Did my pharmacist rip me off?

May 25, 2005 7:28 PM

Did my pharmacist rip me off? The Codeine isn't working.

Yesterday, I got a prescription for the generic equivalent of Phenergan Syrup with Codeine (1 tsp doses of Promethazine and Codeine). I’ve had a codeine prescription before, and I remember it quickly got me out of sore throat/coughing hell and into a deep sleep in no time. This time around, I feel nothing and stay awake for hours on end. Is there a third-party way to have the bottle tested to see if the pharmacist omitted the narcotic portion? I’d hate to make a direct, false accusation.

posted by tfmm to Health & Fitness (18 answers total)

Call the pharmacy and read your post back to them. You are not making an accusation; you're merely inquiring as to the effectiveness of a prescription medication. In such a case, the pharmacy is the right place to start. If not satisfied, call your doctor.
posted by Doohickie at 7:39 PM on May 25, 2005

give it to someone who knows what they're doing is an option -- have them chug a bit and give you their impression.

FWIW codeine cough syrup won't really "fuck you up" with a regular dose. If you take three or four times the regular dose for syrup you might start feeling the codeine kick in -- was your previous codeine prescription in pill form?

also, I don't know about you, but opiates don't typically make me sleepy -- they make me wake up. Maybe last time there was something else added to your Rx that knocked you out?

can't help with the testing question, sorry.
posted by fishfucker at 7:41 PM on May 25, 2005

Response by poster: Actually, my most logical first step would probably be to ask the doctor how the syrup should affect me. I guess the only remaining question is: How often does stuff like this happen?
posted by tfmm at 7:47 PM on May 25, 2005

Best answer: Most prescription drugs are not compounded in the pharmacy, but are manufactured "ready to serve". So it's not too likely that your pharmacist actually mixed up a batch of cough syrup for you; s/he probably just measured out a certain volume of ready-made syrup for your prescription.

You don't say you're still coughing, so if that's been taken care of, it sounds like you may be getting the right dose of codeine. Are you taking anything else for your cold? Maybe that's keeping you awake. For example, the decongestant pseudoephedrine (sudafed) keeps me awake all night and makes my heart race, and even if it's combined with something that normally makes me very sleepy, the sudafed wins.

Make a list of what else you've been taking and ask your pharmacist if any of those things might be keeping you awake, before asking whether there was a mistake with the codeine dosage.
posted by Quietgal at 8:01 PM on May 25, 2005

As I live somewhere where codeine-based drugs don't require a prescription, I'll just put a word in about my experiences of it's effects.

Like others who have commented, codeine on it's own doesn't make me sleepy. If it's combined with pseudoephedrine as you might expect in a cough syrup, it definately won't make you sleepy. It's only when it's combined with something like doxylamine succinate in drugs like Mersyndol that it can knock you out (or if you take a huge dose).
posted by Jimbob at 8:18 PM on May 25, 2005

Aren't there some pharmacists lurking? I'm pretty sure that medicines like this are often compounded in the pharmacy. Anyway, that's still the first place to go with your question. It's not an accusation to say that the medicine treated you differently last time and you're wondering what could be up.
Perhaps the last medicine included an antihistamine of some sort.

FWIW, codeine itself didn't make me sleepy, but the relief of the pain was overwhelming enough that I got a sorta mini wave of euphoria and then fell asleep hard. Surprised by this reaction (since all packaging/looking stuff up indicated no sleepy factor) I tried a little of the leftover on a minor headache. Sure enough, no headache, but I didn't conk out like before.
posted by desuetude at 8:33 PM on May 25, 2005

