How soon is too soon?

[shortney25]

My fiance was in a terrible car wreck several years ago and broke his collar bone and several other bones. His doctor has been prescribing him Vicodin (generic version, Hydrocodone?) ever since. He gets 160 a month 1-2 pills every 6 hours, up to 8 a day. If he has one refill left on this particular script and last got it filled on August 14th, what is the earliest date they can refill it? We always go to Walmart for all our meds and some months they've filled it nearly 1-2 weeks early. I just ask because he is going to run out early this month and do not want to send up any red flags with the doctor or pharmacy. He is taking them as prescribed, not abusing them. He usually takes 1-3 a day, but has had to take more this month due to an increase in pain. Any help or knowledge on this situation is appreciated.

[skmedlin27703]

Sometimes it depends on the insurance, some drugs can be filled earlier than others and it varies from state to state. You can call the insurance company and have them run a test claim... or call the pharmacy & ask when his refill date is... they will tell you the soonest he can refill... a tech would prob answer and not think twice unless you sound nervous or act strange... just be calm and a matter-a-fact... my doc writes "DO NOT FILL UNTIL" date on my rx so I cannot even fill mine a day early... others are more flexible... good luck.

[geminigirl1963]

I'm sorry your fiance is having more pain.

Realistically, if he was taking the maximum 8 per day, every day, a script of 160 pills would last 20 days.  Some pharmacies will do a refill one or two days early (also depends on the insurance).  I have NEVER heard of one doing a refill 1-2 WEEKS early.  My question about that is - WHY would you even attempt to get a refill 1-2 weeks early if he's taking the meds exactly as prescribed?  There are a couple of things that "flag" that comment to me (and may also to a pharmacist or doctor) - a) if he's taking the meds as prescribed, there is no reason to request a refill 1-2 weeks early b) even if they did fill it 1-2 weeks early, and he's taking them as prescribed, that would mean he actually would be 1-2 weeks' worth of medication ahead (would have an extra 1-2 weeks of medication on hand).  Therefore, if he's going to be running out early this month, has he also gone through that additional 1-2 weeks' worth of meds or has he run out early in the past and that was the reasoning for such an early refill?

I completely agree with him calling his doctor and explaining that he's had an increase in pain.  He needs to be 100% honest with his doctor as to how much of the medication he is taking.  One concern is, if the vicodin he is taking has 500mg of tylenol in each tablet and he takes the 8 per day that he is permitted, it is at the maximum daily amount of acetaminophen.  So therefore, if he has increased the number of pills he is taking a day, that is also increasing the amount of acetaminophen he is getting.  While it's not good to take more narcotic than prescribed, sometimes the taking more of the acetaminophen than the maximum daily dose can be even worse.  Acetaminophen overuse can cause serious liver damage and most of the time you don't experience any symptoms of this damage until it is too late and the damage is too severe.

To me, it sounds like if the 8 vicodin per day that he is allowed is no longer sufficiently controlling his pain, he may benefit from a long-acting medication to replace the vicodin, which is short acting.  A long acting medication will give him a more steady flow of pain relief so he won't experience the peaks and valleys of pain control.  Many doctors will prescribe a short acting medication to their patients who are on long-acting meds - for breakthrough pain - but many patients on long acting meds find that they either don't need to take the BT meds or their need for them is greatly reduced.

Definitely speak to his doctor a) about the amount of meds he's taking and b) see about sweitching to a long-acting med with something for breakthrough pain.

Best of luck.

[mellie4]

If he is only allowed to take 8 a day and he has taken more due to increased pain, then that's a red flag and he could be in trouble with his pain team.  Always call and ask if your meds aren't working.  I have had to call in the past, and they always give the okay to add more (take 2 instead of 1) and then when it comes time for the refill, she'll write it slightly different for the next scrip.  My team doesn't like you to take even one extra as it is seen as a violation of the contract.

I think I would come clean to them about the pain being bad and that you ran out early and see what she says.  Ask to have them reevaluate the pain, as he may be undermedicated.  Hopefully be upfront will ease any problems you could run into.