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A glance at the Phase III results of Vertex's new painkiller VX-548

2024.02.03 08:58 Robert_Larsson A glance at the Phase III results of Vertex's new painkiller VX-548

A glance at the Phase III results of Vertex's new painkiller VX-548
TLDR: The painkiller VX-548 successfully concluded its Phase 3 trial in acute pain. Efficacy was as expected similar to Vicodin. Vertex will seek FDA approval in 2024. Potential future off-label use relevant to IBS patients.
Three days ago the long awaited top line results of the new painkiller VX-548 were presented to the public. Fortunately the results were positive and delivered as expected. To understand the results we should take a closer look at the top line data and approach it critically, putting the results into context and reflect upon what they could mean for IBS patients in the future.
Origins
Most of you will probably have seen our posts pertaining to the so called selective sodium channel blocker VX-548. As is usual for Vertex the drug has had several predecessors which produced multiple successful Phase 1 & 2 trials over the years. These substantiated that NaV1.8 indeed is a viable target for pain control in the clinic and that pharmacological relevant selectivity over other sodium channel subtypes can be achieved. Here are the Phase 2 results for the predecessor drug which was called VX-150:
  • Phase 2A in acute pain (scroll down to the table)
  • Phase 2B in acute pain (scroll down to "Outcome Measures" and look at number 2)
  • Phase 2 in neuropathic pain (scroll down to the table)
Eventually a possible food effect was observed and Vertex ended up trying out a few other candidates before putting VX-548 into clinical trials.
Results for VX-548
Finally we arrive at the Phase 3 approval trial of said drug. The trial was a randomized controlled trial with a Placebo and an active Vicodin (5mg hydrocodone + 325mg acetaminophen) arm for comparison. This Vicodin dose is considered standard of care and a decent painkiller for post surgical pain. VX-548 was administered orally with an initial dose of 100mg followed by 50mg every 12 hours (at 12, 24 and 36 hours after the first dose. The indication was acute post surgical pain in patients undergoing either Abdominoplasty or Bunionectomy. We will compare the results to the highest dose in the Phase 2 dose ranging studies as well to gain some perspective. The main measurement is the so called summed pain intensity difference over 48 hours (SPID48). In the table below you can see the summary from the Phase 2 & 3 trials in acute pain (higher score equals greater pain relief):
Results summary acute pain
Trial/ SPID48 Placebo Vicodin VX-548
Phase 2 AB 72.7 85.2 110.5
Phase 2 BU 101.0 115.6 137.8
Phase 3 AB 70.1 111.8 118.4
Phase 3 BU 70.6 120.1 99.9
\SPID48: Summed pain intensity difference over 48 hours*
\HD/APAP: Hydrocodone + Acetaminophen (Vicodin)*
\AB:* Abdominoplasty
\BU:* Bunionectomy
Phase 2 Source: https://investors.vrtx.com/news-releases/news-release-details/vertex-announces-statistically-significant-and-clinically
Phase 3 Source: https://investors.vrtx.com/news-releases/news-release-details/vertex-announces-positive-results-vx-548-phase-3-program
Side effects were mild to moderate without any serious adverse events in all of four trials.

Graphs comparing pain relief over 48 hours for the two main Phase 3 trials
Source: Vertex Pharmaceuticals
Source: Vertex Pharmaceuticals
Additionally Vertex performed an extended Phase 3 safety and effectiveness study in 256 patients, in a broad range of surgical and non-surgical moderate-to-severe acute pain conditions. Patients received an initial dose of 100mg of VX-548 followed by 50mg every 12 hours for up to 14 days. The results were as follows:
VX-548 was generally safe and well tolerated in this study. AEs were mostly mild or moderate, and there were no SAEs related to VX-548. The safety profile in this study was generally consistent with randomized, controlled Phase 3 studies with VX-548.
Patient perception of VX-548 effectiveness in treating pain as measured by a patient global assessment (PGA) at the end of treatment showed 83.2% of patients reporting VX-548 as good, very good, or excellent.
Source: https://investors.vrtx.com/news-releases/news-release-details/vertex-announces-positive-results-vx-548-phase-3-program
Neuropathic pain
Further we recently saw results for VX-548 in a Phase 2 trial in patients suffering from painful diabetic neuropathy, a type of chronic neuropathic pain of peripheral origin. The active arms in this study were compared to 100mg of Pregabalin three times daily for 12 weeks. The trial showed an average pain reduction of approximately 36-39% at week 12, which was equal to Pregabalin (see the press release). Safety showed only mild to moderate adverse events with no serious adverse events noted.
Interpretation
We can see that VX-548 significantly outperformed Placebo while rivaling Vicodin across trials. Indeed the Phase 2 result in the Bunionectomy trial raised some eyebrows due to a significant Placebo response. Looking at previous trials and comparing the Placebo responses put that issue to rest. This Phase 3 strengthens the observation again. With the additional Phase 3 extended safety trial and the data from the diabetic neuropathy study it seems likely that VX-548 is a new and effective painkiller with decent safety and efficacy. Vicodin at this dose provides serious pain relief for moderate pain but for severe acute pain you'd want to double or triple the dose. The fact that VX-548 rivaled Vicodin is something I would like to describe conservatively as "good". The fact that VX-548 was just about as efficacious as Pregabalin in the diabetic neuropath trial however, is something I would describe as "OK". The specific pain type does matter in relation to the MoA. Though new drugs tend to perform better closer to approval than over time, the active arms as comparisons are very helpful in gaining an insight into the quality of the result, well done Vertex. The one question mark I do have is that there was no clear dose response in the dose ranging Phase 2 trials. But as we only have the highest dose to compare to in this Phase 3 I fear we'll have to wait for an answer on that.
Overall this is good news. A new painkiller with a new mechanism of action is always important either as a replacement or as an addition to existing therapies. The fact that it seems to work in both acute pain and neuropathic pain only adds to its utility. The only criticism I've seen so far comes from biotech finance people, who point out that it did not beat Vicodin in efficacy. This has to do with the fact that insurance companies will make it hard for some to exchange their low price opioid prescription to a more expensive drug without significant added efficacy. This argument belongs to the investment perspective IMO and I don't find it particularly interesting for our discussion as it relates to share price rather than clinical utility. I find it astonishing that they believed VX-548 would beat Vicodin in the first place, especially if one has some experience looking at pain trials. Further I would add that most pain patients aren't pain free and in need of an additional drug to improve their QoL beyond the status quo. Since this is a sodium channel blocker it will be very interesting to see if it can potentiate already existing painkillers, especially opioids for which there is some animal data. The biggest news however is that patients who don't have many treatment options today might finally have one in the near future, which brings us to IBS.
Relevance to IBS
Opioids like Vicodin are not recommended for IBS and are really hard to get even for serve patients. Existing pain therapies are quite weak and the data not very convincing. If NaV1.8 turns out to be a clinically relevant target for IBS pain which evidence suggests it very well could be, then VX-548 might be applicable to us. The repurposing of drugs is how the vast majority of IBS treatments have landed in the guidelines. Although Vertex will seek approval for VX-548 later this year, it will take time to publish case reports in overlapping IBS patients, compassionate use attempts in serve patients and finally arrange the necessary trials to legitimize its use in moderate and perhaps even mild IBS patients. In time we'll hopefully have an answer. This is what the road ahead looks like and with some luck it begins sooner rather than later. The best case we can realistically hope for in my mind is that VX-548 becomes the Vicodin for visceral pain. This would mean serious efficacy to IBS patients who today have nothing even close to that effect size to treat their pain with. All in all this Phase 3 is good news no doubt about that.
Evolving Story
This is hopefully just the beginning of sodium channel blockers as new therapies for pain. There are many additional therapies in the pipeline and even Vertex is looking to continue to develop more molecules, which could be used synergistically to complement VX-548 by targeting NaV1.7&1.9 for example to achieve even great pain relief. An approval of VX-548 this year will aid funding of this continued endeavour greatly.
Second Opinion
After writing all of the above u/jmct16 sent me the following analysis which some of you might be interested to read as well. It's written by a well known journalist who tracks pain drugs and who seems to have made a similar assessment to mine, though I find it a bit sloppy to not take the Phase 2 trials into account šŸ˜‰
I hope you enjoyed this walkthrough. Have a great day and take care! -Robert
submitted by Robert_Larsson to IBSResearch [link] [comments]


2023.07.18 01:34 Secure_Fisherman_328 DPT Calls Surgeon's Office for a Dr. to Dr. Consult

I work as an RN in a VA hospital, so every single one of my pt's sees PT daily. Before I got further, I love PT. Seen many times were a pt was admitted with knee or ankle issues and the subsequent mobility limitations made ADL's so hard that they were admitted for failure to thrive and PT got enough mobility back to get them home to family instead of a skilled nursing facility.
Currently, I am staying with my mom who had a total knee replacement with secondary diagnosis of parkinsons, and a persistently high Morse Fall Scale. Day after discharge we had a home health RN case manager stop by the house and go over all the in home services that will be coming over the next 4 weeks. What days a CNA, RN, and PT would come through and such like that. RN completed a full med rec.
Below is a general accounting of what happened. Names have been changed to protect a full-fledged Noctor.
PT arrives introduces himself as Dr. Random Guy, I replied, "Nice to meet you Dr. Random." He replied, "I prefer Dr. Guy and I would like to start with a 'medical focused med rec'" I ask what that was and stated that he knew that the RN Case Manager did one a little bit ago, but that he needed to do a full one in case he needs to have a Dr. to Dr. discussion with the surgeon about medication management as, "sometimes orthopedic surgeons don't focus on what happens after surgery." At this point, I'm super excited to see where this goes and I was not disappointed.
Mom was on hydrocodone/APAP 5/325 1-tab QID PRN pre-op pain with a note in the directions to take "max 3,000mg APAP from all sources per 24 hours" printed on the label. Post surgery she is taking APAP 500mg 2-tab Q8 hours for 10 days, again with a note on the Rx label about max 3,000mg per 24 hours from all sources. All prescribed by the same surgeon and filled at same pharmacy.
PT starts going on how its very dangerous to be prescribed two drugs both with APAP and states there is a "Level-2 Drug Interaction" that he has to contact the surgeon about before he can start the hands on PT session. I offered him the pain med log that the office ask me to keep which showed only the scheduled APAP and stated that the Norco was for pre-op and we had oxycodone 5mg available for post-op pain.
Dr. Guy spent 20 full minutes on the phone trying to get the office staff to put him on the phone with the surgeon, for a "Dr to Dr discussion on medication therapy." Believe it or not the surgeon was in surgery and would not come out of a surgical suite to talk.
To his limited credit, the PT session was very through and the written plan is detailed and well written and we will be following it. Although, I won't leave my senior citizen mother alone for a therapy session with him.
TLDR: DPT wants to have a Dr to Dr discussion with a surgeon about meds that the surgeon prescribed.
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2022.12.18 18:15 Bailey85 Hemorrhoidectomy and painkillers.

