Pharmacogenomics pharmacogenetics image

by Leah Samera, PharmD Candidate, Class of 2018

As with most things, when it comes selecting a drug regimen for the treatment of chronic disease, one size does not fit all. If you take medications, you may have wondered why that is the case. One reason is because of pharmacogenomics.

Pharmacogenomics refers to “the entire spectrum of genes that interact to determine drug efficacy and safety.” In practice, many people may use the terms pharmacogenomics and pharmacogenetics interchangeably.

Pharmacogenetics, however, also refers to variants of one gene that affect drug response. The study of both pharmacogenomics and pharmacogenetics can help to optimize drug therapy and minimize drug toxicity based on an individual’s genetic profile.

What is a gene?

A gene is a series of codons that specify a particular protein. Genetic variation may result in altered protein sequence and function or in altered protein levels. This is significant, because these proteins can have an effect on how your body interacts with medications.

How do pharmacogenomic variations affect drug response?

The impact of pharmacogenomic variations on drug response have traditionally been divided into four categories:

  1. Those that affect drug pharmacokinetics. Pharmacokinetics refers to how a medication moves through a person’s body, i.e., how the drug is absorbed, distributed, metabolized, and eliminated.  An example of a genetic variation that affects pharmacokinetics is one in which drug metabolism is altered, subsequently affecting plasma concentration.
  2. Those that effect on pharmacodynamics. Pharmacodynamics refers to a person’s therapeutic response to a medication; this depends on a medication’s affinity and activity at its site of action. An example of a genetic variation that affects pharmacodynamics is one in which binding of a drug to its receptor is reduced, thereby decreasing therapeutic efficacy.
  3. Those that affect idiosyncratic reactions. An idiosyncratic reaction is an adverse reaction to a medication that is both rare and unpredictable. An example of a genetic variation that affects idiosyncratic reactions is one in which the likelihood of a hypersensitivity reaction to a certain drug is increased.
  4. Those that affect disease pathogenesis or severity and response to specific therapies. Pathogenesis refers to the origination and development of a disease. An example of a genetic variation that affects pathogenesis is a specific molecular defect related to the development of certain malignancies for which there are targeted therapies.

How can the study of pharmacogenomics help to optimize your drug therapy and minimize side effects?

Organizations like 23andMe allow people to “access, understand, and benefit” from the study of pharmacogenomics. With their simple home-based saliva collection kits, all you have to do is order their Health + Ancestry service; register, and spit into, the provided tube; and mail the kit back to their lab via the pre-paid package. Next, their lab extracts, processes, and analyzes the DNA from the cells in your saliva. Within 6 to 8 weeks, you get an email notifying you that you can view your results in your online account and discover what your DNA says about you. By sharing those results with your healthcare providers, they then can use that information to ensure that you get the most benefit from your medications while minimizing the risk of side effects.

References:

  1. Cavallari LH, Lam Y. Pharmacogenetics. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey L. eds. Pharmacotherapy: A Pathophysiologic Approach, 10e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com.ezproxy4.library.arizona.edu/content.aspx?bookid=1861&sectionid=146077703. Accessed September 12, 2017.
  2. Roden DM. Pharmacogenetics. In: Brunton LL, Knollmann BC, Hilal-Dandan R. eds. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 13e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com.ezproxy4.library.arizona.edu/content.aspx?bookid=2189&sectionid=167889559. Accessed September 12, 2017.
  3. Tantisira K, Weiss ST. Overview of pharmacogenomics. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed September 13, 2017.
  4. Our Mission. 23andMe.com. https://mediacenter.23andme.com. Accessed September 13, 2017.
  5. How it works. 23andMe.com. https://www.23andme.com/howitworks. Accessed September 13, 2017.
  6. Our science. 23andMe.com. https://www.23andme.com/genetic-science. Accessed September 13, 2017.

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Anxiety medications and children photo

by Jenny Bingham, PharmD

Across the United States, the rate of antidepressant use in children is rising. It has led to prescription costs exceeding $100,000 in the four states with the highest antidepressant prescription rates for children: Colorado, Florida, Pennsylvania, and Texas.

