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Treatment

  • 32 mg of buprenorphine?
    • We do NOT want a lot of patients on such dose 
    • 32mg may be justified if patient has a high body weight, undergoing extreme stress 
  • Barbiturate 
    • No contraindication if this is a patient’s regular medication. Suggested to start at a lower dose if patient has not been on it before, for example, 12 mg QD. 
  • Gabapentin
    • Gabapentin is considered a controlled substance in AL, KY, MI, ND, TN, VI, and WV.  (date last updated (02/11/22) 
      • Due to potential abuse it is limited to a maximum of 1 month of Rx (similar to other telemedicine services)  
      • While it does not show up in most PMP reports, it is imperative to check the history tab on our e-prescribing software to confirm the patient is not obtaining prescriptions in parallel from different providers 
      • Maximum dose should NOT exceed 2,400 mg (in rare circumstances 3,600 mg) 
  • Fentanyl
    • Microdosing patients on fentanyl
      • Fentanyl stays in system for quite a long time, need to wait 2-3 days before prescribing buprenorphine 
      • Lower dose to transition is the way to go and gradually increase the dose 
      • There are overlapping protocols for transition but best practice might be to tell patients to go 2-3 days without the previous drug before transitioning  
  • HIV 
    • Tenofovir disoproxil fumarate-emtricitabine (300/200 mg once daily) plus dolutegravir (50 mg once daily)  
    • or Tenofovir disoproxil fumarate-emtricitabine (300/200 mg once daily) plus raltegravir (400 mg twice daily). 
    • Should send to 24h pharmacies.  28 days. Pt will needs HIV test now, in 6 weeks, 3 months, six months  
  • STD 
    • We generally treat for both chlamydia and gonorrhea, unless the patient has a test result only showing one of them positive and the other one negative. We treat with 7 days of doxycycline 100 mg BID (treats the chlamydia) and a one-time dose of 800 mg Cefixime once (treats gonorrhea and is the only approved oral alternative to ceftriaxone).  
    • STD (Sexually Transmitted Diseases) Treatment (Chlamydia,  (Web view
  • Syphillis 
    • “states have different regulations but generally it’s the lab’s requirement to report. Empiric treatment, depending on the state, is a little gray zone because we haven’t confirmed the diagnosis.” – T.O 
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