Is it normal for a surgeon to write a prescription for Oxycodone/Acetaminophen 5-325MG every 4-6 hours for a procedure like this?
She originally wrote me a script for Hydrocodone-APAP 10-325 every 4-6 hours but that did virtually nothing for my pain.
Iā€™m in serious pain and Iā€™m kind of at a loss if I should call my surgeon back up and ask for something stronger or just go straight to the hospital and have them handle the pain for me.
My surgery was on the 15th and Iā€™ve only eaten 2 yogurts and maybe had 6 hours of sleep since then. I live in my tub now, the hot water does help with some of the pain but barely.
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2022.10.18 04:35 Ok-Resolution-1121 Generic Meds Inconsistency

Last week my PM doctor increased my dose of oxy/apap from 5/325 to 7.5/325. With docs permission I was taking 2 tablets twice a day and now doing the same with new meds. This dosage is working well and brings my pain down from an 8 to a 4 with both of my chronic conditions. My question though has to do with the different generic brands. When I was taking the 5ā€™s my new pharmacy had Rhodes (or RP) and they seemed to kick in fast and generally work pretty well. When I was switched to the 7.5ā€™s my new pharmacy didnā€™t have them in stock and couldnā€™t get this dose delivered in a timely manner with any generic brand. So I had the rx sent to my old pharmacy instead where it was filled with Mallincrodt. Iā€™ve never had a problem with Mallincrodt in the past but these donā€™t seem to work quite the same. Takes longer to kick in, makes me drowsy instead of energized, doesnā€™t ā€œfeelā€ as strong but still reduces pain about the same. If all generics are suppose to be equivelant then why the differences? Iā€™m starting to come to the conclusion that everyoneā€™s bodies are different and maybe we just process the different fillers in different ways. What are your experiences with this subject and do you have a favorite generic of Percocet and why? Thanks
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2022.10.01 20:46 Bubzoluck [SAR Saturday] Five finger salute!

[SAR Saturday] Five finger salute!
Week 4 of SAR Saturday! Last week we asked why the dose of acetaminophen is set at 325mg? After all, its a bit arbitrary that 325mg would be the number that this old medication would be set at when 300 a more natural number. Well here's the answer: acetaminophen was set at 325mg because it was the same dose as Aspirin which is 5 times the weight of a barley seed! How scientific right? Alright let me explain:

A diagram showing the connection between traditional weight systems. The italicized boxes show the weight system (Troy system for precious metals, apothecary for medicines, avoirdupois for the wool trade, etc.). On each line is a non-italicized unit which shows where those systems overlap.
  • Before the standardization using grams, milligrams, and other standard units, pharmacy used the traditional English Weight System. The base unit of the English Weight System was the grain which was the average weight of wheat or barley seeds as established in the Renaissance era. From there, larger and larger units were derived to represent larger and larger objects' averages. For example, one pound (which lb comes from the Greek libra) is equal to 7000 grains or 16 ounces (which is actually a Roman unit). 14 pounds was equal to 1 stone (st), a unit of measurement that is still used in England to this day. A hundredcounterweight (cwt) is 112lbs or 8st. 1 Ton is 20cwt or 2240lbs. Probably the most interesting one on there is the Clove or Nail which is equal to either 7lbs of wool or 8lbs of cheese.
    • So what does this have to do with Acetaminophen? Well when APAP was first marketed in either 1852 or 1877 (we don't know) but was definitely developed after the release and success of Aspirin. Aspirin was dosed in terms of grains and the standard dose was to give someone 5 grains of aspirin because you have five fingers (yes, seriously). When acetaminophen was released it too followed the same dosing of 5 grains. Eventually when the standard units were adopted in 1889 and became popular to use in pharmacy by 1920ish, the dose of acetaminophen swapped from 5 grains to 325 milligrams due to each grain being about 65mg. Yup, the dose we take is due to 5 seeds laying on a table. Congrats to the 5 people who got that question right! Congratulations to me for coming up with some red herrings to trick y'all ;)
Alright, now for the next question. We all know that hands are pretty amazing: you can pick stuff up, rotate them, bang tools together, make fire (caveman noises), and eat cake with them (Homer noises). So since you're so well aquainted with them, tell me which of the following facts are true:
View Poll
submitted by Bubzoluck to SAR_Med_Chem [link] [comments]


2021.12.10 07:19 Mandy1496 Methocarbamol + Oxycodone?

I do understand that the two interact but my specific question is: how long after taking oxycodone (and throwing it back up 30 mins later) can I take methocarbamol?
25 years old, female, 225 llbs, 5ā€™2, no alcohol, no recreational drugs.
I vaginally took Misoprostol 6.5 hours ago for a non-viable pregnancy, took Oxycod/APAP 5-325 roughly two hours in and threw it back up 30 mins after taking it. I did feel the effects but very slightly and for very little (maybe an hour). I am in pain again and want to know how soon I can take the Methocarbamol (750mg) I was just prescribed. Thank you in advance.
submitted by Mandy1496 to AskDocs [link] [comments]


