Saturday, January 03, 2009

Is there a doctor (or an NP or a pharmacist) in the house?

Turns out it's not a cold, or isn't a cold any more. It's my annual bout with sinus infection and bronchitis. 

Which leads to a question: Why on earth does every NP or doc I see at the doc-in-a-box not want to prescribe Tessalon Perles for my cough? They are firmly against Tessalon and intead write scrips for Tussionex.

Now, I know Tessalon is dangerous if you chew the little capsules, and I know that it "only" lasts something like three hours in the average person. I know that Tussionex (by contrast) has the added benefit of having an antihistamine in it, and that hydrocodone works beautifully as a cough suppressant. However, I hate, hate, hate anything with hydrocodone in it. 

It makes me stupid. It makes me constipated. When I do finally wake up after taking a half-dose of the stuff, I'm shaky and nauseated. It kills the cough, yes, but the side effects are horrendous. Right now I'm willing to put up with the side effects, but I'll probably dump the three-quarters full bottle of Tussionex down the drain in three days, when I've reached my limit.

Tessalon is nice. I take it, I don't cough all night, I wake up un-stoned and happy and well-rested in the morning, without all the crappy side effects of the narcotic stuff. 

Even after 'splaining this to the NP last night, even after pleading for something non-narcotic, I walked out with a scrip for...Tussionex. The NP told me firmly that she refuses refills for that particular drug, so don't even ask. And I wondered, again, why anybody would prescribe something potentially abuse-able with a wide range of fun side effects rather than prescribing something *else*, without the abuse potential and the side effects, even when asked.

I figure there's some huge, good reason for that. What is it, you guys?


Anonymous said...

Well, you're a health care professional, so prolly you already know and have tried it, but I swear by zinc supplementation at the first sign of viral illness. Zicam in the gel swab form is my fave -- no yucky aftertaste. Taken religioiusly every four hours, it really can "reduce the severity and duration of symptoms"! Just an idea for the next awful cold.
Sorry to hear about the sinus involvement. I've had 6 sinus surgeries. Sinus pain is tough and so exhausting.
Anyhoo, can't help with the cough medicine conundrum, sorry.

The Frog said...

They know that you're planning on chewing them up and entering a pizza-eating competition, subsequently choking yourself to death.

And then your family will sue.
Come on, critical thinking skills are important!

#1 Dinosaur said...


That's a prescription, not an endearment.

Try a teaspoon of honey at bedtime, and as often as you want through the day. It soothes the throat as well or better than any medicated syrups, and it has some antibacterial properties, plus no side effects (unless you're diabetic. Even so, sugars go haywire with acute illness anyway, so I don't think it would do all that much harm.)

There's even peer-reviewed evidence for it, as opposed to the formal studies for zinc, which show nothing but placebo effect.

The real bottom line is that nothing works very well for a cough. Antihistamines are irrelevant, as the cough from a URI isn't histamine-mediated; they just make you drowsy, which helps you sleep, which is what you want. Even those tessalon perles are basically placebo. Sorry.


Maybe it's these side effects they don't want people to have. Ah hallucinogenic versus opioid stupor, guess what one the seekers would favour?
"There have been rare occurrences of bizarre behaviour, including confusion and visual hallucinations, when Tessalon is taken with other prescribed drugs. Check with your doctor before taking Tessalon with other medications".
I couldn't resist looking it up as we don't have that over here. Or alot of what you guys seem to have.
Good luck

Anonymous said...

How about fear? Not prescribing Tessilon due to the fear of what you COULD do with them?
Good question?
It's not like you don't have a very informed, and valid point?

Sorry dear.
Best of luck with the infection.

Brenda said...

My mom recently had knee replacement surgery. Even tho she told them she didn't like taking hydrocodone they prescribed it to her anyway. After about 5 days at home taking her pain pills... with said hydrocodone in them, she was going loopy and having horrible dreams and was very depressed. Dad got her doctor to prescribe something to help her with the stomach aches from the pain pills but she was still not doing well with the loopyness. Needless to say, we got her off the pain pills as quickly as we could. She is still a bit depressed but now I think it's just from her not bouncing back as quickly as she thought she should have. It's only been 5 weeks. She is 75 years old. Back to my point. Hydrocodone is evil.

Why don't they listen?

Dr. Alice said...

Tessalon is one of my favorite meds for URIs. I've *never* heard of this kind of concern for its use before, and yes, I know you aren't supposed to chew it. I just tell patients to swallow it.

The idea that someone would flat refuse to prescribe it strikes me as weird.

Anonymous said...

several years ago my husband had a severe asthma attack while we were on vacation. when we went to the ER for treatment, the staff didn't realize that around 25% of asthma attacks present as coughing rather than wheezing...and the first thing the triage staff wanted to do was give him cough drops...and when we declined, then they tried to push those pearls. They acted all ticked off that he was in the ER for a 'cough' when in previous instances said cough left him hospitalized over night! Luckily the doctor finally did get him nebulized. The doctor said that the pearls worked by inducing some sort of paralysis that stopped the coughing - and that is why they were only prescribed when the used could be trusted to take them as directed. He never did explain why someone who was coughing so badly from asthma that he was barely able to breathe might have been such a candidate for the pearls....


Anonymous said...

One of my former allergists (probably retired by now) gave me Tussalon Perles all the time -. much more convenient for working people.

First time I saw him, he asked me when I had broken my nose...wish I'd gotten my nose fixed (septoplasty) those many years ago!

Anonymous said...

Hmm... I'm prescribed the 'dro for a serious assault wound and even tripling dosage doesn't cause bad side efx. If your receptors bind to it the intended purpose is the only ends.

Pjay said...

Their not helping me any! I hate them! What's the big deal with these things, I'd rather have something that I know worked for me in the past and be done with it, the problem with being properly treated these days have nothing to do with the patient but rather the abusers of medication. This is what it's come to people! Better start looking for some good old home remedies.

just my opinion said...

Anonymous up there asking for triple his dose is what prescribing Hydrcodone leads to. Thats what she should be careful with!!

Anonymous said...

I'll take the Tussionex any day.

Unknown said...

I have them don't want them first 200 mg made me sick