Zollinger-Ellison syndrome - stomach image

by Derek Matlock, PharmD

What is Zollinger-Ellison Syndrome?

Do you suffer from Zollinger-Ellison syndrome (ZES)? If so, you may be in rare company. According to the National Institute of Diabetes and Digestive and Kidney Diseases, Zollinger-Ellison syndrome is a rare disorder. It occurs in about one in every 1 million people. Normally, when we eat, our body releases a hormone called gastrin, which tells your stomach to make acid to help break down foods and liquids. For patients with ZES, this mechanism is disrupted by tumors or “gastrinomas.” These tumors form in the pancreas or upper small intestine and secrete abnormally large amounts of gastrin from tumors, resulting in peptic ulcers to be formed.

It Might Be Your Genes

Some people with Zollinger-Ellison syndrome may go undiagnosed as the disorder is rare and its cause is not clear. In 75% of cases, ZES is sporadic or random, whereas in 25% it is associated with MEN 1, an inherited condition characterized by pancreatic endocrine tumors, pituitary tumors, and hyperparathyroidism.  Therefore, your doctor may perform a thorough medical and family history to help diagnose ZES. Additional tests may include endoscopy or various imaging and blood tests. They may even measure the amount of acid in your stomach. For patients with sporadic ZES, the most common symptom is abdominal pain. While patients with the inherited form of ZES mostly complain of diarrhea. Other symptoms include, heartburn, nausea, vomiting, stomach bleeding, and weight loss.

Managing Zollinger-Ellison Syndrome

Currently, the goal of managing ZES is to limit complications of the disorder by suppressing acid secretions. Thus, the main medications used in ZES are proton pump inhibitors, or PPIs, like omeprazole (Prilosec®) or pantoprazole (Protonix®), prescribed at high doses. For patients who do not respond to treatment with PPIs, octreotide is used, which stops the secretion of gastrin, the hormone that tells our body to secrete acid for food breakdown. Currently, the only cure for ZES is surgical removal of the tumor or tumors, but this may not be an option in cases where the tumors have spread to other parts of the body. In that case, chemotherapy with medications like streptozotocin, 5-fluorouracil, and doxorubicin are used to shrink tumors.

Zollinger-Ellison syndrome is a rare disorder that may be suspected in patients with multiple or repeat peptic ulcers. Currently, medications like proton pump inhibitors are the main treatment option, while surgery and chemotherapy are options in certain patients. Remember, when taking proton pump inhibitors, they are best taken 30-60 minutes before a meal and may also come with their own unfavorable side effects. Be sure to talk to your doctor or pharmacist about what can be done to best optimize your treatment options for ZES.

Resources:

  1. Medscape: Zollinger-Ellison Syndrome
  2. National Institute of Diabetes and Digestive and Kidney Diseases: Zollinger-Ellison Syndrome
  3. UpToDate: Management and Prognosis of the Zollinger-Ellison Syndrome

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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.

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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

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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.

 

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use your prescription drugs. Connect with a pharmacist at SinfoniaRx
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ScriptSave WellRx - Heliobactor Pylori stress image

Heliobacter pylori Eradication and Antibiotics

by: Derek Matlock
Pharm.D. Candidate 2017
Washington State University

Heliobacter pylori is a bacteria highly prevalent worldwide and is closely linked to duodenal ulcers (which affect the upper section of your small intestine), gastric ulcers, and peptic ulcer disease. It is also linked to an increased risk of developing gastric cancer in an infected person. Despite being more common in developing countries with poor socioeconomic conditions, the American College of Gastroenterology states that 30-40% of the U.S. population is infected with H. pylori, putting them at risk for conditions such as peptic ulcer disease — which affects the stomach lining — and gastric cancer.

Anitbiotics for Ulcers?

Numerous research studies and testing have not only supported these correlations, but they have also demonstrated the benefits of eradication using medications, specifically antibiotics, for patients suffering from complications of H. pylori.

Prior to the discovery of H. pylori, lifestyle factors such as smoking, eating spicy and acidic foods, and stress, were considered the major causes of ulcers. Thus, the main treatment choices were popular acid suppressing medications such as ranitidine (Zantac®) or omeprazole (Prilosec®). These medications can help improve ulcer-related pain and symptoms, and might even heal the ulcer, but they do not treat the underlying H. pylori infection. Without treating the infection, symptoms and complications are likely to reappear.