2021.09.11 06:25 DiliciousCandy642C 888mg dxm

Setting: In my house with multiple family members home Friend's house with mom gone almost all day Second friend's house with family home Returning to my house at the end
Drugs: 888mg dxm poli, stolen vape, disposable blue razz fume, 3 energy drinks, hydrocodone with acetaminophen, and assorted stims on the side
Weight: approx 155lbs
Previous experience: weed, alcohol, dxm, dph, hydrocodone, dextroamphetamine, methylphenidate, caffeine, nicotine, gabapentin
Got a gallon of water to stay hydrated
11:15pm Just dosed
11:45pm Feeling small head high. Gonna grab a monster and plug in my vape
11:48pm Took a piss. No body high yet. Still very easy to walk up and down stairs. Got my monster
11:54pm Messing with shit on my computer to play music. Under a blanket with my dog. Can feel the effects slowly increasing. My movement feels slightly slower than usual.
12:11am I can see my pupils expanding when I snap people. Not very big rn. Barely noticeable. Small amounts of stomach pain.
12:17am Downstairs in the bathroom. Hoping this isn't how I spend the whole trip
12:23am Back upstairs. Anxious about the peak. Back in bed under blanket and scrolling through tiktok. Pupils now big enough to notice easily. Feeling somewhat dissociated. My thoughts have slowed down and become less complicated
12:38am Starting to get that light feeling. My eyes feeling strained. Sometimes I'll just stop and look around for a second
12:42am Going to lay down and listen to the playlist. Using shitty earbuds. Feeling great other than stomach issues. Have trash can incase of puke
12:47am Switching music to something more psychedelic
12:56am Spent 5 minutes trying to find a video talking about binaural beats so that I could remember the name of them
1am It's almost as if my brain slips into the realm of the music to listen more clearly. No closed eye visuals yet. When in deep focus on music I feel as though I'm not part of the world I'm in. It's extraordinary
1:06am I feel myself morphing into different shapes and items. I feel pasted onto the world. Like how you would copy and paste a word. I feel as though I'm floating across the surface of this existence, but stationary
1:09am This other world is so easy to manipulate. It flows and just exists. Not so rigid. As if everything there was meant to be. It's amazing. I can still discern that I took dxm and that the world is still going on around me. I have to leave my phone screen on because I'm using YouTube for music. I'm going to switch to SoundCloud for music
1:13am The music is humming. Almost whirring. Like powering up as laser. Sounds of nature in background. Struggling to use my phone
1:19am Changed music. Phone is looking slightly blurry, but just because my eyes are out of focus. Sounds similar to Subnautica noises. Pinging noises and splashing. High af
1:23am Seeing myself as water droplets. Falling underwater and meeting a point where 4 different pillar tips come together. Standing on Greek pillars
1:25am See myself soaring through a clear tube. Synchronizing with the pings of noise
The tube is shrouded in clouds and sitting a top a waterfall. With dark grey stones and rocks. At the bottom a hole a small pool. The pool is circular and spiny rocks surround one half. Pointing up and in. Diagonal
1:33am Music is getting super intense, but in a positive way. ƍ hear distorted sounds of my fan spinning in the background. It adds an amazing vibe. Sounds like a weed eater hitting mud. That hum
Distant maracas shaking noises
1:37am High af. Know I wouldn't walk right. Feeling super light. Stomach almost settled. I think I could still walk if I wanted to. Would look a bit weird, but I could
1:40am I move around like a drone in the other world. It's big swirling sweeps and movements. Not walking pace or way of doing things. I'm so high that I dripped my phone and had to backup a small amount to grab it.
1:43am Extremely dissociated. No ego death. Texting my girl. Definitely more emotionally open rn
1:45am So many different frequencies. There are hums, but they keep changing. It's amazing. I keep forgetting that I'm listening to music.
1:47am The ringing is super cool. Every little sound is so much different and better. As if I'm picking up on something that's out of reach for sober people. Using my hands feels zoomed out. There is a motor noise. I'm gonna switch the sound back
1:50am Everything feels small. My hands are the only thing that is normal size. I just sat up and feel so far removed. Fucking incredible. I love this. Other than the puke feeling
1:58am Went to piss downstairs. Had to struggle down and up the stairs. Being aware of robo walking while robo walking is so cool. My body keeps clinching up and my depth perception is gone. My bed looks 90ft off the ground if I look at it a certain way. Might try to find a show
2:01am Asked for movie recommendations and sitting upright with legs under blanket
2:08am My brain is fried. The noise that you hear when you put earbuds in is amplified so it's super open and static. I keep switching between worlds. 2 separate ways of thinking.
2:11am I'm sitting up and my phone is in my hands. Everything fades away when I focus on it. The background around the bed kinda dropoffs and becomes grey. The noise is just fan noises, but more static
2:13am Everything keeps getting even more disconnected and dissociated. It's the perfect thing for me
2:17am Screen blurring and body itches. I feel like I'm in my own world. Similar to an rpg. As if I'm a game of some sort
2:21am Bouta lay down and close my eyes. Trying to finish snapping my girl, but challenging in this state
2:25am So disphoric and dissociated. It's my favorite feeling of all time. As I type this I feel as though I am not myself. So fucking weird and crazy
2:27am Gonna finally lay down and listen to the music
2:31am So out of it I had to remind myself I am human
2:39am I think this is peak. My brain keeps jumping to do things then forgetting. Listening to juice wrld and chilling. I'm shaking softly and feeling like I'm gonna throw up. I'm super dissociated it feels like those aren't bad thing, but under the haze I can still control it
2:48am Feel like I'm losing control of it and need to go downstairs. Not sure if I can. I'm gonna try to get cash to move for better laying position
2:54am So mf high. Everything looks so small and elf like. The angles and shit are weird
2:57am It feels like being upright while dizzy and not being able to control anything
3:07am Still tweaking
3:11am Super itchy and listening juice wrld
3:21am Laying down. Under blanket. I feel like a doll. You could just put my limbs in any position and I would let you. So fucking weird. Imma get off my phone for once.
3:29am I'm vibrating and shaking. My dog has crawled further under the blanket. My head itches. I have to keep reminding myself I took dxm
3:38am I'm so out of it. The music pulls me in and pulls me further. To the other world
3:55am I'm still high af, but I think this is past peak. My head and neck itch like a mf. Been trying to scratch, but ik it'll just hurt when I come down
4:19am Music still on. Still very high
4:30am Disconnected from everything
7:15am Just we up. Still can't walk and an heavily under the influence
10:07am Can't walk straight and my pupils are fucking huge
Spent almost all of last night in my bed. I was worrying about random shit and trying to get out of the bed. I sat there for 10 minutes trying to get up and grab the chain for the lights on the fan. I was balancing on one knee with one hand on my night stand and the other extended. Teetering and trying not to fall. Eventually got them off and laid down. Out of nic
10:57am I think I'm on after glow. Still dissociated. I'm going to redose tonight
11:49am Trying to go to sleep and find some music to fall into
11:52am I want to go get my monster, but I can't. I want to redose, but I have to wait. Still feeling euphoric and light. My mind is fading in and out of the music. Concentrating on different thing
1:43pm Still robowalking. I'll be starting my Zoloft script tomorrow so I'll redose tonight
7:39pm At a friend's house. Pupils huge and still feeling after glow. Can't redose tonight
Ended up just chilling all night. Drank 2nd monster around 11pm. Went on a walk at 12 am. Was tweaking cuz of cops patrolling area. Went to sleep at about 3am. Woke up at 10am. Got food at 12pm.
4:00pm Just got back from Walgreens. Afterglow fading slightly. Snorted 30mg Adderall. Uncapped pills and dumped them into my rolled dollar bill. Leaned back my head while putting the dollar to my left nostril. Closed my eyes and inhaled. Nasal drip is sweet and pleasant. Nose feeling slightly clogged. Throat dry is dry.
4:11pm Laying on the sofa with it in reclining position. About to get up for my monster
4:17pm Wiped up dog piss. Bout to put my shoes on and walk to another friends house. Got my monster and watermelon Arizona. Plus 3 waters
5:19pm Staring feeling the addy as I walked over. Chilling on the bed. Almost finished monster. Got a disposable for 5$. Trying to get a disposable plug
5:49pm Got a bunch of monster tabs and found a bunch of 40mg amphetamine pills in the cans. Homie gave them to me. Sitting in a camo folding chair under overhang and watching them play basketball. Met a kid named Logan
7:41pm Addys got me buzzing hard af. Bouta go force some food down. In my room. Was otp with my girl for a while. Talked to my step brother some. Moved pills and vapes.
11:54pm Been twitching and moving this whole time. Sweating slightly, but not uncomfortable. My girl fell asleep. Waiting to call in the morning. Scrolling through bunch of different apps. Waiting for a homie to call me and on discord predominantly. Keep forgetting to update. Time blurring, but not a bad feeling. Heart beating fast. Don't think dangerously though. Listening to lil darkie. Music euphoria with specific songs is crazy.
12:09am Switched music to legends never die and it's perfect. Snapping my friend while waiting for him to be able to call. I'm more in touch with my emotions I think. It's the dxm. Really made me see things different. Like an actual trip. Feeling fucking exemplary
Cracking my knuckles leaves this numb and tingly feeling in my hands. It's insanely nice
12:30am On call with different friend. Waiting for the snap one to text me back. Bitter taste is not as strong. Kinda dry though. Need to hydrate. I'm most likely past peak already. Might not sleep tonight. I'll attempt to make plans with people tomorrow. I have to start school the morning. Can't wait for a cold relaxing shower. Nic buz is amazing cuz my tolerance is like 0. I keep forgetting that I've been wanting to put deodorant on for hours. Then I just get sidetracked and focus on something else
My lungs feel weird af. Not a bad thing. Not too worrying, but off
12:45am Bob Marley hitting different. It feels as if there's more laters to the sounds rn. As if I'm experiencing hidden nuances
1:08am Can't really find music that I want to listen to so I just keep switching it then getting bored of it. Having a hard time keeping track of conversations I'm having. I feel like I'm on the comedown, but not sure if I'm still feeling afterglow along with it. My head feels so heavy. Not too tired surprisingly
1:26am Getting uncomfortable. Gonna drink some water and walk around my room for a bit. Contemplating getting some sleep or just laying down for a little while. Possibly getting nic sick. Stomach is developing nausea
1:38pm Had to let my dog (Cashmere) out. Brother's dog (Spudley) was scratching at his door to get out. It was locked so I couldn't do anything. Sidewalk appealing to senses. Peacefully cold and settling. Grass was wet. Back upstairs and in my bed with Cash under blanket and between my legs. Hearing Spudley being let out rn. Feeling guilty even though ik it's not my fault. My gait was off so I was walking noticably different. No one is up though. Other than whoever let spud out
3:05am My temperature keeps fluctuating. I'm cold in my feet, but my torso is sweating. I keep forgetting to grab the disposable from the floor. Chilling on discord and queued up some 03 greedo. Should've put him on earlier. It's the perfect vibe
4:06am About to grab the vape and put on a movie
6:07am Really connected with friend some discord. Otp with my girl before she leaves for the day. Still high. Mood going up and down. Low-key feeling inadequate af and generic. Not sure what the plan is for the day
Went downstairs after hearing my parents get up. Said bye to stepdad from upstairs. Had to coax cashmere down stairs and noticed my legs wobbling. Sort of shaking as I go down the stairs. Had to convince my mom to not take Zoloft which went pretty well. Started 18.5mg concerta daily doses. Still feeling the addys so not sure how that will affect my state. Feel very tweaky and stimmed up still. Had to take both dogs out to potty and then talked to my mom for about 5 minutes. Left to walk dogs around the block. Struggled to control them. Especially when bagging and picking up poop. One lady looked like she was scared to death. It was hilarious.
8:15am Sitting back in bed. About to go shower. Still talking on discord.
10:49am Just got out of the shower. So claiming and refreshing. That slick and soft clean feel on the skin is so nice. Starting school in a sec. The high has balanced out to almost equal parts head high and body high. Hopefully the crash isn't too bad. Waiting to plan something for later today after I finish some school
11:24pm Just got done wish school. Think what I'm feeling is actually a tweaky ass crash and soreness expressing itself in my body. Gonna take a nap
5:00pm Just woke up. Feeling sore af and mentally exhausted, but not as bad as it could be. My pupils are still off the rails
Walking around the house for a while until I had to go outside and put up the fence. Sat there holding it up for 5 minutes. The rest of about an hour was spent sweating and uncomfortable. Waiting for food and still trying to confirm plans for tomorrow since I couldn't do shit today
7:33pm Back upstairs in my room. Hungry af
8:02 pm Had a small bowl of red beans. Was gas. Waiting to decide what I'm going to take and when
8:24pm About to grab a 40mg amphetamine dose and take it. Will be taking orally and most likely more insufflated as the night progresses
8:36pm Did some research on the pill itself. It turns out to be methylphenidate hcl. Still gonna take 40mg and see how it goes
8:42pm One 40mg pill down the hatch. Have 18 more left for later
9:18pm It's starting to activate sightly. Might get off of discord because I feel like I'm bothering them even though ik I'm not. Stomach a bit unsettled. Not nausea, but not hungry. Very foreign
9:21pm I'm slowly accepting that I'm walking further and further away from who I once was. I'm becoming a shell of myself. I can feel it all drifting away. Ik I'll be one of those people who end up leaving a image of a abhorrent and pathetic person in all their minds
9:25pm I think I pulled something in my shoulder, but I can't fucking tell
9:30pm Noticed I've been clenching my jaw together a bit hard. Causing some pain, but it should go away in a while. Reminds me of MDMA
9:59pm Turning off my snap and discord notifications. Getting overwhelmed. Gonna watch Dr. Strange and drink the Arizona watermelon drink
10:14pm Barely feeling the high. Don't want to take another atm. Going to stay up a while and finish the movie. Hopefully will be better in the morning and I'll have recuperated a sliver
10:30pm About to crash again. The high heels like it's resting on my limbs and building up energy
6:12am Woke a few minutes ago. Eyes still haven't adjusted to the lighting in the room. They're straining and blurring slightly. The best way I can describe how I feel rn is an energetic soreness. I'm able to do things I enjoy or want to do, but I don't believe I'd be able to do much else. My phone was off the charger when I got up and on 32%. Just plugged it in. Going to pee and try to go back to sleep. Went on SoundCloud and pulled up 03 greedo since it was playing some random recommended artist. These ads be pissing me off
6:18am Pupils remain giant and haven't gone down. Will most likely add pictures tomorrow. Paused music to get up
6:28am Walked down the stairs and my legs were too tense so I proceeded to almost fall down the whole thing. Felt as if my legs were just helping me glide down. Alarm wasn't armed and I leaned closer to it and the wall. My arm reached around them to the right and my middle finger flipped the switch. Light hurt my eyes, but I adjusted it a bit for better view. Sam was sitting on the middle of our red couch while looking tired af. He was just sitting there. He might have been asleep and I woke him up by accident. Asked him if he was just turning his phone off to not get caught and he told me that he was just chilling. I went to the bathroom and flipped the lights outside. Had to blink a few times walking into the door and my gaze went up to the mirror. Confidence is on point today. My hair is looking similar to a messy anime character which I think is cool. Didn't even notice that my jogger strings were untied and pissed. Tied them up when I was done then washed my hands after checking my pupils in the mirror for a second. Then walked out and turned off the light before going back to get cashmere. Talked to Sam a bit about what he was doing today. He was waiting to leave with my mom on a walk then he has work at 9 this morning. So my mom will drive him. Back in my room now and going to see if my girl is up. Have to turn the lights on and my foot fell asleep (had to retype and added more details) (stopped typing at 6:41am)
6:44am My girl is on the bus. Left her a voice message. Gonna boot up discord and check the servers
Ski (close friend) changed his name to "THE REAL RYAN REYNOLDS" in the server. Then in the smaller one it is "deadpool". Almost cried. Idk why it made me so happy that he changed it to what I recommended. Been pretty emotional and impulsive on stims. Not really liking it, but I would say that people take it more positively than as me coming off too strong thankfully.
7:07am Spent some time checking snap stories. Not much going on today that I can actually go to. Got my earbuds in and vibing out.
7:11am Peered out my window and it's covered in droplets from the rain. It should be raining all day. Wishing I had some weed and nic. Rain is the perfect vibe for highs
Gucci of my city is so fucking hard
7:19am Og is taking 125mg dph today and will be joining us whenever we do the group trip. He wants to get some dxm for it
7:23am Posted on Twitter "03greedo one of the greats of today". He has quickly become one of my favorite artists and is so perfect for my highs. Loving the discord servers too. Great vibes and people. Life is feeling better lately and might just be due to being high, but who knows? Hopefully I feel the same after I have to stay sober
7:26am Added another photo of my pupils to the collection. Going to put into the discord
7:47am Had conversation with my mom about cashmere. She kept him up all night. About to leave for walk with him
7:50am Walked out the front door as I pocketed my earbuds. Had to put the leash under my foot while cash peed. It's drizzling and humid as balls
7:55 a.m. Had to stop for Cashmere approve on the corner. Went to pick up the poop and got it all in the bag. As I was flipping the bag inside out to tie off it burst at one of the seams. How do you use one hand to hold the bag. Cashmere's leaves was under my left foot. Had to use my other hand to grab another bag open it up and slip other bag inside. About halfway down the block by now
