Savings card vs. savings coupon image scriptsave wellrx

What’s in a name and why does it matter?

Although many patients tend to think of the ScriptSave WellRx program as a coupon for their meds, your free prescription savings card is actually a lot more powerful.

In addition to the obvious differences, like the fact that you would normally only get to use a regular coupon for one transaction (related to just one very specific product, as stated on the face of the coupon), there are some additional and very important features that make for big differences between an Rx discount card (like ScriptSave WellRx) and a coupon.

Here are a couple of important things to keep in mind. Understanding these differences will also help to explain why an insurance provider can’t allow you use the ScriptSave discount in addition to their own reduced rates, or why a pharmaceutical manufacturer won’t allow you to apply their copay savings program together with our low prices.

  • A regular coupon works by lowering the end-price of a product, cutting it by the exact amount shown on the coupon. The coupon has a fixed value, and the retailer will subtract that fixed value from the current sales price. For example, the regular coupon might say, “Take $5 off the price of XYZ.” When this happens, the savvy consumer might decide to shop around in order to find the store that sells this product for the very lowest price…THEN s/he will receive an additional $5 off that lowest price upon surrendering the coupon.
  • In contrast, what we do with the ScriptSave WellRx program is to negotiate lower final costs for each specific medication. We don’t negotiate a fixed coupon value. Instead, we negotiate a final discounted price. This is a subtle but important difference. With our program we’re saying, “We can get you a specific medication for a negotiated final price of $X.” This being the case, if the patient can find a pharmacy that will fill their prescription for a final out-of-pocket cost that’s lower than our negotiated price (perhaps as a result of the drug being on a low copay list with their insurer), they may not want to use their Rx discount card for that particular medication. Meanwhile, the same patient may have a second prescription that’s not covered by insurance and where the ScriptSave out-of-pocket cost is the lowest discounted price available…in which case one script gets filled with ScriptSave and the other does not.

Can it be used with insurance, Medicare, Medicaid, etc.?

Here’s another example to help illustrate. We’ll start by laying out three basic pricing options for filling a prescription at a given pharmacy…

  1. An insurance policy (including Medicare and Medicaid) includes a list of drugs (known as the Formulary) for which covered patients will pay a predetermined negotiated rate.
  2. Similar to the prescription drug formulary at an insurance company, the contracts that ScriptSave has negotiated with its pharmacy partners also result in pre-determined out-of-pocket costs. These rates are available to ANY patient who chooses to pay cash.
  3. At the same time, a generic drug list at a retail pharmacy shows the final prices for certain drugs at that pharmacy.

Of the three pricing options listed above, a patient is free to choose the price that makes the most sense for each of the prescriptions they are filling. However, this is a one-or-other choice. There’s simply no way to “stack/combine” the savings from an insurance payer together with the savings from a cash discount card, because the prices being offered under each option are contractually agreed and final.

Another way to put this is to say that, in the world of a regular coupon, the value of the coupon is always the same no matter which store it gets redeemed it at. Therefore, the final out-of-pocket cost for any product that has a coupon will vary based on how much the store is selling the product for in the first place. Meanwhile, an Rx savings card like the ScriptSave WellRx card will deliver a fixed final out-of-pocket cost (and so it’s the value of the discount that changes with every prescription being filled, relative to the original cash price for the drug in question).

In short, prescription savings programs are NOT coupons. While it might be easy to think of them in this way (and you may even hear us refer to them as such), it’s important to keep the differences in mind. Furthermore, you’ll want to choose your savings program based on its reputation and relationship with pharmacies … because it’s these relationships that matter when it comes time for the pharmacist to honor the savings card or mobile app.

As part of the Medical Security Card Company and ScriptSave suite of pharmacy programs, the ScriptSave WellRx program boasts well over 20 years (founded in 1994) of history and relationships with our pharmacy partners. We believe this helps make ScriptSave WellRx second-to-none.


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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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depression or anxiety medications,
visit www.WellRx.com.

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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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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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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
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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?

 

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,
visit
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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!

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who can help with non-emergency prescription questions
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ScriptSave WellRx diabetes check image

by:
Jeshvi Manhar, 2017 PharmD Candidate/ Sapna S. Patel, PharmD

ScriptSave WellRx - sound alike-look alike medications and diabetes imageSound-Alike/Look-Alike Medications are very important to identify and help reduce medication errors. There is a list of several medications starting with the letter “T” that have become available to treat diabetes. This may lead to confusion among patients and physicians, so it’s important YOU understand how to safely recognize and use your diabetes medication to minimize problems and possible complications.

Tradjenta® decreases the amount of sugar your liver makes and increases the amount of insulin your pancreas makes. This medicine is the easiest to differentiate, since it is an oral tablet taken once daily.

