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PEBC: Theme of the Week: You Have a Lot of Strength(s)!

Looking at the pharmacy shelves, it becomes clear that there are certain drugs which are available in a wide range of strengths and take up a great portion of the drug wall. What is the reason behind the dose variability?

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1) Warfarin (Coumadin): 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg. 6 mg 7.5 mg, 10 mg. Warfarin is a blood thinner and the wide number of strengths reflects the variability in response to warfarin, based on age, diet, medical conditions, genetics and interactions. Using the International Normalized Ratio (INR) obtained from blood work as a guide, some patients require as little as 1 mg daily, whereas others greater than 10 mg!

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2) Levothyroxine (Synthroid): 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 300 mcg. Levothyroxine is a thyroid supplement, and similar to warfarin, levothyroxine is dosed based on blood work (thyroid stimulating hormone and free T4 hormone), which explains the variability.

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3) Hydromorphone controlled-release (Hydromorph Contin): 3 mg, 4.5 mg, 6 mg, 9 mg, 12 mg, 18 mg, 24 mg, 30 mg. Hydromorphone is an opioid used for pain control, and the level of pain control required varies between individuals. Note that there is a trend to reduce opioid use, so very few patients will be on the highest strength.

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4) Lisdexamfetamine (Vyvanse): 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg. Used for attention-deficit hyperactivity disorder, clinicians may elect to use a lower strength, and slowly titrate up based on patient response.





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