8:01 a.m. Cashmere keeps pulling on the leash have to keep rearranging his collar on him. He stopped about 2/3 down to the third corner to poop in somebody's yard. How to put the leash under one of my feet and still had to double bag the poop. Some of it got on the outside of the bag since they're too small to work with easily
8:03 a.m. An older woman with a long hair half white and half gray was at the corner working on her garden. She was kneeling while messing with some weeds and flowersHad a small conversation with her and told her to have a nice day. Getting to the last corner now. Should be home in about 5 minutes. Working up a small sweat. Not feeling too uncomfortable and my heart doesn't feel unhealthy. Also doesn't seem to be beating extremely fast. l have to take my concerta when I get home
8:09 a.m. Talked to my mom of the training cashmere to walk better. He had to drink some water and I used my gallon water bottle to fill it up. He is now eating
8:17 a.m. I was going down the stairs when I had to step over Spud. As I got to the bottom of the stairs I had to enter my mother's office. I was required to wait 5 minutes as my mom finished up some of her work. Went to wash my hands in the kitchen. As I was returning to the living room and walking toward the stairs my mom came to give me my dose. So 18.5 mg of prescription methylphenidate is now in my system. Took with a small sip of water right after taking off my shoes and socks. Now sitting in bed and going to lay down most of the day. I don't believe that I have any plans today
Found a really cool small YouTube channel from one of the servers. I enjoy the content and will probably watch while on the dxm. The visuals on the videos look like what my idea of acid is. Found a link to a 3000mg dxm report and will be reading during my trip
8:33 a.m. Was looking for my delsym to make sure I have it for the planes trip. Was freaking out because I didn't know where it went. After a little bit of fumbling through my stuff and searching I found it in one of my drawers. I still have absolutely no clue where the trash for the generic brand went
9:32 a.m. Was doing some research on combinations of stimulants and opioids. Found out that stimulants increase the effects of opioids and decrease the drowsiness. Quickly went downstairs and looked around. Assumed my mom took Sam to work. Noah was playing on the computer and focus on his game. Quickly and quietly walked over to the pantry. Kneeled and attempted to quietly and swiftly look through the bag of prescriptions. Grabbed six hydrocodone 5-325 mg with acetaminophen. Held in my hand and receded to my room. We're walking around downstairs notice my balance is slightly off and I feel a small amount of pressure in the back of my head. More somewhere to a headache than anything worrying. Going to take 10 mg of the hydrocodone and go from there
9:45 a.m Took a sip of water and popped the pills in my mouth. Got one down with the sip and got the other down with another. A bit harder than I would think, but they are a bit bigger than I'm used to. Didn't taste as bad as methylphenidate, but not as good as dextroamphetamine. Stomach a bit disturbed, but that's just in general
9:53 a.m. Added the 4 hydros to the stash with the 18 methylphenidate hcl. Waiting for the hydros to kick in. Will take more if they don't affect me much
10:13 a.m It's raining outside and it's so peaceful. My body is relieved of some of the sore and tensed muscles. I believe the hydros have begun to work. I am not feeling much of a high though
Have received 2 book recommendations from the pillhead server. Very nice people. Both books are my Oliver Sacks
10:18 a.m. When adding picture to cache of pupil pics I noticed they have shrunk almost all the way back to normal size. I believe it's because of the lighting and hydros. It's so surprising how no one ever notices my enlarged pupils
10:28 When walking around my room I seem to be lighter than normal. Going to check the dose info for peak time. No noticable head change yet. Still affected by soreness and such, but it continues to lessen and become less noticable
10:34 a.m. Popped another 5mg hydro with some water. Pocketing a 4th one for later. My body seems to be slowing down a bit
10:36 a.m. Going to add the other 2 pills to my pocket. Totalling to 3 on me for later. Going to gauge affects and dosage as day progresses. My speech isn't impaired to my knowledge. Although I'm typing slower than normal and feeling calmed. All of this was relatively expected
11:03 a.m. Had to set up Xbox and now on couch with cash. Mom and Noah are downstairs. Still feeling perfectly functioning. At least enough to be down here. Going to play some ghost recon breakpoint. I love it
11:16 a.m. Have taken one of the 5mg in my pocket. On a total of 20mg rn. Took forever to get into the game, but I'm gonna have so much fun. Listening to music on my phone too
11:32 a.m. Got some opioid itches coming through. It's bothering me, but I'm trying to ignore them. Not feeling as fucked up as I want
11:36 a.m. Been feeling a slight tightness in my chest for a while. I'm sweaty af and I hate it. My music won't load and it's pissing me off. I just want to be highšŸ˜­
12:45 p.m. Talked to ski. He got his tabs in today. We're going to dose with og at 3am. I'm going to take my other 10mg hydros. Not feeling it much. I'm back upstairs after putting my hoodies on to wash. Want them both clean for my trip
1:12 p.m. Sitting on the toilet upstairs. My other 2 hydros I just took. Had to go back and forth from my room to here a few times. Grabbed my mom's vape juice and had to use a dropper like 4 or 5 times to fill up the pop. Took forever, but now I have nic for tonight and it'll be amazing
Got out of the bathroom after a nice shower at approximately 2:10 p.m.
2:27 p.m. Switched my hoodies into the dryer. Finally decided to stop hand drying my soft hoodie. Hopefully it doesn't get messed up. Got 7 more 5-325mg pills.
3:03 p.m. Was going to take more, but deciding against it as I'm not feeling good. Went downstairs and washed my mug. Took both dogs out. Had to walk them around some before they would potty. Took Spud first and then cashmere. Have to go outside and pick up Spudley's shit later. Wiped both their feet off. Collected 2 blankets for my bed. Have cashmere with me again and warm af. Grabbed my gallon water bottle and my mug. They're now on my desk and nightstand
4:57 p.m. Ski just dosed. Og on dxm and dph rn. Gonna try to get this delsym bottle down and keep it down. Stomach tweaking so I'm not sure
5:43 p.m. Called my girl for a bit. Turning off my snap notifications. Going to dose in a sec. Stomach feeling slightly better
5:56 p.m. Struggled to get down. Hopefully will keep it down. 888mg dxm trip otw. Hopefully I don't get seratonin syndrome. Cashmere is downstairs still. My light is on, but I'm gonna get up and turn it off. Need to put music on my computer
Hope I get into a coma or at least ego death. Would take my hydros and stims, but too much of a pussy for a painful death. I'm so tired of lying to myself about what's going on in my life. I'm so done with pretending people love me and that they actually think I'm gonna go anywhere in life. I'm so fucking done. Wish I wasn't a pussy
6:04 p.m. My vape is charging on my portable charger. Colin is here again for some reason. Hopefully no one needs anything tonight. Need to be left alone
I've realized how little I matter. I've slowly pushed myself into people lives and convinced them to care. I then juts cause pain and suffering in their lives. I try to help and it seems to them like I do, but it just makes them care more and hurts them more. I even managed to let ruby get taken. I can't ever get over it. I let him do it all. I let him get taken. I didn't even call the mf because I was too mf scared to call. I TOLD HIM I COULDNT BECAUSE I WAS FIXING MY VAPE. I've lied to everyone in my life. I will never open up. I can't anymore. I hope I die soon. More than ever. I have become my dad. I knew I could never be better. I'm so glad that most of the people ik can't ever see me or see who I am. I hate my life and it's my fault. I've never appreciated anything enough. My family is so fucking good. Everyone around me tried so fucking hard. I'll never be good enough for anything or anyone. I need to get high. I need some percs. I need to leave
6:43 p.m. Stomach is still mildly nauseous from dxm. That buzzed feeling is building in my arms and face. I'm under my blanket with my light/scent diffuser thing. It's getting hot, but I'm boxing it so I'll figure it out. Going to put on the peep doc and try not to feel too suicidal
7:17 p.m. Left the servers. Trying to get her to leave and take my soul with her. I can't ever do this again. I don't deserve anything good. The dxm is already hitting me, but not much. My pod is almost 1/2 done. Will run out by the end of the night. Will probably cry at least once. I will never stop hating myself. I'll never be good enough
7:53 pm Dxm hitting nice af. Went into my mom's room to go to the bathroom. Grabbed some juice. Now have a full bottle and don't have to worry about nic. Hopefully she doesn't notice. Went downstairs. I feel like I'm on stilts rn. My calves feel heavy and sore, but they're slowly fading to the weightless vibe of dxm. I'd say this my favorite comeup so far. Had my mom bring cashmere to me. Going to bring him out and put his food in my room
8:02 pm Brought Cash out. Wind felt amazing. Movement made me burp a whole bunch. Probably going to puke eventually. I'm experiencing something close to Alice in Wonderland; that size change. As if I'm growing taller and shorter. It keeps morphing my depth perception. Had to bring cashmere a few driveways down because he was barking at something. The dogs have been weird after the hurricane. I wish I knew what it was. He peed and pooped so he should be fine without leaving the room for a few hours. Weird door alarm went off as I came inside. I was holding cash's leash with my right hand. Grasping it excessively tight since I can't feel how hard my touch is. Put in my code and it didn't light up or unlock so I put my thumb on the protruding leaf like metal sheet and pushed down. As I opened the door I held it open with my right hand. This weird alarm went off. It's supposed to be for entering the wrong code 3 times in a row, but that wasn't what happened. It just started flashing red as I got inside. I attempted to mess with it, but Jeremy fixed it by closing and locking the door. Apparently it needed to lockdown for a second. My fingers might have accidentally pressed the buttons while I was holding the door open. I then talked to Jeremy about what happened. Then took cashmere's pinch collar off and hung it up on the wall with the leash. We have 2 little boards with 4 hooks on them at the bottom of the stairs on the left. I then softly tugged cashmere upstairs by his collar. We are now snuggling in my bed and I'm feeling high af(stopped typing @ 8:12pm)
8:15 pm Struggling to type because it feels quicker than normal and at the same time slowed down some. Super weird. I'm not dissociated yet
8:20 pm My mouth is vibrating almost. Feels like when your teeth chatter, but without the clacking together and cold. Just weird shaking or twitches. As I sat up I looked down at my legs and they look huge
8:23 pm Leaned over my legs to reach for my vape. Accidentally knocked over my juice. Had to turn on my phone light and stand up. I then kneeled down and put the little bottle upright. I'm now laying on my right side with cashmere infrint of me and curled up in a cute little ball. Have my vape right next to me now
8:27 pm My phone is looking smaller than I'm used to. My hands look bigger than my mind thinks they should be. It's super cool. The size changes of those 2 things are the same as the last trip too
8:30pm Got cash to move closer to me. High kicking in even more. Got earbuds in and listening to 03
8:37pm Texting ski on discord. Reenabled notifications. Gonna try to convince him to call. The dxm is making the vape so nice and smooth. Not really tasting it though
8:42pm After looking around I noticed that my room appears much bigger and open than normal. It's so cool
8:45pm My eyes and body feel extremely accelerated in relation to movement
8:56pm Ski is now in my mind like an older brother. Already love him so much. I hope I can keep him in my life as long as possible
The dxm has me so high I can easily hit blinkers on my vape
9:04 pm Me and ski on discord. He's painting for me and I'm so happy. My thoughts are flooring so freely. As I describe what I want him to paint it takes me to this darkened first with mushrooms and high trees. Fog blowing into the forest and drifting in beautiful wisps past me
9:06 pm I feel like a midget and and that most things are tiny or big. Things are shifting as my fov moves. Almost just lost my vape. My body is so nice and tight, but only in my right hand and up the forearm. I'm assuming it's what an asleep limb feels like on dxm
9:11 pm Taking out my earbuds relieves the high somewhat. Dissociation is starting now and I'm so happy. My hands feel heavy though
9:12 pm I'm having to blink a lot. My vision is compiling it feels. As if my gaze is snapping up to words that I'm not trying to look at while I'm trying to type. Creating this affect where I look up and down swiftly and periodically. Small ringing in my right ear. It was from the ac starting up. My lungs can open up so much now and I love it
9:21pm Switching between speakers on my computer and earbuds plugged into my phone is a world of difference
9:30pm I keep switching between snap and discord, but my body is going numb and the letters are small. My phone seems like a little toy phone
9:31pm I'm having this feeling that I'm about to skip away from time. It's going to lose its presence and importance in my mind. Happening slowly. My body I'd feels like a brick when I hold it still now instead of a feather, but as soon as I sit up that feather feeling returns. As I lay back down my limbs grow heavy for a second time. Mostly my arms when I try to have them elevated infront of my face while being my phone. My whole body is developing this feeling. Going to attempt to move cashmere or something else.
When I lay down I feel as if my body morphs all together and freezes in the place I'm holding it. In my boxers rn and noticing that I'm more flexible than normal and feeling free
9:41 pm Cashmere flipped onto his right side and has his back pressed to me. Getting up and going to fill vape
9:43pm I found the perfect way to describe it. When I lay down my whole body goes numb other than my forehead itself
9:47pm Sat up. Succeeded in getting 03 greedo playing on computer. Will work on vape. Might have shit my pants
9:55pm completely out of it. Forgot I had a family and anything other than my room. Going to fill vape and go on walk with Cash. Didn't shit my pants. Just tripping
10:03 pm As I was getting dressed everything looks more pronounced. Best way to describe it is thicker and smaller
10:05 Shoes are on and I'm sitting on the edge of my bed. I have a weird mf taste in my mouth and my body is shaking/going numb. Had to hide vape. It is safe with the ejuice
10:14pm Outside on a walk with cashmere I feel a mix of heavy and light. Ok I'm walking all fucked up. Wind is so nice and night allows my eyes some rest, but still to look around and experience. Have to pick up cash's poop
10:35 pm Time has lost all meaning. When I picked up the poop I was stumbling about slightly. I just grabbed it in the bag and threw it in the trash. Didn't tie it or anything. Feels like 12 hours have passed since I dosed, but not true. As we were leaving the side of the block where he pooped he was sniffing at many random patches of grass and hurricane damage. Such as fallen, trees leaves, and sticks. After the yard past the side of the block where the poop rested; the next houses side walk was covered in a 6" layer of water. I pulled cashmere through the yard and realized quickly through the soaking of my shoes that the yard was drowned. I got him into the driveway and we ran 2/3 of that side. As we turned the corner we had slowed to a steady walking pace. I was trying to watch infront of me when he took off, but he didn't. I'm so fucked up that I have to white knuckle the leash or else I'm holding it too loose. I tried to look at what he was barking at and interested in, but I couldn't make out exact form since I'm so inebriated. I believe that it was a cat. The sky was beautiful and looked just like sunrise to my tweaker eyes. When I got home still said nothing to Noah. Not wanting to chance him seeing something strange. I was walking crazily though. When I looked up at the sky and clouds they seemed to just take over my mind with how magnificent they are. They made me lose track of time and everything else. I closed my eyes and walked for a few seconds. Best feeling in the world. Walked cashmere in the street most of the way around the block. One of the tarps flapping on the roof of a house freaked me out. Got inside and struggled to get cashmere's paws dry. I was very cautious and gentle. He isn't as clean as he could be, but I'd rather him be safe and dirty than hurt and clean. Dropped the leash and pinch collar on the floor before picking it up and placing it on the Google. Then I led cashmere upstairs to my room with me. Had such a hard time filling the pod. Listening to 03 on my computer. Cashmere in my bed and working with the pod to get it ready. (stopped typing at 10:58pm)
11:05 pm Cleaned off the pod. Paused my PC. Adjusted on the bed. Getting up to turn the light out and feeling so weird and amazing. Going to lay down and just chill for a few hours
11:12pm Went downstairs to wash my hands then realized that my entire body is numb still. It's going to be numb for a while. I might have induced psychosis, but idk
11:14pm Going to get into bed and relax all night with vape in hand and dxm feelings slapping. I just realized I have to go shit my guts out šŸ˜­(didn't go downstairs yet)
11:21pm I'm really worried about ski. He's not active, but I hope he's okay. I haven't talked to him for an hour and he's high as balls. I miss the servers. Idk why I had to have a mental breakdown right before dxm and ended up fucking the shit out of my life
12:04am Met Francis in someone that's no one's server
1:03am Ski was just painting. I've made my life something I can't return to
1:26am The numb feeling has almost when off. I really enjoyed the trip, but was terrible situation. Still moderately high, but more in control now. Very angry and hating myself
7:16am Not really sure how I feel. I don't think I'm high anymore, but haven't stood up. After sitting up just now I remain very high. Can still hit blinkers on my vape. Going to try to repair some of the damage I did yesterday
7:25am I texted her this morning and she just pretended I didn't say shit. I told her I love her and she said it back, but I don't even know what's real anymore. Not because of the drugs; it's because I'm so confused about her. It's going to eat away at me all day. Every day. I'm going to to ask her out today after she gets back from school(complicated ass situation)
7:59 am Switched positions in my bed. Now behind cashmere. Refilled my pod again. It might be burnt, but I can't tell until I come down. I'll probably just mope around all day
8:24 am HOLY FUCK. RUBY'S BACK. I MISSED HIM SO MUCH
9:17 am Ski changed his profile picture from comic Deadpool singing everyone bites the dust to the gasping Deadpool scene where the bullet goes in his ass. It's kinda funny. Ik for a fact I'm gonna hurt so much when I come down
9:28 am Messaged an old friend. Asked him if he wanted to go to a movie next month. Going to text another friend and check on them
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2020.09.28 11:55 0110100011 Question about how multiple pain meds are administered?

