Has anyone had problems obtaining their lorazepam (Ativan) medication from the pharmacist?
I went to Walmart on Wednesday to pick up my lorazepam. My usual dose since January had been 1.5 mg (3 x 0.5 mg pills) per night to help me get through the bone pain from the medication and, at that time, the recuperation from my spine surgery for my L3 90% compressed disk.
In August, I took, with the ok from the doctor, 4 x 0.50 mg tablets at night because of the problem I was having from the itch/rash and the bone pain from starting up the Velcade. (See the forum thread about my stem cell transplant for information about my post-transplant itch.) When I went to pick up the medications at Walmart, the pharmacist acted like was an abuser since I needed a refill earlier than normal, and refused to fill it and acted like I had done something wrong.
The doctor called Walmart to explain that he approved the earlier refill, but the pharmacist still would not fill until this Tuesday.
Without the medication, I am back to sleeping one hour or 1 1/2 hours and waking up because I itch.
Any suggestions are appreciated.
Forums
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Aclinkboca - Name: AC
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Dec 2015
- Age at diagnosis: 46
Re: Difficulty getting Ativan (lorazepam) prescription fille
Hi AC.
Sorry you are without the lorazepam. Might I suggest that you ask the on call doctor to try to call the pharmacist tomorrow and explain the situation in detail? With luck you'll get a different pharmacist.
I am a primary care doctor and my husband has myeloma and used lorazepam from December 2015 through his transplant in June (0.5 - 2 mg / night) but was without complications and able to stop it in June. He starts dexamethasone with maintenance chemo next week at day 100. The first thing we filled was the lorazepam. It does lead to some habituation and dependence over time, but that was the least of our concerns.
The pharmacist is misguidedly worried about abuse and dependence and has corporate guidelines and hoops that he or she needs to clear. Walgreens lost a multi-million dollar judgment over over-prescribing in 2014, and the government has become increasingly concerned and supervisory with regard to controlled medications. You are the unfortunate victim of this new heightened scrutiny.
As a prescriber, I have to keep detailed records, which include drug testing, prescription reports (CURES reports), and prescription history. A note on the prescription detailing a dose increase would usually satisfy the pharmacist.
If not, I'd recommend playing the cancer card. A pharmacist that cannot understand your situation is frankly a pretty poor pharmacist and your dose is not excessive.
In general, whenever a doctor increases a controlled medication, he or she should inform the pharmacy to avoid the problems you are facing.
I hope you get your prescription tomorrow and this is just another illogical bump in your path to wellness. I hope you will laugh about this all someday - as we plan to.
rick
Sorry you are without the lorazepam. Might I suggest that you ask the on call doctor to try to call the pharmacist tomorrow and explain the situation in detail? With luck you'll get a different pharmacist.
I am a primary care doctor and my husband has myeloma and used lorazepam from December 2015 through his transplant in June (0.5 - 2 mg / night) but was without complications and able to stop it in June. He starts dexamethasone with maintenance chemo next week at day 100. The first thing we filled was the lorazepam. It does lead to some habituation and dependence over time, but that was the least of our concerns.
The pharmacist is misguidedly worried about abuse and dependence and has corporate guidelines and hoops that he or she needs to clear. Walgreens lost a multi-million dollar judgment over over-prescribing in 2014, and the government has become increasingly concerned and supervisory with regard to controlled medications. You are the unfortunate victim of this new heightened scrutiny.
As a prescriber, I have to keep detailed records, which include drug testing, prescription reports (CURES reports), and prescription history. A note on the prescription detailing a dose increase would usually satisfy the pharmacist.
If not, I'd recommend playing the cancer card. A pharmacist that cannot understand your situation is frankly a pretty poor pharmacist and your dose is not excessive.
In general, whenever a doctor increases a controlled medication, he or she should inform the pharmacy to avoid the problems you are facing.
