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injectable mtx, pharmacy
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Sorry if this topic has been covered before at length. The search function hasn't worked for ages on this site.
I saw my doctor last week, and she decided to move me from oral to sq mtx, and faxed the pharmacy. When I went to pick it up, the pharmacy said it had to be intramuscular, not subcutaneous, and that they couldn't give me that drug with those needles. They claimed to have both called and faxed the Dr.'s office, and hadn't had a response. I told them I was on vacation for the next few days, and they seemed to think they'd have it straight by the time I got back. Fast forward a week: talked to the really smart, competent pharmacist yesterday. Nothing ready, nothing in stock, no communication from the doctor's office, nada had happened while I was gone. I was supposed to get a call from them today, nuthin'. Should this be this hard? Is SQ use off-label? Sure doesn't look like it to me. Posted on 06/13/12, 06:12 pm |
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Mthx injections are sq. I had a big discussion about this with my rheumy and the insurance nurses. I would just buy the mthx, and go somewhere else and get the needles. I don't think they have the right to tell you how to take this drug against your rheumy's wishes. 
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According to drugs.com, mtx is to be dosed IM, IV or IA.
http://www.drugs.com/pro/methotrexa... That said, IM isn't really for a lay person to inject. There are more risks if not properly trained. While it may be "off label" it is an accepted practice. The pharmacist should not be denying you your medication because of personal preference. http://www.pharmacist.com/AM/Templa... Out of curiosity, what did they want to give you that was different? Needle length, etc?
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I was just over there again. I guess the doc specified SQ, but the needle length she specified is for IM. The people at the pharmacy did say today that they will work with me, and they are not bound to give me the type of needle on the prescription. Now they're not sure about being able to find the vial of mtx- their main supplier says it's back-ordered from the manufacturer. My doctor said she had some patients have trouble getting it a year or so ago but not recently. Anyone else having trouble? Does it really have to be this hard???
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No, it really doesn't need to be this hard. If you have been trained how to give a SQ injection there is an array of lengths of needles that can be used (3/4" to 1 1/4" or so).
As far a difficulty getting it, there are not necessarily shortages of it, but some of the manufacturers are not making it right now. http://www.fda.gov/drugs/drugsafety... I was suppose to start injectable this month, but because production isn't at 100%, we're waiting, again. Ugh. Good luck. I will never understand why human medicine makes things so complicated.
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I found some today at another pharmacy, then had to argue with them to get needles (which WERE on the prescription), and the insurance won't cover it "because it's a 200 day supply and they don't cover that much at once. No, it doesn't come any smaller." There goes $70 and my temper. They're morons, I'm afraid.
If anyone is looking, this vial is from APP pharmaceuticals. Have I asked yet whether or not this has to be this difficult?
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By law, they have to fill with the smallest available volume within your alotted Rx.
Meaning, if you use 2mL a week and a 10mL vial is the smallest available. They script out a 10mL vial every month for your 30day co-pay. They cannot prorate it. Right now, with the shortage smaller vials are harder to come by direct from the manufacturer. 40 mL vials are not on back order. These medications are not optional. It is ridiculous that anyone should have to beg, borrow and plead to get the medication that is prescribed. I just had a discussion with the manager at the CVS that I use for my shorter term meds(my insurance will only cover 21 days at retail; for the same price as a 30 day mail order. They also charge $30 a month for brand name at retail or $30 for 90 mail order. It is a crock!)
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I think I can help with some of the confusion.
I did a little research and found out that MTX is not approved by the manufacturer for sub-q injections for Ra......that is because it is so old that the manufacturer only got it approved for use with cancer. So if a pharmacist who knows nothing goes by what the manufacturer says, they will see IM or IV, IA use for cancer treatment in high doses. However, for Ra, we take a tiny amount in comparison to cancer usage and so it's safe if injected sub-Q. I would suggest you check with other pharmacies in the area to see if they are familiar with injectible MTX for Ra. It may not be manufacturer approved but it is FDA approved. Jenny
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I don't know if this is ok or not...but I use a large chain grocery store pharmacy---starts with the letter K-- and they not only have my MTX, they sell me individual needles for a very very reasonable price....less than a quarter each. I can buy as many needles as I need. it shouldn't be this hard. I would definitely be looking at another pharmacy. I also get fuel points for my scrips which kind of helps with the pain of having to buy so many drugs!!!
good luck.... marianne
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Just take the longer needle and inject it SQ. I never even look at the needle size. Just inject it under the skin. IM is painful and not necessary.
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Marianne, as long as they are sealed it shouldn't be an issue.
Technically, no one needs an Rx for syringes. Though, insurance companies will not cover them (even for diabetics) without an Rx.
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