common food and drug interactions - scriptsave wellrx blog image

by Stephanie Forbes, PharmD

We’ve all gone to the pharmacy to pick up a new medication and been counseled on interactions with other drugs. But, what about foods that might interact with the new medication?

Oral medicines are absorbed into the bloodstream through our gastrointestinal tract (GI tract). For this reason, food or drinks can sometimes interact with the absorption of the medicines we take.  In some cases, food can actually help with absorption, but in other instances it can be a hinderance, and cause less of our medicine to be taken up into the bloodstream.

Some antibiotics, like amoxicillin/clavulanate extended release (Augmentin) and cefuroxime (Ceftin) are better absorbed when we take them with food. Lovastatin is another example of a medicine that has improved absorption when taken with food. In contrast, some medicines (bisphosphonates like alendronate, antibiotics like ampicillin) are absorbed less when taken with food, and should be taken on an empty stomach.

Foods That May Interact With Drugs

Below are some foods and environmental aspects that can interact with the frequently prescribed medications .

Calcium Rich Foods

When we think of calcium, we tend to think of dairy products. In addition to milk, cheese, and yogurt, calcium supplements and some antacids containing calcium can interact with some medicines. Most commonly interacting with calcium are antibiotics, like ciprofloxacin, tetracycline, and doxycycline. The calcium may bind to the antibiotics creating a substance that prevents them from being absorbed.

Grapefruit

Grapefruit and grapefruit juice an affect the metabolism of drugs through a pathway called CYP450, a metabolism pathway through the liver. The impact of grapefruit (and juice) on this can increase the effects of some drugs to a dangerous level.  Furanocoumarin chemicals, compounds found in grapefruit, can interact with enzymes in the liver and small intestine. Some examples of medicines that interact with grapefruit are simvastatin, felodipine, and ticagrelor.

Vitamin K Rich Foods

Patients who are prescribed the blood thinner warfarin are likely familiar with this drug-food interaction. Anticoagulants like warfarin inhibit vitamin K, which an essential component in the process that makes clotting factors, which help prevent bleeding. A frequent misconception with this interaction is that vitamin K rich foods should be avoided; however, that is not the case. Most important is to keep a consistent intake of vitamin K in your diet, and avoid adding in new foods like kale, spinach, or other leafy greens.

Key Takeaways

Keep in mind, this is not a comprehensive list and other foods and beverages may interact with medications (alcoholic beverages, pickled, cured, and fermented foods, etc.). Always check with your pharmacist or doctor for any dietary considerations when starting a new medication. For additional help between doctor & pharmacy visits, it may be possible to turn to technology. For example, by searching for a given prescription drug on the ScriptSave WellRx website (or mobile app), a patient can click through to the “Lifestyle Interactions” tab, where upon they will see details of known dietary interactions for that drug (the example linked to here is for Atorvastatin/Lipitor, and shows details of the aforementioned MAJOR interaction with grapefruit juice).

Technology tools like ScriptSave WellRx are not just able to flag dietary/lifestyle interactions. They can also highlight potential interactions between the different medications in a patient’s personal prescription regimen. Patients are able to create a free account either on the ScriptSave WellRx website or through the mobile app and, by unlocking the free virtual Medicine Chest, they are able to load details of their own medication to a secure account. The medicine chest is then able to flag not just the known food/dietary interactions with the patient’s own specific drug list, but also potential interactions between the different prescription medications themselves.

References:

  1. Gilchrist, Allison. 5 Dangerous Food-Drug Interactions. Pharmacy Times. September 17, 2015. https://www.pharmacytimes.com/news/5-dangerous-food-drug-interactions. Accessed November 25, 2019.
  2. Technician Tutorial, Drug Interactions 101. Pharmacist’s Letter/Pharmacy Technician’s Letter. October 2016.
  3. Avoid Food-Drug Interactions: A Guide from the National Consumers League and U.S. Food and Drug Administration. April 4, 2017. https://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/GeneralUseofMedicine/UCM229033.pdf. Accessed November 25, 2019.
  4. Bushra, R., Aslam, N., & Khan, A. Y. (2011). Food-drug interactions. Oman medical journal26(2), 77–83. doi:10.5001/omj.2011.21


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dangers of some drugs in older adults - scriptsave wellrx blog image

by Gabriel K. Rallison, PharmD Candidate Class of 2020,
University of Arizona College of Pharmacy

As we age, many of us may struggle to do things that were once so easy. With age, the way your body handles medication can change, too. Side effects may become more noticeable and last longer than they used to.

Potentially Inappropriate Medications for Older Adults

Due to these changes, the American Geriatrics Society published a list of medications that are potentially inappropriate for use by persons over 65 years old, commonly called the Beers Criteria.1

There are several common over-the-counter (OTC) medications on this list that should be avoided.

Antihistamines

The first OTC drug to avoid is diphenhydramine (Benadryl). Diphenhydramine is an antihistamine drug commonly used to treat cold and allergy symptoms and as a sleep aid. However, in older adults, diphenhydramine can cause very unpleasant and sometimes dangerous side effects. Side effects include confusion, dry mouth, difficulty urinating, constipation, and blurred vision.2 Diphenhydramine will often be found alone in products, or in combination with other medications. When buying cold or allergy medicine, make sure to check the active ingredient list to make sure it doesn’t contain diphenhydramine.

A sister drug to diphenhydramine, chlorpheniramine (ChlorTabs), can cause many of the same side effects in older adults and should likewise be avoided.3 As alternatives for treating cold and allergy symptoms, look for products that contain loratadine (Claritin), fexofenadine (Allegra), or cetirizine (Zyrtec).2 These are newer medications of the same type as diphenhydramine, but without the side effects that make diphenhydramine dangerous.

Aside from treating allergy symptoms, drugs from this class are also used to treat motion sickness. These drugs, including dimenhydrinate (Dramamine) and meclizine (Antivert), cause many of the same side effects are diphenhydramine and chlorpheniramine, and should likewise be avoided.1

Non-drug options for prevention of motion sickness should be used instead. To prevent motion sickness, current advice is to keep your eyes closed or looking at the horizon, while avoiding close-up visual tasks like reading when moving.4                      

NSAIDs

NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of medications including ibuprofen (Advil, Motrin) and naproxen (Aleve).2 These drugs are generally used to treat mild to moderate pain, but also have side effects that become more noticeable and dangerous in older adults. NSAIDs can cause stomach ulcers, stomach bleeding, increased blood pressure, kidney damage, and can even make heart failure worse.3 Additionally, these medications can interact with blood thinner medications such as warfarin and increase your risk of bleeding.