Best answer: I'd be surprised if the pharmacist makes up the concoction themselves. Very. Unless they were in the middle of nowhere with no supplies for ages or in a developing country -- but even then, I'd think it highly unusual in this day and age.
I just wonder if your reaction to the medication on these different occasions can't be explained in other ways. Such as: were you sicker last time or more tired or had had less sleep or were particularly stressed by school/work such as to make you more susceptible to the effects? A normal dose of cough syrup codeine doesn't usually knock most of the population out. It has (I believe) some direct analgesic effects on the throat plus it provides a modest level of pain relief for a sore throat. I'd personally be more surprised if it made me drowsy.
on prev:
desuetude writes "the relief of the pain was overwhelming enough that I got a sorta mini wave of euphoria" Exactly -- and that's also tied to other drugs you may be taking, your general health level, tiredness and amount of sleep you've had. Questioning the codeine would be low on my list of things to think about as causing less success versus last time.
posted by peacay at 8:46 PM on May 25, 2005

FWIW, I shadowed in a hospital pharmacy last year and pretty much everything was pre-packaged as some members mentioned here- the pharmacist themselves had very little role in actually procuring the drugs for use.
posted by jmd82 at 8:52 PM on May 25, 2005

FWIW, if you're uncomfortable contacting the prescribing pharmacist, I've found that random pharmacists out of the phone book are generally very helpful when inquiring about medication. All of my prescription meds in the past few years have been grey-market/illegal, since I can't afford a doctor, and when I have questions as to effects/interactions/etc., I've called up pharmacists at random — they've been universally willing to tell me what they know.
posted by IshmaelGraves at 9:39 PM on May 25, 2005

Err, not the prescribing pharmacist, the pharmacist who filled the prescription, of course.
posted by IshmaelGraves at 9:40 PM on May 25, 2005

Does the bottle have Able Laboratory listed as the manufacturer? if so, you might want to see this.
posted by karmaville at 10:00 PM on May 25, 2005

tfmm, if the syrup contains only codeine, it will ease your cough, but without making you sleepy.

It was the promethazine component of the first syrup that made you sleep before.
posted by Ervin at 11:34 PM on May 25, 2005 [1 favorite]

I'm not sure that this bears exactly on tfmm's questions, but compounding RX is alive and well in the U.S. You just need a knowledgeable doctor and a decent pharmacy that does compounding.

Compounding can take medications and mix them into delivery mechanisms better suited to a patient. For pediatric patients in particular, most oral medications can be safely compounded into lollipop or suppository form, often a more convenient and safer delivery mechanism for the very young or invalid.

Additionally, compounding pharmacists can swap out medications to achieve a better result. For example, some severe pain sufferers do not handle Tylenol very well. Normal hydrocodone based pills come with at least 325mg of Tylenol. A compounder can swap that out with Advil, aspirin, or reduced Tylenol load.

This is all done in consultation with your doctor. It really is a wonderful service that few people are aware of in today's age of mega-pharmacys.

Check out a like http://www.pccarx.com/about_comp.asp that explains it better than I.
posted by PissOnYourParade at 11:37 PM on May 25, 2005

FWIW, codeine cough syrup is fairly common. It was almost definitely not compounded (although that is a remote possibility; at any rate your pharmacy should be able to tell you).
posted by neckro23 at 2:26 AM on May 26, 2005

When the doctor gave me codeine (combined with acetaminophen/paracetamol) I had been kept awake most of the time by my enormous and painful tonsils, so when the codeine got rid of the pain I slept (and snored) like gangbusters. I don't think the medicine itself had a big sleepy effect if any. It was definitely less sleepy effect than a dose of Nyquil.

So are you unable to sleep or do you just not have to sleep?
posted by TheOnlyCoolTim at 4:28 AM on May 26, 2005

For what it's worth, cough syrup with codeine used to ease my cough and knock me out, but over the past few years (and 3 or 4 different pharmacies) codeine has had no discernable effect on me or my cough. I assume the change is something physiological with me.
posted by jalexei at 7:02 AM on May 26, 2005

Are you still pooping? Then there might not be codeine in your cough syrup.
posted by kindall at 7:34 AM on May 26, 2005

As a doctor, I can say if one of my patients' prescriptions wasn't having the desired effect, or was having an undesired effect, I'd want to know about it immediately.

Call your doctor.
posted by ikkyu2 at 12:16 PM on May 26, 2005