Non-adherence not an option image

  • We think so … and we’ve found others who agree
  • We’ve also released LOTS of tools to help

At ScriptSave WellRx, we’ve lost count of the number of studies and surveys presented that show just how close the relationship is between high out-of-pocket costs for prescription drugs and the rate of prescription abandonment or non-adherence.

It’s one of the core reasons we do what we do – to fill gaps in prescription coverage, in an effort to make medications more affordable to those who struggle in the face of high deductibles, copays and out-of-pocket costs.

Rather than rehashing another set of adherence survey results (if you’re reading this, you probably understand adherence all too well), we have decided to share some first-hand insights to the importance of medication adherence (and some of the related struggles) from a handful of everyday patients.

Adherence matters, and these patients agree. You can read for yourselves the accounts of these patient advocates, as they tell their own stories, in their own words, about why prescription adherence it so vital.

THEN, once you’ve heard these first-hand accounts, we’ve included details of some free tools that we provide to help patients stay adherent. The ScriptSave WellRx program is so much more than just another prescription savings card. Our members are given access (at NO COST) to many adherence-based tools in addition to our fast, easy, free price-check tool. More details below.

Behavioral Health

The first account is from Gabe Howard. Gabe is an advocate for mental health issues and he lives with bipolar and anxiety disorders. As he will attest, life without his psychiatric medications can lead down some pretty dark roads. Read more at …

“Is High Cost Preventing Access to Psychiatric Medication?” – click here

(…and Gabe also posted a short video on this topic via his Facebook feed. You can watch it here – it’s less than 2mins)

Reflex Sympathetic Dystrophy (RSD)

Next up is Barby Ingle. Barbie is a minor celebrity in her own right, but she also deals with chronic pain. Read her take on the idea of non-adherence at …

“Free Programs That Help Pay for Prescription Drugs” – click here

Living with Lupus

Then we have Charlotta Norgaard. Charlotta’s daily struggle includes her fight with Lupus, which led her to set up the Lupus Friends & Family Foundation. Read what she has to say about the mere suggestion of non-adherence in here world…

“Prescription Adherence – and why it matters” – click here

Migraine Sufferer

Finally, there’s Sarah Hackley. Sarah’s insights into the topic of non-adherence will give an idea as to what it’s like to be a prisoner of migraines when the budget doesn’t quite stretch far enough to pick up a new prescription for a non-covered drug. Read about her struggles in …

“Affording Prescriptions When You’re Chronically Ill” – click here

Tools to Help with Medication Adherence

It’s a simple fact: drugs don’t work in patients who don’t take them. The causes of non-adherence, when a patient either accidentally or knowingly does not take medications as prescribed, can be complex. As we’ve already addressed in this blog post, non-adherence is often the result of cost; patients who simply can’t afford their medications. However, good habits and a good understanding of the medication can also be a big part of adherence.

With this in mind, we created the Medicine Chest. Registered ScriptSave WellRx members have free access to a complete suite of tools and resources, including:

  • Ask a Pharmacist
  • Pill Reminders
  • Refill Reminders
  • Medication Info (in both English and Spanish)
  • Medication Videos
  • Mood-tracking (to review side effects, etc.)
  • Price-check and Pharmacy Locator

Plus, registered members can connect directly to their pharmacies, like CVS or Walgreen’s, to automatically import their existing prescription information!

We hope these first-hand accounts on the importance of medication adherence have helped. Download our free app from the iOS app store or the Google Play Store, and get registered to take advantage of our free medication adherence tools. If you’re struggling to afford your medications, visit www.WellRx.com to compare the cash price at pharmacies near you. You may find prices lower than your insurance co-pay!

Best U.S. Prescription Savings image

A ScriptSave WellRx Pharmacy Price Comparison Across the US

Jul 26, 2017 – (Newswire) The prescription discount program, ScriptSave WellRx, has just completed a national price analysis of the biggest pharmacies, grocers, and retail chains, trying to uncover who has the lowest prices when it comes to prescription drugs.

Their data analysts looked at every national retail chain pharmacy in the country. Large discount retailers, like Walmart and Costco; grocery stores, like Albertson’s and Safeway; drug stores like Walgreen’s/Duane Reade and CVS were all included in this computer-based analysis.

ScriptSave WellRx discovered prices for some prescription drugs varied by more than 300 percent in the same neighborhood. For more expensive prescriptions, that’s a price fluctuation of more than $300.