While occasional use may not present as great a risk, regular use of either ibuprofen or naproxen should be avoided unless closely followed by your doctor. As an alternative to NSAIDs, you can use acetaminophen (Tylenol). When using acetaminophen, it is important to limit your dose to 1,000 mg or less per dose, and less than 3,000 mg per day to avoid causing liver damage. If you regularly drink alcohol, you should use even less acetaminophen.

Are There Other Medications Older Adults Should Avoid?

The medications mentioned are by no means an exhaustive list, and there may be other medications, OTC or prescription, that should be stopped or adjusted for use in older adults. You should never stop taking a prescription medication without first talking to the doctor who prescribed it, even if it is on the Beers Criteria.

Any questions you have concerning any prescription medication you may be taking should be directed to your doctor or pharmacist. Your pharmacist can recommend OTC medications to help treat what ails you while minimizing undesirable side effects. While we all get older, you can rely on the direction and training of health professionals around you to make the trip as comfortable as possible, helping to minimize the bumps along the way.

References

  1. For Older People, Medications Are Common; Updated AGS Beers Criteria® Aims to Make Sure They’re Appropriate, Too. (n.d.). Retrieved October 10, 2019, from https://www.americangeriatrics.org/media-center/news/older-people-medications-are-common-updated-ags-beers-criteriar-aims-make-sure.
  2. Eng, M. (2008, June 19). Potentially Inappropriate OTC Medications in Older Adults. Retrieved October 11, 2019, from https://www.uspharmacist.com/article/potentially-inappropriate-otc-medications-in-older-adults.
  3. Ten Medications Older Adults Should Avoid or Use with Caution. (n.d.). Retrieved October 11, 2019, from https://www.healthinaging.org/tools-and-tips/ten-medications-older-adults-should-avoid-or-use-caution.
  4. Brainard, A., & Gresham, C. (2014, July 1). Prevention and Treatment of Motion Sickness. Retrieved October 24, 2019, from https://www.aafp.org/afp/2014/0701/p41.html.


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patient doctor communication image - scriptsave wellrx blog

by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

Have you ever left your doctor’s office feeling more confused than when you arrived? Maybe even felt like your doctor didn’t understand your concerns? You’re not alone. When over 300 patients were interviewed after being released from the emergency room, only 6 in 10 patients were able to correctly describe their doctor’s directions.1

Good healthcare begins with good communication. If the doctor doesn’t understand your concerns and you don’t understand the doctor’s directions, you may not be getting the best care possible.

There’s a growing awareness in the medical community regarding the need for effective doctor-patient communication. We have several simple recommendations to help you in that process.

Eight Things to Consider on Your Next Doctor Visit:

  1. Write down your concern(s). When thinking about your health concerns, write down when it started, what you think may have caused it, how often it happens, what it feels like, things that make it better, things that make it worse, in as much details as possible.

    Having written notes will help you organize your thoughts during the short time you have with the doctor. Additionally, they will help you better answer the questions your doctor will have. The more information you can give them, the better they will be able to help you.
  2. Consider bringing someone who can support you. A friend or family member can help catch things that might otherwise be missed, ask questions you may have not thought of, and help keep track of the information and instructions shared by the doctor.
  3. Be honest and straightforward about any concerns you have. Your doctor is required to protect your privacy and will only share your information with other healthcare professionals as required for your care. Even if it may be embarrassing, or you feel it may be irrelevant, it is important to share everything. Your doctor should be nonjudgmental and understanding. When you share openly, it will help the doctor see the full picture and catch things that may otherwise be missed.
  4. Don’t be afraid to ask questions! Doctors can sometimes use terms that are overly complex and hard to understand. It’s perfectly okay to ask for clarification in simpler terms or ask them to explain it again. Then, once you think you understand, repeat the information back to your doctor in your own words. This technique, called teach-back, can help you to internalize information and let the doctor know if anything was missed.
  5. Create and maintain a medication list. It can be frustrating for everyone (healthcare team and patients alike) when in response to the question “What do you take?” the answer is, “the little round white pill.” Hospitals can, and do, call pharmacies to find out what patients are taking, but having a list up front can save time and prevent potentially harmful prescribing.

    In not knowing what you are taking, your doctor may mistakenly prescribe medication that could interact with what you are already taking. This could lead to your medications being less effective or additional side effects, so it’s important to create and maintain an up-to-date medication list.

    When making your medication list be sure to include, at a minimum:
    – medication name
    – strength, dose, and frequency of dose
    – reason for taking, and any special instructions that medication may have.

    For example:
    – levothyroxine (name)
    – 125 mcg (strength)
    – One tablet (dose) every morning before breakfast (frequency)
    – For low thyroid hormone (reason for taking), take levothyroxine by itself ½ hour before any other food, medicine or drinks (special instructions).

    When making your list, make sure to include any medicated creams, patches, inhalers, implants, suppositories, or any other less conventional forms of medications, like medical marijuana (MMJ).

    Make sure to include any over the counter medications and supplements you take as well, as many of these may interact with other medications you are taking. 
  6. Consider any language barriers. There can often be language barriers between a doctor and their patient. This can lead to problems in receiving quality medical care.

    In the United States, you have a legal right to oral interpretation and written translation of any medical communication into your preferred language. This may take the form of written instructions or drug labels in your language or having an interpreter in the room or on the phone when you are with your doctor. These resources can help break the language barrier that could otherwise make it hard to get care.
  7. Include other members of your healthcare team. Questions about a medication? Talk with your pharmacist, especially when starting a new medication! Your pharmacist can advise you about side effects to watch out for, possible issues with other medications or supplements you may be taking and give you additional advice about how to improve your medication regimen.
  8. Work together with your doctor for the best outcome. If you have concerns with the treatment plan, ask about them! Work actively with your doctor to decide the plan that will work best for you.

Good medicine is not one size fits all, and as you voice your concerns and strive for better communication, you and your doctor can work as a team to make sure you get the best care possible.

