Just wondering, is there any procedure here in Thailand for getting written prescription refills from a doctor for medications that only can be obtained from hospital pharmacies, and aren't available from regular pharmacies?

Basically, I'm trying to figure out if there's a way I can obtain some ongoing medication that my Thai doctor certainly would certify/agree that I need without having to go back to the hospital every time and pay for unnecessary outpatient doctor visits.

Last time I went for a visit, the doctor agreed and gave me a prescription for 10 tablets of something you'd normally take up to 3 a day (a decongestant for sinus problems). It's nothing dangerous or addictive or problematic for the patient taking it, in other words, nothing that would require ongoing doctor monitoring or supervision.

In the U.S., the doctor would give me a prescription and then, if appropriate for an ongoing medicine and need, would include in the prescription the ability to have it refilled a certain number of times for a certain quantity at the pharmacy without having to go back for more outpatient visits. But here in Thailand, I've never seen anything comparable to that...

In the past, I've asked a couple times at different hospital pharmacies, and their answer seems to be that the only way they're provide anything is through a prescription coming from a doctor's appointment.

No such arrangement AFAIK. Best option is to get a larger amount prescribed to begin with, if possible.

Psuedoephedrine (decongestant) is probably the drug prescribed and there was a big scandal in Thailand not so long ago because millions of these tablets were going missing and allegedly ending up being processed into methamphetamine (YaaBaa) which is a class 1 drug in Thailand.

So this former pharmacy drug is now controlled in Thailand and I should imagine a stringent paper trail being required from Doctor to Patient.

Psuedoephedrine (decongestant) is probably the drug prescribed and there was a big scandal in Thailand not so long ago because millions of these tablets were going missing and allegedly ending up being processed into methamphetamine (YaaBaa) which is a class 1 drug in Thailand.

So this former pharmacy drug is now controlled in Thailand and I should imagine a stringent paper trail being required from Doctor to Patient.

You hit the nail dead on the head. But unfortunately, it's not just Thailand. What used to be a commonly available over the counter drug in the U.S. (and a widely used one at that) for sinus problems also became restricted some years ago.

And at least for me and many others from what i read, the substitute drug that was put into the OTC formulations -- phenylephrine -- is nowhere near as effective as its predecessor. In my case, I find it to be pretty useless.

http://en.wikipedia.org/wiki/Phenylephrine#Questions_about_effectiveness

Questions about effectiveness

Pharmacists Leslie Hendeles and Randy Hatton of the University of Florida suggested in 2006 that oral phenylephrine is ineffective as a decongestant at the 10-mg dose used, arguing that the studies used for the regulatory approval of the drug in the United States in 1976 were inadequate to prove effectiveness at the 10-mg dose, and safety at higher doses.^[9] Other pharmacists have expressed concerns over phenylephrine's effectiveness as a nasal decongestant,^[10] and other clinicians have indicated concern for regulatory actions that reduced the availability of pseudoephedrine.^[11][12]

A subsequent meta-analysis by the same researchers concluded that the evidence for its effectiveness is insufficient,^[13] though another meta-analysis published shortly thereafter by researchers from GlaxoSmithKline found the standard 10-mg dose to be significantly more effective than a placebo.^[14] Additionally, two studies published in 2009 examined the effects of phenylephrine on symptoms of allergic rhinitis by exposing sufferers to pollen in a controlled, indoor environment. Neither study was able to distinguish between the effects of phenylephrine or a placebo.^[15][16]

Pseudoephedrine^[15] and loratadine-montelukast therapy^[16] were found to be significantly more effective than both phenylephrine and placebo.

The Food and Drug Administration has stood by its 1976 approval of phenylephrine for nasal congestion as the debate continues.^[8]

I guess I need to try to decide between the expense and hassle of trying to get my sinus doctors here to continue prescribing a sufficient per appointment supply vs switching to a different nasal decongestant medication, and then trying to figure out what the medicine here in Thailand ought to be.

No such arrangement AFAIK. Best option is to get a larger amount prescribed to begin with, if possible.

Thanks Sheryl... I've noticed a distinct reluctance lately of the doctors here to do that -- even though I have a clear medical history that warrants it.

Do you have any opinion about what's the best, hopefully no side effects, available OTC alternative???