I hope you get your prescription tomorrow and this is just another illogical bump in your path to wellness. I hope you will laugh about this all someday - as we plan to.
rick
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rick - Name: rick
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: nov 2015
- Age at diagnosis: 50
Re: Difficulty getting Ativan (lorazepam) prescription fille
I sympathize with your situation.
However, I often deal with the flip side of this situation, as I manage the affairs of a mentally disabled adult who will try everything possible to secure extra prescriptions or early refills for benzodiazepines and related drugs so that he can totally "check out" for days and weeks at a time. If he can abuse a drug, he unfortunately will. benzodiazepines like lorazepam are especially alluring and very addictive to abusers and have screwed up many a person's life. I have been thankful when doctors, pharmacists, and other professionals have called my managee to the carpet when he attempts to abuse the system. Unfortunately, while you have a very legit reason for obtaining your prescription, you have been caught up in a system that is rife with folks who abuse various prescription drugs.
However, I often deal with the flip side of this situation, as I manage the affairs of a mentally disabled adult who will try everything possible to secure extra prescriptions or early refills for benzodiazepines and related drugs so that he can totally "check out" for days and weeks at a time. If he can abuse a drug, he unfortunately will. benzodiazepines like lorazepam are especially alluring and very addictive to abusers and have screwed up many a person's life. I have been thankful when doctors, pharmacists, and other professionals have called my managee to the carpet when he attempts to abuse the system. Unfortunately, while you have a very legit reason for obtaining your prescription, you have been caught up in a system that is rife with folks who abuse various prescription drugs.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Difficulty getting Ativan (lorazepam) prescription fille
Hi Aclinkboca,
I hope that you can get your prescription filled where you sent it, but if not, ask your doctor if he or she works with another pharmacy to fill prescriptions. There may be more of a personal relationship there, and the pharmacists would know your doctor and could call if they had a concern too.
Of course, there are problems with the abuse of prescription drugs, but your situation would not fall into that category.
Good luck!
I hope that you can get your prescription filled where you sent it, but if not, ask your doctor if he or she works with another pharmacy to fill prescriptions. There may be more of a personal relationship there, and the pharmacists would know your doctor and could call if they had a concern too.
Of course, there are problems with the abuse of prescription drugs, but your situation would not fall into that category.
Good luck!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Difficulty getting Ativan (lorazepam) prescription fille
Last week, when I visited my hematologist to discuss the results of my first round of chemotherapy, I had the opportunity to report on the side effects of my cyclophosphamide, Velcade, and dexamethasone (CyBorD) treatment regimen. Amongst those side effects is sleeplessness due to the dexamethasone. My hematologist was firmly in favour of my taking some medicine to help with that symptom. She said, “Not sleeping well is harmful to your health.”
She also said she would have preferred prescribing zopiclone (Imovane, Zimovane) instead of lorazepam (Ativan). Although zopliclone has concerns similar to those of lorazepam, my hematologist thinks it is more effective than lorazepam. But after I explained that I had had sleep walking and sleep cooking episodes with zopliclone years ago, she quickly agreed to prescribing lorazepam with instructions to “use as needed.” She had no problems whatsoever.
I intend to keep good records as to when and how much of my lorazepam I end up using. I will do this because I certainly don’t want to find myself dependent upon a benzodiazepine. I would hope that my pharmacist, or one of my doctors, would be able to advise me on whether I was taking too much if that were to occur.
I found it very surprising for a pharmacist to not fill a prescription, especially without checking with the prescribing physician. I realize pharmacists can provide an essential service in keeping tabs on what drugs we are taking, but I think they can overstep their bounds if they deny service when it is needed. If such a thing happened to me, I would tell pharmacist to consult with the prescribing doctor and remind him (politely, of course) of his ethical duties to a patient.
Joe
She also said she would have preferred prescribing zopiclone (Imovane, Zimovane) instead of lorazepam (Ativan). Although zopliclone has concerns similar to those of lorazepam, my hematologist thinks it is more effective than lorazepam. But after I explained that I had had sleep walking and sleep cooking episodes with zopliclone years ago, she quickly agreed to prescribing lorazepam with instructions to “use as needed.” She had no problems whatsoever.
