Doctor vs Pharmacist.. who is wrong?

Question

I just found out my 4 year old toddler has anemia and the doc prescribed her 30mg of, from what i can read, Ferinsol 3 times a day. I took the prescription to Walmart and they would not fill it cause they said it was a lethal dose for a 31lb child. The pharmacist even called the doc and the doctor didn't understand why Walmart had a problem with it and would not change the prescription. In the end the pharmacist would not fill the prescription and gave me some over the counter med for now but my question is is the doctor or the pharmacist wrong?
We still have to go to get more tests run to find out why she is anemic. For dinner we always have a meat a vegetable and a side. Mostly green beans cause that’s her favorite. She’s not the kid you always hear about eating crap all day long. The snacks she has during the day is always apple sauce, bananas, crackers, or cheese sticks. She has milk with almost every meal and if not milk she will have apple juice or water.

The only lab test run on her so far was a hemoglobin or hematorit that came back as 9.7 Maybe this will help. Also what I can read the prescription says FerinSol. It has a big F and big S on it. Thank you all so much!!!!!

Answer 1

You said that the doc prescribed Ferisol, is the doc a Pediatrician or a General Practitioner? if he is a Pediatrician
then he should know however if Walmart is your regular pharmacy he would know what other medications your child is taking.
Ferisol is an Iron supplement and 90 mg per day for a 4 year old sounds a bit excessive to me and after a bit of surfing I would go back and KISS your pharmacist, accidental overdoses of iron containing products is a leading cause of fatal poisioning in children under 6 years of age

Answer 2

This is a confusing question, because there are many similarly named iron products, and if you're reading the doctor's handwriting on the Rx, then it can be hard to tell. There is a Fer-In-Sol which is liquid formulation made by Mead-Johnson (http://www.meadjohnson.com/app/iwp/HCP/Content2.do?dm=mj&id=-8703)
If this is the product described, there may also be confusion whether the dose is for iron sulfate or just the elemental iron it contains. The maximum dose I can find for children is:

Infants and Children:

Severe iron deficiency anemia: 4-6 mg elemental iron/kg/day in 3 divided doses

So in the case of your child (31 lbs = 14.1 kg) would be 56.4 - 84.5 mg elemental iron each day. If the prescription is 30mg three times a day (90 mg), then it is certainly above even the highest dose recommended, and that's assuming your child has a severe iron deficiency. If I were the pharmacist I would also be very concerned about this dose as iron overdose is very serious. The doctor may have misinterpreted dosing guidelines that call for 90 mg of iron sulfate rather than the elemental iron, which would be a much lower dose (18mg elemental iron, 180% daily value). Severe iron deficiency is also often treated with iron injections, so sending you to the pharmacy for such a high dose also seems unusual.

Answer 3

There is risk of overdose of iron salts in young children, so if you do use them, lean toward smaller doses, and definitely start small. I don't know that you even need a prescription for them. Many experts don't consider iron salts a good treatment for anemia. It's a simple salt, and can fool the body into thinking it has all the iron it needs, without providing the more complex forms that the body actually absorbs and uses. Try gradually incorporating raw spinach into your salads. Saute it lightly in a little olive oil with some onion or garlic. Mix it in pasta, lasagna, spaghetti, and so on. Make some molasses cookies. Consider folic acid and vitamin B12. Cow's milk contains almost no iron.

At the very least, get other opinions from competent medical professionals. Be completely sure the prescribed dosage is well within the manufacturer's guidelines for the age and weight.

I am not a doctor and I can't prescribe medicine. All I can do is tell you what I know. Good luck!

Answer 4

The physician's dosing is correct assuming iron deficiency is the cause of the anemia. Fer-in-Sol may be given

Children 1—5 years:

3 mg elemental iron/kg/day PO in 1—2 divided doses for mild-moderate iron deficiency;

4—6 mg elemental iron/kg/day PO in 3 divided doses for severe deficiency.


Your child weighs about 14 kg so you could see a dose anywhere from 42 mg/day to 84 mg/day though this dose should be divided over multiple administrations.

Iron toxicity may occur with increased dosages, however a more important question would be" is the cause of anemia actually iron deficiency?" The hematocrit is simply a measure of the amount of red blood cells. It does not tell you whether iron deficiency is the cause. Iron deficiency is only one cause of anemia; there are many that can range anywhere from other vitamin deficiencies (B12, folate) to more serious causes. In order to make the diagnosis of iron deficiency, a ferritin binding study and a total iron binding capacity (TIBC) should be carried out.

If iron is not the cause, then taking 90 mg/day can be dangerous.

Answer 5

i think you would probably change your doctor to get a second opinion because there is a risk factor on the Prescribe medicine the pharmacist would not say at all if it wasnt instructed by the opinion of another Physician and they would not sell unless directed by a Lead i believe they have also Medical experts working w/ these pharmacist and the Prescribed drug is to strong for the childs safety''or i would suggest if you doubt that 30mg x3 a day is to High then you can ask the pharmacist opinion to lower it to at least 18mg x 3 a day for iron supplemental that is fair treatment or whatever the pharmacist said

Answer 6

The doctor is right. The dose the doctor has prescribed for your child is a total of 6mg/kg each day. Iron (which is the active ingredient in Fer-in-sol) is toxic at 20mg/kg and the dose ordered is quite a lot lower than this.

However, it is your choice whether to give the medication to the child.

Have a look at the dose of your over-the-counter medication and check that the amount of iron you give to your child each day does not exceed 140mg/day (10mg/kg) - it should be well UNDER that level.

Answer 7

Call another pharmacist right away, from a different pharmacy, like one at a hospital would be best. Ask her/him this question. I think you should do this first because it's very accessible.

Now, second, make an appt with a different ped. doc. Get a second opinion and you will have your answer. Good luck.

Answer 8

Get a second opinion if you are concerned, from another doctor and pharmacist (I would be concerned too). The situation does not sound good with the two differing in opinion, and better be safe than sorry. If you can find our the answer, maybe one of these two is wrong, and you can let them know.

Answer 9

This reminds me
A patient went to a doctor . The doc said "I dunno the diagnosis but try this" and he scribbled a prescription. Assistant physician asked " Doc , isn`t it dangerous to prescribe an unknown drug?". "Sure" said the doc "but how do I live?"
The patient took the presciption to a pharmacist and asked for the medicine. The pharmacist said "I don`t understand the prescription but try this medicine" and handed over some medicine to the patient. Assistant pharmacist asked " isn`t it illegal to dipense an unknown medicine?"
"Yes" said the pharmacist "but how do I live?"
The patient collected the drug ,went to his house and dumped it in garbage tin.

"Why"asked his wife "after paying the doctor and pharmacist you destroy the medicine?"
"How do I live?" asked the patient
Jokes apart if your child is well nourished but still anemic rule out a congenital anemia

Answer 10

Fer-in-sol Dosing