Sorry if this is a stupid question, but I'm transitioning to a hospital pharmacist role and have a question about multiple pain meds on a patient and how nurses administer them.
Hospital policy states we can have multiple medications with PRN reasons of 3 separate pain scales (1-3, 4-6, 7-10). While training I came across a patient who had the following:
  1. Tylenol 1g - 2 tabs q6h for pain 1-3
  2. Percocet 10 - 1 tab q4h for pain 4-6
  3. Percocet 10 - 2 tabs q4h for pain 7-10
  4. Tylenol 1g - 2 tabs q6h for FEVER
  5. new order for Oxy IR 20mg 4 tabs TID prn pain (needed to clarify the order due to overlap with percocets)
Anyway, my questions are :
  1. Can't a patient technically take over 4g of APAP with these orders or not?
  2. I read that you should be cautious at MME > 90. Isn't this guy over 90 MME with the oxyIR and percocets? I wouldn't feel safe verifying something like that, unless I know for sure they are tolerating it for a while...
Suppose he has constant 7-10 pain all day, so Percocet 10/325 2 tabs q4h = 3.9g APAP. But what if his pain goes down between those doses, can't he get a percocet for scale 4-6 which would push him over 4g or am I just thinking too much?
Thanks for any insight from the other side.
submitted by 0110100011 to nursing [link] [comments]


2020.09.28 10:38 0110100011 Question about PRN pain meds and scales in a hospital setting?

Sorry if this is a stupid question, but I'm transitioning into a hospital pharmacist and have a question about multiple pain meds.
Hospital policy states we can have multiple medications with PRN reasons of 3 separate pain scales (1-3, 4-6, 7-10). While training I came across a patient who had the following:
  1. Tylenol 1g - 2 tabs q6h for pain 1-3
  2. Percocet 10 - 1 tab q4h for pain 4-6
  3. Percocet 10 - 2 tabs q4h for pain 7-10
  4. Tylenol 1g - 2 tabs q6h for FEVER
  5. new order for Oxy IR 20mg 4 tabs TID prn pain (needed to clarify the scale due to duplicate)
Anyway, my questions are :
  1. Can't a patient technically take over 4g of APAP with these orders or not?
  2. I read that you should be cautious at MME > 90. Isn't this guy over 90 MME with the oxyIR and percocets? I wouldn't feel safe verifying something like that, unless I know for sure they are tolerating it for a while...
Suppose he has constant 7-10 pain all day, so Percocet 10/325 2 tabs q4h = 3.9g APAP. But what if his pain goes down between those doses, can't he get a percocet for scale 4-6 which would push him over 4g or am I just thinking too much?
Sorry if that's confusing. I'm paranoid of making a mistake and since I saw all those orders were verified prior, I wouldn't know how to handle something like that just because I feel it's excessive and might go over a max daily dose.
Thanks for any help.
submitted by 0110100011 to pharmacy [link] [comments]