Which pharmacies have the best prescription medication prices?

ScriptSave WellRx negotiates medication prices in bulk with pharmacies, so they have an insider view of how prescription drugs are priced.

In 2017, researchers with ScriptSave WellRx compared prices for some of the most popular prescription drugs sold in the U.S.

This analysis found the price for the cholesterol drug, rosuvastatin (generic version of Crestor), varied from $16 to $106, depending on the pharmacy being used.

Celecoxib (generic Celebrex), an anti-inflammatory drug, ranged from $22 to $96, and the sleep medication, Lunesta, was $24 to $137 at different pharmacy locations.

The allergy drug, Flonase, was $14 to $21. Other popular drugs showed similar price disparities.

Why do prices for prescription drugs vary so much?

The Vice President of Product for ScriptSave WellRx, Shawn Ohri, says there are multiple factors that determine how pharmacies price the same prescription drug. Ohri compares it to the neighborhood gas station. Prices for the same product can vary immensely even on the same corner.

“The prescription drug industry is a complicated business with many factors that influence how a prescription drug is priced,” Ohri said. “Grocery stores, drug stores and big box retailers all have different overhead and pricing strategies that determine how corporate prices their prescriptions. It really does pay to shop around. We’ve created WellRx as a tool to allow customers to do that.”

Free Mobile App Reveals Prices at Local Pharmacy

In the past, consumers had no way of comparing prices for their prescription other than calling around and asking for a quote. Now, consumers can find the lowest price for their prescription by downloading the free mobile app, ScriptSave WellRx.

The company, based in Tucson, Arizona, has compiled a proprietary pricing database and it is now sharing that information with the public via their website and their free mobile app.

ScriptSave WellRx is consumer friendly. Users type in their zip code and the name of their prescription drug. The mobile app then reveals the prices for that drug at every nearby pharmacy. Consumers need to show their ScriptSave WellRx mobile app or discount card to get the lowest price at the pharmacy.

“Last year, ScriptSave helped customers save more than $1.3 billion through our innovative pharmacy savings programs,” said Ohri. “As healthcare costs continue to rise and consumers become responsible for more out-of-pocket costs for their healthcare, it will become more important to shop around for the best price. Our goal is to keep customers healthy, while also bringing more pricing transparency to this industry.”

Ohri says on average consumers can expect to save 45 percent and in some cases more than 80 percent on their prescription costs with the ScriptSave WellRx app.

Consumers can download the free ScriptSave WellRx’s free mobile app (for iPhone and Android) and visit their website for more information.

WellRx is also offered to groups, including employers, health plans, insurers, and other affinity organizations.

 

 

Press Contact:

Mark Macias
​Email: mmm@maciaspr.com or 646-770-0541

 

You can find the original ScriptSave WellRx press release here.


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Behavioral health medications for anxiety or depression - image

Jenny Bingham, PharmD
University of Arizona College of Pharmacy

There are a number of mental conditions that shape mood and behavior. Any condition that affects a person’s thinking, feeling or mood, falls into a medical classification of Behavioral Health.  Such conditions may affect someone’s ability to relate to others, or maintain reasonable function every day. Each person may have different experiences, even if they have the same diagnosis as someone else.

Depression is the most common behavioral health condition in the general population1. Without treatment, depression can lead to decreased quality of life2, increased suicidal thoughts, and overall worsened health outcomes. The most common method of treating depression is to target serotonin and how the body uses it.  Serotonin regulates mood and ultimately is what makes you feel happy. When we have low serotonin levels, you can feel depressed or anxious. Antidepressants each have their own unique mechanism of action that are specific to certain neurotransmitters in the brain.

Anxiety can affect our ability to function due to excessive worry. Without treatment, anxiety can also lead to a worsened quality of life and can even be debilitating for some patients3. Anxiolytics are the medication class used to treat anxiety. The most common method of treating anxiety is to target serotonin and/or norepinephrine.  Norepinephrine is responsible for motor action, cognition, the body’s alert system, and feeling energetic.  When we have low norepinephrine, it is harder to cope with every day stressors and things that are beyond our control.

How do these medications work?  

These medications are often classified as reuptake inhibitors. They target the neurotransmitters serotonin and norepinephrine, to name a few.  Medications prevent the body from recycling these neurotransmitters. By preventing them from being recycled too soon, it allows the body a better chance to use them to improve mood and/or relieve anxiety.

