Xofluza

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migm

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Maybe I've been worse at keeping up to date lately but I have heard very little about Xofluza.

Anyone want to talk about this medication? No other threads on studentdoctor really discuss this. Mechanism is different than the neuraminidase inhibitor of tamiflu. Indications are uncomplicated flu >12 days old. Ton of exclusions with the phase 2 trial that was used to approve it. Cost? Availability? Will you or have you used it? What will you tell patients about it?
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Seems like a pharma sponsored study, with crap results, and unbelievably ridiculous exclusion criteria.

Who did they bribe at the FDA to get this approved?
 
I rarely even prescribe tamiflu. Why would I prescribe this stuff?

It's like prescribing an expensive medicine for the common cold. The vast majority of people who get the flu do just fine after experiencing a few days of feeling like shiit.
 
I don'
thegenius said:
I rarely even prescribe tamiflu. Why would I prescribe this stuff?

It's like prescribing an expensive medicine for the common cold. The vast majority of people who get the flu do just fine after experiencing a few days of feeling like shiit.
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Really? I wish I could prescribe Normasaline or Glucositabs. Patients love prescriptions.
 
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Of course the NPs at work are giving scripts for this out like candy, so I can deal with the complaints from people at the $80 a pill it costs.
It's also ridiculous that the patient and their insurance companies will pay more for this drug than they will to see somebody at the urgent care.
 
I give Tamiflu in the 48 hour window because the CDC continues to recommend it for a large swath of ED type patients. It's annoying.
 
thegenius said:
I hear ya. They come to the ED for free and want something, and if you don't give it you get in trouble. Love this country.
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I give out so many prescriptions for naprosyn for BS pain complaints because of this. Generally people don't know what it is. If they do, I use celecoxib instead.
 
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thegenius said:
I rarely even prescribe tamiflu. Why would I prescribe this stuff?

It's like prescribing an expensive medicine for the common cold. The vast majority of people who get the flu do just fine after experiencing a few days of feeling like shiit.
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Angry Birds said:
Patients love prescriptions.
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That's why. 10 or more years ago, the long gone DocB said that the pts in his ED would demand a script. He'd write for Tamiflu. The DC instructions would be in a neat pile on the bed, and the RX would be gone. Then, the pt goes to the pharmacy, finds out how expensive it is, and doesn't get it filled.
 
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GeneralVeers said:
Ketorolac 10mg tabs one po q8h prn pain. Love it.
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Me too. I just hate it when they have an "allergy" to NSAID's. I wish we could prescribe Panadol, which is just the brand name for Tylenol abroad.

Actually, we should be able to prescribe Prescriptrex, the one med for all your prescription needs. Placebatrol would be good too.
 
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Angry Birds said:
Me too. I just hate it when they have an "allergy" to NSAID's. I wish we could prescribe Panadol, which is just the brand name for Tylenol abroad.

Actually, we should be able to prescribe Prescriptrex, the one med for all your prescription needs. Placebatrol would be good too.
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Isn't that basically what Tamiflu is?
 
GonnaBeADoc2222 said:
I give Tamiflu in the 48 hour window because the CDC continues to recommend it for a large swath of ED type patients. It's annoying.
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I offer it to all my eligible patients, but I say stuff like
"the CDC recommends it, and the company that makes it wants you to think it works."
"But actually...it's a lousy drug."
"Maybe you'll feel better 12-24 hours more quickly."

"It causes stomach pain, diarrhea, and there are even weird case reports of people in Japan going crazy after taking it."
"so I generally don't recommend it unless you are pregnant, old, have COPD, on dialysis, or have other major chronic diseases."

"Plus it's several hundreds of dollars for the pills, and someone is going to pay for it. It's your insurance, and my insurance premiums go up and taxes go up."

"So your family member is eligible for Tamiflu, and if you want it I will prescribe it. Just want to present the pros and cons."


After I say that stuff....9/10 don't want it. What a surprise based on the way I put it.
 
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thegenius said:
I offer it to all my eligible patients, but I say stuff like
"the CDC recommends it, and the company that makes it wants you to think it works."
"But actually...it's a lousy drug."
"Maybe you'll feel better 12-24 hours more quickly."

"It causes stomach pain, diarrhea, and there are even weird case reports of people in Japan going crazy after taking it."
"so I generally don't recommend it unless you are pregnant, old, have COPD, on dialysis, or have other major chronic diseases."

"Plus it's several hundreds of dollars for the pills, and someone is going to pay for it. It's your insurance, and my insurance premiums go up and taxes go up."

"So your family member is eligible for Tamiflu, and if you want it I will prescribe it. Just want to present the pros and cons."


After I say that stuff....9/10 don't want it. What a surprise based on the way I put it.
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Jealous that you have an educatable population.

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"Plus it's several hundreds of dollars for the pills, and someone is going to pay for it. It's your insurance, and my insurance premiums go up and taxes go up."
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LMAO...as if any of the people showing up to an EMERGENCY department for a cold or a flu are going to care about this. The fact that they are anti-social system-abusers is why they are there in the first place.
 
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GeneralVeers said:
LMAO...as if any of the people showing up to an EMERGENCY department for a cold or a flu are going to care about this. The fact that they are anti-social system-abusers is why they are there in the first place.
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True Dat.

I don't tell the homeless or medicaid patients my blurb. Only the ones that I feel have an IQ > 100 that actually care about things other than when they are going to get their next toke hit. :)
 
thegenius said:
True Dat.