2020.07.18 17:57 Army_Bot Summary For: Weekly Question Thread (3/11 to 3/17)

wtf do ad soldiers do at ft dix, in my window and thinking about it just want to know if im getting myself into a ft polk situation but in bumfuck jersey
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I'm an AIT soldier on orders to my first duty station. I filled out my part of the DA 5434 but my sponsor hasn't filled out there section and it's been a few weeks. I was told they won't cut my orders unless the sponsor fills out the form. What do I need to do to get a sponsor?
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Current 31B with 4 months left in my reserve contract. Graduating with my Bachelors degree in May and I was trying to decide what I want to do next. Retention told me to just go full hooah and re-enlist for another 6 years and eventually Iā€™ll get slotted for OCS, which is my end game move. I want to move to the 35F or 35L but retention said it doesnā€™t matter and I should just take the bonus for the 31B re-enlist and move on because OCS will change what Iā€™m doing anyways. I think heā€™s full of it and I was hoping for an unbiased opinion.
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What is 13F life like as a Ranger, both at home and deployed. Do they hang back but close enough to call for stuff or will they go in with infantry and door kick/trigger pull some times?
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Is 33 too old to enlist?
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What is cat 4?
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Can meps see your medical records ? I know a lot of you guys are going to say Iā€™m lying to meps the only reason Iā€™m asking is because my recruiter told me to lie . I donā€™t want a bunch responses telling me not to lie because I have already decided lying is the wrong choice
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so i was made aware that i cant get either option 40 or 4 due to my med waiver for 1 screw in my leg. however was curious about me being able to volunteer for airborne and or rasp... in that case some people told me i likely would not be able to even volunteer due to my injury which occured 6 years ago and hasnt even given me trouble since . is this true. i would really like to take a shot at airborne and rasp. but cant find much info as it pertains to my specific predicament
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Long story short, I've been on IRR for 3 years with no contact with the Army besides sending in a yearly deferment for school the entire time. I report to BOLC this Fall and after 3 years I have forgotten pretty much everything I've learned prior to commissioning.
What can I do as a refresher in the meantime so I'm not completely lost? I'll be taking the bar this summer and I'm branched in a non combat arms position on active duty.
Also can't get my orders from HRC because I don't have a valid CAC but that's a different headache.
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Can you transition from active duty to reserve in one term? Or do you have to wait til your enlistment is renewed?
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So I just enlisted today for a six year contract with 25S signal corps. Ive talked to a few people about it and some say really good things, and some people say some really bad things. Some say its easy as hell and some say its as hard as Crypto-linguistics. Can someone set me straight on this? Im doing satellite communications operatomaintainer. Hell some people even says its alot of travel.
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Looking to pick the brain if anyone who has been to CBRN BOLC in the past few years or so.
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Has anyone ever met with a battalion commander to get a waiver approved? Just want to know what to expect.
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I noticed I have like a 2 week gap between my 11X OSUT and jump school on my orders- obviously, because thatā€™s when the next school cycle starts and such. I guess my question is what am I gonna do during that gap? Do I get to take leave, or am I gonna hang out at my training company and do whatever? Just curious.
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Who is responsible for fastening a troop strap on an lmtv? Or who is liable if a soldier falls out the back and there in no troop strap?
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Thoughts on 35p and 68s?
My husband did DLI twice, so I'm a little more familiar with that.
68s sounds fantastic and I'm currently finishing my bachelor's with classes that focus on environmental health and epidemiology - so it seems right up my alley. (It's a general studies degree since I had the hrs but no true concentration - it ended split between education and health promotion).
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My spouse is choosing to live away from me. I did not force her or neglect her. She is living in another town and got a job by her own accord. All of my BAH goes to military post housing. We have no children. Am I obligated to send her any of my regular pay?
I'm gonna check with my post legal aid office on Monday, but if anyone can share some insight, I would appreciate it.
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PCS from OCONUS to CONUS. Do I get a seperate 10 PTDY to pick up my car from the one I used to house hunt?
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Iā€™m thinking about re enlisting because I received an entry level separation from the navy and all my meps stuff is still good but I want a good MOS that will transition well into a civilian job my ASVAB score was a 91. And the recruiter Iā€™ve been talking to is doing what he can to help but the sergeant in charge of the station is pushing me and trying to rush me into signing a contract
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Still looking at MOS' to decide on, I like the concept of 35Q and 17C ive already gotten some info on 17C, but id like to know more about 35Q (i already checked the mega-thread and only found two mentions of the MOS, and it was only in passing.)
Im particularly interested in the Day to Day and what the work is like.
Im also looking for a position that has a decent to high chance of allowing me to live off base (with or without recompense) as i have a pet cat that I would like to keep with me, (I obviously dont mind having to leave him here with my parents for basic and AIT)
Im fine with hearing recommendations for other completely different MOS's aswell! I really dont know specifically what I want to do, so anyone who has experience with an MOS and thinks It might fit me feel free to point it out.
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Can 35 series volunteer for Regiment? If so, are they just enablers with a scroll or are they doing Ranger shit? Where does the new RMIB fall into all this? Is this where all intel Rangers end up? Thanks.
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I'm some kid just asking questions, don't know much
-Thinking of enlisting after college. Heard that college boys become 2nd lieutenant but they go to through OTC, is this true? -If I was to enlist active duty, what's the minimum and average I have to serve? -If I do 32nd Airborne that's more years on my service? -Can I change my MOS throughout or ? I'm thinking of doing 31B (military police) or 31D (criminal investigations special agent) because it leans more towards my career path in FBI. However, 18B (special forces weapon sergeant) is cool af becuase i like guns and that's an interest to me. -Can I choose where I can be stationed? Like Germany?
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Can I join the army if I have a herniated disc? I have a herniated disc that's causing my sciatic nerve to shoot pain down my left leg, been like that for 8 months now. If my back ever improves can I join? Should I? I'm currently a high school junior.
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Had juvenile misdemeanor when I was 17, got it expunged and all that jazz. Recently went to a recruiter to join, told him about past history and he said he may not need waiver for it. Took background check and everything came back clean, nothing showed up. Heā€™s suggesting to not tell anyone and not claim any past criminal history occurred. Is my recruiter setting me up for failure? Should I request to start the waiver process regardless of what he suggest?
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Awesome thatā€™s for the help, didnā€™t sit well in my gut. Thanks again for the reassurance.
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Is there a regulation concerning rucksacks? I brought a malice back for when I attend ABOLC and just want to make sure I'm good or if I should return it?
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How easy is it to get a medical role in the army and what would life look like in that kind of role? I'd really like to be able to travel and learn new skills!
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We're about 20 months from a potential deployment and were allegedly getting NOS'd this month (National Guard).

If our state accepts the mission, whats the next step? When do we actually receive orders?

Bonus points if anyone knows anything about the UH60 A/L situation in Afghanistan because ive heard there are very very few.
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Anyone know anything about the current status of 35L being open to non-prior service? I've googled around and I can't find anyone who has actually done it or if they're still taking people.
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Reserve officer here, looking to go Active early next year. My question is about the new paternity leave policy. If I'm reading the reg correctly, I will only get the 3 weeks of paternity leave if I had already served for 12 months of active time prior to that. My situation is that we WERE planning to have a baby summer of 2020, but at that point I may have only been active for a couple of months. Would there be other leave available for me to use? Or would I be screwing myself over and we should just pick a different time to have another kid? Just not familiar with leave policies in general on active duty. Thanks for any explanation.
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So as far as 35P goes: Are they currently in demand right now? And what exactly justifies the $40k signing bonus?
I see itā€™s listed in demand on GoArmy.com but I donā€™t know how often it gets changed/if itā€™s really accurate so figured Iā€™d ask here.
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Hello! I am going through a difficult situation right now and am asking for anyone with expertise on the subject. I enlisted for 3 years 40 weeks for active duty. I then re-enlisted to serve in the National Guard near the end of my active duty obligation for a 3-year $5,000 bonus. I am now being told that my ETS from the National Guard isnā€™t until my MSO. My MSO is 4 years 1 month and 4 days from the time I enlisted in the National Guard, not 3 years. When I spoke with Retention, they told me that their was no option to only serve 3 years, and that there is only a try a year option or serve out the entirety of my MSO. I am now being kept a year passed what I thought would have been my ETS, and am being involuntary pulled out of college and being sent to Kuwait. Thoughts? Knowledge? HELP!
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Question about receiving bus driver training:
Our instructor said there used to be a way that you could take your certificate to the DMV of your respective licensed state and get your CDL using just that piece of paper and testing out on the written test there.
Is there still a way to do that? Is it still a thing?
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Any recommendations on Army and/or Air Force Recruiters (both Active and NG) in the DFW area?
I thought that this community might have some specific connections and recommendations for recruiters in the DFW area, especially those involved in Guard units in the area. Are there any specific recruiters in the area you would recommend, or should I just go to the nearest recruiting office?
Also, I likely need a med waiver. So I would need someone willing to work with me on that.
I have a bachelors degree (3.35 GPA in an engineering field) so I think I could be eligible for OCS/OTS as well as enlisted.
Are there any NG units in the area you would recommend?
Any additional advice would be appreciated- thanks!
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Iā€™ve heard rumors and I donā€™t want to take them without getting a more current view. Will being a Mormon affect a career as an us army officer?
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Looking to join the reserves with no prior service. I had two felony charges for possession of marijuana under 2.5 oz and possession of paraphernalia resulting from the same incident as an adult a long time ago. In the state I was arrested in, any amount was considered a felony. Both charges were dropped due to a pretrial diversion program I entered. They showed up on my rap sheet with a statement that said "No Felony Convictions." My recruiter isn't sure what to make of it.
Is it possible to get a moral waiver for this and is there a realistic chance at doing so if I can?
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I would like to enlist in the military for personal reasons and financial reasons, but I would also like to be a graphic designer and hopefully lead myself into UX/UI design. Has anyone here done any graphic design in the military? I know if there has been work done its been really small. I only hear the Navy has a small portion of work done in there. But recently I found out the Army has their own page dedicated for graphic design called Multimedia Illustrator. https://www.goarmy.com/careers-and-jobs/browse-career-and-job-categories/arts-and-media/multimedia-illustrator.html
Im 17 and I want to pursue this career path but i'm wondering if the Army and this enlisted job specifically can help me out in this field for experience. I already have high school experience.
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how close are you to combat as 14p, iā€™m stuck between it or 19d, thanks.
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So Iā€™m very close to joining the Reserves currently, but I also am 100% certain I want to go to college, I have a weighted gpa of 3.86, i am apart of honor society, and a junior in high school. I love my country and I want to join both because of that and to help pay for my education. My question is what is the procedure for applying to college? For basic and AIT it would take 6 months to complete after high school. Do I apply to colleges and universities before I leave for basic or do I apply once I get back? I guess my main worry is getting stuck in a crummy college because I took 6 months after graduation to apply. But Iā€™m not sure how the application process for that works, can i apply and get accepted and not start school until the following spring after training? Or do I have to wait to apply all together? I know I asked a lot and it might be confusing if you need some clarification I might be able to try and word it differently, but thanks to anybody who can help.
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I'm currently a freshman in college and after this semester will have over 40 credits completed. I'm planning on being an actuary which is a very weird job that involves risk management for insurance companies. The way to get further in your field is by taking exams that are absurdly difficult and require intense amounts of studying.
Because these exams are supposed to be so hard I'm worried that going through college and then joining the military would be a bad option since I'd likely forget a lot of what I learned. I'm debating on going into a financial type of MOS (such as Financial Management Technician 36B) for either 2 or 4 years, then if I want to make a career out of the military I can while also being able to work on my degree and either finish it while on duty or after my years are up.
Thoughts or suggestions?
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So I may or may not have improperly washed my ACU top and fucked up the velcro. Is there anyway to fix it? I've tried cutting at it with scissors and shaving it a bit but it doesn't seem to be too effective, am I doing it wrong?
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MEPs processing. How picky are they? Also, has anyone had an issue with being Dqā€™d and how soon can you try again after that? Also Iā€™m a fully certified civilian EMT. Wanting to translate to 68 whiskey. What is the round about afqt percentage that will get me there? I know the GT and ST reqā€™s but all the practice testing I have been using do not show the line scores like the icat or the asvab.
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  1. Recruiter had to send my paperwork to the USAREC surgeon. Anyone know how long this usually takes?
  2. Would I be able to take the DLAB and pick a job on the same day since already have my physical/asvab done?
  3. How does the job selection process work for the army?
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Yeah, I mean it was my first choice of an MOS but I was also considering 91B because I know that would help both in my personal life and also if I decided to go to school for Mechanical Engineering but like Iā€™ve said, Iā€™m also interested in business administration, I guess I just have to weigh all the options in the coming months.
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I have had financial troubles in the past, leading to a couple things reported in collections on my credit report. They total up to around $2500. Will this prevent me from enlisting?
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I am an approved DAT waiver. MOS I'm most interested in is 15W but there is a chance that I may not get it because of security clearance. I got mixed answers at my recruitment station and said I may still be able to get it.
Are DAT waivers completely closed off to jobs even with the lowest level of security clearance?
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I'm reenlisting for Alaska for a 20 level slot. However, I'm definitely going to be a SSG before I report there. Is there any chance of my orders just getting deleted due to this or will I still go?
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I'm preparing for Ranger school and I read in a couple of places that you shouldn't take creatine while training before going. Is this legitimate advice? I don't see how it could negatively affect me, but maybe I'm missing something.
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I'm preparing to enlist with the army but still didn't decide on a MOS My brother recommended 2MOS's: Infantry and Calvary scout How is life for Infantry or Calvary scout? Is it a deathly job? I'm not very afraid to go out to combat but I don't want to die out in combat and leave my family alone. Also can anyone recommend any other MOS's?
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Can I join with clinical depression and ADHD? I want to join the National Guard when I get older but idk if my depression/ADHD will disqualify me?
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Can I bring my dog with me to bolc?
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Whatā€™s everyoneā€™s favorite shoes to wear for PT?
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Best way to lose 180 lbs quickly to re enlist?
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Does being in the army lead to health problems? you hear about soldiers who served having back pain, arthritis and no cartilage left in their knees.
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Any of you Army folk at kadena on this thread? I need a favorino šŸ˜­, youā€™ll even make some moneys. My ocps got torn and i need a new set but they wonā€™t let me buy them šŸ˜‚
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Is there anything that would be good to bring with me to basic?
Will anyone look at you sideways if you use a fountain pen in OCS?
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Can I enlist if I'm diagnosed with a mild case of Bi-Polar disorder?
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Is there a regulation with a time limit on receiving a negative counseling? And or even receiving both of those counselings at the same time? I.E. getting 2 counselings 14 days later at the same time for two missed appointments, with an immediate recommendation of article 15.
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hey, weird question. If you wan to be a doctor in the army, do you have to go through med school first or do you go through med school as your technical school after basic?
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Does anyone still report to a new unit in dress uniform?
I'm talking like knocking on your commander's door in your Blue's, saluting and stating "So and so reporting to such and such unit."
Just wondering if that would impress a BC these days or just make him or her think you're a fucking weirdo
I think I saw a Major do it at my first unit at Campbell, but haven't since.
Edit: Yes, downvote me for asking an honest question, thanks!
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submitted by Army_Bot to ArmyWQT [link] [comments]