What can you do to make them work better for you?

We know that the body needs certain building blocks to make serotonin and norepinephrine. An important concept to remember is that no matter how many medications are prescribes to treat these conditions, they don’t stand a chance at being effective without the right precursors; an interesting concept in today’s world. The majority with these conditions take more than one medication.

Step 1: What is your protein source?

The greatest building blocks for serotonin are things that you might already have in your kitchen.

Complete proteins are the main precursor for tryptophan, which is later turned into serotonin. You might think that tryptophan only comes from turkey on Thanksgiving, but did you know that you can also get it from eating beef, venison, buffalo, pork, fish, shellfish, cheese, cottage cheese, milk, yogurt, and eggs? 

The building blocks for norepinephrine are also found in your kitchen.

In addition to eating complete proteins, it’s also important to eat incomplete proteins as well. You can find these in nuts, grains, beans, legumes, and soy.

Step 2: What else is included on your meal plan?

When we think about serotonin building blocks, key vitamins play an important role as well.

  • Vitamin B6. Great nutritional sources of this vitamin are found in whole grains, vegetables, and nuts.
  • Vitamin B12. This vitamin is found in meats, fish, liver, and milk.
  • Folic acid and Vitamin D3 are often found in fortified foods.
  • Omega-3 Fatty Acids are found in fish, dairy, and grains.

Step 3: Don’t forget about your supplements and vitamins.

Over-the-counter supplements can help you fulfill your dietary need of the vitamins mentioned above. But, there is a caveat.  Did you know that you can actually take “too much” of a vitamin? When in doubt always review your supplements and medications with your pharmacist for safe use.

As a patient, take comfort knowing that you can control how well your medications work for you. You are the rate limiting factor in the equation. These simple modifications can make a world of difference with managing depression and anxiety. After all, the best investment you’ll ever make is in yourself.

References:

  1. Kessler RC, Ormel J, Petukhova M, et al. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry 2011; 68:90.
  2. Daly EJ, Trivedi MH, Wisniewski SR, et al. Health-related quality of life in depression: a STAR*D report. Ann Clin Psychiatry 2010; 22:43. 
  3. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:617.

For the best Rx price on prescription
depression or anxiety medications,
visit www.WellRx.com.

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Is your blood pressure too high?

by Rick Lasica, PharmD
Post-Graduate Year 1 Resident

High blood pressure, also known as hypertension, affects nearly 1 in every 3 adults in the United States. Hypertension is often referred to as the “silent killer,”  because for the most part, hypertension doesn’t have any warning signs or symptoms. You might not even know you have it. If left untreated, hypertension increases your risk for heart disease and stroke, two of the leading causes of death in the U.S., according to the Centers for Disease Control and Prevention (CDC). So when is high blood pressure too high?

Blood Pressure by the Numbers

Blood pressure is reported as two numbers: systolic blood pressure (top number) and diastolic blood pressure (bottom number). Systolic pressure is the pressure of your blood against the walls of your heart when it beats, while diastolic pressure is when it rests (between beats). Normal blood pressure is less than 120/80 and pre-hypertension (the range before an actual diagnosis of hypertension) is between 120-139 for the top number and 80-89 for the bottom number. A consistent blood pressure reading of 140/90 or greater means you have hypertension.

Preventing and Treating Hypertension

Luckily, there are many ways to prevent and treat hypertension. Lifestyle factors such as smoking tobacco, eating foods high in sodium, not exercising enough, being obese, and drinking alcohol, all increase the likelihood of developing hypertension. These are manageable risk factors that should be minimized or avoided. If all of these lifestyle factors for hypertension are modified in a positive manner and your blood pressure is still high, your doctor might start you on a medication to help it stay controlled. There are several classes of hypertension medications, all of which work differently in the body. Each class of medications works differently to lower your blood pressure, and has unique side effects you should be aware of. Your doctor or pharmacist can discuss these with you.

Common High Blood Pressure Medications

The angiotensin II receptor blocker Valsartan (Diovan) is one of the top high blood pressure medications, followed by the beta blocker Metoprolol Hydrocholorothiazide (Lopressor HCT), Olmesartan (Benicar), and Olmesartan and HCTZ (Benicar HCT).