References

  1. Crane, J. A., Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997 Jan-Feb;15(1):1-7. https://doi.org/10.1016/S0736-4679(96)00261-2 Accessed Sep 24 2019.
  2. Ha, J. F., & Longnecker, N. (2010). Doctor-patient communication: a review. The Ochsner journal, 10(1), 38–43. Accessed Sep 24 2019.
  3. Clancy, C. M. How to Talk to — and Understand — Your Doctor. American Association of Retired Persons. https://www.aarp.org/health/doctors-hospitals/info-09-2010/finding_your_way_how_to_talk_to_8212_and_understand_8212_your_doctor.html Accessed Sep. 25 2019.
  4. Howley, E. How to Make Sure Your Doctor Understands Your Medical Condition. U.S. News. Jan. 16 2018. https://health.usnews.com/health-care/patient-advice/articles/2018-01-16/how-to-make-sure-your-doctor-understands-your-medical-condition Accessed Oct 1 2019.
  5. Don’t Be Shy: 4 Tips for Talking to Your Doctor. Johns Hopkins Medicine. N.d. https://www.hopkinsmedicine.org/health/wellness-and-prevention/dont-be-shy-4-tips-for-talking-to-your-doctor Accessed Sep 24 2019.
  6. Health Literacy | Understanding What Your Doctor Is Saying. American Heart Association. N.d. https://www.heart.org/en/health-topics/consumer-healthcare/doctor-appointments-questions-to-ask-your-doctor/health-literacy–understanding-what-your-doctor-is-saying Accessed Sept 25 2019.
  7. Executive Order 13166. Limited English Proficiency (LEP).gov. https://www.lep.gov/13166/eo13166.html Accessed Oct 2 2019.


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Do you have GERD - blog image

by Misgana Gebreslassie, PharmD Candidate,
Class of 2020 University of Colorado

Roughly 18 to 26% of Americans have GERD, and the majority are adults between the ages of 30 to 60 years. GERD is a short for gastroesophageal reflux disease, a condition where stomach fluid (acid) backs up into the esophagus (the tube connecting the mouth and the stomach) and causes aggravating symptoms.

Other names that you may have heard for GERD are acid reflux or heartburn. Often acid reflux is caused by muscle weakness of the lower esophageal sphincter, a valve that lets food and drinks into the stomach. [1,2,6]

What are the symptoms of GERD?

Symptoms are typically present after eating and can be different from person to person. The most common ones are: [1,6]

  • Heartburn or burning in the chest
  • Sour taste or burning feeling in the throat
  • Stomach pain
  • Difficulty swallowing food or choking
  • Sore throat or hoarse voice
  • Cough that is not relived by anything
  • Spitting up
  • Frequent burping
  • Asthma

How is GERD treated?

Treatment of acid reflux include lifestyle changes, antacids such as Tums, or stronger stomach acid suppressants like histamine 2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs). [2,3]

Changes to diet or lifestyle can help control symptoms of heartburn and the following changes can be helpful: [2,3,4]

  • Stay away from foods and beverages that can lead to acid reflux or heartburn. Foods and beverages like: coffee, alcohol, chocolate, fatty foods, spicy foods, and citrus fruits/juices
  • Raise the head of your bed 6 to 8 inches
  • Try eating smaller portions and avoid sleeping or lying down within 3 hours of eating a meal
  • Lose weight. Being overweight can contribute to GERD
  • Stop cigarette smoking
  • Wear loose fitting clothes

Do Antacids Treat GERD?

Antacids work by neutralizing or reducing the acidity of the stomach. They are used for milder symptoms and are taken as symptoms occur to relieve heartburn symptoms.  These drugs can affect the absorption of other drugs. Always ask your pharmacist to check for interactions with your current medications as well as how and when to take them.[4]

What Other Drugs Can Treat GERD?

Histamine 2 receptor antagonists (H2RAs) work by suppressing acid secretion in the stomach. They are stronger than antacids in controlling heartburn symptoms. Overall, they are very well tolerated.[3]

Proton pump inhibitors (PPIs) also work by suppressing acid secretion in the stomach. They are used when heartburn symptoms are not well controlled by H2Ras or when symptoms are troublesome affecting quality of life.

PPIs work best when taken on empty stomach half an hour before the first meal of the day. PPIs may alter the way some drugs work. Ask your pharmacist or doctor to check for interactions with your current medications before taking them.[5]

Medicine
Type
Generic
Name
Regulatory
Status
Brand
Name
AntacidsCalcium CarbonateOTCTums
Aluminum hydroxide, magnesium
oxide and simethicone
OTC Maalox
Histamine 2 receptor antagonistsCimetidine OTC Tagamet
Famotidine OTC Pepcid
Nizatidine OTC Axid
Ranitidine OTC Zantac
Proton Pump Inhibitors (PPIs)EsomeprazoleRxNexium
DexlansoprazoleRxDexilant
Lansoprazole15mg – OTC Prevacid
Omeprazole OTC Prilosec
Omeprazole + sodium bicarbonate OTC Zegerid
PantoprazoleRxProtonix
RabeprazoleRxAciphex
OTC = over the counter (without prescription); Rx = prescription only; * Regulatory status obtained from FDA website [7]

All antacids and H2RAs are available over the counter whereas this would only apply to some PPIs. Sometimes these medicines are cheaper without a prescription. If cost is a concern for you ask your pharmacist to help you find ways to reduce your medication cost.[7]

scriptsave wellrx lower prescription price image

References:

  1. Gastroesophageal Reflux Disease (GERD). In DynaMed Plus [database online]. EBSCO Information Services. http://www.dynamed.com.proxy.hsl.ucdenver.edu/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 26, 2019. Accessed on 8/8/10/2019
  2. Patient education: Acid reflux (Gastroesophageal Reflux Disease) in adults. The Basics. In: UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited date unknown). Available from  https://www-uptodate-com. Accessed on 8/10/2019
  3. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. In: Talley NJ & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 28, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  4. Vakil NB. Antiulcer medications: Mechanism of action, pharmacology, and side effects. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 22, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  5. Wolfe MM. Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited Nov 29, 2017]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
  6. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology. 2008 Oct;135(4):1383-1391
  7. Over-The-Counter (OTC) Heartburn Treatment. U.S. Food & Drug Admiration. https://www.fda.gov/drugs/drug-information-consumers/over-counter-otc-heartburn-treatment. Published date unknown. Updated on March 5, 2018. Accessed 8/10/2019


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measles vaccine image

by Gabriel Rallison, PharmD. Candidate, Class of 2020
University of Arizona

If you follow recent news, you’ve probably heard about measles outbreaks cropping up in California1, Washington2, and New York.3 The Centers for Disease Control and Prevention (CDC) reports, as of September 2019 there have been 1,241 confirmed cases of measles in the United States this year, a number already higher than the previous four years combined.4 With so many cases, this year marks the largest outbreak of measles in the United States in 27 years.5

What is measles?