As the number of antidepressant prescriptions rise, it’s only natural that parents will have a growing number of questions about those medications. Here’s a list of common questions other parents have had when starting pharmacotherapy for their child’s anxiety and/or depression:

How many pills will my child have to take?

The simplest answer is, it depends. Pharmacists are trained to know FDA approved indications for mental health medications. By incorporating pharmacists into the healthcare team, they can help find medications that have dual purposes and decrease the amount of pills in the regimen. Talk to your pharmacist about the medications and if there are alternatives.

How will pharmacotherapy affect my child?

Each patient responds differently to medications. Whereas some patients that are prescribed a common first-line antidepressant (fluoxetine) and tolerate it well, others may have an entirely different reaction. Certain medications can have negative side effects, including:

  • shaking
  • drowsiness
  • weight gain
  • insomnia
  • dizziness
  • dry mouth
  • blurred vision
  • bleeding, and,
  • constipation.

These side effects can be extremely detrimental to a child’s quality of life. It’s important to have open communication with your healthcare provider to ensure that side effects don’t get in the way of medication adherence, school performance, or self-esteem. Current literature provides clinicians a wide variety of information about which side effects are more prominently reported in individual cases. This database of knowledge helps further individualize therapy and avoid potential side effects.

What risks are associated with pharmacotherapy?

Parents should be aware of the potential for abuse, especially with commonly prescribed anxiety medications (ex. alprazolam) that are rated as controlled substances.

Adolescents are at an increased risk of suicidal ideation when initiating certain medications. Family members must be educated on how to monitor, identify, and report these to the provider.

One must also consider the risks of not seeking appropriate treatment, like self-medication with illicit drugs, tobacco, and alcohol. Self-medication can unfavorable effects on one’s mental and physical health.

Are there alternatives to pharmacotherapy?

If a parent decides against using medications, trained therapists can provide alternative options, if appropriate. Cognitive behavioral therapy is a common tool that incorporates education, relaxation exercises, coping skills, stress management, and assertiveness training.1

Other approaches include: interpersonal therapy, motivational interviewing, dialectical behavior therapy, supportive therapy, and family therapy. These tools can also be used in combination with medication to improve depression and anxiety. Parents should work closely with their physician to determine if this is a safe option as monotherapy.

Final Thoughts

Decisions about using medications to treat anxiety and/or depression in children must be catered specifically to the patient. It is imperative for health care providers to approach this sensitive topic as a group, including the patient and parents. Pharmacists are a great resource for optimizing medication effectiveness and reducing pill burden.

References:

  1. Beck JS. Cognitive Behavior Therapy: Basics and Beyond, 2nd ed, Guilford Press, New York 2011. p.391.

Download the free WellRx 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!

 

 

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noacs - warfarin alternatives

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

Not so long ago, a diagnosis of atrial fibrillation (AFib), deep vein thrombosis (DVT), or pulmonary embolism (PE) meant that a prescription for the blood thinner, warfarin (Coumadin), was likely coming your way. In recent years, multiple other blood thinners have become available, and you may have wondered if any of them could be right for you.

What are NOACs?

The NOACs, or novel oral anticoagulants, are a new breed of blood thinner that have arrived on the market within the last ten years. This class of medications includes:

How are NOACs Different from Warfarin?

Multiple clinical trials comparing these alternative warfarin medications have all shown that the NOACs are just as effective as warfarin, and that they have a similar (or lower) risk of bleeding. Warfarin has been around for decades and has been proven to be both safe and effective at preventing blood clots, but it’s no secret that it has its problems. Here are some key differences to note when comparing the newer anticoagulants with warfarin and when deciding what is right for you:

