I received this question the other day: How do you handle a situation in which the provider writes for an unusual dosing regimen.  The example was an alternate regimen than the traditional Zpak dosing.  Unusual dosing regimens for medications is something you may see rarely or might see on a regular basis depending upon the providers you work with.  How to handle these situations can be a challenge to say the least.  Here’s a few strategies to help you navigate this issue.

1. The very first question you should ask is: Did the provider make a mistake?  We all make mistakes and when you see something that just doesn’t seem right, you should clarify.
2. If you don’t think the provider made a mistake, what is the diagnosis, and does that make a difference? In the azithromycin example, it can be used for a lot of different infections and can have different dosing regimens.  Recognizing the diagnosis can help you determine the appropriateness of a medication regimen.
3. Understanding the provider’s openness to listen.  This can be a difficult one, but recognizing the perception of pharmacy from the provider’s perspective can be incredibly helpful in determining your approach.  You will encounter challenging providers as well as those that are very easy to work with.
4. Another question to ponder: Is this dosing safe and effective for the patient? If it is not proven safe and effective, that is going to give you a stronger case to recommend changing.
5. When clarifying, it can be a helpful idea to clarify why they are doing an unusual dosing regimen.  This will help you understand for future situations as well.
6. Whenever you question something a provider does, be prepared to offer a solution.  There is NOTHING more annoying to providers than someone who identifies a problem and has no solution to solve it.

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