Should suppositories crumble?

LadyTexan

I mentioned in an earlier post that DH's hemorrhoids are causing him severe pain again. I spoke too soon when I said both docs came through because dealing with one of the doctor's office has been very frustrating. I am on the verge of firing the Gastro, but I am unsure if there is any other option in our small town. 

Wednesday 4/21, I message PCP and Gastro through their respective portals regarding my husband's severe pain. PCP responds promptly and sends Rx to our preferred pharmacy for antibiotic and pain med. I pick them up and we start the meds. LVN from Gastro's office responds more slowly and wants to send an Rx for suppositories to a compounding pharmacy that I have never used. I message back through the portal saying no thank you because PCP has sent in scripts for pain meds and antibiotics (for diverticulitis) and we are set. LVN calls me back later in the day stating the suppository script is important. She states how DH responds to the suppository will indicate whether another FlexiSigmoidscopy is necessary. I instruct the LVN to call in the med and state that I will pick it up in the morning.

Thursday afternoon, I go to the compounding pharmacy to pick up the suppositories. Pharmacy states that they haven't received an Rx from the Gastro. Then begins phone calls from me to the Gastro to have them resend the Rx. However, the Gastro phone line repeatedly goes to afterhours voice mail during office hours. I go home and message the portal. I specifically ask for a phone call. The Gastro LVN and receptionist start messaging me through the portal. ARGH. Frustration. Frustration. Frustration. Pharmacy blaming Gastro. Gastro blaming pharmacy. And finally I pick up the suppositories Saturday am. 

Every suppository that I have opened so far (3 total) have fallen apart. Please see the picture. Before I blow my top, can some one tell me if this is normal?

M1

Sadly it doesn't surprise me if these are the compounded ones LT.  They were literally mixed and put in a mold, and they don't have the same ingredients that a commercial one would.  I'd complain to the gastro that it was a waste of money.....

Jo C.

Not supposed to crumble; this is the compounding pharmacies issue. I would think they would provide you with new ones at no further cost.  Did you call them, report the issue and request a they replace the defective ones?

Do you know what was in the suppositories that required a compounding pharmacy?  

There are OTC suppositories for hemmorhoids which we are all aware of, and there are also suppositories that require a prescription and ones with prescription strength cortisone in them . . . .  wonder what was causing necessity for a compounding pharmacy rather than a regular pharmacy.  

Sadly; pain meds often cause constipation or at the least very hard stools both of which can certainly exacerbate the hemmorhoid problems.

J.

LadyTexan

I returned the crumbling suppositories and received a full refund. The pharmacy offered to remake them at no charge but I declined. When I picked up the meds, I didn't receive the drug sheet regarding what was in the suppositories. Just an oh by the way, they may cause a drop in blood pressure so watch for fainting and light headedness. I'll do my best to avoid that pharmacy in the future.

I have since learned from the Gastro's LVN that the ingredients in the suppositories are lidocaine and nifedipine. The Nifedipine is what causes the decrease in blood pressure. I presume to take the pressure off the hemorrhoids. 

I think there has been a huge communication hiccup by everyone, including me. I should have been more proactive in learning the chemicals involved. I further think the communication could have been more effective had the Gastro spoken directly with me instead of filtering info through the LVN and receptionist. I feel that I have had to do so much research via Google just to figure out what Nifedipine is now that I know it is one of the ingredients.

The LVN at the Gastro's office is now sending the script to another compounding pharmacy as I am completely done with the first one. 

BTW - Preparation H makes an OTC external use cream with 5% lidocaine. It is pricey at $24 per tube. When DH is crying with pain, it seems like a small price to pay.

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Jane Smith

LT, I am so sorry. How frustrating for you, on top of everything else, and when you don’t want to spending time and energy on this sort of idiocy. 

I wonder if there is a prescription lidocaine cream, that might be cheaper than the OTC kind, if your insurance will cover it?  Not that you want to call the doctors again, but since the PCP is more responsive, maybe drop them a message?

M1

Well you've taught me something, I've never heard of nifedipine in a suppository before. Wanna research this a little bit and run it by my pharmacist daughter also...sorry you're both having so much trouble.

Jo C.

It comes to mind . . . . has your husband actually been physically (manually/digitally) examined by his primary care MD or his Gastroenterologist re the onset of the severity of hemmorhoid pain?  This ordinarily does not require a scoping.  Reason I ask, is that there is a possibility that because of the level of pain being experienced it may be that he has a thrombosed hemmorhoid which would need to be ruled in or out and if present, addressed so as not to cause damage to tissue.  It is a very, very painful condition.

CORRECTION:  Has the doctor in the past ever prescribed a suppository with cortisone for significant hemmorhoid issues?  There is also a prescription cream with cortisone, (I had listed incorrect name; the following is accurate.) "PROCTOSOL-HC"   However; if  the hemmorhoid is thrombosed, that is more serious and there will probably be a different approach.

Sometimes I have found that if a patient has dementia, it is necessary to prompt the physician regarding NOT attributing level of complaint, etc. mostly to dementia and pass things off that ordinarily would be treated differently in a person without dementia.  Never let a physician do that whether it is conscious or unconscious by the MD..  A person with dementia has multiple body systems and pain levels just like everyone else.  I have had to address that multiple times.

 When things are this dicey, I do not speak only to the nurse on the phone; there may be insufficient or incorrect communication to the doctor, or even communication with personal bias re the patient or caregiver, etc.; I ask for the physician to return my call.  I do this only for serious issues.

So hope relief is found soon.

J.

Jo C.

CORRECTION:   In my Post, I somehow inadvertantly misnamed the prescription hemmorhoid cream that contains cortisone . . . . I have corrected the name in the Post, but in case that was not seen, wanted to make a second entry.

The correct name of  the prescription strength hemmorhoid cream that contains cortisone is, "Proctosol-HC."

Apologies are extended.

J.