Triple Therapy for Ulcers

After the discovery of the bacteria causing these conditions, appropriate antibiotics have been able to eliminate the infection in the majority of individuals, thus resolving the infection and its complications. The following antibiotic regimens are being used, and the triple therapy is the most common.

  1. Triple therapy: Omeprazole 20 mg twice daily + Clarithromycin 500 mg twice daily + Amoxicillin 1,000 mg twice daily or Metronidazole 500 mg twice daily
  2. Concomitant quadruple therapy: Omeprazole 20 mg twice daily + Clarithromycin 500 mg twice daily + Amoxicillin 1,000 mg twice daily + Metronidazole 500 mg twice daily
  3. Bismuth quadruple therapy: Omeprazole 20 mg twice daily + Bismuth subsalicylate 262 mg four times daily + Tetracycline 500 mg four times daily + Metronidazole 250 mg four times daily

Although the triple therapy remains an effective choice, a preference for quadruple therapies may soon become more common, as the risk for patients to fail treatment due to antibiotic resistance becomes a growing concern in the science community.

As the United States prevalence of H. pylori continues to decline, the resistance to antibiotics, specifically Clarithromycin, makes the infection more difficult to treat. As a patient, it is essential to inform your doctor about any recent antibiotics you may have taken, as this may help in the selection of a better treatment option.

References:

  1. American College of Gastroenterology Guideline on the Management of Heliobacter pylori Infection
  2. CDC: Heliobacter pylori Fact Sheet for HCPs
  3. Medscape: Heliobacter pylori Infection
  4. WebMD: What is H. Pylori?

 

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generic aspirin tablets

by: Rick Lasica, BS
University of Arizona College of Pharmacy PharmD Candidate, Class of 2017

Many people take aspirin occasionally to provide relief from various conditions (e.g. pain, inflammation, fever, headaches), but what about taking a low-dose aspirin every day for prevention reasons? As with all medications, aspirin poses various benefits and risks that need to be taken into consideration before you start taking it. Studies have shown that certain individuals would benefit the most from taking a low-dose aspirin and others shouldn’t take it at all.

Why Take Low Dose Aspirin?

Our bodies make cells called platelets, which help stop us from bleeding uncontrollably. In order to stop this unnecessary bleeding, a blood clot is formed. In this case, the blood clot is beneficial, but sometimes blood clots are formed when they aren’t needed, which have the potential to lead to a heart attack or stroke. Aspirin is a non-steroidal anti-inflammatory drug (NSAID) commonly referred to as a “blood thinner” because it stops platelets from working together to form a blood clot.

Even though aspirin has many potential benefits, it also has many side effects, some serious, that might occur. Most importantly, it can increase your risk of bleeding, both inside and outside of your body. This might be noticed through your gums bleeding while brushing your teeth, any unexplained bruising on your body, or black/tarry stools. Other side effects that might occur are ringing in the ears, nausea/vomiting, dizziness, or yellowing of the eyes/skin.

The United States Preventive Services Task Force (USPSTF) recommends that people aged 50-59 years with an increased risk of heart problems who have never had a heart attack or stroke in the past would likely benefit from taking a daily low-dose aspirin in order to help reduce the chance of one from happening. Also, people who have had a heart attack or stroke are at an increased risk of having another one, and would likely benefit from it as well.

However, you should never start taking aspirin, or any medication, before talking with your physician or pharmacist about it. They will make an assessment of your condition and weigh the benefits and risks of you taking it and make the ultimate decision of whether or not you should take it as part of your daily regimen. Certain people should not take aspirin if they have had any serious bleeding events, are on certain medications, have a high fall risk, or have specific medical conditions. So, next time you interact with your doctor or pharmacist, ask them if they think it is appropriate for you to take a daily low-dose aspirin.

References:

  1. United States Preventive Services Task Force Recommendations on Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer
  2. WebMD: Aspirin
  3. FDA: Safe Daily Use of Aspirin

 

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 medications,
www.WellRx.com.

Compare prescription drug prices at more than
62,000 pharmacies nationwide.

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