Can pharmacists legally change a doctor's prescription dosage form?

Answer 1

When a doctor writes a prescription, he usually can sign it either "substitution permitted" or "dispense as written". The usual "substitution" is dispensing a generic drug in place of a brand-name drug- this is the SAME chemical compound, approved by the FDA as being absorbed exactly like the brand-name drug. When a doctor writes a prescription for Viagra (active ingredient sildenafil citrate) and signs it as "substitution permitted", the pharmacist can then dispense generic sildenafil citrate in the same dosage, which saves the customer a lot of money. It's the same active ingredient in the same purity and concentration absorbed in the same way with the identical effects-only it's much much cheaper. The pharmacist can't be creative, change the dose or decide that he'll give you some different compound like Cialis (a different compound) to treat your erectile woes when making a substitution.

So no, the pharmacist doesn't have the liberty to dispense a different compound to you. He might give you the same thing in a generic form and not ask for your permission. However, since the brand name and the generic forms are chemically equivalent (NOT identical) , you are well within your right as the customer/patient who is purchasing it to specify that you DO want to receive brand name instead of generic formulations. It is no different from the choice which you are given readily in the pharmacy between, e.g. Bayer's Aspirin - the original brand - and Walmart aspirin. If the two products were absolutely identical why would a pharmacy even carry anything but the store brand aspirin?

It is often claimed that there is absolutely no reason not to choose generic drugs whenever they are available. This is far from a hard and fast rule. For one thing, generics are not required to be "identical" to the brand formulation, only equivalent which can me that you could receive something not exactly the same chemical version as the brand. For another thing, the FDA gives generic makers much, some would say too much leeway in assuring the amount of the active ingredient that is present in each pill or unit. Generic manufacturers are permitted to vary the active ingredient content to as low as 75% of the amount the brand name tablet has and as high as 125% and still be within accepted limits.

This variation from brand contents will not likely make a difference for most medications but it certainly will for drugs where very careful titration of blood levels of ceratin drugs are a life or death matter. A good example of this is a drug called Coumadin, known as warfarin as a generic. The acceptable level of Coumadin in your blood is an extremely narrow band - too little and your risk for stroke skyrockets - too much, and your chances of dying from internal bleeding grows exponentially. Indeed, is is so important to keep the levels correct that people who take this drug must have their blood levels tested anywhere from 1 to 4 times every single month.

The problem with warfarin isn't just the difference between brand Coumadin and generic warfarin. That's because , like most generics, sometimes 2,3 5 or 10 different companies make their own formulation of generic. And because pharmacies are free to use the generic versions made by any authorized manufacturer, a patient can often be jumped from one month to the next with different generics of the "same' drug. Only each manufacturer operates with the same latitude of including from 75% to 125% of the active ingredient making for a constantly moving dosage that is next to impossible to keep standard levels of in the blood.

Some people liken the difference between brand name and generic as akin to the difference between Coke and Pepsi. Coumadin is but one example of many, particularly pain medications or medications absorbed through the skin where variations in formulation can and does have a huge potential for compromising the patient's health either through skin delivery systems or through stomach absorption.

Answer 2

The doctor writes the dosage based on his/her knowledge of the patients situation and medical history, which the pharamcist is not privy to, nor is qualified to make that judgment.

A pharmacist cannot legally change any part of a prescription without the doctor's permission to do so. The pharmacist can get the doctor's permission by phone, fax, or by email, and the permission to change has to be followed up with a signed prescription from the prescribing doctor.

If a pharmacist violates this industry and profession standard, which is also a LAW, he/she can lose their license.

NOTE: Unless a doctor writes "As written" or wording to that effect, the ONLY thing a pharmacist can do, legally and per industry norms, is to SUBSTITUTE a generic for the brand name of a drug. Most prescription plans do not pay for brand name drugs. But this is the ONLY thing pharmacists can do.

Answer 3

No. The prescription is written as a certain strength based on medical findings. Some medications are written to enhance the benefits of another medication. The pharmacist does not have the same education as a specialist/doctor. To change the dosage of a medication is to put a patient in jeopardy of relapse or harm.