Pharm Report Issue No. 12
A newsletter to update clinic staff on current issues in healthcare
Issue XII
Package Size Guide
When writing prescriptions, it is important to keep the package sizes of medications in mind. Some medications must be dispensed in their original containers in order to protect the medication or the patient. When writing prescriptions for these medications, please write for quantities consistent with the package size available.
Medications that Must be Dispensed in their Original Containers
| Accolate (zariflukast) | Edarbyclor (azilsartan, chlorthalidone) | Onfi (clobazam suspension) | Treximet (sumatriptan, naproxen) |
| Addyi (flibanserin) | Effient (prasugrel) | Pradaxa (dabigatran) | Triumeq (abacavir, dolutegravir, lamivudine) |
| Aggrenox (dipyridamole, aspirin) | Epclusa (sofosbuvir, velpatasvir) | Quillivant XR (methylphenidate suspension) | Trulance (plecanatide) |
| Atripa (tenofovir, emtricitabine, efavirenz) | Gengraf (cyclosporine) | Rinvoq (upadacitinib) | Truvada (tenofovir, emtricitabine) |
| Biktarvy (tenofovir, emtricitabine, bictegravir) | Genvoya (tenofovir, emtricitabine, elvitegravir, cobicistat) | Rybelsis (semaglutide) | Tukysa (tucatinib) |
| Carafate (sucralfate) Suspension | Harvoni (sofosbuvir, rilpivirine) | Sirturo (bedaquiline) | Tybost (cobicistat) |
| Cimduo (tenofovir, lamivudine) | Juluca (dolutegravir, rilpivirine) | Stribild (tenofovir, emtricitabine, elvitegravir, cobicistat) | Vemlidy (tenofovir) |
| Complera (tenofovir, emtricitabine, rilpivirine) | Kaletra (lopinavir, ritonavir) | Symfi (tenofovir, efavirenz, lamivudine) | Virecept (nelfinavir) |
| Creon (pancrelipase) | Linzess (linaclotide) | Symtuza (tenofovir, emtricitabine, darunavir, cobicistat) | Viread (tenofoir) |
| Crixivan (indinavir) | Lucenyra (lofexidine) | Tabrecta (capmatinib) | Vosevi (sofosbuvir, velpatasvir, voxilaprevir) |
| Descovy (tenofovir, emtricitabine) | Norliqva (amlodipine solution) | Tecfidera (dimethyl fumarate) | Ziagen (abacavir) |
| Dostinex (cabergoline) | Norvir (ritonavir) | Tekturna (aliskiren) | Zydelig (idelalisib) |
| Edarbi (azilsartan) | Odefsey (tenofovir, emtricitabine, rilpivirine) | Tivicay (dolutegravir) | All insulin products |
Insurance companies call the shots when it comes to how much of a medication a patient can use per day over a period of time, which we call the days’ supply of the prescription. This is easily calculated with oral dosage forms, such as tablets. When the prescription reads “Take 1 tablet by mouth up to 4 times daily as needed for pain,” 20 tablets means a 5 day supply of medication. This becomes more difficult with topical medications. Prescriptions that state “Apply to the affected area 2 times daily” leave the pharmacist guessing just how big this affected area is. In general, one gram of cream of cream or ointment will cover an area about the size of your hand. Sample directions for a prescription that is to be used twice daily could be “Apply to the affected area on arms 2 times daily (patient uses approximately 2 grams per application).” A 60 gram tube can be expected to last 15 days. A 454 gram jar would last over 100 days and would not be covered by most insurance companies.
Below is a list of topical corticosteroids with their dosage forms and package sizes. Please write prescriptions for quantities consistent with available package sizes and appropriate for the duration of therapy.
