antipsychotic medications - wellrx blog image

By Rosanna Sutherby, PharmD

Antipsychotics are medications used to treat psychosis associated with mental illnesses, such as schizophrenia and bipolar disorder. Other names for antipsychotics include neuroleptics and major tranquilizers.

More Than Just Treatment for Bipolar Disorders

Antipsychotics are divided into two classes. First-generation (typical) antipsychotics were developed in the 1950s and have been associated with unpleasant side effects, such as involuntary movements, repetitive motions, or inability to move. Second-generation (atypical) antipsychotics were developed in the 1980s, and they are generally less likely to cause movement-related side effects. However, you should be aware of other side effects and precautions if you take these newer drugs.

The following is a review of commonly prescribed second-generation antipsychotics.

Abilify (aripiprazole)

Abilify (aripiprazole) works by regulating chemicals, such as dopamine and serotonin, in your brain. Abilify is used alone or in combination with other medications to treat the following conditions:

  • Schizophrenia
  • Manic and mixed episodes of bipolar disorder
  • Depression
  • Irritability associated with autism
  • Tourette’s syndrome

The following are common side effects associated with Abilify:

  • Difficulty with speech
  • Problems with balance
  • Nausea
  • Vomiting
  • Dizziness
  • Anxiety or restlessness
  • Drooling
  • Stiffness
  • Trembling
  • Shuffle walk
  • Uncontrolled movements of the face, neck, and back

This is not a complete list of side effects. Talk to your doctor or pharmacist to learn more about the side effects of this medication.

Abilify may increase thoughts of suicide in some people. Immediately let a healthcare provider of caregiver know if you feel depressed or have thoughts of hurting yourself.

Abilify may add to the drowsiness effects of other medications or substances that make you sleepy or decrease alertness. If you are taking Abilify, check with your doctor or pharmacist before taking any drugs that may cause drowsiness, including the following:

  • Alcohol
  • Antihistamines
  • Sleeping medications
  • Medications for anxiety
  • Muscle relaxants
  • Prescription pain medicine

This is not a complete list of drug interactions for Abilify. Talk to your pharmacist about interactions between Abilify and other medicines that you take.

Seroquel (quetiapine)

Seroquel (quetiapine) is an atypical antipsychotic that works by regulating dopamine and serotonin in your brain. It is used alone or with other medications to treat the following:

  • Schizophrenia
  • Depression
  • Manic and depressive episodes of bipolar disorder
  • Obsessive-compulsive disorder (OCD)

The most common side effects seen with Seroquel include the following:

  • Drowsiness
  • Dry mouth
  • Dizziness
  • Constipation
  • Weight gain
  • Muscle weakness
  • Abdominal pain
  • Chills
  • Confusion
  • Postural hypotension (drop in blood pressure when you get up quickly from a lying or sitting position)

Seroquel may increase blood sugar levels. Talk to your doctor if you notice increased thirst or increased urination. If you have diabetes, make sure to monitor your blood sugar levels closely while taking Seroquel.

Seroquel may increase thoughts of suicide in some people. Immediately let a healthcare provider of caregiver know if you feel depressed or have thoughts of hurting yourself.

Seroquel may have other side effects. A conversation with your doctor or pharmacist will help you understand other side effects you may experience while taking this medicine.

You should not mix Seroquel with other medications that may cause drowsiness, such as:

  • Alcohol
  • Antihistamines
  • Sleeping medications
  • Medications for anxiety
  • Muscle relaxants
  • Prescription pain medicine

Seroquel interacts with drugs that are processed through your liver. Talk to your pharmacist about possible drug interactions between Seroquel and other medications you are taking.

Risperdal (risperidone)

Risperdal works by regulating dopamine and serotonin in your brain. It is a second-generation antipsychotic used alone or in combination with other drugs to treat the following conditions:

  • Schizophrenia
  • Manic and mixed episodes of bipolar disorder
  • Irritability associated with autism
  • Tourette’s syndrome

Common side effects of Risperdal include the following:

  • Drowsiness
  • Tiredness
  • Sore throat
  • Runny nose
  • Shaking
  • Dizziness
  • Anxiety
  • Aggressive behavior
  • Nausea
  • Vomiting
  • Stomach pain or discomfort
  • Problems with vision
  • Shuffle walk
  • Memory problems
  • Problems with balance
  • Constipation
  • Dry mouth
  • Weight gain

Immediately let your doctor know if you experience any of the following symptoms while taking Risperdal:

  • Seizures
  • Trouble breathing
  • Rapid heartbeat
  • High fever
  • Changes in blood pressure
  • Excessive sweating
  • Loss of bladder control
  • Muscle stiffness
  • Abnormally pale skin

These may be symptoms of a life-threatening reaction known as neuroleptic malignant syndrome (NMS) and requires immediate medical attention.