  1. Warfarin requires frequent trips to the lab to have your INR (international normalized ratio) checked. Also referred to as PT time, Prothrombin time is a blood test that measures how long it takes blood to clot, or how well the medication is working. You may potentially need to change your dose to increase or decrease the clotting time. NOACs do not require lab monitoring or frequent dose changes.
  2. NOACs do not have the high potential to interact with food or other medications like warfarin does, meaning there are fewer restrictions. This means no more worrying about how much salad you can eat on a day-to-day basis, or if you are allowed to have that glass of grapefruit juice in the morning. It is still recommended, however, to check with your doctor or pharmacist before starting any new medications, as there are still some medications that may increase your risk of bleeding when taken with the NOACs.
  3. NOACs begin working quickly, while warfarin may take up to a week to start working. Because of this, patients with a DVT or PE starting warfarin may require “bridge” therapy with heparin or enoxaparin (other fast acting blood thinners) to prevent clots while waiting for the warfarin to take effect. This “bridge” therapy is not necessary with the NOACs.
  4. Unlike warfarin, not all of the NOACs have a reliable reversal agent if you were to begin bleeding. With warfarin, if your INR becomes too high or if you are having signs of bleeding, you may be given vitamin K, or phytonadione, to reverse its effects. Currently, Pradaxa is the only NOAC that has an approved reversal agent, called Praxbind (idarucizumab). While bleeding is rare while on the NOACs, the lack of reversal agent is something to keep in mind when deciding which medication may be right for you.
  5. NOACs may not be appropriate if you have decreased kidney and/or liver function. Your doctor will review your labs and information to determine if your kidneys/liver are functioning well enough for you to take one of these medications.

The recent approval of the NOACs has provided prescribers and patients with more options to choose from when a blood thinner is necessary. Because these medications are still relatively new, there is a lot left to learn about their use and limitations, so they may not be appropriate for everyone. It is always important to discuss any questions or concerns with your doctor when starting any of these medications or when switching from one to another.

 

References

Leung LLK, Direct oral anticoagulants and parenteral direct thrombin inhibitors: Dosing and adverse effects. In: UpToDate, Mannucci PM (Ed.), UpToDate, Waltham, MA.

Hanley CM, Kowey PR. Are the novel anticoagulants better than warfarin for patients with atrial fibrillation? Journal of Thoracic Disease. 2015;7(2):165-171. doi:10.3978/j.issn.2072-1439.2015.01.23.


Download the free WellRx 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,
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Always ask the cash price - you could save on your prescriptions

The “he said/she said” of Rx pricing tools

If you’ve ever used a prescription price-check tool for an Rx savings program (like ScriptSave WellRx), only to have been told a different price when the time came to collect & pay for the prescription at the pharmacy, then the next few paragraphs are for you.

Regardless of the product or service, it’s an infuriating thing to be quoted one price online, but to then be confronted with a different reality at the store (unless, of course, the price comes down – then we love it).

What can be done to avoid bad price-quotes?

For patients using prescription savings programs, there are a few steps that can be taken to help reduce the potential for errors with an Rx price-check tool.

In short, there are some very important things to keep in mind when doing a price look-up with a prescription discount card and overlooking any single one of them has the potential to make a mess of things.

In no particular order, at ScriptSave WellRx we always recommend that our members keep the following pointers in mind:

    • Potential Problem #1
      Prescription prices can be volatile and it’s not uncommon to find regular (even daily) price changes across pharmacies in any given zip code.
    • Recommendation
      When using a price-check tool or mobile app to review the lowest prescription prices in your zip code, be sure to perform one final look-up on the same day that you end up collecting & paying for your script. As frustrating as it might be to discover that prices changed for your medication overnight, it’s far less frustrating to realize this before you leave home. Especially if you also discover that the same medication actually came down in price at a different pharmacy nearby (perhaps even giving you the opportunity to make arrangements to transfer the prescription).

     

    • Potential Problem #2
      Prescription medications come in many different strengths, forms, quantities, etc. There’s also the matter of brands & generics. However, a price-check tool for a prescriptions savings card like ScriptSave WellRx has to start somewhere – and the default settings on the website will generally only return pricing results for one very specific version of each medication. For example, perhaps the price-check tool will show results for the most commonly filled strength, quantity, form and manufacturer of the medication that you’re searching for.
    • Recommendation
      When the results of your price-check are returned by the website or mobile app, ALWAYS take a few minutes to review the details against the details on your prescription … and make the necessary manual changes (if any are needed) using the drop-down menus that determine the drug’s Strength, Quantity, Form, Brand/Generic, etc. (see Fig.1)