I intend to keep good records as to when and how much of my lorazepam I end up using. I will do this because I certainly don’t want to find myself dependent upon a benzodiazepine. I would hope that my pharmacist, or one of my doctors, would be able to advise me on whether I was taking too much if that were to occur.
I found it very surprising for a pharmacist to not fill a prescription, especially without checking with the prescribing physician. I realize pharmacists can provide an essential service in keeping tabs on what drugs we are taking, but I think they can overstep their bounds if they deny service when it is needed. If such a thing happened to me, I would tell pharmacist to consult with the prescribing doctor and remind him (politely, of course) of his ethical duties to a patient.
Joe
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Wobbles - Name: Joe
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: June 2016
- Age at diagnosis: 67
Re: Difficulty getting Ativan (lorazepam) prescription fille
Thank you everyone for the comments.
I have not been able to receive a refill. I called the on-call physician, who told me that on the weekends, there was nothing that he could do because I needed a paper prescription in Florida. He told me he could not just call in another prescription to another pharmacy. During this weekend, I have continued not able to sleep and I also have continuous headaches during the day. I am trying my best to make it through until Tuesday when I go for my weekly Velcade and can talk directly with a doctor.
My doctor's called in on Friday around 4 p.m. Eastern Time to talk with the pharmacist and told the pharmacist at Walmart that he authorized me to take more in August due to complications from a stem cell transplant and that I had multiple myeloma. That is the part that shocked me the most, because I understand – as others wrote – about safeguarding the people that are abusing drugs and other patients that might have a mental disease where it would not be appropriate for a pharmacist to refill the lorazepam.
When the pharmacist first told me I needed to have the doctor call to approve the early refill, I did not have a problem at all. It was after my doctor talked with the pharmacist that I still do not understand how a pharmacist, after hearing a doctor personally, could refuse to fill it.
The end result is that the pharmacist who refused to refill and is supposed to have an ethical duty to the patients has placed me in more danger from stopping the medicine all the sudden and not being able to sleep.
AC
I have not been able to receive a refill. I called the on-call physician, who told me that on the weekends, there was nothing that he could do because I needed a paper prescription in Florida. He told me he could not just call in another prescription to another pharmacy. During this weekend, I have continued not able to sleep and I also have continuous headaches during the day. I am trying my best to make it through until Tuesday when I go for my weekly Velcade and can talk directly with a doctor.
My doctor's called in on Friday around 4 p.m. Eastern Time to talk with the pharmacist and told the pharmacist at Walmart that he authorized me to take more in August due to complications from a stem cell transplant and that I had multiple myeloma. That is the part that shocked me the most, because I understand – as others wrote – about safeguarding the people that are abusing drugs and other patients that might have a mental disease where it would not be appropriate for a pharmacist to refill the lorazepam.
When the pharmacist first told me I needed to have the doctor call to approve the early refill, I did not have a problem at all. It was after my doctor talked with the pharmacist that I still do not understand how a pharmacist, after hearing a doctor personally, could refuse to fill it.
The end result is that the pharmacist who refused to refill and is supposed to have an ethical duty to the patients has placed me in more danger from stopping the medicine all the sudden and not being able to sleep.
AC
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Aclinkboca - Name: AC
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Dec 2015
- Age at diagnosis: 46
Re: Difficulty getting Ativan (lorazepam) prescription fille
Nevermind getting it filled, good luck even getting a prescription if you live in Massachusetts. My nurse practitioner (NP) at Dana Farber said she won't write prescriptions for it anymore, I am to take Benadryl (diphenhydramine). The Benadryl does not work on dex insomnia, at least for me.
I asked my doctor and he said he would continue to write prescriptions for Ativan. I see the doctor every 3 months, NP the other months. Hopefully, the script and quantity I get from the doctor will take me through 3 months. I can't sleep the nights I take dexamethasone, so I like the 0.5 mg Ativan on those 2 nights each week. With the Ativan I can usually get 4 good hours in even on the dex.