Risperdal may increase your blood sugar levels. Let your healthcare provider know if you notice increased thirst or increased urination.

Medications that affect your central nervous system may worsen some side effects of Risperdal. Talk to your doctor or pharmacist before taking any drugs that may cause drowsiness or affect concentration, including the following:

  • Alcohol
  • Antihistamines
  • Sleeping medications
  • Medications for anxiety
  • Muscle relaxants
  • Prescription pain medicine
  • Seizure medication
  • Antidepressants

This is not a comprehensive list of side effects or drug interactions for Risperdal. Always discuss your medicines with your pharmacist to understand potential side effects and drug interactions.

Geodon (ziprasidone)

Geodon is an atypical antipsychotic that works by regulating dopamine and serotonin in your brain. It is used alone or in combination with other medications to treat the following:

  • Schizophrenia
  • Manic and mixed episodes of bipolar disorder
  • Tourette’s syndrome

Common side effects of Geodon include the following:

  • Cough
  • Problems with speech
  • Restlessness
  • Problems with balance
  • Fear or anxiety
  • Shuffle walk
  • Stiffness
  • Trembling
  • Uncontrolled movements of the face, neck, and back
  • Sore throat
  • Fever

Like Risperdal, Geodon can cause NMS. Immediately let your doctor know if you experience any of the symptoms of NMS discussed above.

Geodon may cause dangerous changes in your heart rhythm, especially if combined with other medications that may affect your heart rhythm, including the following:

  • amiodarone (Cordarone)
  • azithromycin (Zithromax)
  • levofloxacin (Levaquin)
  • moxifloxacin (Avelox)
  • chlorpromazine (Thorazine)
  • dofetilide (Tikosyn)
  • sotalol (Betapace)
  • tacrolimus (Prograf)
  • pimozide (Orap)
  • thioridazine (Mellaril)

This is not a complete list of side effects or drug interactions for Geodon. Always discuss your medications with your pharmacist to understand potential side effects and drug interactions.

Be sure to compare prescription prices before filling your medication. You can use a free Rx savings card to get the lowest prescription price at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.ncbi.nlm.nih.gov/books/NBK84635/

https://www.wellrx.com/abilify/drug-information/

https://www.wellrx.com/seroquel/drug-information/

https://www.wellrx.com/risperdal/drug-information/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726098/#:~:text=Neuroleptic%20malignant%20syndrome%20(NMS)%20is,muscle%20rigidity%2C%20and%20autonomic%20dysfunction.

https://www.wellrx.com/geodon/drug-information/

https://www.wellrx.com/https://www.wellrx.com/prescriptions/

get to know your pharmacist - wellrx blog image

by Marina Matthews, PharmD Candidate,
University of Kansas School of Pharmacy

As one of the most trusted and accessible health care professionals, pharmacists work on the front lines of patient care. Approximately 67,000 pharmacies operate in the United States today, and nearly 95 percent of the population lives within 5 miles of a pharmacy.

While pharmacists are best known for dispensing prescription medications and helping patients use them safely, today’s pharmacists are trained and licensed to provide a number of additional services needed by many patients.

Pharmacist Training

In 2000, the licensing switch was mandated from Registered Pharmacist (RPh) to Doctor of Pharmacy (PharmD). This means all graduates after 2000 have to be licensed as a PharmD and are trained as such. Not only did the licensing switch, but the amount of schooling has also changed. Pharmacy school is an additional 4 years of graduate training after receiving an undergraduate degree or completing all pre-requisites.

Additionally, pharmacists can receive further postgraduate training in the form of a residency or fellowship. These programs can be one or two years of specialized training in various areas of pharmacy, such as emergency medicine, critical care, oncology, and outpatient care.

These pharmacists are highly skilled and most continue to become Board Certified in their specialty. Board certification requires you pass a specialty-specific exam of medical and clinical knowledge.

Pharmacist Services

During school, pharmacists are trained to provide a variety of services. Conducting health and wellness testing, helping patients manage chronic conditions, administering immunizations and helping patients understand and manage their medications are just some of the things pharmacists can help with.

In some states, legislation has been passed allowing pharmacists to provide services to patients that enhance access to care. Services include intramuscular medication administration, such as once monthly antipsychotics. Pharmacists may also prescribe medications under collaborative agreements with providers, and provide point-of-care testing for blood pressure, blood sugar, or flu tests and vaccines.

