Rich Z (WebSlave)

Originally Posted by WebSlave

contractually, they are not allowed to do that.

Please keep that in mind. Businesses such as labs are famous for sending bills, shaking the tree to see if money falls out.

Originally Posted by Lucille

Please keep that in mind. Businesses such as labs are famous for sending bills, shaking the tree to see if money falls out.

As I mentioned before, I had someone claiming to be a urologist (or a reasonable facsimile thereof) come into my hospital room uninvited. Asked me how I was doing. I explained what happened. They gave me too many blood thinners after my stent insertion in my artery, and I pissed blood afterwards. By 10:00 or 10:30 that night (I spent the night in the hospital) it had gone away.

They sent me a bill for $40 for an office visit. It went into the "round file". Anyone else sends me a bill for something I did not request and/or for just poking their head into my room, will be treated the same way.

I will pay bills I owe. None other.

Not real crazy about this blood thinner I am taking. I bruise REAL easily now. And it doesn't feel like just a superficial skin bruise. Feels like my muscles are getting bruised. I was working on the generator the other day, and removing the spark plugs I had my left arm pressed up against the frame to get a bit more leverage. Well, damn. Got a swollen purple area on the inside of my forearm now that is tender to the touch. I am passed the 4 week period where my cardiologist said I could resume normal activities, but I am scared the death I will do yard work and come out of it looking like I have purple polka dots all over me. There are always things bumping and smacking against me when doing yard work. That deep bruise I had on my upper left leg took forever to go away. Actually still feels a bit tender to the touch.

I already contacted my cardiologist about it, but he seems to think it's normal. I don't agree. I feel MUCH more fragile concerning my vascular system now. So screw it. I am cutting those 10mg pills in half and only taking a half dose each day now. Perhaps it is the fact that in the past, every time I saw someone with these purple red patches on their arms and legs, seems they died not long afterwards. So I am just not going to go that route. My body, my choice. I have an appointment with the cardiologist in February, and I will tell him then my choice. Actually I wasn't all that keen when they gave me 4 or 5 of these blood thinner pills right after my second stent was put in, and I was pissing blood afterwards. Now THAT can't be normal...

So, I am supposed to have an appointment up in Tallahassee Friday morning with my new primary care physician. But this is the current prediction for landfall for hurricane Ian on Friday at 08:00am. Am I being a weenie thinking I may not be able to make that appointment?

When reading up about my blood thinner (prasugrel), I found that the recommendation is to give someone after having a stent placement 60mg of this medication as a initial dose. So apparently they gave me six (6) of those pills after my second stent was put in. I don't remember them doing that after my first one, but in any event, I was already taking 10mg per day before the second stent, and quite likely that was just too much. Had me pissing blood soon afterwards.

So with my easy bruising, I just think that 10mg is too much for me. Hence my deciding to cut back to 5mg per day. But I will say this. That coating on the pill was apparently to block that awful bitter taste of the medication. But it beats getting those reddish purple/black bruises on me whenever I bump against something. The bruise on my left forearm actually looks like it is starting to clear up now. And it doesn't feel painful to touch as it was a few days ago.

Oh yeah, I was reading that giving 10mg prasugrel to someone over 75 years old was contraindicated because of the chance of excessive bleeding. Like maybe excessive bruising too? Well, perhaps I have higher mileage than many other 72 year olds? In any event, my body was telling me it just didn't like that 10mg dose. It was making me feel too damned fragile!

Rich, make sure that the tablet is not enteric-coated or else you would be causing yourself a problem by breaking that coating.

Originally Posted by nickolasanastasiou

Rich, make sure that the tablet is not enteric-coated or else you would be causing yourself a problem by breaking that coating.

How do I tell?

And what sort of problem?

This is all I can find about the coating so far:

6.1 List of excipients

Tablet Core:
Microcrystalline cellulose
Mannitol (E421)
Croscarmellose sodium
Hypromellose (E464)
Magnesium stearate

Film-Coat:
Lactose monohydrate
Hypromellose (E464)
Titanium dioxide (E171)
Triacetin (E1518)
Iron oxide red (E172) {only Efient 10 mg}
Iron oxide yellow (E172)
Talc

Source: https://www.ema.europa.eu/en/documen...rmation_en.pdf

Some tablets of prasugrel have an enteric coating in order to have dissolution of the tablet and release of the drug occur in the intestine instead of the stomach. It could be for various reasons like bioavailability improvement, conversion efficiency to its more active metabolite occurring in the proper place (intestine and liver), and reduction of risks of things like gastric bleeding.

If a tablet has an enteric coating, you are not supposed to split or crush it. Is the tablet scored? If it is not scored, then it is not intended to be split and the active pharmaceutical ingredient is not guaranteed to be equally distributed throughout the tablet, in which case half of the tablet is less likely to contain half of the dosage, making dosing irregular and unpredictable. If it is scored and if it does not have an enteric coating (sometimes also referred to as a film coating, but it depends), then it should be able to be split.

Originally Posted by nickolasanastasiou

Some tablets of prasugrel have an enteric coating in order to have dissolution of the tablet and release of the drug occur in the intestine instead of the stomach. It could be for various reasons like bioavailability improvement, conversion efficiency to its more active metabolite occurring in the proper place (intestine and liver), and reduction of risks of things like gastric bleeding.

If a tablet has an enteric coating, you are not supposed to split or crush it. Is the tablet scored? If it is not scored, then it is not intended to be split and the active pharmaceutical ingredient is not guaranteed to be equally distributed throughout the tablet, in which case half of the tablet is less likely to contain half of the dosage, making dosing irregular and unpredictable. If it is scored and if it does not have an enteric coating (sometimes also referred to as a film coating, but it depends), then it should be able to be split.

No, the tablets are NOT scored.

I guess I need to contact my cardiologist and just tell him I want to have the dosage reduced and get the 5mg pills. This bruising I am getting is just not normal. I got this bruise on my left forearm on the 19th just by bracing my arm on part of the generator to get some leverage to remove the sparkplugs, and I STILL have that darn discoloration that makes me look like some sort of leper or something. Makes me scared to death to do anything because just what used to be an inconsequential bump against something is no longer inconsequential.

And these aren't just surface skin bruises, neither. These go right to the muscle, which really aches for quite a while. Something is just not RIGHT.