4 week prescribing

cthornley Member Posts: 627
edited 2. Apr 2010, 11:31 in Living with Arthritis archive
I presume a few people have been effected by the new guidance on prescribing mtx for only 4 weeks at a time and I was wondering if anybody else was as annoyed by it as me?

Basically new guidance says that MTX (and some other drugs) should only be prescribed for a max of 4wks at a time this is because “it is recommended as good practice and to prevent any possible errors”
OK so they are looking out for patient safety ....well no, I fail to see how only prescribing for 4wks prevents errors,
According to the national patient safety agency most of the bad errors with MTX over the years have occurred in hospital or due to over prescribing the wrong amount
The only time I have had a prescribing error with MTX was when a locum tried to give me 20mg a day rather than a week........I picked up the mistake immediately and anyway if i’d waited 4weeks for it to have been picked up at the next prescription I would either be very ill or dead so 4wks doesn’t really work here.....my dr tried to tell me it was linked to monitoring...aha that makes more sense you say...but no it doesn’t because I have 2 monthly monitoring so surely at the minimum i should get 2monthly prescribing.
You may wonder why I’m so annoyed , my sister couldn’t understand why it bothered me so much until I explained
Until this ruling I used to get 3mths at a time...I am a stable patient, who has been on the drug 8 years, i’m monitored at the hospital, and have had no problems in this time
This was great as I already spend enough time at the hospital and gp’s now in addition to spending a couple of hours at the hospital every two months + my regular appointments (usually half a day )
I now have to book an appointment every month to see a gp to get a prescription and then go the chemist and get it filled (a minimum of 2.5hours if i’m lucky)
Its hard enough to hold down a full time job with RA without having to take huge amounts of time out of my working day to do this , the GP doesn’t work lunchtimes and I have a toddler fulltime so before and after work are a def no no. and they will not let me have my prescription on repeat due to the monitoring
I have an understanding boss but its difficult when I have to take this much time off when I’m well let alone when anything I need when i’m poorly

Surely a better approach would be not to blanket apply a RECOMMENDATION like this and to get a dr to apply their common sense on a case by case basis
I understand some people need keeping an eye on more than others and this will change over time and circumstances but regular review & decisions based on the individual would cover this...common sense and Dr education would seem a more valid approach to me

Sorry rant over ....just wish sometimes people would consider that my life is hard enough without them making it even more difficult


  • frogmorton
    frogmorton Member Posts: 27,376
    edited 30. Nov -1, 00:00
    Hi Cthronley


    You wrote that so well!!!

    How right you are too - wish those who decided this silly idea could read your post.

    2.5 hours to get essential meds :roll: unbeleivable :roll: Trying to do what they want too - work and not calim ESA - sorry but i am shaking my head form side to side on this one.

    Will be interestyed to see if this is happening to others


    Toni xx
  • gemmapetken
    gemmapetken Member Posts: 263
    edited 30. Nov -1, 00:00
    when i was on mtx i used to pop in to the gp surgery and get a repeat prescription every month. i have never been able to get 3 months~!!!

    is there any way you can ask for your gp to put mtx on your repeat prescription list so all you have to do is ask for it and they get the prescription for you?

  • abfab1963
    abfab1963 Member Posts: 41
    edited 30. Nov -1, 00:00
    I SO agree with you!! Good points indeed.

    I am fed up going to my doctors to fill out a repeat presciption request (We cant ring for a repeat prescription as it blocks the telephone lines!!) and then go back to collect the precription, 48 hours later and then take it to the chemist. My GP opening hours are 8.30 to 5.30 with possibly one or maybe 2 nights per week until 8.00 (NO set nights??) I work.....8.30 to 4.30......why are these things SO difficult.

    Im mature, sensible and capable of KNOWING what my medication should be, who do they make me get a prescription SO often.

    And another thing, as I am sure a lot of you are the same...getting bloods taken regularly..another nightmare for me!! 1st availble nurses appt is 9.20am.....and of course they cant keep the blood overnight......I WORK!!!!!

    Abfab has now climbed off her soapbox! :-)

  • Wonkylegs
    Wonkylegs Member Posts: 3,504
    edited 30. Nov -1, 00:00
    wonder if this is why the last delivery of MTX injections I received was only for 4 weeks supply :? :? when I used to get 8 weeks supply at a time :? :?

    It does seem ridiculous that the tablets are not on repeat - when I took tablets (years ago) mine usually were although I had to get the script directly from the doctor rather than the receptionist, but it only took a minute for them to hand it over.