Other frequently prescribed high blood pressure medications are the ACE inhibitor, Lisinopril (Prinivil, Zestril), Amlodipine besylate (Norvasc), a calcium channel blocker, and the generic diureticHydrochlorothiazide (HCTZ).

See Your Doctor for High Blood Pressure

It’s important to see your healthcare provider regularly so that they can monitor your blood pressure. Let them know all of the medications you are taking, including anything that doesn’t require a prescription, such as herbals and supplements, since these might be contributing to your high blood pressure. Also, if a new medication to treat your high blood pressure is needed, they will work with you to find a blood pressure medication that doesn’t interact with a medication you might already be taking.

By working with your healthcare provider, you can keep your blood pressure under control to help ensure a long and healthy life!

Resources:

  1. Centers for Disease Control and Prevention
  2. Mayo Clinic
  3. WebMD

For the best Rx price on all of your blood pressure medications,
visit www.WellRx.com.

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percent opting out of healthcare graph If you’re a ScriptSave® WellRx member, you probably know only too well what it means to face high out-of-pocket costs for prescription medications. We hear this message from members every day and so it didn’t come as a huge surprise when we read details from a Bankrate.com survey.

One quarter of surveyed Americans report that they, or someone in their family, have skipped vital medical care because of the cost. The Bankrate Money Plus Survey also revealed that more than half of those who responded worry about not being able to afford health insurance.

Health Care Anxiety

The survey findings come at a time of rising healthcare costs and huge increases in some health insurance premiums, while increasing insurance deductibles further weigh on the issue. In the survey, 56% say they’re either very or somewhat worried that they might not be able to afford health coverage in the future.

percent concerned about healthcare coverage graph

High-deductible Dilemma – An Expensive Healthcare Punt

High-deductible plans and HSAs (Health Savings Accounts) have been central in the healthcare debate. Such plans hype lower monthly premiums, as compared to traditional insurance. For many, this ends up being little more than an expensive punt (what gets ‘saved’ in premium costs comes back to bite many patients in the form of much higher out-of-pocket expenses when they submit a claim to their insurance provider).

In 2016 the average annual premium for employer-sponsored health insurance was $6,800 for single coverage in a preferred provider organization (PPO), according to data from the Kaiser Family Foundation (KFF).

By comparison, the average annual premium for a high-deductible health plan available through an employer was somewhat more affordable. KFF found that to be $5,762. The trade-off for the lower premium is that the consumer is responsible for saving the necessary amount of money needed to meet a higher deductible in the event of illness or requiring medical attention. In theory, under a high-deductible plan, employees can use a tax-advantaged HSA to cover qualified medical costs so these premium savings can be deferred, tax free, in order to meet future medical expenses. However, for many, this simply does not happen.

Saving Where You Can

No matter how the debate on healthcare reform ends up playing out, here are some things a savvy patient might wish to think about now to make the most of their existing insurance benefits:

  • Get an annual checkup: Finding out if you have early underlying health issues earlier in the year and treating them, brings you closer to meeting your deductible before year-end.
  • Consider low-cost health care alternatives: See if your insurance plan grants access to telehealth services. These online virtual doctor visits can be an inexpensive (and faster!) alternative to many minor medical conditions.
  • Know your network: While your Primary Care Provider may be in-network, many specialty physicians and services may not be. You’ll be paying more for care from out-of-network services, and what you pay may not go toward your annual deductible. 
  • Get a free ScriptSave WellRx prescription savings card (or mobile app): For those facing high out-of-pocket costs for prescription drugs, be it due to a gap in insurance or high insurance copays/deductibles, a free download of the ScriptSave WellRx prescription savings card might help. As a patient, the card (or mobile app) won’t cost a penny to use. If it helps, great—enjoy the benefit of a lower-cost medication. If not, then it didn’t cost anything to try. That said, this savings program did yield an average savings rate is 45% (with savings up to 80%*) in 2016, and the ScriptSave WellRx program is contracted with over 62,000 pharmacies, nationwide. You might be surprised to find out you’re eligible for low-cost prescriptions with your ScriptSave WellRx card.

References:

http://www.cnbc.com/2017/06/07/heres-why-a-quarter-of-american-families-are-skipping-their-doctor-visits.html

http://www.bankrate.com/banking/savings/money-pulse-0617/ 


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transitions of care home health image

“It all started with pain radiating down my left arm. It was hard to breathe and I was short of breath. I knew something was wrong and called 911. I was rushed to the hospital. I remember the sirens, but they slowly faded away. Then I woke up. There was a man in a white coat telling me that I’d had a heart attack. He handed me some medicine bottles and prescriptions. Before you know it, I was discharged and on my way home.”