I don't tell the homeless or medicaid patients my blurb. Only the ones that I feel have an IQ > 100 that actually care about things other than when they are going to get their next toke hit. :)
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This is not a knock on you. But how many years out are you? I feel this speech would be tiresome and you’ll get jaded soon and prescribe everyone Placebotrol as well. It’s just so much faster.
 
Angry Birds said:
This is not a knock on you. But how many years out are you? I feel this speech would be tiresome and you’ll get jaded soon and prescribe everyone Placebotrol as well. It’s just so much faster.
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4.5 yrs. it does get tiresome. I don’t say it often, but I don’t fight with patients on this one either. I had some worried mom about her kid who was playing on her iPhone who cut me off and said “I want it” and I immediately said no prob.

It’s why I’m in the bottom half in my group for efficiency. I talk more to patients on average than the others. Plus I debate in silence about certain work ups, the necessity of getting CTs, etc. others in my group just order everything right away, not knowing they had a Ct done three days ago that was negative
 
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shookwell said:
People love Naproxen prescriptions
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Most of our regulars are onto naproxen or naprosyn. It don’t work they say.

Some are suspicious of us offering anything but Percocet. I’ll say “nabumetone” or “relafen” and they won’t have it, even though they haven’t heard of it.

I remember some young woman came in with a migraine asking for dilaudid....I said nope! with a smile. “Have you had metoclopramide?

30 minutes later she said “ doc, whatever you gave me was the bomb! That **** was good!”
 
thegenius said:
4.5 yrs. it does get tiresome. I don’t say it often, but I don’t fight with patients on this one either. I had some worried mom about her kid who was playing on her iPhone who cut me off and said “I want it” and I immediately said no prob.
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And this, ladies and gents, is the downfall of medicine.
 
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GonnaBeADoc2222 said:
And this, ladies and gents, is the downfall of medicine.
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I stopped trying to educate, involve the patient in rational decision-making, and spending time counseling patients. I just give them what they want and discharge them. I went Full Veers.

My patient complaints have pretty much evaporated.

This is why its okay to hate the muggles.
 
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RustedFox said:
I stopped trying to educate, involve the patient in rational decision-making, and spending time counseling patients. I just give them what they want and discharge them. I went Full Veers.

My patient complaints have pretty much evaporated.

This is why its okay to hate the muggles.
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Same here (though I am FM not EM, but its the same idea).
 
Was actually having this conversation with friends the other day.

By far my #1 most prescribed medication during residency = Naprosyn.

Usually for patients after minor fender benders with no signs of trauma who strolled into the ER after stopping at McDonalds.
 
thegenius said:
4.5 yrs. it does get tiresome. I don’t say it often, but I don’t fight with patients on this one either. I had some worried mom about her kid who was playing on her iPhone who cut me off and said “I want it” and I immediately said no prob.

It’s why I’m in the bottom half in my group for efficiency. I talk more to patients on average than the others. Plus I debate in silence about certain work ups, the necessity of getting CTs, etc. others in my group just order everything right away, not knowing they had a Ct done three days ago that was negative
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Well I can’t sanction being in the botton half in terms of efficiency.

As far as CTs, stopping them from CT can actually make you more efficient. How much time you spend arguing with patients should be directly correlated to efficiency. So it’s wise to spend two extra minutes debating CT if you can save the time by not getting it. Nothing kills efficiency more than CTs. But this is not the case with Placebtrol which saves time.

Of course this is just my view. I prioritize efficiency above all else.
 
Angry Birds said:
Well I can’t sanction being in the botton half in terms of efficiency.

As far as CTs, stopping them from CT can actually make you more efficient. How much time you spend arguing with patients should be directly correlated to efficiency. So it’s wise to spend two extra minutes debating CT if you can save the time by not getting it. Nothing kills efficiency more than CTs. But this is not the case with Placebtrol which saves time.

Of course this is just my view. I prioritize efficiency above all else.
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I agree. I'll give it a go trying to prevent unnecessary CT scans on younger people. Usually when I tell them they will get cancer, they choose not to get them.
 
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GeneralVeers said:
I agree. I'll give it a go trying to prevent unnecessary CT scans on younger people. Usually when I tell them they will get cancer, they choose not to get them.
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Yep. And I’ll say: “A CT scan can be equivalent to 1000 xrays. So it’s like getting an X-ray every day for three years.”

That number might be high but I guess it depends on a number of factors such as what’s being scanned or X-rayed and is it with iv contrast or not. But it’s the speech a colleague of mine uses so i stole it.
 
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RustedFox said:
This is why its okay to hate the muggles.
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I had to look up muggles in a dictionary. I didn’t know what it meant:

Muggle
1. (noun) A person who possesses no magical skills or abilities (originated from the 'Harry Potter' novels).

2. (noun) A colloquial term for marijuana. The word 'muggle' can be pluralised to 'muggles', and still retain the same meaning.

3. (verb) A colloquial term for the action of smoking marijuana.
1. "The Dursleys were what the wizards called Muggles (not a drop of magical blood in their veins)" (extract from 'Harry Potter And The Chamber Of Secrets', by J.K. Rowling).

2. (Said to employee at drive-through:) 'I'll have a Big Mac, fries, a Coke... (whispers:) and a dime bag of muggle(s)'.


Heh
 
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