     

    FIGURE 1
    ask cash price filter - results image

    • Potential Problem #3
      Your pharmacist does not recognize or is not familiar with your prescription savings card.
    • Recommendation
      If you’re using the ScriptSave WellRx card or mobile app, you can be confident that if your pharmacy showed up in our price-check tool, it’s more than likely that we have a contract with them to accept your savings card. We do our best to keep our database up-to-date so as not to send members on a wild goose chase. Perhaps the best way to approach using a ScriptSave WellRx card is to do so with confidence. Although this program is NOT insurance, an Rx savings card includes the same pharmacy processing information that pharmacists see & use every day on all the different insurance cards they deal with. That being case, simply hand your ScriptSave WellRx card to the pharmacist, point to where the card shows the Rx BIN, Rx PCN, etc. and ask,
    “Would you please process my prescription using these details and let me know what my out-of-pocket cost will be?”

     

    If you’re absolutely sure that you’ve taken care of these 3 common issues and yet you’re still facing prices at the pharmacy that are higher than the quotes being shown on the ScriptSave WellRx website/app, there’s one more thing to double-check…

     

    • Potential Problem #4
      Your pharmacist used a different discount card.
    • Recommendation
      There are a number of reasons why this might have happened – and it can certainly be the result of an easy & honest mistake. For example, the ScriptSave WellRx card includes a set of codes that the pharmacist must enter into the computer before being able to tell you the price of your medication. If you look at your ScriptSave WellRx savings card or coupon, you’ll see where it says “RxBIN: 006053” (together with RxPCN, Group # and ID #). Similar codes also appear on insurance cards and they work in the same way.
       
      As with insurance, if you visit the same pharmacy each time, your name, address, DoB, etc. are saved on file for speed & convenience. As part of your saved pharmacy record, the pharmacy also stores a record of any insurance card or Rx Savings program that has been used in the past. Therefore, if you’ve used a different savings card but have since discovered more favorable pricing with ScriptSave WellRx, it’s very possible that the pharmacist simply assumed that your stored details were the same as the details on the WellRx card that you just handed him/her. Also keep in mind that no pharmacist ever wants a patient not to be able to afford their physician-prescribed medications. As such, they’re often on the lookout for ways to help their patients afford their meds (even if the patient doesn’t realize it). Therefore, even if you think you’ve never used another prescription savings card in your life before, it’s certainly not unheard of for a pharmacist to have used one on your behalf because he or she knew that it would save you some money and help you out. If that’s the case, the details pertaining to the RxBIN, RxPCN, etc. from that other card may very well be saved to your profile. This would explain why you’re receiving a discount … but not at the level that was indicated on the ScriptSave WellRx website.
       
      Take a few minutes to familiarize yourself with your savings card and next time you think you might be in this situation, politely ask the pharmacist,
    “Is there any chance you can double-check the processing details, please? Can we just be sure that we’re using the ScriptSave WellRx details as shown here on this card/coupon/app, because I was quoted a slightly lower price earlier this morning, and I’m sure it was for the same strength & quantity that’s on this prescription?”

    U.S. Based Call Center Support

    Another useful hint to keep in mind is that all ScriptSave WellRx members are serviced by a toll-free customer support number (staffed by real people right here in the U.S.). If you ever have a problem, you can call the support line toll-free at 1-800-407-8156, Monday through Friday, from 9am to 8pm EST, and our friendly staff will be glad to help get to the bottom of any issues. Given the real-time need that many patients face with filling their prescriptions, if you’ve had issues at a particular pharmacy in the past, it might be helpful to call our support staff ahead of your next visit to fill your prescription. If necessary, our staff may be able to call your pharmacy on your behalf – ahead of your visit – so that everything is smoothed out before you arrive to pick-up and pay.