This was how Nancy described her heart attack. After several days in the hospital,  Nancy was discharged home, and now has to take four new medications every day. That can add up to a lot of out-of-pocket expense.

This scenario happens all too often, and through an unfortunate set of events, Nancy was re-admitted into the hospital just three weeks later.

Moving Through the Healthcare System

Transition of Care (TOC) is the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another.1 This definition by The Centers for Medicare & Medicaid Services (CMS) describes the process of a patient navigating the health care system and the unfortunate, but common reality that gaps in care develop between the hospital and outpatient setting.

A Growing Healthcare Need

This area of healthcare is expanding and becoming more important to help reduce readmission rates and the cost of healthcare. Pharmacists are expanding their roles by providing TOC services to patients newly diagnosed with specific conditions and/or a flare-up of a chronic condition or disease. Quite often will a patient’s medication therapy change upon admittance to a hospital and then at discharge from the hospital. They may be prescribed new medications after a hospital stay. The goal is to ensure the continuity of care for patient and help fill the gap, by:

  • Providing education about a condition
  • Monitoring a condition
  • Helping patients understand their medication.

Why Transition of Care Matters

Helping patients understand their prescription medications allows them to get the most benefit from them, and, to understand why it is important to take their medications as prescribed. Helping patients save on prescription medication costs is what ScriptSave WellRx does.

It is not just pharmacists that are expanding into this role, but other health care professionals like nurses, doctors, and case managers, too. It takes a care team effort and patient-centric approach to ensure that each patient is getting the best, high-quality care available.

 

References:

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/8_Transition_of_Care_Summary.pdf


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prescription savings pill-splitting - wellrx

by Hayde Blanco, PharmD Candidate
University of Arizona College of Pharmacy

Pill splitting refers to breaking a pill down to obtain a smaller amount of the whole pill. Your doctor can write a prescription that is usually double the dosage of what you should take in one day. You can then cut the pill in half, making the smaller dose that should actually be taken. For instance, a medication might be prescribed for 40 mg, but then the pill is split so you actually end up taking 20 mg.

Why Split Pills?

Pill splitting can be a huge help in cost savings if the same amount of the larger and smaller doses are sold at a similar price. Some of the most common reasons for pill splitting are:

  • Reduce the costs associated with a medication
  • Take a dosage of a drug that is not already available.

These methods can be useful to help some people save on their prescription medications, but are not suitable for everyone or for every type of pill. There are some risk factors that should be taken into consideration before splitting any pills.

Pill Splitting Concerns

When a pill is split, there may be different amounts in each half of the pill. Since the active ingredient in each pill is not usually evenly distributed throughout the pill, this may lead to one half containing more of the active ingredient than the other, giving it more potency. Some pills may be hard to split due to having an unusual shape, being too hard, or crumbling easily. There are also some medications that should never be split.

Pharmaceutical companies create some pills that are scored, meaning that they have a line down the middle to make it easier to split.

pill splitting sertaline
This pill is generic sertraline 100mg (an antidepressant) with a line down the middle. Generic pricing for 30 tablets of 100mg averages about $11.50. Generic pricing for 30 tablets of 50mg averages about $10.00. By cutting the 100mg dose in half, you would save close to half of the cost.

Some of the risk of pill splitting is related to the individual, instead of being related to the pill. A common issue is forgetting to split a pill, which could lead to taking double the amount of the prescribed dose. The directions might also be unclear if the bottle says to take one daily, but your doctor says to take one-half daily. You should always verify with your doctor if you are not sure about the prescription dosage you should be taking.

​Although there are risks involved with pill spitting, it can be an appropriate cost saving technique for some people. If pills are being split, there are some recommendations that should be followed to reduce the risks.

What are the Risks?

Some of the risk can be related to the individual instead of being related to the pill. A common issue is forgetting to split a pill, which could lead to taking twice or more of the needed dose. The directions might also be unclear if the bottle says to take one daily, but your doctor says to take one-half daily. Always verify with your doctor if you are not sure how much you should be taking.

​Although there are risks involved with pill spitting it can be an appropriate cost saving technique for some people. If pills are being split, there are some recommendations that should be followed to reduce the risks.

