drug-seeking behavior

February 19, 2009 9:58 AM

Can I ask my doctor to increase my dosage of a prescribed antibiotic based on studies I've read?

Yesterday my doctor recommended Rifaximin for SIBO. As far as I can tell, the FDA approved Rifaximin for travelers' diarrhea, and my doctor prescribed it at that dose (600mg/day for 3 days). According to two studies I've found, higher doses--like 1200-1600mg/day for 7 days--are significantly more effective.

It's not a systemic antibiotic, and the studies indicated side effects did not increase significantly at higher doses, so I want to go for it.

This doctor managed to misdiagnose me a year ago in an effort to get me into his IBS study, so I'd really like to be fully armed with facts before I talk to him about this. Is it okay for me to ask him to increase the dosage? Is he actually able to prescribe it at doses that high?

(He gave me the 3-day course entirely in samples, which strikes me as shady, but means he wouldn't need to prescribe quite as much.)

posted by anonymous to health & fitness (12 comments total)

Sure, why not?

You are the first, last, and best advocate for your own health. The doctor is a licensed source of expertise & prescriptions, but in no way is he an ultimate authority.

Bring the evidence with you. If he won't listen, find another doctor. OTOH, perhaps he will provide you with reasonable explanations why this isn't a good idea... but it all begins with communication.
posted by IAmBroom at 10:21 AM on February 19 [1 favorite has favorites]

BTW,
(He gave me the 3-day course entirely in samples, which strikes me as shady, but means he wouldn't need to prescribe quite as much.)

Time to quit staring in the proverbial gift horse's mouth. He was being nice to you & your pocket. Why on earth do free meds from a doctor seem suspicious to you?
posted by IAmBroom at 10:24 AM on February 19

Ditto IAmBoom: why not? you can ask your doctor anything, or should be able to; if your doc won't communicate then go elsewhere. The doc may or may not agree with you, then it's your choice whether to find another. Most doctors I know don't disregard their patients' input, but might have a better understanding of the pros and cons and whether or not to agree. As for free samples, I've been very appreciative when docs have saved my pocket that way.
posted by airplain at 10:31 AM on February 19

If you are this bitter, you need a new doctor.
posted by KAS at 10:43 AM on February 19 [2 favorites has favorites]

There really aren't any tests for IBS -- it's something diagnosed based on symptoms, not test results.

The best course, if you want a higher dose, is to outline your case, stating what you've read and why you think a higher dose is warranted. But you should also realize that those studies you've read are quite likely a very small sample of information that's out there, and that your doctor has undoubtedly read much more than you have. He has more facts than you on which to base a prescription. Outline your case, but accept the possibility that he might think it's a bad idea.

And if you're still distrustful of the guy, you should find a new doc.
posted by mudpuppie at 10:45 AM on February 19 [1 favorite has favorites]

I disagree with IAmBroom.

Yes, you are an advocate for your health. But, you hire a doctor because he's an expert in a field you are not. He's been to medical school, and so is (compared to someone who has not been) an authority in medicine. He's not just an on-demand prescription pad who annoyingly sits between you and all drugs.

Frankly, I'm suspicious of doctors who want my opinion more than they want to practice medicine. Anyone can google up a few articles, but doctors spend more time thinking about medicine in one day, than I will in years.

If you don't trust your doctor to keep up with the latest news, breakthroughs, and studies in medicine, and understand how those might apply to your unique biological conditions, it seems that you would want to find another doctor.
posted by Houstonian at 10:45 AM on February 19 [2 favorites has favorites]

If you don't trust your doctor to keep up with the latest news, breakthroughs, and studies in medicine, and understand how those might apply to your unique biological conditions, it seems that you would want to find another doctor.
Houstonian , you are assuming that every competent doctor out there has comprehensive knowledge of every pertinent piece of information out there. That's just naive.
posted by IAmBroom at 10:52 AM on February 19

My understanding is that if a med is prescribed off-label, it must be prescribed at the recommended dose for the approved indciation. So you can ask, but there may very well be guidelines preventing him from upping the dose.

IANAD!
posted by oh really at 11:29 AM on February 19

He can prescribe pretty much anything he wants (as long as it doesn't endanger you). However, insurance doesn't have to pay for it.

I think rifaximin can get expensive - it could cost a couple hundred bucks to get the high dose 7 day treatment. Your insurance might have limitations, like you have to do the 3 day low dose course first.

There is nothing shady about getting samples. Drug reps hand out samples to doctors all the time, and doctors use them routinely.

Personally, I would try the 3 day course. If it doesn't work, I would print out the studies and bring them to my next appointment and ask what he thinks of trying a longer, higher dose course.
posted by selfmedicating at 11:41 AM on February 19 [1 favorite has favorites]

Forgive me if I am suspicious of shiny presents from someone who neglected to run the appropriate tests before diagnosing me with IBS and shunting me into his IBS research study.
posted by moonlet at 1:32 PM on February 19 [+] [!]

If you are that uncomfortable with your doctor, change doctors. You should be able to respect and trust your doctor, not be this suspicious of him.

Fire him, let his office know why, and find a new one.
posted by SuzySmith at 11:59 AM on February 19

You should feel comfortable asking your doctor anything. Whether or not he decides to prescribe the higher dose, however, is his or her decision. Just because you want something done, it's ultimately the physician's responsibility if something goes wrong.

Also, I'll say it again: IBS is a clinical diagnosis, not a laboratory one. There are not tests to confirm it, just like there aren't tests to confirm migraines.
posted by gramcracker at 12:56 PM on February 19

Can I ask my doctor to . . .

What is it with people's deference to this particular profession? Can you imagine a similar post starting with "Can I ask my lawyer to . . ." or "Can I ask my architect to. . ."?

Tell him what you want.
posted by Neiltupper at 9:19 PM on February 19 [1 favorite has favorites]