Measles, also known as rubeola, is a viral disease that can lead to fever, cough, runny nose, and red, watery eyes.4 These symptoms will usually appear about 7 to 14 days after being infected, before which a person may not even know they are sick.

In addition, a few days after these symptoms start to show, a measles rash will appear. This rash normally starts on the face and spreads down the body, starting with small red spots that will merge over time. The rash will usually remain for about five days before fading away.

Why should I be concerned?

The measles virus is spread when an infected person coughs or sneezes, releasing viruses into the surrounding area. Once in the air, the virus can remain there for up to 2 hours, with anyone passing through the area at risk of breathing in the virus and getting sick.3,4

This virus is very contagious, which means that if exposed people are not protected by a vaccine, they have a 9 out of 10 chance of catching the disease!2 While measles is technically considered eliminated in the US, recent cases come from unvaccinated people traveling outside of the country, catching measles abroad, and bringing it home with them.1,2,4

Measles symptoms generally are not very severe, but this disease can have very serious complications including:

  • permanent hearing loss
  • severe lung diseases
  • swelling of the brain
  • pregnancy complications
  • death.4

Before the vaccine for measles was developed, over 3 million people were infected annually, with 48,000 hospitalized and 400 dying from measles and related complications each year.

How can I protect myself?

The best protection for measles is the vaccination.1,2,3,4 The measles vaccination is available as a combination vaccination with mumps and rubella, together called the measles-mumps-rubella or MMR vaccine.4

This vaccine works by teaching your body’s immune cells what to watch out for and helps prepare the body’s defenses for the viral attack. The vaccine is very effective, and when used as recommended is 97% effective at preventing measles.4

For most adults, the CDC recommends getting one dose of the vaccine, with certain conditions requiring a second dose achieve full immunity.9 In small children, the recommendation is to get one dose at 1 year old, and a second dose between 4 to 6 years old.9 The vaccine can and should be given to children under 1 year of age if planning on traveling internationally.3,9

Is the vaccine safe?

Yes, the MMR vaccine has been shown in repeated studies and trials to be safe and effective.2,3,6 While there have been concerns expressed that vaccines may cause autism, dozens of studies over the last 25 years including tens of thousands of patients have found no link between vaccines and autism.7,8

Additionally, the vaccine component purported to cause harm, a preservative called thimerosal, has never been a part of the MMR vaccine.6 The most common side effect of vaccines is redness and soreness at the injection site, and in rare cases a mild fever or rash may arise.4

Where can I get the vaccine?

The MMR vaccine is available at your doctor’s office or your pharmacy and is free of charge with most insurance plans.  If you don’t have a regular doctor or pharmacy, you can use https://vaccinefinder.org/ to find a location near you.10

Pharmacies are especially convenient, with 9 in 10 Americans living within 5 miles of a pharmacy.  At most pharmacies, no appointment is required, and your pharmacist can have you vaccinated and on your way in mere minutes. So then, what are you waiting for?

References

  1. Disneyland, Universal Studios Hollywood Visitors Reportedly Exposed to Measles. TIME. Aug 24, 2019. https://time.com/5660904/new-zealand-teenager-measles-southern-california/ Accessed Sept 20, 2019.
  2. Measles Cases Mount in Pacific Northwest Outbreak. NPR News. Feb 8, 2019. https://www.npr.org/sections/health-shots/2019/02/08/692665531/measles-cases-mount-in-pacific-northwest-outbreak. Accessed Sept 23, 2019.
  3. US in danger of losing measles-free status, a ‘mortifying’ effect of anti-vax movement. USA Today. Sept 13, 2019. https://www.usatoday.com/story/news/nation/2019/09/13/us-could-lose-measles-free-status-if-outbreak-continues-new-york/2300281001/ Accessed Sept 19, 2019.
  4. Measles (Rubeola). Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/measles/index.html Accessed Sept 19, 2019.
  5. U.S. measles cases reach highest level in 27 years. NBC News. May 31, 2019. https://www.nbcnews.com/health/kids-health/u-s-measles-cases-reach-highest-level-27-years-n1012401 Accessed Sept 23, 2019.
  6. Vaccine Safety. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccinesafety/index.html Accessed Sept 20, 2019.
  7. Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. Journal of the American Medical Association. April 21, 2015. https://jamanetwork.com/journals/jama/fullarticle/2275444 Accessed Sept 23, 2019.
  8. MMR Vaccine Does Not Cause Autism: Examine the evidence! Immunization Action Coalition. N.d. http://www.immunize.org/catg.d/p4026.pdf Accessed Sept 23, 2019.
  9. Immunization Schedules. Centers for Disease Control and Prevention. N.d. https://www.cdc.gov/vaccines/schedules/index.html Accessed Sept 19, 2019.
  10. Vaccine Finder. HealthMap.  N.d.  https://vaccinefinder.org/


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dangers of vaping and e-cigarettes - blog image

by Marcos Puente, PharmD Candidate Class of 2020
University of Arizona

If you have transitioned from regular cigarettes to electronic cigarettes (e-cigarettes) or vaping products for a safer and healthier alternative, you may want to reevaluate your decision. Until recently, many people believed that e-cigarettes and vaping were considered a “better” option compared to cigarettes because they do not release tar as well as other toxic gases found in cigarette smoke.5

Although many individuals have found that transitioning to e-cigarettes or vaping has helped with reducing their use of traditional cigarettes, and in some cases have helped cigarette smokers quit overall, recent cases of lung illnesses have raised the question: are e-cigarettes and/or vaping truly a better, safer alternative to traditional cigarettes?

An Epidemic of Lung Ailments

Vomiting, coughing, shortness of breath, and fatigue have been the most common signs and symptoms most individuals have complained about after vaping/using e-cigarettes within the last 90 days4. As of September 7, 2019, there have been at least 450 cases of an unknown lung disease possibly related to vaping, which has already claimed the life of three people across the nation. The Food and Drug Administration (FDA) and Center for Disease Control and Prevention (CDC) are investigating extensively to pinpoint the exact cause of these lung disease outbreaks and if they are in anyway related to vaping and/or using e-cigarettes3.