During COVID-19

Because of the coronavirus, the pharmacist’s role has become more apparent to the community. Some states have already passed laws allowing pharmacists to administer COVID-19 testing to increase access to tests, and it will most likely be nationwide in the near future.

In times of physical distancing, pharmacists are readily available by phone to answer questions and address any medication issues patients have. This provides a network to the community which can reduce visits to the hospital and physician offices. As a community hub for immunizations, once a vaccine is on the market for COVID-19, pharmacists will be able to administer them to patients in the community.

Pharmacists are valuable team members to the health care community. They provide access, support, and necessary services to patients that extend far beyond dispensing prescription medications. While states license and determine the scope of practice for pharmacists, Congress can – and must – better ensure that patients have access to healthcare through pharmacist-provided services.

Using pharmacist services will improve access to healthcare, particularly in medically underserved communities. It also can prevent increased costs of healthcare as it prevents patients from seeking care in more costly settings, including the hospital emergency department.


References:

  1. https://www.pharmacytimes.com/publications/career/2019/careerswinter19/public-perceives-pharmacists-as-some-of-the-most-trusted-professionals
  2. https://www.accp.com/
  3. https://www.bpsweb.org/

sunscreen-melanoma - wellrx blog image

By Rosanna Sutherby, PharmD

As the weather gets warmer, many are naturally spending more time outside. This means more exposure to the sun and more focus on sunscreen and sun protection to prevent sunburn, premature skin aging, and skin cancer.

According to the American Cancer Society (ACS), skin cancer is the most common type of cancer. Although melanoma accounts for only 1% of all skin cancers, it causes the most number of skin cancer deaths because it is most likely to spread to other parts of the body.

Melanoma is a type of skin cancer that starts in the melanocytes, which are the cells in your skin that make melanin. Melanin is the pigment that makes your skin tan or brown, and it protects your skin from the sun’s ultraviolet (UV) rays. Melanoma occurs when melanocytes grow out of control and form a tumor.

The National Cancer Institute estimates that about 100,000 new cases of melanoma will be diagnosed in 2020. However, when caught and treated early before it spreads to other parts of the body, the five-year survival rate for people with melanoma is over 90%.

Protecting yourself from the sun’s damaging UVA and UVB rays is essential to preventing skin cancer. Sunscreens and sunblocks have come a long way from the oily or white creams that originated in 1946. Read on to learn what skin cancer prevention and skin cancer treatment look like today.

What Is the Difference Between Sunscreen and Sunblock?

Sunscreen contains chemicals that absorb the sun’s UV rays before they can penetrate and damage your skin. Sunblock forms a protective barrier on top of your skin that prevents the sun’s UV rays from passing through.

Ingredients that act as sunscreen include:

  • oxybenzone
  • avobenzone
  • octinoxate
  • octisalate

Ingredients that act as sunblock include:

  • zinc oxide
  • titanium dioxide

What’s New with Sunscreen

Although popular sunscreens have been effective in protecting your skin from damage related to UV rays, there have been reports suggesting that active ingredients, such as oxybenzone, avobenzone, and others, may be absorbed into your skin in higher amounts than previously known. The effect of these chemicals circulating in your blood is unknown, and the U.S. Food and Drug Administration (FDA) has proposed further research to determine safety standards.

While research continues, the FDA recommends that you continue to use sunscreen and other protective measures to avoid sunburn and prevent skin cancer and premature skin aging.

If you are concerned about chemicals that your body may absorb from your sunscreen or find the white film left on your skin by traditional sunblock less than appealing, newer options are available.

Scientists have recently developed sunscreen that contains tiny particles, or nanoparticles, of zinc oxide and titanium dioxide. Reducing the size of zinc oxide and titanium dioxide particles to minuscule sizes before adding them to your sunscreen allows for non-chemical protection without producing the white, pasty look of traditional sunblock.

Examples of sunscreens that contain zinc oxide or titanium dioxide nanoparticles include the following:

  • Neutrogena Sheer Zinc Mineral Sunscreen Lotion
  • Aveeno Positively Mineral Sunscreen
  • Vibriance Sheer Zinc Sunscreen
  • Bio Secrets Sunscreen Gel

These and other nanoparticle mineral sunscreens go on clear on your skin and form a barrier made up of micronized particles that help deflect the sun’s UV rays, preventing them from entering your skin.

Advances in Skin Cancer Treatment

Melanoma maintains a high survival rate when caught and treated early. However, researchers continue to search for better treatment for melanoma that has spread to other parts of the body. Scientists have made advances in the treatment of both early-stage melanoma and more advanced skin cancer.

Surgery to remove the melanoma tumor is still the standard treatment for melanoma that has not spread, but new drugs have been developed that target mutations in melanoma cells or that use the body’s immune system to fight the cancer cells.

