Concerns With Getting Two Different Percocet Prescriptions

Trey asked

I get a normal prescription for Percocet 10/325 every 7 days and it was filled yesterday. However, I had wisdom teeth removed today and the dentist prescribed 7.5/325 of Percocet, which my wife attempted to filled. The pharmacist held the prescription and they said they would verify in morning with doctor if it could be filled. I have had another wisdom tooth removed about a month ago and this was done and the prescription was filled without any problem. I just want to know is this normal and to ensure that my dentist was not wrong in writing the script or with my wife in attempting to get it filled.

Answer

Thanks for writing to us!

We get questions along these lines fairly regularly and we are more than happy to talk about what a retail pharmacist would be thinking in a situation like this.

First and foremost, this situation would (or at least should) necessitate a closer look by your pharmacist. It isn't a common occurrence that someone gets two different strengths of the same drug, which in this case is Percocet (oxycodone/acetaminophen).

You aren't doing anything 'wrong' but as a pharmacist, we have a professional and legal requirement to ensure our patients are on a medically appropriate therapy and are not involved in substance abuse, misuse or diversion.

I don't say this to imply that is what is occurring here, but we are trained to look for unusual situations and 'red flags', with 'red flag' simply being a term used to describe a circumstance which raises reasonable suspicion.

Examples of 'red flags' a pharmacist could be looking for are:

• A patient wanting to pay 'cash' for controlled substances.
• Receiving controlled substance prescriptions from a variety of doctors.
• Receiving controlled substance prescriptions from out of state.
• Filling two different strengths of the same controlled substance.
• Filling a controlled substance at multiple pharmacies.

Now, many times, these situations happen and nothing untoward is occurring. Nevertheless, they warrant looking into.

Getting back to your situation, let's summarize:

• You have a regular prescription for Percocet 10/325 filled routinely every 7 or so days from a specific doctor.
• You received another prescription for Percocet (a different strength, 7.5/325) written by a different provider.
• The pharmacist explained that there would be a delay in filling it until they verified with one or both of the providers that have written you the Percocet prescriptions.

There are a few things here that would raise the eyebrows of your pharmacist, notably the fact that you are getting two different strengths of the same controlled substance and they are coming from different prescribers (even if one is a dentist).

Not even taking into account the legal aspects of this, the pharmacist may be concerned for your safety.

Percocet contains oxycodone, a potent opioid analgesic. Taking another 7.5 mg, on top of your usual 10 mg, a couple times a day is a fairly large increase in dose.

You could be putting yourself at risk for additional side effects, like nausea, constipation, dizziness and breathing complications. Additionally, once you go back to only the Percocet 10/325, you may not find it as effecitve in relieving pain if you have become used to a higher dose (i.e. increased your tolerance).

Everything that I have discussed here has to be considered by the pharmacist filling your prescriptions.

They (the pharmacist) will likely call the dentist to ensure they know you are already on Percocet, and a higher strength at that, and to inquire as to whether or not they want to alter your therapy.

They may also reach out to the prescriber that does your maintenance Percocet prescription, especially if you have a 'pain contract' (i.e. a pain treatment agreement), which often stipulate that you cannot accept a narcotic from another provider.

The most important thing you can do in situations like this is simply to remain in close contact with your doctor/dentist as well as your pharmacist to discuss everything that is occurring.

From your question, you clearly aren't trying to hide something or have anything done without the knowledge of your other providers. Being upfront and available to explain what is being done for your treatment is the best way to ensure everything runs smoothly.

I don't know your exact medical situation, so it would be difficult to try and guess what the outcome of this will be.

You may have your therapy altered in terms of changing your dosing schedule of Percocet, your dentist may change the drug prescribed or you may just be counseled on safe and appropriate use.

I wish you luck and be sure to reach out to us if you have any further questions!