Tanzeum® and Trulicity® are in the same class of medications called GLP-1 Receptor Agonists. These medications are injected under the skin but, they are not the same as insulin! They decrease your blood sugar by releasing more insulin and slowing down your body’s digestion. The easiest way to differentiate these medications from insulin is that Tanzeum® and Trulicity® are injected under the skin once a week without regard to meals.

Now, let’s discuss the three medications that are insulin: Toujeo® U-300, Tresiba® U-100, and Tresiba® U-200. Insulin works by allowing blood sugar to move into the cells and be used as energy. Toujeo® and Tresiba® are considered long acting insulin and are injected under the skin once daily without regard to meals. These medications are not interchangeable! Toujeo® U-300 is the concentrated form of Lantus®. Toujeo® U-300 is 3 times the concentration of Lantus®! It would be easy to inject the wrong dose (especially when switching from one medication or concentration to another). Tresiba® U-200 is twice as concentrated as Tresiba® U-100! Toujeo® U-300, Tresiba® U-100, and Tresiba® U-200 are all packaged in green boxes, making them look alike. Before injecting your medication, take measures to ensure you know what the name and concentration of your medication is, what the box, pen and/or needle looks like, and how your medication should be used correctly. If in doubt, ask your pharmacist about the brand you’re buying and study the label before using the medication.

GENERAL INJECTION TIPS:

  1. Using 29 gauge 5mm pen needles for under the skin injection may cause less pain
  2. Roll the pen between the palm of your hands before use to decrease discomfort or pain
  3. Common injection sites are stomach and thigh
  4. Make sure to rotate injection sites to prevent buildup of fatty tissue and pain
  5. Wipe injection site with alcohol wipe then wait for a few seconds before injecting to reduce stinging
  6. Be sure to safely dispose and use a new needle prior to each injection to prevent infection.

 

Reference:

LexiComp®, 2.20.17, JM PharmD Candidate at OSU College of Pharmacy/SSP PharmD

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, like
Tradjenta,
Trulicity,
Lantus,

visit
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ScriptSave WellRx image - save on diabetic glucagon kits

by Benita M. Daniel
University of Arizona, College of Pharmacy
PharmD Candidate, Class of 2017

Weakness, anxiety or irritability, a general sense of confusion — these are signs of low blood sugar, or hypoglycemia. It often happens when diabetics take too much insulin.

Hypoglycemia happens to many people with diabetes, and it can be serious or even fatal.

Severe hypoglycemic episode, also referred to as insulin shock, can occur when the body has too much insulin that can lead to low blood sugar levels.

The possible causes for insulin shock include:

  • Overdose of insulin
  • Long interval time between each meals
  • Exercising without eating
  • Consumption of alcohol without eating food

If you’re experiencing a hypoglycemic episode, don’t panic. Most incidents of low blood sugar and can be treated at home.

One of the fastest, most effective treatments is with a glucagon injection. Glucagon is a natural hormone that is produced by the pancreas in response to high levels of insulin in the blood. The administration of glucagon injection is indicated for emergency uses only especially in patients who are experiencing severe hypoglycemic symptoms.

Severe hypoglycemia often results when early low blood sugar symptoms are untreated. It is recommended to use Glucagon if you experience:

  • Irritability
  • Tremor
  • Excessive sweating/hunger
  • Seizures
  • Weakness
  • Confusion
  • Unconsciousness

Glucagon pen injections are typically dispensed in Glucagon Emergency kits that contains a vial of glucagon (powder form), syringe with attached needle containing the sterile diluting agent with instructions on how to mix it prior to administration. It is important to ensure that you and your family including close relatives are properly instructed on how to use glucagon injection in the case of an emergency. A detailed instruction for use is provided by the manufacturing company. Since, glucagon products are currently available in market primarily in powder form, it is necessary to make sure that these necessary steps are taken prior to the administration of glucagon injection:

  • Inject the diluting agent contained within the syringe into the glucagon vial/bottle
  • Gently swirl the glucagon vial/bottle until it is a clear liquid. It is important to make sure that glucagon is not administered until it has a clear and water-like consistency
  • Using the same needle as before, draw up all the contents within the glucagon bottle
  • Sterilize the preferred injection sites: buttock, arm or thigh with an alcohol swab. Insert the needle into the injection site immediately after the reconstitution occurs.
  • If the patient does not respond to the first dose of glucagon, call 911 and physician and administer another dose of glucagon
  • After the administration, make sure to discard any remaining unused contents of the injection since the glucagon is typically unusable.