I see there was a prior thread that addressed the same basis for my question...

http://www.thaivisa.com/forum/topic/545919-what-is-an-alternative-to-pseudoephedrine/

Pseudoephedrine should in any event not be needed, or taken, for prolonged periods. If you have a chronic condition a different approach -- such as use of a steroid nasal spray and/or one of the newer generation allergy meds, and/or sinus lavage, might be a better approach.

I suggest you consult a different ENT. If you are in Bangkok, Prof. Songklot at St. Louis is very good.

On the subject of pseudoephedrine, I see there also was another past thread where Sheryl and others chimed in with advice and experiences on related other medications.

http://www.thaivisa.com/forum/topic/681025-substitute-for-pseudoephederine/

It's really hard to know. I've seen a lot of sinus doctors over the years both in the U.S. and now Thailand, and gone thru three rounds of sinus surgery some years back.

And in all those visits, I don't think I can ever recall any doctor telling me WHY, especially after all the sinus surgeries addressed structural issues, I was still having sinus problems. They all tend to just write down chronic sinusitus as the diagnosis and typically prescribe antibiotics, which usually provide short term relief.... until the next time.

I have allergies, I know that and have been tested for them in the past.

So all in all, it's kind of hard to know what approach to pursue -- antibiotics, decongestants, antihistamines, nasal cortico-steroids. And the doctors don't seem to be much help in navigating that maze.

I have twice taken people with chronic sinus problems whom other doctors had been unsuccessful in treating to Prof. Songklot and in both instances he was able to help. Worth a try,

About the refills, I have had a different experience then the above. At an international hospital in Bangkok I was written an Rx with a refill amount and was able to go back to the same hospital pharmacy and fill the refills without reconsulting with the Dr. On another medication I was able to take the Rx. To the Government pharmacy and one of two things happened. First they offered to fill all the refill amounts at one time with no need to come back, 30 with 3 refills so a total of 120, which I did do. Another time I only filled the amount written and returned for the refills. But when I returned for the refills with 3Xs written in the "Refill" area I was only allowed two refills as they said I had already refilled once? I calmly and politely explained that refill meant to fill again and that I had only filled the original 30 and still had an additional 90 allowed. They politely explained I had filled once so only 60 allowed. This made no sense as they had given me 120 pills for the same Rx. The previous time?

At the time I did go the refill amount at both the hospital and government pharmacy they wrote the amount filled on the original Rx. Handed it back to me and told me to return when I needed the rest with that original Rx. Neither of these Rx were for a controversial medication.

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That's an interesting account and experience.

FWIW, here in Thailand, I've never actually been given a written paper prescription sheet for drugs, like I'd always have received back in the U.S.

Here in my experiences at quite a few different private hospitals, the hospital doctor simply orders the medications through his hospital pharmacy and you pick up the medications from the pharmacy after paying your bill. But here, I've never yet received a written prescription paper that I would be able to take back to the hospital pharmacy on a subsequent visit. Nor have I had any doctor here ever give me any medication with any notion of refills involved.

But I will ask the doctor about what you recount, next time I have an appointment.

The hospital pharmacies are normally much more expensive than outside pharmacies. I am not sure but I believe that the Dr, gets a percentage of the drugs filled at the hospital that they ordered? The only other pharmacy I would really trust outside the hospital pharmacies would be the Government pharmacies. Be sure that the Rx. Is written in blue pen and not black and has the hospital stamp on it as well.

Within the hospital the Rx. Is usually written on the Dr. Notes and scanned into your record so you would never see a written Rx unless you specifically ask for it to take to an outside pharmacy.

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The problem with what you're saying is, AFAIK, the medicines that you need an actual prescription to obtain typically are only available at hospital pharmacies with a doctor's prescription.

Whereas the outside commercial/business pharmacies sell all kinds of medicines, including those prescribed by doctors, but they typically won't have or sell those that actually require a prescription.

Antibiotics are a good example. Back in the U.S., can't get them without a doctor's prescription. But here, you can walk into any pharmacy and pretty much order and buy almost anything you want in terms of the common antibiotics -- without any prescription.

On the flip side, restricted items like pseudoephedrine now are ONLY available thru hospital pharmacies with a doctor's prescription. But AFAIK, even if you had a written prescription, you wouldn't be able to obtain that medicine at any regular commercial pharmacy.

PS - I have frequently in the past told doctors I want to fill their prescriptions at outside pharmacies, assuming the item was available outside, and they've typically agreed. But in those cases, I can't recall any where the doctor has actually written me a traditional paper prescription. They've just told me, OK, get such and such medicine and take it so many times per day.