What We Now Know

  • CDC and FDA are warning consumers about the vaping-linked lung disease
  • CDC is recommending avoiding e-cigarettes while the FDA is suggesting avoiding products that contain THC (marijuana compound that produces a high)3
  • It is still too early to pinpoint an exact cause or culprit for the outbreak of these lung illness cases3

Potential Cause of these Lung Illness Cases

Although an exact explanation has not been recognized as to what is causing these recent lung disease outbreaks, health investigators have linked vaping to the underlying cause of these lung ailment cases. A clinical psychologist from San Francisco, Dr. Danielle Ramo, suggests that certain additives in the vapor being released from these vaping products contain oils that can be highly dangerous and toxic if heated and inhaled.1 One of the oils being identified in many of these recent outbreak cases is vitamin E, which is commonly used as a supplement and topical moisturizer/cream. Although Vitamin E is safe when applied topically and consumed as a supplement, it can cause damaging effects when inhaled as smoke.3 Although not all vaping products and e-cigarettes contain these additives, it is sill highly recommended to avoid these products until further research and studies have been completed.1

What this Means to You

If you are currently using e-cigarettes or vaping as an alternative to traditional cigarettes, it is highly recommended to quit until a definitive cause is identified for the growing number of lung disease cases across the nation.4 It is too early to determine if a certain brand is responsible for these outbreaks or if the lung illness cases are related to a specific ingredient found in some products offered on the shelves, or possibly even a black-market product being sold which can potentially contain an unsafe chemical. Whatever the cause may be, quitting e-cigarettes and vaping overall can potentially decrease your risk of developing future lung disease (e.g. COPD, lung cancer).

Need Help Quitting?

There are services and support to help assist you in quitting vaping and/or using e-cigarettes. To get free, personalized support from an expert you can call 1.800-QUIT-NOW or 1.800.44U-QUIT to talk with a tobacco cessation counselor. There is also becomeanex.org, a website designed to help support and give you resources to help you quit smoking or vaping.2

Sources:

  1. Graff, Amy. “57 Cases of Lung Illness Linked to Vaping Reported in California, 1 Death.” SFGate, San Francisco Chronicle, 9 Sept. 2019, www.sfgate.com/bayarea/article/vaping-California-acute-lung-disease-death-14424730.php
  2. “Imagine Your Life without Tobacco. Looks Great, Right?” Become An EX Smoker, Learn to Quit Smoking, Stop Smoking Cigarettes, www.becomeanex.org/.
  3. Lavito, Angelica. “What Should People Avoid Inhaling during Mysterious Lung Disease Outbreak? Health Officials Disagree.” CNBC, CNBC, 7 Sept. 2019, www.cnbc.com/2019/09/07/cdc-fda-clash-on-warning-consumers-during-lung-disease-outbreak.html.
  4. Richtel, Matt, and Denise Grady. “What You Need to Know About Vaping-Related Lung Illness.” The New York Times, The New York Times, 7 Sept. 2019, www.nytimes.com/2019/09/07/health/vaping-lung-illness.html
  5. Ross, John. “E-Cigarettes: Good News, Bad News.” Harvard Health Blog, 5 Aug. 2019, www.health.harvard.edu/blog/electronic-cigarettes-good-news-bad-news-2016072510010


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by Cherokie Dyer, PharmD candidate class of 2020,
University of Florida

Alzheimer’s is an irreversible brain disease best known for the hallmark sign of dementia. It is believed that Alzheimer’s is caused by plaques that form in the brain and damage your memory, thinking skills, and ability to do simple tasks. Usually the disease shows up around 60 years of age, with rare exceptions.

Treatment for Alzheimer’s

Currently, there are a few treatments to help with the symptoms of Alzheimer’s disease including agitation, loss of appetite, mood, and paranoia but there is no cure for the disease itself. In the past, Alzheimer’s disease seemed to be a random occurrence in old age.  The good news is that we now have research to suggest that it can be prevented or delayed.

Five ways to Prevent Alzheimer’s

There is not one specific behavior that you can start to prevent or delay Alzheimer’s. Rather, the Rush study lends evidence to suggest that it is a combination of four or more of these lifestyle behaviors that can lower your chances of getting Alzheimer’s. These findings even apply to people with an increased risk of Alzheimer’s due to genetic factors and family history.

  • Not Smoking
  • Exercising for at least 150 minutes a week at a moderate or vigorous level
  • Eating a brain supporting diet
  • Very light to moderate alcohol consumption
  • Engaging in late-life cognitive activities

The Alzheimer’s study indicates that practicing two or three of these behaviors can reduce your risk by about 37%. Practicing four or five of these behaviors can reduce your risk by 60%.

What is a Brain Food?

While most of these Alzheimer’s preventing behaviors are self-explanatory, two may need further explanation: ‘Eating a brain supporting diet’ and ‘light to moderate alcohol consumption’.

The MIND diet was developed by the same researchers as the Rush Study and incorporates recommendations from two popular heart healthy diets. It stands for Mediterranean-DASH Intervention for Neurodegenerative Delay and it was adjusted based on foods that would be accessible for Americans to readily include in their diet.

The MIND diet emphasizes ten foods you should eat daily and five foods you should avoid.

Start Eating: Green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and one cup of red wine

Avoid Eating: Red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

Key Take Aways

  • Alzheimer’s is a progressive disease that can manifest as severe dementia.
  • There currently is no cure, but there is hope to prevent or delay it as you age.
  • Embracing at least four out of five lifestyle adjustments found in the Rush Study can lower your risk of developing Alzheimer’s disease by 60%.

References:

https://www.nia.nih.gov/health/what-alzheimers-disease

https://www.nbcnews.com/health/aging/can-alzheimer-s-be-stopped-five-lifestyle-behaviors-are-key-n1029441

http://www.nbcnews.com/id/57163245/ns/technology_and_science-science/t/mind-your-diet-protect-against-alzheimers/#.XS5OzehKiUl

Mind Diet – https://www.ncbi.nlm.nih.gov/pubmed/25681666

Findings from the Rush Memory and Aging project – https://www.ncbi.nlm.nih.gov/pubmed/22471867



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by Cherokie Dyer, PharmD Candidate,
Class of 2020, University of Florida

When was the last time you felt stressed?

Stress is so common that there is an organization called, “The American Institute of Stress.” According to this group, there are 50 common signs and symptoms of stress. Many of the signs we think about when it comes to stress are difficulty making decisions, excessive anxiety, worry, guilt, and nervousness. Other common signs include increased frustration, irritability, and edginess. We can determine these signs based on our interactions with people. But… did you ever think about what stress is doing to your body on the inside?

How does Stress affect the body?