It is critical to treat the early signs and symptoms of hypoglycemia in order to prevent the progression of severe symptoms of hypoglycemia. Here are some helpful tips to help you prevent low blood sugar levels or hypoglycemia:

  • Identify early signs and symptoms of low blood sugar levels
  • Carry glucose tablets or sugary snacks such as candy or regular soft drink
  • Make sure to take insulin doses after each meal
  • Avoid exercising for longer periods of time without eating any sugary snacks
  • Avoid drinking alcohol without eating
  • Test blood sugar levels regularly as recommended by the doctor in order to ensure blood sugar levels are within goal.
  • Ask your doctor for glucagon injection if in case of emergency

There have been recent developments of newer agents such as Glucagon pens (G-pens) that are currently in Phase 3 of Clinical trials. As per the manufacturing company, Xeris Pharmaceuticals, “Glucagon pen is a highly stable, ready-to-inject glucagon solution as an alternative to the existing glucagon emergency kits and to provide various products addressing the broader problems of hypoglycemia in both the diabetic and non-diabetic population.”

Glucagon pens are prefilled auto-injectors that will activate immediately with the contact of the human skin and works in similar methods to that of an Epi-pen.  Additionally, it does not require multiple steps prior to the administration of the medication to ensure the patient receives the active form of glucagon.

The elimination of the reconstitution will help in the fast and efficient administration of glucagon and this can prevent further complications of hypoglycemia including coma. G-pens seems to be a promising area of research and it will be fascinating to see the positive outcomes that would result due to the development of Glucagon pens.

Recheck your blood sugar after 15 or 20 minutes. If it’s still low, take another 15 to 20 grams of a quick-acting sugar, and eat something if you can. If your sugar level stays low after 2 hours or if your symptoms don’t get better, seek medical attention.


References:

http://www.healthline.com/health/diabetes/insulin-shock#Overview1

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html?loc=lwd-slabnav

http://pi.lilly.com/us/rglucagon-ppi.pdf

http://www.xerispharma.com/pipeline


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photo ScriptSave WellRx vitamin supplements

by Sandra Leal, PharmD, MPH, CDE, FAPhA

The US supplement industry is a $30 billion dollar business.1 The Council for Responsible Nutrition estimates that almost 70% of US adults use dietary supplements.2 Before I continue, I must state that I do not have any conflicts of interest and rest assured, although I am a pharmacist, I do not support ‘Big Pharma’ when it comes patients unnecessarily being prescribed medication.

Personally, I use caution when it comes to dietary supplements for one simple reason – they are not regulated like prescription medications. The FDA is the administration that regulates the approval and use of prescription medication. What this means is that on a prescription bottle labeled with a specific amount of ingredients, you can be certain that the actual amount in a given tablet, capsule, cream, suppository, solution, etc. is between about 95% and 105% of what the label actually states. As an example, if you are prescribed to take a tablet that is 100mg in strength, then you can be certain that the amount is between 95mg and 105mg of that medication.

On the contrary, dietary supplements are regulated by the Dietary Supplement Health and Education Act of 1994. Since they are not regulated like drugs, companies that manufacture and produce dietary supplements are able to put whatever claims they want on their bottles. It is possible and highly likely that what is stated on the supplement label is not what is in the actual tablet or capsule. In fact, the New York Attorney General and the Federal Trade Commission have recently filed suit against Prevagen for their claims of memory boosting.

Moreover, many weight loss dietary supplements contain botanicals and plant-derived ingredients that can cause and make health problems worse. Sometimes, these supplements can interact with prescription medicines that you are prescribed. St. John’s wort, in particular, can negatively interact with a number of medications, including Statins (Crestor, Simvastatin), Warfarin (Coumadin), and Tricyclic antidepressants, like Elavil or Pamelor.

I believe there are great health benefits and medicinal properties of nutraceuticals, however there is a great need for credible research and evidence before I would be comfortable recommending these products to my patients. Throughout my years of practice, I have found that many patients do not consider dietary supplements, OTC products, and vitamins as medications. I would recommend that the next time you have an appointment with your doctor, inform him/her of everything you take, even those that you purchase in a store or online, just to ensure that they are safe for you and do not interact with your prescription medications.

The next time you think of taking a supplement, remember that right now you have no way of knowing for sure what’s really in your supplement bottle. And despite the promising on the labels, the pills probably won’t make you any healthier (unless you have a medically diagnosed deficiency), and they might even be hurting you.

 

References:

  1. http://www.vox.com/2016/3/10/11179842/dietary-supplements-medical-evidence
  2. http://www.crnusa.org/CRNPR14-CRNCCSurvey103014.html
  3. http://annals.org/article.aspx?articleid=1789253
  4. http://www.iflscience.com/health-and-medicine/23000-people-us-end-er-annually-because-supplements

For the best Rx price on Crestor (rosuvastatin), Zocor (simvastatin), Lipitor (atorvastatin) and other statins,
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