Targeted Therapy

Targeted therapy uses drugs that block the effects of mutations in specific genes that can lead to the growth of melanoma cells. Medications currently approved for targeted therapy for melanoma include the following:

Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICIs) are a type of immunotherapy that enables your body’s T cells to kill cancer cells without killing healthy cells. ICIs currently approved to treat melanoma include the following:

Adoptive Cell Therapy

Adoptive cell therapy (ACT) is a type of immunotherapy being tested for the treatment of melanoma that has spread to other parts of the body. ACT uses T cells harvested from the patient’s own blood or tumor. The cells are multiplied in large numbers in the laboratory and given back to the patient to enhance the immune system’s ability to fight the cancer cells. Sometimes, the T cells are modified in the laboratory to make them better at killing cancer cells.

Researchers are continuing to study new treatments for melanoma, including using combination therapies and safer or more effective ways to use currently approved drugs.

Melanoma has a high survival rate when detected and treated early. Doctors recommend doing a skin self-exam once a month to check for any changes in skin marks and coloration. The best way to prevent skin cancer is to protect yourself from the sun’s UV rays by using sunscreen or sunblock regularly, wearing protective clothing, and limiting your time in the sun from 10 a.m. to 2 p.m.

It’s a great time to be outdoors, so be smart about the sun and go outside!

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/

https://seer.cancer.gov/statfacts/html/melan.html

https://www.fda.gov/news-events/press-announcements/fda-advances-new-proposed-regulation-make-sure-sunscreens-are-safe-and-effective

https://www.sciencemag.org/news/2015/09/new-nanoparticle-sunblock-stronger-and-safer-scientists-say

https://www.cancer.gov/types/skin/research#:~:text=Laser%2DBased%20Device%20Detects%20and,Has%20Spread%20to%20the%20Brain

https://www.wellrx.com/tafinlar/drug-information/

https://www.wellrx.com/braftovi/drug-information/

https://www.wellrx.com/zelboraf/drug-information/

https://www.wellrx.com/mekinist/drug-information/

https://www.wellrx.com/mektovi/drug-information/

https://www.wellrx.com/cotellic/drug-information/

https://www.pharmacytimes.com/publications/health-system-edition/2020/January2020/new-skin-cancer-treatments-show-promise

https://www.wellrx.com/yervoy/drug-information/

https://www.wellrx.com/keytruda/drug-information/

https://www.wellrx.com/opdivo/drug-information/

https://www.cancer.org/cancer/melanoma-skin-cancer/detection-diagnosis-staging/detection.html

women & high blood pressure

By Rosanna Sutherby, PharmD

Nearly half of all adults in the United States have hypertension (high blood pressure), and 43% are women. The American College of Cardiology (ACC) and the American Heart Association (AHA) define hypertension as blood pressure that is 130/80 mm Hg or above. High blood pressure is a significant risk factor for heart disease, killing more women than any other illness.

Different stages in life can bring about various changes in blood pressure for women. Understanding how your body works can help you control your blood pressure and prevent hypertension as you move through life’s different phases.

Does Your Menstrual Cycle Affect Your Blood Pressure?

Some studies show that premenstrual syndrome (PMS) may affect your blood pressure. A 1991 study found that a woman’s blood pressure fluctuates based on different stages of her menstrual cycle. The study found that blood pressure tended to be highest at the start of the menstrual cycle and lowest between days 17 and 26.

more recent study found that young adult women who experienced PMS had higher diastolic blood pressure than those without PMS. Further studies are needed to determine if PMS is a risk factor for developing hypertension later in life.

How Do Birth Control Pills Affect Your Blood Pressure?

We now know that oral contraceptives, or birth control pills, that contain estrogen can increase blood pressure in some women.  High blood pressure can develop as early as six months or as late as six years after you start taking oral contraceptives. You are more likely to have high blood pressure while taking birth control pills if:

  • You are overweight.
  • You have a history of high blood pressure during previous pregnancies.
  • You have a family history of kidney disease or high blood pressure.

Even if you do not have the risk factors listed above, you must talk to a healthcare provider before taking birth control pills. Your doctor will need to conduct a thorough physical exam and take a detailed medical history. He or she will also assess your blood pressure before starting birth control pills and regularly after that.