Splitting Pills Safely

  1. Always discuss your choices with a pharmacist or doctor before deciding to split a pill.
  2. Have a general understanding of which pills are appropriate to split and which are not.
  3. Use an appropriate pill cutter. Using a pill cutter instead of a knife or other object cuts the pill more evenly and leads to better distribution of the active ingredient.
  4. Cut the pills right before taking them instead of cutting them all at the same time. Since the distribution of the active ingredient is often not the same on both sides, taking both halves on consecutive days allows for a more even intake of the active ingredient. Additionally, a medication might not be as effective at treating your symptoms when it is broken down and exposed to air and moisture over time.
  5. Make sure you are can put this into practice safely or have someone help you if you can’t. If you have any problems with memory, trouble using your hands, or do not think you would be able to split the pills on an ongoing basis this will not be an appropriate technique to use.

These medications are usually appropriate to split, but always check with your pharmacist or doctor if it is okay to split your medication:

  • High blood pressure medications
  • High cholesterol medications (statins, like Lipitor, Crestor, or Zocor)
  • Depression medications.

These pills should not be split:

  • Capsules
  • Enteric-coated medications
  • Extended release or long acting medications
  • Combination pills containing more than one drug
  • Prepackaged pills, like birth control
  • Certain classes of medications, such as chemotherapy drugs
  • Pills with a small therapeutic index (these pills need to be taken at a very precise dose because they can lead to side effects more easily if more than the prescribed dose is taken or they might not be as effective if too little is taken).

Always remember to talk to your healthcare provider to be sure it’s appropriate for you to split a certain pill before using this cost saving technique. When done correctly, pill splitting can be a safe and effective method to reduce prescription medication costs.

 

References:

https://www.linkedin.com/pulse/tablet-splitting-risky-practice-stuart-silverman

http://www.consumerreports.org/drugs/is-it-safe-to-split-pills-in-half/

http://www.consumerreports.org/drugs/get-the-right-pill-splitter-and-save-money-on-your-medication/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827917/


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Role of vitamin d and statin induced muscle pain

by James Ketterer, PharmD

Statins are a class of drugs used to lower cholesterol and decrease the risk of cardiovascular events. They work by inhibiting an enzyme from completing an early step in the body’s process of synthesizing cholesterol. Statins are among the most commonly prescribed medications in the country. Approximately 1-2% of patients on statins report experiencing muscle pain. This pain can present itself in a variety of ways but most often results in flu-like aches and pains. The muscles may feel stiff or sore like the feeling after working out. This usually effects the larger muscles of the body such as parts of the back or thighs. This side effect is often responsible for patients discontinuing the use of these drugs.

Does Vitamin D Play a Role in Statin-induced Muscle Pain?

Do statins cause muscle pain? The exact cause of this phenomenon is not completely understood, but many researchers have hypothesized that vitamin D levels may play a role. Vitamin D is mainly produced in the skin from sun exposure. However, this source is not active. The liver and kidneys are responsible for activating the vitamin D which then plays a role in facilitating intestinal absorption of essential nutrients as well as balancing bone health homeostasis. Vitamin D deficiencies often present with similar muscle pain as those found as a side effect in statins.

Some researchers have theorized that statins could reduce vitamin D levels because certain types of cholesterol carry vitamin D and when the cholesterol is reduced, less vitamin D could be transported. On the other hand, many have theorized that since both vitamin D and statins are metabolized by the same enzyme in the liver, the use of statins could delay metabolism of vitamin D, thus increasing levels in the blood.

Muscle Pain in Clinical Trials

Clinical trials and various other studies and reports have yielded mixed results on muscle pain in statin users with low compared to high levels of vitamin D. A large analysis of these trials showed that more studies resulted in statin users having higher levels of vitamin D on average. One retrospective study divided statin users into 4 groups, 1 being the lowest vitamin D levels and 4 being the highest. Group 1 was 1.21 times more likely to develop muscle pain than group 4. Another study showed statin users with vitamin D levels of less than 15 ng/mL were 1.9 times more likely to experience muscle pain compared with non-statin users. The statin users with higher levels of vitamin D did not have higher risk for muscle pain compared with non-statin users.