    Final Thought – Love your Pharmacist (and Always Ask the Cash Price)

    Please always keep in mind that pharmacists have a LOT going on and they can be incredibly busy. Although they can make it look simple at times, that’s generally a reflection of their professionalism & experience, and their role in a patient’s healthcare is not to be underestimated. Pharmacists are a truly valuable resource and they juggle a lot of different tasks. If you meet a pharmacist who looks at your prescription savings card and doesn’t immediately recognize it, don’t be surprised. We can’t expect every pharmacist, at every pharmacy, to recognize and remember every single savings card and insurance program that they have a contract with. More often than not, if you ask your pharmacist (politely) to try processing your prescription using the details on the card, they will be happy to give it a try. If that doesn’t work, and if you’re using a card from ScriptSave, you have a tollfree support number to call for assistance.

    As for “Always Ask the Cash Price” … that’s a must-do for patients who don’t want to over-pay (especially for those WITH prescription insurance). For more insights on this, read our blog post on why you should Always Ask the Cash Price.


    Download the free WellRx 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!

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pill boxes medication adherence

If your doctor has prescribed a medication for you, you want to be sure you’re getting the most benefit from that drug. Medication adherence is important to get the most benefit from the medications used to treat your condition. The causes of non-adherence, when a patient either accidentally or knowingly does not take medications as prescribed, can be complex. 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, and can help you stick to your medication schedule.

Medication Adherence

World Health Organization defined adherence as “the extent to which a person’s behavior – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.” The concept that healthcare professionals manage medical conditions is true only in case of hospitalized patients. The bottom line is, medications don’t work in patients who don’t take them, or don’t take them as prescribed.

In an outpatient setting, the healthcare professionals’ role is limited to providing products (medications and/or monitoring devices) and educational tools. Taking medications, on time and properly, is left up to the patient or their in-home caregiver. There are several techniques to help you remember to take your medications as prescribed and manage their own medical condition. As the patient, you have the ultimate control for safe and effective treatment.

Two Steps to Medication Adherence
Adherence to medication can be achieved in two simple steps; understanding and behavior changes. Understanding includes knowledge of your medical condition and how your prescribed medication can help to manage it. Here are a few helpful websites:

  1. http://www.patienteducationcenter.org/ – The health-related content on the website is provided by Harvard Medical School. Medical conditions are listed alphabetically from A to Z.
  2. https://medlineplus.gov/ – Produced by the National Library of Medicine, provides reliable information on medical conditions, drugs, herbs, and supplements.
  3. https://www.wellrx.com/ – ScriptSave® WellRx allows you to search for the lowest prices on prescription medications at nearby pharmacies, and provides overviews of the medications. Our Ask a Pharmacist phone line lets you talk to a pharmacist about prescription medicines, dosing, or medication interaction questions. Registered members have access to a free suite of personal wellness tools in the Medicine Chest, including:
  • Ask a Pharmacist
  • Pill Reminders
  • Refill Reminders
  • Medication Information (in both English and Spanish)
  • Medication Videos
  • Mood-tracking (to review side effects, etc.)
  • Price-check and Pharmacy Locator

Behavioral changes mean finding ways to stay on track with your medication schedule. Finding the right tool or a combination of methods that fit best your lifestyle is key to medication adherence. Here are some ways to stay on track:

  1. Integrate your medication to your daily routine, such as brushing your teeth or watching your favorite TV show.
  2. Set one/multiple daily alarm using a clock, mobile phone, or computer.
  3. Ask a family member and/or friend give you a call remainder.
  4. Pill boxes are another way to organize your scheduled medications. Pill boxes are available in different forms that allow you/your caregiver to fill them daily, weekly, or even monthly.
  5. Medication charts can be developed by own or with the help of a healthcare professional. Keep an updated chart with medication names, dose, when you take them, and what are you taking them for. You can refer to the chart if you get confused with your medications.
  6. Plan ahead for medication refills and mark a calendar to make sure you always have your medication when necessary.
  7. If you have a smart phone, the free ScriptSave WellRx app can be used to remind you to take your medications, refill your medications, and track how the medications make you feel.

We hope these tips on 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!


For the best Rx price on
prescription medications,
visit www.WellRx.com.
Compare prices at more than
62,000 pharmacies nationwide.

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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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on medications,
visit www.WellRx.com.
Compare prices at more than
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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


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

Compare prices at more than
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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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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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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

 

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