage of four per day, she only has enough for 22 days. One would think the prescription would at least state the minimum dosage and include enough of it for a full 30 days. It is such a shame that people have to be such mind readers and jump through hoops to get the help and relief they need, and if they don't know these unspoken "rules" they can be labeled as drug seeking and be discharged. Very sad.
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