Mexican Prescription protocol?

[thesarge7]

I get a prescription from a Mexican doctor for a controlled medicine. For 6 months, I have had no problems with getting a 30 day supply, which happens to be 4 packages of 30 tablets.Recently, Guadalajara Pharmacy said that the limit was 2-boxes and I would have to get a new script. I checked with other locations and they said the same, but in another state, it was not an issue. Now I am told that the doctor forgot to put on the script "how long my treatment is for". i.e. take 4 tablets per day for 14 days. AGAIN, another Guadalajara Pharmacy is telling me to get a new script.

My question is; Are there any written protocols or rules in MEXICO regarding how a doctor must write their prescriptions, or are the pharmacies making things up as they go? The doctor does not have an answer.

I am traveling so going back to the doctor who gave me the script will not be possible, and SOMETIMES, new doctors give me a hard time and will not write the script. So I spend a lot of time running around town looking for pharmacies that will accept the script or a doctor that will write one.

[ichbinsaege]

From what I understand, if it is a controlled substance, the farmacia is supposed to keep the prescription and when you run out of what you are prescribed, you need to go back to the doctor to get a new prescription.

[thesarge7]

Thanks for your response, but that is not what I am having an issue with. It is HOW the prescription is written and HOW the pharmacy decides if it is acceptable or not. In fact, any controlled medication, narcotic or not, the pharmacy will keep the script. It just seems that either the pharmacy is making up rules as they go, or the doctors may not know what the rules are.

I am still researching. I have found the Mexican equivalent to the U.S. DEA at COFEPRIS . The rules and regs are in Spanish, so it is taking some time for me to figure out. But they do have protocol on how to write prescriptions.

[austinx]

It seems Farmacia Guadalajara is making up the rules as they go. A while back they were wanting picture ID for controlled stuff. That lasted about a month. Who knows whats up with them.

[geeser]

The rules are not widely enforced. A couple of years ago they added antibotics to the prescription required regimen. That included Flagel® which contains an antibotic along with the amoeba killing metrondazole. It one eats raw oysters you will eventually pick up an amoebas.

I could spend $100MN for a prescription since the Guadalajara demanded one or try other pharmacies. The other pharmacies in this area all required a prescription but that was not the case in Guadalajara or in other towns.

[More Liana]

What? ALL pharmacies in Mexico require prescriptions for controlled substances, and many pharmacies do not carry controlled substances at all.

The Farmacia de Similares around the corner from our place in Mexico City has known us for 3 years and will sell us antibiotics without a prescription; they believe that we are not antibiotic abusers and know that I, for one, am subject to frequent ear infections that require Clamoxin (Augmentin, in the USA). The last time I had an earache, the clerk said, "You don't need to see the doctor, we know what you have, you know what you have and we all know what you need."

[phxfunguy]

geeser, on 20 Nov 2013 - 09:34 AM, said:

The rules are not widely enforced. A couple of years ago they added antibotics to the prescription required regimen. That included Flagel® which contains an antibotic along with the amoeba killing metrondazole. It one eats raw oysters you will eventually pick up an amoebas.

I could spend $100MN for a prescription since the Guadalajara demanded one or try other pharmacies. The other pharmacies in this area all required a prescription but that was not the case in Guadalajara or in other towns.

Flagyl is the brand name of the generic metronidazole which is an antibiotic, there aren't two medicines in Flagyl. It is an unique antibiotic that is also an antihelminthic that works against some protozoans, amoebas, and worms. But becasue it is first and foremost an antibiotic, it may fall under the script rule now. Interestingly enough, antifungals are excepted and available still OTC even though they could have the same potential for overuse by uninformed shoppers.

As to the controlled substance issue, yes, it is very important to get the original script written for the exact duration of treatment and get a carbon copy from the doctor. The pharmacy will keep the original and dispense your one time limit (which may vary of course) but you can get "refills" off the original script at the same pharmacy. They will have to look in a paper file to find the script and having the carbon copy and your previous receipts to show they have it there could help. In Mexico there is no computer record of scripts, no "phone orders," no automatic refill line, and the doctor cannot call the pharmacy for any script.

[ComputerGuy]

Interesting to discover what kind of training the staff at the pharmacy counter have. My guess is little or none. Licensed? No idea. I do know that for years I bought my Mom's prescription medications, and would cajole the Dr. each time to write up three or four scrips in advance. He certainly never suggested that he could write any kind of long-term scrip.

[Joco]

The rules are not widely enforced. A couple of years ago they added antibotics to the prescription required regimen. That included Flagel® which contains an antibotic along with the amoeba killing metrondazole. It one eats raw oysters you will eventually pick up an amoebas.

I could spend $100MN for a prescription since the Guadalajara demanded one or try other pharmacies. The other pharmacies in this area all required a prescription but that was not the case in Guadalajara or in other towns.

Flagyl and other anti-parasite drugs do not need a prescription and antibiotics that now need a prescription are not controlled substances. Barbiturates and other pain killers are controlled substances and carefully monitored.

[Natasha]

Flagyl is the brand name of the generic metronidazole which is an antibiotic, there aren't two medicines in Flagyl. It is an unique antibiotic that is also an antihelminthic that works against some protozoans, amoebas, and worms. But becasue it is first and foremost an antibiotic, it falls under the script rule now. Interestingly enough, antifungals are excepted and available still OTC even though they could have the same potential for overuse by uninformed shoppers.

As to the controlled substance issue, yes, it is very important to get the original script written for the exact duration of treatment and get a carbon copy from the doctor. The pharmacy will keep the original and dispense your one time limit (which may vary of course) but you can get "refills" off the original script at the same pharmacy. They will have to look in a paper file to find the script and having the carbon copy and your previous receipts to show they have it there could help. In Mexico there is no computer record of scripts, no "phone orders," no automatic refill line, and the doctor cannot call the pharmacy for any script.