When a patient experiences what is believed to be the side effect of a drug, they are often taken off of the drug to see if the symptoms resolve. If they do resolve, sometimes the patient is started back on the drug to see if the symptoms return. This a referred to as a “rechallenge”. One chart review showed that returning vitamin D levels to a sufficient level before a rechallenge in statin users who had experienced muscle pain, increased their tolerability to statins.

Do Vitamin D Supplements Help Reduce Statin-induced Muscle Pain?

Some studies have given vitamin D supplements to statin users experiencing muscle pain. While these studies were uncontrolled, they did show improvement in muscle pain in nearly 90% of patients.

These are just a few of the examples of research looking at the correlation between stain use and vitamin D levels as a possible cause of muscle pain. While nothing is definitive at this point, patients on statins that are experiencing muscle pain may want to explore vitamin D supplementation as a possible resolution plan. The benefits of statins are well documented in patients with heart risks. Any side effects should be attempted to be overcome before giving up on the statin and assuming it is the cause.

References:

Gregory, Philip J. ” Vitamin D and Statin-Related Myalgia”. Medscape. 2017. Web. 10 Mar. 2017.

Simvastatin.  Micromedex Solutions.  Truven Health Analytics, Inc. Ann Arbor, MI.  Available at: http://www.micromedexsolutions.com.  Accessed March 20, 2017.


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low carb high fat diet metabolic syndrome - wellrx image

by James Ketterer, PharmD Candidate
University of Arizona College of Pharmacy

A Low Carbohydrate High Fat diet (defined as either less than 26% of total energy intake coming from carbohydrates or less than 130 grams of carbohydrates per day) may not be the best dietary choice for everyone. Defined as either less than 26% of total energy intake coming from carbohydrates or less than 130 grams of carbohydrates per day. It has, however, been shown to be as safe and effective, if not more so, than High Carbohydrate Low Fat diets, for people with high cholesterol, diabetes, and non-alcoholic fatty liver disease. In fact, clinical studies have shown that Low Carbohydrate High Fat (LCHF) diets effectively lower blood sugar, triglycerides, insulin, and saturated fat. They also can help reduce blood pressure and weight and even increase levels of good cholesterol which could eliminate the need for damaging cholesterol medicines.

Reducing Hunger, Lowering Daily Calories

LCHF diets inherently increase the relative amount of protein and fat consumed per day. These diets are primarily made up of leafy green vegetables, nuts, fish, eggs, seeds, unprocessed meats, dairy, and plant oils. While it may seem counter-intuitive that consuming more fatty foods would cause weight loss, this is not the case. LCHF diets have been known to decrease hunger resulting in an overall decrease in daily caloric intake. It has also been proposed that LCHF diets provide a specific metabolic advantage by encouraging ketosis and ketone burning. This doesn’t go without scrutiny as LCHF is often referenced as a fad diet. As with all lifestyle and diet changes, we strongly encourage any such changes to be done under the supervision of a physician..

A 24-week clinical study looked at 363 overweight and obese patients who chose to start either a LCHF diet or a ‘low calorie, high nutritional value’ diet. In the 102 patients with Type 2 Diabetes, weight loss was significantly greater (−12.0% vs −7.0%) and their A1C and fasting blood glucose levels decreased significantly more with the LCHF diet. More patients on the LCHF diet were able to decrease or discontinue their diabetic medication as well.

A Decrease in Cardiovascular Risks

The increase in dietary fat consumption in LCHF diets has led to many misconceptions. One of the biggest concerns is risk for developing cardiovascular disease. However, several studies have shown that LCHF diets actually decrease cardiovascular risk more than HFLC diets. The increase in dietary protein has led some to worry that kidney function could be impaired. To date there has not been any evidence to suggest these negative effects occur in people with normal kidney function including diabetics. The most common side effects that do occur are fatigue, headache, and muscle cramps. Most people that experience these effects, do so within the first few weeks of adapting to the diet, then these events subside. The most common failure of all diets is lack of adherence. Studies have shown that people find it no more difficult to adhere LCHF diets than to others, and some people may even find it easier due to the hunger reducing effects.

The individual responses to dietary strategies may change from person to person, but LCHF diets have been proven to be a safe and effective option for improved health outcomes, especially in patients with metabolic syndrome.

References

Noakes, Timothy David and Johann Windt. “Evidence For The Prescription Of Low-Carb High-Fat Diets”. Medscape. N.p., 2017. Web. 22 Feb. 2017.