Stress can be a good thing in an emergency. It turns on your ‘fight or flight’ response. This gives you that ‘adrenaline rush’ feeling, which is the release of cortisol and epinephrine. Stress raises your blood pressure, makes your heart beat faster, and boosts sugar levels in your blood. It can also slow down your digestive tract, make your muscles tense up, and make your breathing become more rapid. All these bodily reactions are great to help you act during a crisis.

However, it’s not good when our bodies are constantly flooded with stress for a long period of time.

  • Heart racing and blood rushing may cause inflammation in arteries and lead to heart attacks or strokes.
  • Constant boosts in blood sugar can affect insulin and lead to pre-diabetes.
  • An impaired digestive tract can keep the body from getting valuable nutrients and lead to hard or loose stools.
  • Constantly tensed muscles can cause tension headaches and migraines.
  • Rapid breathing can cause hyperventilation and lead to panic attacks.
  • Increased cortisol may cause the body to hold on to belly fat.
  • These reactions can start to make the menstrual cycle irregular or lower sperm counts.
  • Stress can also affect eating patterns making us want to eat more or less than usual.

Believe it or not, constant stress can wreak havoc on our body in a multitude of other ways. Especially if you already have medical conditions like heart disease, diabetes, irritable bowel syndrome, or obesity. Your constant stress could very well be the thing that’s preventing your medications from helping you get better.

Two Key Strategies to Manage Stress

Try to prevent it and cope with it when it comes. Figure out the things that trigger your stress. Do your best to avoid them or work around them. For instance, if leaving on time for work stresses you out, invest in a new alarm or get up even earlier to give yourself more time.

There are other ways to prevent stress besides just avoiding your triggers.

  • Carve out some more alone time for yourself
  • Do more of the things that you bring you joy
  • Make the effort to get near 8 hours of sleep
  • Eat more fresh foods and whole foods
  • Avoid stimulants like caffeine.

If you are already feeling stressed out, then there are a ton of options that you can try:

  • Calming activities like prayer, yoga, massages, and/or deep breathing
  • Active movements like going for walks, jogs, lifting weights, or taking group classes like kickboxing
  • More of your favorite hobby, listen to music you like, play with your pet more often, or participate in volunteer work.

The options are endless and there is no correct answer!

Bottom Line

Stress can be negative for both our sanity and our bodies. There are a variety of ways to deal with stress. Identify when you feel the most stressed out. Do your best to avoid that trigger and/or cope with those feelings, and your body will thank you in return.

References

https://www.stress.org/stress-effects
https://www.stress.org/military/combat-stress/management
https://www.stress.org/daily-life



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by Emily Ross, PharmD Candidate,
Class of 2020

You can add it to your morning coffee or smoothie. It is available in drops, creams, gummy bears, face masks and so much more. Some say it can help with anxiety, depression, insomnia, arthritis pain and a variety of other issues. You have likely seen it in your local market, pharmacy or shop on the corner. That’s right, we are talking about the latest health trend – CBD.

With all these new products to hit the market it has people wondering: Is CBD safe? Does CBD work? Should I use CBD? We are going to discuss these concerns and more to see if CBD is worth all the hype.

What is CBD?

Let’s start off with basics – CBD stands for cannabidiol. This is a chemical component of the plant Cannabis sativa which has two primary species – hemp and marijuana. The hemp variety contains a higher percentage of CBD. The other major component in the cannabis plant is THC – which is the psychoactive agent responsible for producing the effects most people associate with marijuana. For the purposes of this article, we will be focusing on CBD.

What is CBD Used For?

From relieving pain to helping with insomnia, people are using CBD for a variety of reasons. Many of the problems CBD has the potential to relieve is based on its action in what is called the endocannabinoid  system (ECS.)

This is a special system in the human body that is involved in many life functions including sleep, appetite, pain and immune system. By acting on receptors in the ECS, it may help treat issues listed with the above systems. In addition, it may also have anti-inflammatory effects that would help with chronic conditions such as arthritis.

Another indication for using CBD for many people is to relieve anxiety and depression symptoms. There are studies that show CBD to have an antidepressant effect due to its interaction with serotonin. Serotonin is a molecule in the body that regulates mood and behavior.

In addition, there are unsupported claims that CBD can help to reduce cancer-related symptoms, decrease acne, benefit heart health and may even prevent diabetes. I have just listed a few of the many different reasons people are using this new product.

Does CBD Work?

CBD makes a lot of great promises; however, this only goes so far if there are not proven benefits and results. There have been many studies done in animals and humans with CBD on the possible benefits. CBD has show efficacy in small clinical trials in reducing stress and anxiety, but more research is needed.

The research as to whether it is effective for pain relief is very early and the results are uncertain. As of now, there may be benefits due to the anti-inflammatory properties. CBD works in a different way than traditional prescription pain relievers, such as opioids, so there may be use for combination therapy when recommended by your doctor.

Is CBD Safe?

As of now, there has not been serious or major adverse effects reported in these studies. Though, CBD has been reported to have some side effects and can interact with other medications. Common side effects include:

  • Fatigue
  • Irritability
  • GI upset (nausea, diarrhea)
  • Dry mouth
  • Changes in appetite

Another big consideration is that CBD products are like herbals and other dietary supplements: there is no standardization on products. Different companies have different additives, and those may contain trace amounts of THC.

As of now, there are no regulations (FDA) in place that guarantee the safety of all the ingredients in the product. The FDA has issued a warning statement that there are many unanswered questions about the science, safety and quality of products that contain CBD.

Should You Try CBD? The Bottom Line

CBD comes in many forms and is being used to treat a variety of issues. While there are many convincing reasons to try it, more studies need to be done in order to make a conclusion and treatment decision regarding CBD. Everyone is different and what works for one person may or may not work for another.

The most important thing to remember is to talk to your doctor or pharmacist before starting any new supplement or product to make sure that it is safe for you.

References:

Bemben, Nina M. “CBD Oil and Medical Marijuana: Pharmacists Need to Know the High Points.” Wolters Kluwer, 21 May 2019, www.wolterskluwercdi.com/blog/cbd-oil-and-medical-marijuana-pharmacists-need-know-high-points/.

FDA Office of the Commissioner. “What to Know About Products Containing Cannabis and CBD.” U.S. Food and Drug Administration, FDA, 17 July 2019, www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.

Grinspoon, Peter. “Cannabidiol (CBD) – What We Know and What We Don’t.” Harvard Health Blog, 5 June 2019, www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476.