I have purchased metronidazol tabs at Walmart several times this year (for dog with recurrent colitis) and have never once been asked for Rx.

[ComputerGuy]

Not sure if pet meds falls into this category...

[Joco]

I have purchased metronidazol tabs at Walmart several times this year (for dog with recurrent colitis) and have never once been asked for Rx.

Not sure if pet meds falls into this category...

The pharmacy doesn't know, and I doubt they care, if you are taking the anti-parasitic meds or if your pet is. The human drugs are the same as the drugs bought at a pet store and usually cheaper at a pharmacy.

You do not need a prescription for anti-parasitic antibiotics at any pharmacy. They were excluded from the law.

[thesarge7]

Seems to be a few people here that have some knowledge about prescription protocol. Unfortunately, I cannot make heads or tails of what I found on line, and no one has answered my original post.

Do you know WHAT information is required by law on a prescription, when a prescription is required? i.e. How many tablets taken per day for how long? How many boxes or bottles maximum can one get at a time?

This is where I encountered a problem. Pharmacy said I could ONLY get 2 boxes at a time , when I always got 4 for the month. And another pharmacy said that the doctor needed to state how long I was to take the prescription, i.e.l take 4 tablets a day for 14 days.

[Dr.Santiago]

Hi there.

I was asked to help clarify things here a bit. I'll try to help.

The information required on a prescription for antibiotics and most controlled substances (i.e. Alprazolam, Zoplidem) are the following:

1. Name of the patient.

2. IMPRINTED INFORMATION about the physician: 1. Name, address, phone number, CEDULA PROFESIONAL, University and institution(place of work)

3. Medication being prescribed - Including generic and name brand(if doctor indicates name brand)

4. Dosage and strength (i.e. 2 mg Tablets)

5. Number of boxes and number of pills in the box (this is the major variant in comparison to NOB Rx's)

6. (It is NOT usually needed but I DO IT ) - Indicated route and length of administration of medication. - i.e. "VIA ORAL cada 8 horas, por 7 dias"

Since most of these scripts are kept by the pharmacy I ALWAYS write down on my patient encounter forms the same instructions. Otherwise if it's for scripts that the patient gets to keep (i.e. High Blood Pressure Meds) then the pharmacist usually only cares about the number of boxes that are indicated. I have found that most physicians get away with writing - TOMAR COMO INDICADO.

7. Signature of physician

8. STAMP from physician with CEDULA PROFESIONAL

For MORE STRICTLY CONTROLLED MEDS such as Morphine the SECRETARIA DE SALUD ESTATAL issues a limited number of numbered and specially printed SCRIPT PADS to EACH DOCTOR. Most docs don't usually use these and leave these heavy-duty meds to be written by Anesthesiologists or Pain-Management specialists.

The bigger CHAIN PHARMACIES such as Farmacia Guadalajara and Benavides tend to follow these rules more strictly.

I personally can't wait until the day comes that as a doctor I will be able to write E-Prescriptions as is now the standard in the U.S. I find it a lot easier to write refills and prevent a lot of problems.

Hope this helps.

[Hud]

So can the prescription be written: take one 500 mg tablet 3 times a day for 10 days with meals? Then all would know that you needed 30 tablets to do the course, no?

[phxfunguy]

The only problem with them writing the exact number of days is that the boxes (at least of antibiotics) tend to come in multiples of 7 days and you can only buy a full box. I've never had any problem with them selling me 2 or 3 boxes, whatever is needed to cover the duration, even if the number of boxes isn't indicated. The physician would have to be familiar with the packaging of every antibiotic by every manufacturer to be accurate...but that doesn't appear to be an issue. For narcotics I've only had the experience with Tylex cd 500/30 which is the Mexican equivalent of Tylenol #3 in the US written by a dentist. He didn't indicate the number of tabs on the script and we were sold one box of 30 per script, so had to go back after a week to pick up another. The sleeping pill Tasedan 2 mg comes in a bottle of 60 which you can get with one script and that's a two month supply. It's in the same benzodiazepine class as Valium, Xanax, Ativan, etc.

[thesarge7]

Thanks so much for ACCURATE information. AT least we know what needs to be on the prescription. Believe it or not, some doctors as well as pharmacists are not familiar with the protocol, and we end up either having to return to the doctor for new prescription, or search for a pharmacy that will overlook the info and fill the script.

THANKS AGAIN!!

[thesarge7]

FUNGUY, That is the new problem I am facing now. Guad Pharmacy is critiquing my script because the doctor neglected to state the duration, i.e. take 4 tabs per day for 14 days. They claim that this is required and my script is not valid. Prior to that , they said that the doctor could only prescribe no more than 2 boxes, regardless of how many tablets. I used to get a MONTH supply, 120 tablets, (4 boxes of 30), now they tell me I can only get 2 boxes.

[ComputerGuy]

Dr. Santiago did write this: "5. Number of boxes and number of pills in the box (this is the major variant in comparison to NOB Rx's)". That would seem to be an accurate indication.

[phxfunguy]

For the problem of getting only 2 boxes of a narcotic at a time from Farm Guad which amounts to only a 2 week supply, discuss this issue with the doctor and see if he'd be comfortable with writing you multiple scripts at one visit to cover the pharmacy's rules and your interval between visits...for example 6 scripts for a 3 month interval in this case. Make sure he postdates them correctly so you don't run out before the refill date. I used to have to do this in the US for my patients who were travelling so they could get their chronic pain meds out of state as AZ scripts were accepted in the adjacent 5 states.