 

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ScriptSave WellRx - Statins and Liver Damage

by: James Ketterer, PharmD Candidate
University of Arizona College of Pharmacy

If your doctor has said you have high cholesterol, it’s likely that you’ve heard or read about about the potential side effects of statin drugs and their impact on liver.

Doctors often prescribe statins for people with high cholesterol levels to lower their total cholesterol and reduce their risk of a heart attack or stroke. While statins are highly effective, they have been linked to muscle pain, digestive problems and mental fuzziness in some people and may rarely cause liver damage.

Cholesterol and triglycerides are lipids (fats) that are stored in the body and serve as a source of energy. Lipids, together with proteins and carbohydrates, are the main components of living cells. When lipid levels in the bloodstream are too high or low, this condition is called dyslipidemia. The most common types of dyslipidemia are:

  • High levels of low-density lipoprotein (LDL or “bad”) cholesterol
  • Low levels of high-density lipoprotein (HDL or “good”) cholesterol
  • High levels of triglycerides

You may have heard stories of people who have experienced devastating liver damage from their use of drugs like atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor). Less than 3% of patients on statins report muscle pain while less than 0.5% report rhabdomyolysis (A breakdown of muscle tissue that releases a damaging protein into the blood).

Recently, the risk of statin-induced liver injury has become a hot topic, since this class of drugs is metabolized by enzymes in the liver. Liver injury has a broad definition, but generally includes, at minimum, highly elevated liver enzymes which are directly correlated with liver function and often a precursor to various liver diseases.

Statin Studies

While studies on the safety of these drugs have included thousands of patients, it’s difficult to determine if something like liver injury is one of the side effects of statin drugs, or happening for some other reason. Drug-induced side effects are more commonly identified after a drug hits the market and patients and physicians begin reporting problem cases to the drug manufacturers.

There have been a few studies around the world that have looked at drug-induced liver injury. A study in Iceland identified 96 patients with drug-induced liver injury. Three of those 96 were due to statins (1 with simvastatin and 2 with atorvastatin). During the trial, over 27,000 people were treated with simvastatin and over 7,000 with atorvastatin. That means that 1 out of 27,000 people on simvastatin and 1 out of 3,500 people on atorvastatin had drug-induced liver injury in Iceland over that 2 year period. Of all statins, simvastatin and atorvastatin are responsible for most reported incidents of liver damage, but this is likely just due to the fact that they are prescribed the most.

The Spanish Hepatotoxicity Registry identified 858 cases of drug-induce liver injury. Of those cases they attributed 47 (5.5%) of them to statin use. The total number of patients on statins was not available.

One of the latest studies from the USA ran from 2004 to 2014, examining drug-induced liver injury identified 1188 cases. They determined that about 2% could be contributed to statin use.

A Swedish study compared the reported statin-induced liver injuries to the total number of statin users (based on sales) and found that 1.2 people experience liver injury due to statins per 100,000 users of statins.

A Rare Occurrence

Outside of these large studies, there have been case reports of patients experiencing liver injury following an increase in dosage of their statins. These are few and far between, and are corrected by decreasing or discontinuing the medication. Some of these patients have been restarted on statins and experienced the same liver problems, confirming the drug as the cause. People that experience statin induced liver injury have a generally positive prognosis. These injuries are usually short-term and reversible. One study of interest that looked at 298 patients whom had experienced drug-induced liver injury and found that only 7 of them had any signs of liver problems one year later.

While there’s a lot of information on the safety of statins in the media, the truth is that side effects of statin drugs, including livery injury, are very rare. That’s not to say that they don’t occur, but rather that the benefits in patients with cardiovascular risk, even those with underlying liver problems, substantially outweigh the potential risks.

 

References

Björnsson, Einar S. “Hepatotoxicity Of Statins And Other Lipid-Lowering Agents”. Medscape. N.p., 2017. Web. 9 Mar. 2017.

Simvastatin.  Micromedex Solutions.  Truven Health Analytics, Inc. Ann Arbor, MI.  Available at: http://www.micromedexsolutions.com.  Accessed March 2, 2017.

 

Have questions? Ask a Pharmacist!

We want to make sure you have the information you need to safely
use your prescription drugs. Connect with a pharmacist at SinfoniaRx
who can help with non-emergency prescription questions
about drug interactions, and other medication-related questions.


For the best Rx price on statins,
visit www.WellRx.com.

Compare prices at more than
62,000 pharmacies nationwide.