There is a big drug abuse problem in Massachusetts, so I guess there is a "crack down" on all controlled substances. I think it's sad that cancer patients who might really need these drugs can no longer get them. I've used the Ativan for over 4 years on-and-off and never had an abuse or addiction problem with it. If I could get rid of the dex in the chemo regimen, I wouldn't have the insomnia issue, and I wouldn't even have to ask for it.
I asked my doctor and he said he would continue to write prescriptions for Ativan. I see the doctor every 3 months, NP the other months. Hopefully, the script and quantity I get from the doctor will take me through 3 months. I can't sleep the nights I take dexamethasone, so I like the 0.5 mg Ativan on those 2 nights each week. With the Ativan I can usually get 4 good hours in even on the dex.
There is a big drug abuse problem in Massachusetts, so I guess there is a "crack down" on all controlled substances. I think it's sad that cancer patients who might really need these drugs can no longer get them. I've used the Ativan for over 4 years on-and-off and never had an abuse or addiction problem with it. If I could get rid of the dex in the chemo regimen, I wouldn't have the insomnia issue, and I wouldn't even have to ask for it.
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Melpen - Name: Melissa
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Feb 5, 2014
- Age at diagnosis: 57
Re: Difficulty getting Ativan (lorazepam) prescription fille
Sorry to hear about your medication dilemma. Been through that myself.
In the meantime, you might want to try OTC meds like Benadryl for your itching. Both oral and lotion may help.
Benadryl can also help make you sleepy.
Best,
Steve
In the meantime, you might want to try OTC meds like Benadryl for your itching. Both oral and lotion may help.
Benadryl can also help make you sleepy.
Best,
Steve
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Steve - Name: Steve
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: December 2009
- Age at diagnosis: 55
Re: Difficulty getting Ativan (lorazepam) prescription fille
In an effort to help others so the don’t have to go through what I went through this week, I contacted the DEA and Florida Board of Pharmacy and talked with the Executive Director, who actually was able to work with the pharmacy today to get my prescription refilled.
There appears to be confusion on the lorazepam on all levels after hearing what the pharmacist told me after the true legal facts from the DEA and Board of Pharmacy. I was told that all the rules and regulations that the pharmacy is talking about do not exist. In the State of Florida, lorazepam is a Schedule IV drug, not a Schedule II drug as the pharmacist claimed.
Being a Schedule IV drug, the restrictions under the DEA and State allow for refills and also allow for early refills. I think that a lot of pharmacies tell customers this is a Class II that does have the strict regulations when it's actually a Class IV.
In Florida, a doctor can authorize 6 refills for Class IV. I am providing the information below that the DEA sent me. Under DEA regulations, the Class IV can be filled early and earlier than that if authorized by a doctor.
Lorazepam DEA and Pharmacy Regulations According to the DEA:
Schedule IV Substances Substances in this schedule have a lower potential for abuse relative to substances in Schedule III. Examples of a Schedule IV narcotics include propoxyphene (Darvon® and Darvocet-N 100®). Other Schedule IV substances include alprazolam (Xanax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).
Schedule III and IV controlled substances may be refilled if authorized on the prescription. However, the prescription may only be refilled up to five times within six months after the date on which the prescription was issued. After five refills or after six months, whichever occurs first, a new prescription is required.
A prescription for controlled substances in Schedules III, IV, and V issued by a practitioner, may be communicated either orally, in writing, or by facsimile to the pharmacist, and may be refilled if so authorized on the prescription or by call-in.
Facsimile Prescriptions for Schedule III-V Substances Prescriptions for Schedules III-V controlled substances may be transmitted by facsimile from the practitioner or an employee or agent of the individual practitioner to the dispensing pharmacy. The facsimile is considered to be equivalent to an original prescription.
Telephone Authorization for Schedule III-V Prescriptions A pharmacist may dispense a controlled substance listed in Schedule III, IV, or V pursuant to an oral prescription made by an individual practitioner and promptly reduced to writing by the pharmacist containing all information required for a valid prescription, except for the signature of the practitioner.