Kubala, Jillian. “7 Benefits and Uses of CBD Oil (Plus Side Effects).” Healthline, Healthline Media, 26 Feb. 2018, www.healthline.com/nutrition/cbd-oil-benefits#section7.

Volkow, Nora D. “The Biology and Potential Therapeutic Effects of Cannabidiol.” NIDA, 24 June 2015, www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/biology-potential-therapeutic-effects-cannabidiol.

Williams, Reagan A. “CBD Oil: Leading Patients to Safe Use.” Pharmacy Today, Nov. 2018, www.pharmacytoday.org/article/S1042-0991(18)31505-6/fulltext.



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what is this med for image - wellrx

by Emily Ross, PharmD Candidate,
Class of 2020

Improving Medication Adherence and Management

Managing several different medications can be overwhelming, confusing and time-consuming. Without effective medication management, errors and missed doses may happen easily. This can lead to ineffective drug therapy and not getting results from taking medications. One key to proper medication management is organization. There are simple ways to create organizational systems into your daily routine to get the most benefit from your drug therapy.

Medication Management Tools

  • Pill Box: One of the simplest ways to keep medications organized is to use a daily or weekly pill box. There are a variety of sizes and colors to fit your needs. These range from simple ones that have a compartment for each day to more complex ones that have dividers for each dosage time (ex: morning, afternoon, evening).
  • Medication List: Keeping and maintaining a current list of all the medications you take is very useful to keep up to date on your treatment. It is important to include all over the counter drugs, supplements, and herbals that you may take as well. Taking this to your doctor appointments and the pharmacy ensures all your providers are aware of your medications and can help prevent duplicate drug therapies and potentially harmful drug interactions.
  • Medication App: There is an app for about anything – including managing your medications! There are several apps available to download to your phone or mobile device. Read about the different features of each one and then choose one that best meets your needs. These are available for both android and apple devices. Some examples are:
    • MyMeds: Connects patients, caregivers, and providers to help have better understanding of current medications
    • MyMedSchedule Plus: Simple and easy to use, offers reminders, pictures of medications and tracks how often the medication is taken
    • The ScriptSave WellRx App: In addition to providing prescription price transparency, the ScriptSave WellRx app allows patients to set Take Your Pill reminders, as well as when it’s time to refill prescriptions.

      The WellRx platform also provides free access to some potentially life-saving functionality:
      • Drug Interaction Warnings: Patients can receive and share warnings with their caregivers when drugs in their personal in-app Medicine Chest might interact with each other.
      • Lifestyle Interaction Warnings: This includes warnings about potential drug interactions with certain foods patients eat, or activities they might engage in.
      • Expanded Drug Information: Patients can view detailed information, images, and videos for drugs within the Medicine Chest. Much of this information is available in English and Spanish.

Tips for Managing Your Medications

Now that you have all your medications organized, the next step is remembering to take them! It is easy to forget or miss a dose of your medication but with a few helpful tips – you can minimize the amount of times this happens and improve adherence.  

  • Reminders: This can be as simple as programming a daily reminder or alarm into your phone that alerts you when it is time to take your medication. You could go the more classic route and have a note that is posted in a spot that you see it every day such as the bedside table, bathroom mirror or fridge. You can also set reminders in the ScriptSave WellRx mobile app.
  • Timers: If a device separate from your phone is more your style, there are several options that can provide an alarm or noise to help remind you that it is time to take medication. Likely, there are many items you already own, such as an alarm clock or kitchen timer, that can be set to the time you need to take medication. E-pill® offers several medication alarms and even has devices that combine pill boxes with reminder alerts.
  • Routine: Include taking medications into a daily routine. First, think of a task you do every day, such as brushing your teeth. Make a point to take your medication at the same time you brush your teeth. By joining the tasks together, taking your medications will become part of your daily routine and decrease the chance of missing a dose.
  • Medication Synchronization: Many pharmacies offer medication synchronization programs that allow you to pick up all your medications at one time. This not only cuts down on trips to the pharmacy but also lessens the chance of allowing a prescription to run out before returning to the pharmacy for more refills.
  • 90-Day Supply: If allowed by your insurance, obtaining a 90-day supply of medication is a good way to have adequate stock and minimize pharmacy trips. Similar to the idea of syncing your medications, there is less of a chance of running out of medication and missing doses.

With all these organization and adherence tips, you’ll be a pro at knowing your medication and taking them on time! There are many benefits that come from organization, such as reducing the stress of managing and taking multiple medications. Additionally, it may decrease health care cost by saving the need for more doctor appointment or medications due to gaps in drug therapy.

These are easy steps that can be done to increase how well your medicines work for you. By using the tools for a good organization system and following the adherence tips, you can improve your overall health and well-being.

References:

Fayed, L. (2019, June 24). How to Manage and Organize Medication for Your Safety. Retrieved from https://www.verywellhealth.com/ways-to-manage-your-medication-514511

MyMeds: Redefining the Medication Experience. (n.d.). Retrieved from https://my-meds.com

MyMedSchedule: Free medication schedules, reminders, and health tracker. (n.d.). Retrieved from https://secure.medactionplan.com/mymedschedule/

Pill Timers. (n.d.). Retrieved from https://www.epill.com/alarms.html

ScriptSave WellRx App Makes Medication Management Easier: https://news.wellrx.com/2019/01/23/scriptsave-wellrx-app-makes-medication-management-easier/



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Treatment for Depression and Anxiety: The Fight to End Suicide

by Cherokie Dyer, PharmD candidate class of 2020,
University of Florida

Alarming Suicide Statistics

Over the past 17 years, rates for death by suicide has dramatically risen here in the United States. From 1999 to 2016, 25 states had over a 30% increase in their suicide rates. There’s rarely any one reason for someone to commit suicide. However, most suicides are attributed to life stressors, loss of a relationship, and a recent or approaching crisis. Another huge contributor is the presence of a mental health disorder such as depression or anxiety.

In the year of 2017, the CDC states that there were:

  • 44,965 suicide deaths
  • 13.9 suicide deaths per every 100,000 people
  • 39% of adults 18 and older had serious psychological distress in the past 30 days
  • 56.8 million physician visits resulted in mental, behavioral, and neurodevelopmental disorders as a diagnosis
  • 5.5 million emergency room visits were due to mental health disorders

The Good News

The amount of people being treated for depression and anxiety disorders is also rising. In 2012, the World Health Organization stated that 350 million people across the globe were affected by depressive disorder. This is followed with an increase in diagnosis and treatment of these disorders.

