About Dr. Tara Kompare, Pharm.D. Expertise I can answer a broad range of questions related to community pharmacy practice. My particular
interests include childrens` health and safe medication use for seniors. As the mother of two small children, I am quite knowledgable on many parenting issues from how to handle
a baby with colic to how to get kids to take their medicine. With regards to medication use in seniors, I can answer questions about adverse effects, drugs to generally avoid
in that population, and disease management issues.
Experience I entered the world of pharmacy as a technician for approximately six years. I then went on to receive my Doctor of Pharmacy degree and now work for the Federal Government as an outpatient pharmacist.
Publications Drug Topics Feb.2006 edition ("Why a Kiddie Corner Makes Sense"),
I also recently submitted an article to Pharmacy Times entitled "How to Help Parents Cope With Colic" which is scheduled for publication in the near future.
Education/Credentials B.S. Biology (Old Dominion University 1997)
Pharm.D.(Virginia Commonwealth University 2002)
Question Hello, my name is Jason Willingham, and am asking you for a bit of information, which hopefully you can help me with. Before you simply delete this, I would simply ask that you take a couple of minutes out of your busy day to please read through this entire correspondence, even though it would be out of pure benignity, Thanks. Like I said my name is Jason and I believe I just royally wasted money and time. For starters I'll be upfront and let you know this has nothing to do concerning your pharmacy, but need a Pharmacist’s opinion on this matter and I would be greatly appreciative if you could respond to this email at your convenience. Or at least direct me to someone that could help me w/ this information First thing first, I do live in the States in a very rural area of the Southeast , and have (GAD) General Anxiety Disorder w/ occasional panic attacks. I've been seeing my local psychiatrist for the last few years about my condition and was given several different SSRI/Benzodiazepine combinations e.g., Zoloft-loss of any sex drive, and Clonazepam which made me extremely sleepy. Eventually we found what worked best for me and stuck w/ it settling on- Paxil Cr 37.5 mg, 1 tab PO s.id. prn for anxiety, along w/ Alprazolam PO 2mg q.i.d. prn for anxiety. Only problem is that my Psychiatrist closed her practice and moved to an Urban area and went to work for a practice that will not accept my Insurance, and will not take cash payment. One of the few, local primary care Physicians, will not prescribe Benzos, in any manner, and doesn't like to prescribe SSRI's, unless you a certified Nut. With the nearest city being a good two hour drive. Now here comes the stupid part on my behalf, I for the first time ever went through an online pharmacy to get my medication. Simple fact it was the most convenient way to get my meds. I realize many people who use these Online pharmacies w/ online doctors consults are drug abusers. I AM NOT; I have a legitimate disorder that w/out my meds makes me worry pointlessly about anything and everything you could think of. Next time it will be well worth the two hour drive to another Psychiatrist after my experiences w/ this online pharmacy. As of now my Psychiatrist, before she closed her practice set me up with a ton of Paxil CR samples before she closed her practice, and gave me my last prescription For Xanax w/three refills on 7/05/06. I placed my order on 10/29/06 w/ guaranteed shipment w/in a week for Alprazolam 2mg, Dispense: 90 1 tab t.i.d. prn for anxiety. This was with a U.S. Online pharmacy. They where shipped out and received w/in a week. Please save me the lecture on how stupid this was to do, at the time I thought it would be the most convenient thing to do. I was running low on my Xanax, and as you well know this is a medication especially after taking 12mg s.id. for two years that you can not abruptly discontinue because of seizure potential, and yes I realize I should have made preparations instead of my procrastination. The medication arrived w/in a week, it was Generic Alprazolam manufactured by Greenstone scored G3722, (which happened to be the same generic I was getting from my local pharmacy the tablets where all uniform in shape and size and looked to be the real deal. I compared them side by side to make sure, they where no doubt the same pill, at least to the naked eye. From this point I took 4 mg, my normal morning dose even gave it the taste test by chewing it up, and it had that distinctive Alprazolam bitterness as only Alprazolam does. So I waited the usual 20-30 minutes for it to kick in, only problem was I barely felt it. It was if I had taken perhaps .5 mg's. I waited another hour and tried two more another 4 mg. This time I definitely felt it, yet it was still extremely week. The Generic Greenstones I was picking up at the local drug store would have knocked me out for about eight hours at the least. Now for my question for you: If these meds had simply been expired can you tell me the potency drop off e.g., 98-99% would be my guess, That's if they hade recently expired. I would guess that even if these meds where 4-5 years expired they would have at least 85-90% effectiveness if stored properly. If you could give me any information concerning this subject it would be greatly appreciated. The only other thing I can think of is that they were put together in a compounding pharmacy and simply stamped out w/ an exact replica of the Greenstone tablets and imprinted in the same manner, putting only perhaps half of required dosage into tablet perhaps 1mg of Alprazolam into a 2mg tablet and as mentioned cut out, and imprinted w/ near perfection. If you could give me any ideas on my theories (other than I was an idiot for going this route), Whether the compounding process as I have theorized is possible or not. Or any ideas or realities that you may be aware of that would result in these extremely weak tablets, it would be greatly appreciated. I do Know they weren't totally counterfeit, I can recognize the placebo effect and these definitely had some Alprazolam in them.
Thanks so much for your time, Jason Willingham
Answer Dear Jason,
I am sorry to hear of your negative experience with an online pharmacy. I also understand your predicament which led you to buy your meds from one of these on-line pharmacies.
Your medication was, most likely, expired and/or not stored properly which led to its loss of effectiveness. It is less likely they were "counterfeit" although you never know. I do not recommend doubling your dose as you did since some of the tablets may be at full strength still. It is impossible to estimate the approximate percentage of active ingredient still in tact without knowing the storage conditions and expiration, etc.
With regards to your effective drug regimen for GAD, I would see if there is another Dr. you could try eventhough you may have to make a longer drive than normal. If there are none then I would get a letter from your old Dr. explaining how effective your regimen is for you and bring that to your current Dr. He or she will hopefully be understanding and prescribe you what you need.