I hope that this information can help anybody else that might go through the problems I had in the future.
Anthony
There appears to be confusion on the lorazepam on all levels after hearing what the pharmacist told me after the true legal facts from the DEA and Board of Pharmacy. I was told that all the rules and regulations that the pharmacy is talking about do not exist. In the State of Florida, lorazepam is a Schedule IV drug, not a Schedule II drug as the pharmacist claimed.
Being a Schedule IV drug, the restrictions under the DEA and State allow for refills and also allow for early refills. I think that a lot of pharmacies tell customers this is a Class II that does have the strict regulations when it's actually a Class IV.
In Florida, a doctor can authorize 6 refills for Class IV. I am providing the information below that the DEA sent me. Under DEA regulations, the Class IV can be filled early and earlier than that if authorized by a doctor.
Lorazepam DEA and Pharmacy Regulations According to the DEA:
Schedule IV Substances Substances in this schedule have a lower potential for abuse relative to substances in Schedule III. Examples of a Schedule IV narcotics include propoxyphene (Darvon® and Darvocet-N 100®). Other Schedule IV substances include alprazolam (Xanax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).
Schedule III and IV controlled substances may be refilled if authorized on the prescription. However, the prescription may only be refilled up to five times within six months after the date on which the prescription was issued. After five refills or after six months, whichever occurs first, a new prescription is required.
A prescription for controlled substances in Schedules III, IV, and V issued by a practitioner, may be communicated either orally, in writing, or by facsimile to the pharmacist, and may be refilled if so authorized on the prescription or by call-in.
Facsimile Prescriptions for Schedule III-V Substances Prescriptions for Schedules III-V controlled substances may be transmitted by facsimile from the practitioner or an employee or agent of the individual practitioner to the dispensing pharmacy. The facsimile is considered to be equivalent to an original prescription.
Telephone Authorization for Schedule III-V Prescriptions A pharmacist may dispense a controlled substance listed in Schedule III, IV, or V pursuant to an oral prescription made by an individual practitioner and promptly reduced to writing by the pharmacist containing all information required for a valid prescription, except for the signature of the practitioner.
I hope that this information can help anybody else that might go through the problems I had in the future.
Anthony
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Aclinkboca - Name: AC
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Dec 2015
- Age at diagnosis: 46
Re: Difficulty getting Ativan (lorazepam) prescription fille
To everyone here who responded and are having the same issues: Please read my post on the facts from the DEA. These facts are the same for all 50 states and override any state regulation.
What is important to note is that the script can provide for refills up to 5 months, and that alone will help others from what I am reading based on what was posted in this topic. The other item is that the DEA said Class IV drugs like Ativan have not early refill window. '
The DEA allows for a 72-hour emergency refill, meaning 72 hours worth of Ativan for anything where they need to contact the doctor to confirm the prescription. The DEA placed the 72-hour emergency into their statutes to assist patients like myself and I am sure others.
I talked to a senior investigator for the DEA in Florida. Good luck to others going through the same. In Florida, the Executive Director helped me obtain mine today, helping me avoid having to wait until the end of the week.
"Just Keep Swimming!"
Anthony
What is important to note is that the script can provide for refills up to 5 months, and that alone will help others from what I am reading based on what was posted in this topic. The other item is that the DEA said Class IV drugs like Ativan have not early refill window. '
The DEA allows for a 72-hour emergency refill, meaning 72 hours worth of Ativan for anything where they need to contact the doctor to confirm the prescription. The DEA placed the 72-hour emergency into their statutes to assist patients like myself and I am sure others.
I talked to a senior investigator for the DEA in Florida. Good luck to others going through the same. In Florida, the Executive Director helped me obtain mine today, helping me avoid having to wait until the end of the week.
"Just Keep Swimming!"
Anthony
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Aclinkboca - Name: AC
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Dec 2015
- Age at diagnosis: 46
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