    Hope you get them to see sense ..... why not write it all down like you did for us and send it to the Practice manager, and ask for their thoughts on the impact this has for you?

    good luck!
    Wonky xxx
  • salamander
    salamander Member Posts: 2,028
    edited 30. Nov -1, 00:00
    If you can get your prescription from your GP you are lucky! I have to ring the rheumy nurse at the hospital to ask for one, go to her clinic and pick up the prescription and the print out of my blood results and then down to the hospital pharmacy to wait for at least 40 mins for someone to ask me a billion questions, like a list of all my other medications, etc. Then I get it. Takes the whole morning. No-one is allowed to prescribe Mtx without viewing blood results now. There is supposed to be a 'shared care' protocol but it isn't working yet. The hospital is supposed to be able to send blood results to GP so she can prescribe but they don't do it. This is what I've been told. Forgot to say, I have to go to the hospital to get bloods done too. So, to get my prescription requires at least two visits a month. Never mind all the other appointments I have there. Reckon I go once a week. If I had an employer it would be really hard to do. Am going to ask if I can get my bloods done at my gp but then the rheumy won't have them! You'd think, in the days of computerization, it would be a cinch to sort this out but no way! They want to build a million dollar database but can't manage to send each the results of my bloods tests. It's unbelievable really. Rant over!
  • ichabod6
    ichabod6 Member Posts: 963
    edited 30. Nov -1, 00:00
    I think I have it very easy.
    I can order a repeat prescription by answerphone from my gp
    and then freephone the pharmacy who collect the prescription, make it up and then deliver all within 48 hours.
    As for the new guidance surely the intelligent and worldly wise
    rheumatology consultant who prescribes the medication has enough wit and nounce to decide if a patient is likely to misuse a medication
    by accident or design and the gp with similar attributes who has the day to day overview of our treatment can make a similar decision.
    Who decides that "guidance" is necessary'
    I empatise totally with jt.
  • ichabod6
    ichabod6 Member Posts: 963
    edited 30. Nov -1, 00:00
    I forgot to mention this - a minor moan.
    My current weekly dosage of methotrexate is 25 mg which J take orally. Both my consultant and gp confirm that 10mg tablets are produced, but my chemist says 'guidelines' dictate he can only supply 2.5mg tablets which means every Tuesday morning I have to swallow ten of the little demons instead of three.
  • annie_mial
    annie_mial Member Posts: 5,818
    edited 30. Nov -1, 00:00
    I seem to be the lucky one - I get my bloods done at the GP's surgery, they get the results usually in 24 hrs. I ask for a repeat prescription when I go for the bloods, barring complications it is faxed to the chemists and I collect it 48 hours later.

    I've had delays only twice due to odd blood results, both resolved in a couple of days.

    The Rheumy can view my blood results on the computer, too.

    I really don't have a problem with taking the 10 tabs each week. They're small, so I just float 'em 5 at a time on a spoonful of gravy, swallow and done!

  • valval
    valval Member Posts: 15,897
    edited 30. Nov -1, 00:00
    well i for one agree with you it does my head in the meds i am on can get on repeat every 4 weeks no prob but it all the trailing up to gps(can get chemist to pick it up these days) after waiting 48 hours after ordering it then get meds why 4 weeks who decided that ,why not three months. do not see doc (well when blood pressure sorted) so what difference does it make. i take hrt get three months at a time but get charged for two items as there is two types of meds in the box what is that all about. i do pre pay but it gets me mad they treat us like children who can not be trusted why.
  • ichabod6
    ichabod6 Member Posts: 963
    edited 30. Nov -1, 00:00
    I like the gravy idea. Which?
  • annie_mial
    annie_mial Member Posts: 5,818
    edited 30. Nov -1, 00:00
    ichabod6 wrote:
    I like the gravy idea. Which?

    Not fussy myself........(sausage and mash with) onion gravy, beef stew gravy, gravy flavoured with mint sauce..........sometimes a thick soup, even.

    I do like to have a good meal with my MTX! I have other gastric issues and was really worried about the common nausea side-effect. Swallowing them in the middle of a proper meal seems to have worked for me............not had any nausea worth thinking about.

  • pluggathome
    pluggathome Member Posts: 171
    edited 30. Nov -1, 00:00
    I raised the question of MTX only being prescribed in 4 week scripts with my doctor.

    He said they were only doing four week scripts because of the risk of being sued by patients. He said what was happening is that some of them were not having their bloods taken so they were not being monitored, then getting really poorly and then blaming the doctors for not picking up that things were wrong.

    It's a great shame for those of us who are responsible and do what we need to when we need to and follow the rules.

    I am lucky in that my surgery does my bloods and I can get it on repeat and only have to see docs every 6 months for meds review (if only I went that long without having to see him!).

    My pharmacist is also really good, she picks up on any changes in doses etc and asks me if it's right.

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