2020.05.01 12:21 asterpharma68 Pharmaceutical injection tablets and capsules Aster Pharma

Aster Pharma is one of the top 10 PCD pharma franchise companies offering a wide range of pharmaceutical injection, tablets, capsules, and health supplements. They offer PCD Pharma franchise of injections, critical care products, Pharmaceutical tablets, and capsules. Visit the website if you are looking for pharmaceutical manufacture or third party manufacturing of pharmaceutical injectable. Pharma injections are designed for the healthcare of people. We are the best Pharma Company in India as our manufacturers provide quality pharmaceutical injection. The Pharmaceutical Injections that we manufacture are prepared carefully in the controlled conditions in our laboratories. We are one of the well-known manufacturer, supplier, and exporter of Pharmaceutical Injections. We are wholesale Trader of Pharmaceutical Injections ā€” Piperacillin & Tazobactam Injection, Meropenem 500 Mg/250mg/1mg Injection, and Anti Malaria Injection. Aster Pharma is a manufacturer of Pharmaceutical Tablets and Capsules. Paracetamol Tablet, Vitamin, and Mineral Capsule are offered by Aster Pharma, Panchkula/Chandigarh, and India. The pharmaceutical industry can be divided into the bulk drug and formulations segments. We are very much into the drug formulation segment. Aster Pharma is a Manufacturer, Distributor, Supplier, Trading Company of Pharmaceutical Tablets, and Capsules in India. Pharmaceutical Tablet and Capsule range are available for a franchise business. Aster Pharma is known as top Formulation Pharma Companies in Panchkula/Chandigarh, India as a leading Manufacturer of Tablets & Capsules in India.
We are supplying pharmaceutical injection tablets and capsules in Chandigarh Bihar UP Telangana Kerala Andhra Pradesh Karnataka Tamilnadu Odisha West Bengal and other states of India. Aster Pharma is offering pharmaceutical injection tablets and capsules In Maharashtra Gujarat Rajasthan Madhya Pradesh Punjab Jammu, and Kashmir Jharkhand Chhattisgarh Assam Uttarakhand Tripura Puducherry Mizoram, and Manipur. Find below the brand name of the medicine, drug brand name, price of the medicine, and list of pharmaceutical products manufactured by Aster Pharma.
INJECTABLES
S.NO. PRODUCT NAME COMPOSITION SIZE PACKING MRP
1 ASMIKA-100 Amikacin 100mg Injection 2ml Vial 35
2 ASMIKA-250 Amikacin 250mg Injection 2ml Vial 48
3 ASMIKA-500 Amikacin 500mg Injection 2ml Vial 90
4 ASCLAV-1.200MG Amoxycillin 1gm + Potassium Clavulanate 200mg Single vial 132
5 ASUNATE-60MG Artesunate 60mg Single vial 222.12
6 ASZONE-1GM Cefoperazone 500mg + Sulbactum 500 mg Injection vial vial 295
7 ASZONE-1.5GM Cefoperozone 1000 mg + Sulbactum 500 mg Injection vial vail 375
8 TRAZIM-TM-1.125MG Ceftazidime-1gm + Tazobactam 125mg Single vial 480
9 TRAZIM 1GM Ceftazidime-1gm inj. Single vial 290
10 CEFASTER-1 GM Ceftriaxone 1000mg Injection Single Vial 56.5
11 CEFASTER-S 1.5GM Ceftriaxone 1gm + Sulbactun 500mg Injection Single Vial 110
12 CEFASTER-T 1.125GM Ceftriaxone 1gm + Tazobactum 125mg Injection Single Vial 126
13 ASIME -1.5 Cefuroxime 1500mg Single vial 340
14 ASCOLIN -2ML Citicoline 250mg/2ml inj. Single amp 215
15 ASCOLIN -4ML Citicoline 500mg/4ml inj. Single vial 340
15 ASCALI- 500 MG Clarithromycin 500mg Injection Single vial 955
16 ASCLIN -4ML Clindamycin 600 mg inj. Single amp 340
17 ASDEC-75 INJ Diclofenac Sodium 75mg Injection 5x1 1ml amp 14.5
18 ASCORTISONE 100 MG Hydrocortisone Sodium Succinate Injection IP Single vial 38
19 ASLASTIM -1GM Imipenem 500mg+ Cliastatin 500mg Single vial 2100
20 ASCROS -2.5ML Iron Sucrose 2.5ml Single amp 230
21 ASCROS -5ML Iron Sucrose 5ml Single amp 260
22 EPILEVET -5ML Levetiracetam 5ml Single vial 172
23 ASPINEM-1GM Meropenem -1000mg Single vial 2800
24 ASPINEM-500GM Meropenem -500mg Single vial 1250
25 ASTHIN-10ml L-Ornithine L-Aspartate Infusion Single vial 318
26 MIRAJ PLUS Methylcobalamin, Vitamin B6 & Niacinamide Injection 2ml Dispo 65
27 ADSOLE -40MG Methylprednisolone Sodium Succinate 40mg Inj Single vial 178
28 ADSOLE -125MG Methylprednisolone Sodium Succinate 125mg Inj Single vial 228.44
29 ADSOLE -500MG Methylprednisolone Sodium Succinate 500mg Inj Single vial 675
30 ADSOLE -1 GM Methylprednisolone Sodium Succinate 1 gm Inj Single vial 1075
31 ASCOJA -1500 MG Mecobalamin 1500mcg Injection with syringe 2ml Dispo 55
32 ASCOJA -2500 MG Mecobalamin 2500mcg Injection with syringe Dispo 120
33 ASDECA-25 Nandrolone Decanoate 25mg Injection Single Amp 80
34 ASDECA-50 Nandrolone Decanoate 50mg Injection Single Amp 130
35 ASAMOL -100ML Paracetamol Iv 100Ml Single
36 ASPEN-40 MG Pantoprazole 40mg Injection Single Vial 46
37 ASPIPTAZO-1.125GM Piperacillin 1gm +Tazobactum 0.12mg Injection Single vial 220
38 ASPIPTAZO-2.25GM Piperacillin 2gm +Tazobactum 0.25mg Injection Single vial 430
39 ASPIPTAZO-4.54GM Piperacillin 4gm +Tazobactum 500mg Injection Single Vial 461
40 ASPIRA 15ML Piracetam 15ml Single vial 160
41 ASPIRA 60ML Piracetam 60ml Single vial 465
42 ASPIROX -2ML Piroxicam 2ml Single amp 18
43 ASIZOLE-20MG Rabeprazole 20mg inj. Single vial 130
44 ASANEX -5ML Tranexamic Acid 5ml Single amp 78.5
TABLETS
S.NO. PRODUCT NAME COMPOSITION SIZE PACKING MRP
45 ASNAC-SP Aceclofenac 100mg + Paracetamol 325mg + Serratiopeptidase 15mg 10*10 Alu/Alu 720
46 ASNAC Aceclofenac 100mg + Paracetamol 325 mg 10*10 Alu/Alu 320
47 ASNAC-CL Aceclofenac 100mg + Paracetamol 325mg +Chlorzoxazone 250mg 10*10 Alu/Alu 750
48 ASNAC-A Aceclofenac 200mg Sustained Release 10*10 Alu/Alu 650
49 ASCLAV Amoxycillin 500mg + Potassium Clavulanate 125mg 10*6 Alu/Alu 1015.4
50 ASZITH-250 Azithromycin 250mg 10*6 Blister 600
51 ASZITH-500 Azithromycin 500mg 10*3 Blister 600
52 ASCAL-D3 Calcium Carbonate 500mg + Vitamine D3 250 i.u. 10*15 Blister 650
53 AXIME-200 Cefixime 200mg tab 10*10 Alu/Alu 920
54 AXIME Cefixime 50mg Dispersible 10*10 Alu/Alu 485
55 ASDEC-P Diclofenac Potassium 50 mg +Paracetamol 325 mg 20*10 Blister 250
56 ASDEC-PC Diclofenac potassium 50mg+Paracetamol 325 mg + Chlorzoxazone 250mg 10*10 Alu/Alu 700
57 ASDEC-SP Diclofenac Potassium 50mg+Paracetamol 325 mg + Serratiopeptidase 10mg 10*10 Blister 760
58 ANAZOLE Fluconazole 150 mg 5*6 Blister 230
59 ASURE XT Ferrous Ascorbate 100 mg, Folic Acid 1.5 Mg & Zinc 22.5 mg 10*10 Alu/Alu 950
60 EPILEVET 250 Levetiracetam - 250mg 10*10 Alu/Alu 600
61 EPILEVET 500 Levetiracetam - 500mg 10*10 Alu/Alu 1200
62 ASLEVAST Montelukast Sodium 10mg + Levocetirizine 5mg 10*10 Alu/Alu 960
63 ASNIM Nimesulide 100mg + Paracetamol 325mg 10*10 Blister 320
64 ASTIN Nitrazepam 10 mg 10*10 Blister 430
65 ASLOXA-200 Ofloxacin 200mg 10*10 Alu/Alu 560
66 ASLOXA-OD Ofloxacin 200mg + Ornidazole 500mg 10*10 Alu/Alu 750
67 ASPENTA-40 Pantoprazole 40mg 10*10 Alu/Alu 550
68 ASPENTA-D Pantoprazole 40mg + Domperidone 10mg 10*10 Alu/Alu 580
69 ASCOLD-CP Paracetamol, phenylephrine HCL ,caffeine &Diphenhydramine HCL tablets 10*10 Blister 550
70 PENTOLOX_CT Pantoprazole 40mg + Clintapride 3 mg SR Capsules 10*10 Alu/Alu 1190
71 ASIZOLE 20 Rabeprazole 20 mg 10*10 Alu/Alu 460
72 AXIME - O Cefixime 200mg + Ofloxacin 200mg 10*10 Alu/Alu 1750
73 ASIZOLE-D Rabeprazole 20 mg + Domperidone 10 mg 10*10 Alu/Alu 750
SOFT GEL CAPSULES
74 ASCOJA OD Methylcobamin with vitamins,Alpha Lipoic Acid & Folic Acid Capsules 10*10 Blister 1580
75 ASMEGA omega 3,6,9 fatty acids soft gelatin Capsule 10*10 Blister 2500
76 BONEMEL-CT Calcitriol 0.25mg+Calcium Carbonate 500mg + Zinc Sulphate7.5mg Softgel 10*10 Blister 1300
75 ASCOD-E Vitamin E & Cod Liver Oil 10*10 Blister 2500
CAPSULES
76 ASPRA-OD Omeprazole capsules 20mg+Domperidone10mg 10*10 Alu/Alu 450
77 ASGEN Ginseng, Multivitamin, Multimineral, Antioxidants with Lactic acid Bacillus Capsules 10*10 Alu/Alu 850
78 ASPENTA-DSR Pantoprazole 40mg + Domperidone 30mgSR 10*10 Alu/Alu 860
79 ASIZOLE-DSR Rabeprazole 20 mg + Domperidone 30mgSR 10*10 Alu/Alu 760
SYRUPS
80 ASOVIT Multivitamins + Multiminerals Syrup 200ml Pet bottle 98
81 JOYVIT Multivitamins + Multiminerals + Antioxidant B complex Syrup with monocarton 200ml Pet bottle 87
82 ASKOFF-A Ambroxol 15 mg , Guaiphenesin 50 mg, Salbutamol 1 mg & Menthol 1 Mg Syrup 100ml Pet bottle 58
83 ASCRAN Cranberry, D- Mannose & Potassium Magnesium Citrate Syrup 200ml Syrup 250
84 ASTHIN "L-Ornithine L-Aspartate Nicotinamide Plus Riboflavin
Syrup" 200ml Syrup 300
85 ASKOFF-D "Dextromethorphan 10mg+Chlorpheniramine 4mg+
Menthol 2.5mg Syrup" 100 ml Pet bottle 60
86 ASCOSET Lycopene, Multivitamin & Multimineral Syrup 200ml Syrup 170
87 ASPRO-L Protein Hydrolysate + Niacinamide + Iron chollhe citrate + Manganese Chloride + Zinc Sulphate + L Lysine HCl Syrup 201 ml Syrup 198
88 DIZASTO Fungal Diastase & Pepsin Syrup 200 ml Syrup 99
DENTAL PRODUCT
89 AXINE Cholohexadine mouth wash 100 ml Pet bottle 64
SUPPLIMENTS
90 ASPROD Protein Powder DHA - Chocolate Flavor 200 grm Plastic Tin 400
NEW PRODUCT
S.NO. PRODUCT NAME COMPOSITION SIZE PACKING MRP
91 ANCOMYCIN 1GM Vancomycin Hydrochloride for inj usp Single Vail 150
92 ASAMOL Paracetamol 100ml inj Single Vail 210
EYES DROP
94 BROADMOXI-D Moxifloxacin & Dexamethasone Eye Drop 5ml Drop 110
submitted by asterpharma68 to u/asterpharma68 [link] [comments]