Common Anti-Depressant and Antianxiety medications include:

Brand Name Generic Name Drug Class
Zoloft Sertraline Selective Serotonin Reuptake Inhibitor
Lexapro Escitalopram Selective Serotonin Reuptake Inhibitor
Prozac Fluoxetine Selective Serotonin Reuptake Inhibitor
Wellbutrin Bupropion Dopamine/Norepinephrine Reuptake Inhibitor
Cymbalta Duloxetine Serotonin/Norepinephrine Reuptake Inhibitor
Effexor Venlafaxine Serotonin/Norepinephrine Reuptake Inhibitor
Pristiq Desvenlafaxine Serotonin/Norepinephrine Reuptake Inhibitor
Remeron Mirtazapine Alpha-2 Antagonist
  Amitriptyline Tricyclic Antidepressant

It’s great that more people are getting help for their mental health conditions. The increase in people getting treatment will help to decrease the number of people wanting to harm themselves. If you have sought treatment for anxiety or depression or know someone who sought treatment, I am so happy! Everyone’s life is valuable. If you or someone you know suffers from anxiety or depression and hasn’t yet felt comfortable seeking treatment, don’t hesitate. The awareness of these conditions and options for treatment are expanding; set up an appointment to talk about what you are experiencing.

Things to Remember about your Antidepressants or Antianxiety Meds

These medications take time to work. In many cases, you won’t see an effect until after about 1 month. Taking your medications as prescribed can help strengthen their effectiveness and prevent side effects like dizziness, fatigue and nausea. If significant time passes and you still don’t feel any better, ask your doctor to try you on another medicine. Never quit these medicines abruptly as this can result in bothersome, and sometimes serious withdrawal symptoms. Be sure to follow your doctor’s instruction to taper these medications if it’s determined that they need to be stopped.

Outside of Medicine

Outside of prescription medication, these are 3 valuable ways to improve mental health. Incorporating these changes along with your medication can also increase their effectiveness.

Nutrition: Your body makes all your brain chemicals from the food you eat daily. That’s your protein, complex carbohydrates (fruits, veggies, whole grains), and good fats. If you don’t eat this kind of balanced diet, you may consider taking a daily multivitamin.

Sleep: Getting close to 8 hours of sleep each day gives your body the time to make more brain chemicals. It’s the best opportunity for your body to fix and replace other cells like the nerves and muscles.

Exercise:  Daily exercise improves your brain activity and increases the release of brain chemicals. A great example would be going for a brisk walk outside. The movement, along with getting at least 10 minutes of sun each day, is another great way to both exercise and get your daily vitamin D allowance. Not to mention exercise is a good way to relieve anxiety and avoid personal stressors! 

Suicide Lifeline

If you or someone you know are thinking about harming themselves in any way, call the National Suicide Prevention Lifeline at 1-800-273-8255. You can also text HOME to 741741 to receive texts from the Crisis Text Line. If you feel there is an emergency, you should always call 911 or go to the nearest hospital.

References:

Suicide Prevention websites:

https://www.crisistextline.org/

https://suicidepreventionlifeline.org/

Statistics:

https://www.grandviewresearch.com/industry-analysis/anxiety-disorders-and-depression-treatment-market

https://www.cdc.gov/nchs/fastats/mental-health.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1_w

Medication and Nutrition information:

https://www.fda.gov/consumers/free-publications-women/depression-medicines-help-you

http://www.martiefankhauser.com/


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by Jennifer Bingham, PharmD, BCACP & Stephanie Forbes, PharmD

The Prescription Opioid Addiction Epidemic

Pain is complex and the sensation and intensity can vary among individuals who are suffering, so there are many treatment options — mind-body techniques, acupuncture or physical therapy, and medications, both over the counter and prescription. For many patients with severe pain from injuries or surgery, opioid painkillers are supposed to provide pain relief, but because they have been heavily marketed and inappropriately prescribed, there has been an ever increasing number of deaths throughout the U.S. caused by misuse and addiction.

What is Narcan®?

Narcan® (naloxone hydrochloride) is an opioid antidote.1 It is indicated for patients that has suspected opioid overdose symptoms, such as respiratory and central nervous system depression.1 It is available in two formulations, including injectable and nasal preparations. The nasal spray contains one dose per unit,1 hence it is important to contact 9-1-1 for emergency medical assistance once opioid overdose is suspected to ensure additional assistance is available if needed. 

Who Should Use Narcan Nasal Spray?

Narcan nasal spray is intended for use by people who are experiencing an opioid overdose or are showing signs of opioid overdose.2,3 As mentioned above, it’s use is not a substitute for emergency medical care. Whenever administering Narcan, always call 9-1-1 right away.  Since it is an opioid antagonist, Narcan only works to reverse the effects of opioids, both prescription and non-prescription. Some examples of opioids it reverses are morphine, codeine, opium, hydrocodone, heroin and methadone.4

Who should have Narcan Nasal Spray?

People who receive Narcan are typically taking high doses of opioids for pain management over a long treatment period.2,5 Additionally, those taking extended-release or long-acting opioid medications or receive rotating opioid medication regimens may also have Narcan.   Patients who have a known hypersensitivity to naloxone hydrochloride should not use Narcan.1 Narcan access (needing a prescription) varies across states and the medication should be replaced before the expiration date passes.5

How to Store Narcan Nasal spray?

Narcan nasal spray should be stored in the blister and cartons provided until use.1 A controlled room temperature between 59°F to 77°F with protection from light is recommended for storage, and the product should not be frozen. The nasal spray may be stored at temperatures outside of this range (39°F to 104°F) for brief periods of time only.

Ask your pharmacist if you should talk to your provider about Narcan.

References:

  1. Narcan Nasal Spray (naloxone hydrochloride) [prescribing information]. Radnor, PA: Adapt Pharma Inc; January 2017.
  2. Naloxone. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/treatment/naloxone/. Last Updated April 11, 2019; Accessed June 3, 2019. 
  3. Coffin, Phillip MD, MIA. Prevention of lethal opioid overdose in the community. UptoDate®. Last Updated June 25, 2018. Accessed June 3, 2019.
  4. What Are Opioids. Department of Health and Human Services. https://www.hhs.gov/opioids/prevention/index.html. Last Updated May 15, 2018. Accessed June 4, 2019
  5. Opioid Overdose Reversal with Naloxone. National Institute of Drug Abuse. https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio/. Last Updated April 2018, Accessed June 3, 2019.

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