Topical Steroid Chart
| Medication | Dosage Form and Sizes |
|---|---|
| Very High Potency | |
| Augmented* betamethasone dipropionate (Diprolene) | 0.05% Lotion (30, 60 mL) 0.05% Ointment (15, 45, 50 gm) 0.05% Gel (15, 50 gm) |
| Clobetasol propionate (Clobex, Clodan, Impeklo, Olux, Olux-E, Temovate, Temovate-E, TemovateScalp) | 0.05% Cream (15, 30, 45, 60 gm) 0.05% Cream (emollient base) (15, 30, 45, 60 gm) 0.05% Foam (50, 100 gm) 0.05% Foam (emollient base) (50, 100 gm) 0.05% Gel (15, 30, 60 gm) 0.05% Lotion (60, 120 mL) 0.05% Lotion (metered-dose pump) (68 gm) 0.05% Ointment (15, 30, 45, 60 gm) 0.05% Scalp application (25, 50 mL) 0.05% Shampoo (118 mL) 0.05% Solution (25, 50 mL) 0.05% Spray (60, 125 mL) |
| Desoximetasone (Topicort spray) | 0.25% spray (100 mL) |
| Fluocinonide (Vanos) | 0.1% Cream (30, 60, 120 gm) |
| Halobetasol propionate (Ultravate, Lexette) | 0.05% Cream (15, 50 gm) 0.05% Ointment (15, 50 gm) 0.05% Lotion (60 mL) 0.05% Foam (50 gm) |
| High Potency | |
| Augmented betamethasone dipropionate (Diprolene AF) | 0.05% Cream (15, 45 gm) |
| Betamethasone dipropionate (Diprolene) | 0.05% Ointment (15, 45 gm) |
| Desoximetasone (Topicort) | 0.25% Cream (15, 60, 100 gm) 0.05% Gel (15, 60 gm) 0.25% Ointment (15, 60 gm) |
| Fluocinonide | 0.05% Cream (15, 30, 60, 120 gm) 0.05% Gel (15, 30, 60 gm) 0.05% Ointment (15, 30, 60 gm) 0.05% Solution (20, 60 mL) |
| Mometasone furoate | 0.1% Ointment (15, 45 gm) |
| Triamcinolone acetonide (Triderm) | 0.5% Cream (15, 30) 0.5% Ointment (15, 430 gm) |
| Medium Potency | |
| Betamethasone dipropionate (Del-Beta, Betanate, Sernivo) | 0.05% Cream (15, 45 gm) 0.05% Lotion (60 mL) 0.05% Spray (120 mL) |
| Betamethasone valerate (Beta Derm, Luxiq) | 0.1% Cream (15, 45 gm) 0.12% Foam (50, 100 gm) 0.1% Lotion (60 mL) 0.1% Ointment (15, 45 gm) |
| Desoximetasone (Topicort) | 0.05% Cream (15, 60, 100 gm) 0.05% Ointment (60 gm) |
| Fluocinolone acetonide (Synalar) | 0.025% Cream (15, 60, 120 gm) 0.025% Ointment (15, 60, 120 gm) 0.01% Shampoo (120 mL) |
| Fluocinonide (emulsified base) | 0.05% Cream (15, 30, 60 gm) |
| Fluticasone propionate (Cutivate) | 0.05% Cream (15, 30, 60 gm) 0.05% Lotion (60, 120 mL) 0.005% Ointment (15, 30, 60 gm) |
| Hydrocortisone valerate (Westcort) | 0.2% Cream (15, 45, 60 gm) 0.2% Ointment (15, 45, 60 gm) |
| Mometasone furoate | 0.1% Cream (15, 45 gm) 0.1% Lotion (30, 60 mL) |
| Triamcinolone acetonide (Kenalog, Triderm) | 0.025% Cream (15, 30, 80, 454 gm) 0.1% Cream (15, 30, 80, 454 gm) 0.025% Ointment (15, 80, 454 gm) 0.1% Ointment (15, 30, 80, 454 gm) 0.025%, 0.1% Lotion (60 mL) |
| Low Potency | |
| Alclometasone dipropionate (Aclovate) | 0.05% Cream (15, 45, 60 gm) 0.05% Ointment (15, 45, 60 gm) |
| Desonide (Desonate, DesOwen, LoKara,Verdeso) | 0.05% Cream (15, 60 gm) 0.05% Foam (100 gm) 0.05% Gel (60 gm) 0.05% Lotion (60, 120 mL) 0.05% Ointment (15, 60 gm) |
| Fluocinolone acetonide (Capex, Derma-Smoothe/FS,DermOtic, Flac Otic Oil) | 0.01% Cream (15, 60 gm) 0.01% Oil (body) (120 mL) 0.01% Oil (scalp) (120 mL) 0.01% Oil (otic) (20 mL) 0.01% Solution (60 mL) |
| Hydrocortisone (Cortaid, Cortizone) | 1% Cream 1% (30, 454 gm) 2.5% Cream (20, 30, 454 gm) 1% Lotion (60, 120 mL) 2.5% Lotion (60, 120 mL) 1% Ointment (15, 30, 454 gm) 2.5% Ointment (20, 30, 454 gm) |
Prescription Tips
- Many pharmacies are working on syncing patients’ medications to improve therapeutic outcomes. In order to get medications lined up, pharmacies may request refills a little early or ask to fill prescriptions with odd quantities.
- Ozempic, Trulicity, Mounjaro, Zepbound, and Wegovy continue to be in short supply, so be prepared for patient and pharmacy calls.
- Stimulants, such as the generics for Adderall XR , Focalin XR, and Vyvanse are experiencing supply issues again, so be prepared for patient and pharmacy calls.
- Pharmacy questions? Just call us! If you ever have a pharmacy related question, just call us. We want to work with you to help us provide the best possible care to your patients.
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