2017.08.12 01:58 Turkeypharm Norco vs Lortab??

Not asking medical advice, just wondering the difference!!!!
Are these not the same thing?? I've seen many scripts come in hydrocodone-apap 5/325 saying Norco and just as many that say Lortab?? If they are both brand names and we are dispensing generic why does or does it matter what we put in the system to get us to generic?? I'm a certified tech at the 3 letter?? I get it if the strengths are different from each other....
Also personally, I'm in the process of miscarriage and have gotten 2 scripts for SMALL amounts (think 6 tabs each) in the last month or so, one says Norco and the other Lortab same doseages 5/325?? Coming from an EPIC system.
submitted by Turkeypharm to pharmacy [link] [comments]


2017.05.02 16:09 OverTheFNHorizon Micro dose Lupron...hope it works

Just got an email from my doctor with my protocol and instructions.
May 25th - Baseline May 27th - Begin Microdose Lupron injection (20 units, 2X daily) May 28th - Start Stims for 10-12 days (Gonal/F multi-dose pen) (Menopur 3ml syringe) June 9th - Egg retrieval June 14th - Embryo transfer
She also listed these other medications for me to pick up from the pharmacy. I'm not sure what these are for thorough...
10,000 units of HCG trigger injection Endometrin 100mg (42 tabs) Doxycycline 100mg (5 tabs) Methyprednisolone 16mg (4 tabs) Oxycodone/APAP 5/325 (20 tabs)
submitted by OverTheFNHorizon to InfertilityBabies [link] [comments]


2017.05.02 16:08 OverTheFNHorizon Not sure what some of these mess are...

Just got an email from my doctor with my protocol and instructions.
May 25th - Baseline May 27th - Begin Microdose Lupron injection (20 units, 2X daily) May 28th - Start Stims for 10-12 days (Gonal/F multi-dose pen) (Menopur 3ml syringe) June 9th - Egg retrieval June 14th - Embryo transfer
She also listed these other medications for me to pick up from the pharmacy. I'm not sure what these are for thorough...
10,000 units of HCG trigger injection Endometrin 100mg (42 tabs) Doxycycline 100mg (5 tabs) Methyprednisolone 16mg (4 tabs) Oxycodone/APAP 5/325 (20 tabs)
submitted by OverTheFNHorizon to infertility [link] [comments]


2014.03.22 18:22 shnarph Urgent question for anyone who knows about medication bioavailability in breast milk

So my SO got her wisdom teeth pulled out yesterday and they prescribed her Hydrocodone 5mg/ tylenol 325mg also ibuprophen 800mg. We really don't want our child to ingest any opiates. AT ALL. We have been trying to research how long some of these drugs stay in your breast milk. If anyone has any information on this we would truly appreciate it.
EDIT: I'm sorry for the confusion. The question I was really trying to get answered here was this. How long would the hydrocodone stay in the breast milk after one tab (hydrocodone/acetaminophen(5/325))
submitted by shnarph to breastfeeding [link] [comments]


2014.01.05 07:58 FartMcgill Norco/Lortab/Lorcet/Vicodin

I don't know about other pharmacies but we are backed up everyday because of the stupid APAP change that no one seemed to inform the doctors/nurses of. We seriously have a minimum of 1 person at any given time calling an office asking to change lortab x-500 to norco x-325. Some highlights:
1) After a week of dealing with the change, patients were becoming angrier -
Me: We can fill this, but just a heads up we will need to reach the doctor's office before we can change this medicine.
Ms. Angry: NO! I made sure the doctor wrote out 5-500 this time! "Norco" and "Lortab" are the same thing! I can even google it and show you!
Me: No, ma'am we have to-
Ms. Angry: SEE!!! Right there!! "Norco 5-500" even Google is smarter than you!
Me: Ma'am the "drugs.com" forum is not a reputable source...
2) Calling the number on a Dentist's script for Lortab 5 - Me: Hello I need to get permission for a drug substitution for prescriber "UnpronounceableName"
Foreign Dentist: (in an accent): Yes this is Dr. Foreign
Me: Oh, Hi! Just needed permission to change Lortab 5-500 to Norco 5-325. Lortab with 500mg APAP is no longer being made.
Foreign Dentist: Yes it is.
Me: Um... No, the FDA changed guidelines for Tylenol dosing so we can't order regular Lortab anymore. We only have hydrocodone with 325 or 300 mg APAP.
Foreign Dentist: I wrote a prescription just yesterday for Lortab. Lortab is fine.
Me: Well I'm sure that patient went to a pharmacy that had a few tablets remaining, but we are all out and cannot order any since it is not made anymore. Do I have your permission to change to Norco 5-325mg?
Foreign Dentist: That is fine, but please order more Lortab. he hangs up
3) Yet another Doctor's office call, the Nurse approved the change from Lortab to Norco -
Me: Ok we will get that changed over, and if possible could you give me the DEA number as well? Looks they forgot to write it on the script.
Nurse: Why do you need the DEA number?
Me: ...because Norco is a controlled substance.
Nurse: Since when?
The FDA needs to send letters out to doctor's offices or something next time...
submitted by FartMcgill to TalesFromThePharmacy [link] [comments]


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