If you develop hypertension while taking birth control pills, you will need to stop taking them. Your blood pressure will likely return to normal after discontinuing the oral contraceptives. The following are safe alternatives for contraception if you have high blood pressure:

  • progestin-only pills (norethindrone, Camila, Ortho Micronor, and others)
  • Mirena (levonorgestrel) intrauterine device (IUD)
  • Paragard copper IUD
  • Nexplanon (etonogestrel) implant
  • Depo-Provera (medroxyprogesterone acetate) injection (do not use if your blood pressure is over 160/100 mmHg)
  • over-the-counter products, such as condoms, spermicide, and female condoms

Be sure to keep your appointments with your healthcare provider regardless of what type of contraceptive you are using. You should have your blood pressure checked regularly, especially if you are using an estrogen-containing contraceptive.

High Blood Pressure During Pregnancy

In some cases, high blood pressure may develop during pregnancy. High blood pressure that occurs after 20 weeks of pregnancy is called gestational hypertension. When accompanied by high protein levels in the urine, it is considered preeclampsia.

You are more likely to have preeclampsia if:

  • You or a family member has had preeclampsia during previous pregnancies.
  • You have a history of high blood pressure.
  • This is your first pregnancy.
  • You are very young or older than 35 during your pregnancy.
  • You are obese.
  • You are carrying multiple babies.
  • You have diabetes.
  • You have kidney disease.

Untreated high blood pressure during pregnancy is dangerous for both you and your baby, and preeclampsia can be fatal for you and your baby as well. Because hypertension can often develop slowly without symptoms, you must regularly check your blood pressure during pregnancy.

Immediately let your doctor know if you experience any of the following signs and symptoms of preeclampsia:

  • blood pressure above 140/90 mmHg
  • severe headaches
  • blurred vision, temporary loss of vision, or sensitivity to light
  • upper abdominal pain
  • nausea
  • vomiting
  • shortness of breath
  • swelling of the face and hands

It is important to be as healthy as possible going into your pregnancy. Try to maintain a healthy weight, and keep your blood sugar under control if you have diabetes. If you smoke, quit smoking, and always continue exercising.

Complications of preeclampsia include slow growth of the baby, low birth weight, premature delivery, and damage to your kidneys, liver, eyes, and other organs. However, if your preeclampsia is detected early, your doctor can work with you to help prevent complications.

Related article: Allergy Medicines and Hypertension

Menopause and Hypertension

After menopause, women’s estrogen levels decrease, and this drop in natural estrogen can increase blood pressure. Nitric oxide in your body helps to dilate blood vessels and facilitate blood flow. Studies show that estrogen promotes the production of nitric oxide. As estrogen levels drop after menopause, you have less nitric oxide, and your blood vessels become stiffer. This increases the pressure in the blood vessels as the blood passes through them.

Nitric oxide also plays a role in regulating your salt sensitivity. As your estrogen levels and circulating nitric oxide drop, you may become more sensitive to sodium. This means that consuming the same amount of salt that you did when you were premenopausal may increase your blood pressure.

Maintaining healthy blood pressure is possible after menopause. Avoiding high-sodium foods, exercising regularly, quitting smoking, and getting regular doctor checkups are ways you can manage your blood pressure after menopause.

Regardless of your stage in life, maintaining a healthy lifestyle and having regular checkups with your healthcare provider is essential to keeping your blood pressure under control. If you take medications to lower your blood pressure, you can use a free Rx savings card to get the lowest prescription price at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.cdc.gov/bloodpressure/facts.htm

https://www.wellrx.com/hn/us/assets/health-condition/hypertension/~default/

https://www.wellrx.com/hn/us/assets/health-condition/cardiovascular-disease-overview/~default

https://pubmed.ncbi.nlm.nih.gov/1657498/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116659/

https://pubmed.ncbi.nlm.nih.gov/12263383/

https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

https://www.wellrx.com/norethindrone/drug-information/

https://www.wellrx.com/mirena/drug-information/

https://www.wellrx.com/nexplanon/monographs/

https://www.wellrx.com/depo-provera/drug-information/

https://www.wellrx.com/hn/us/assets/health-condition/gestational-hypertension/~default

https://www.wellrx.com/hn/us/assets/health-condition/preeclampsia/~default

https://pubmed.ncbi.nlm.nih.gov/25366614/#:~:text=Estrogen%20induces%20nitric%20oxide%20production,1.

https://pubmed.ncbi.nlm.nih.gov/16645264/

https://www.wellrx.com/rx-discount-card/enroll/

https://www.wellrx.com/

grapefruit slice - wellrx blog image

By Jacob Silvers, PharmD Candidate Class of 2020
University of Arizona College of Pharmacy

What is a ‘Statin’?

‘Statin’ is the term used to identify a class of medications that reduce cholesterol by lowering cholesterol production in the liver. The generic versions of these medications often have the ending -statin (i.e. brand name Lipitor is also known as atorvastatin). These medications are commonly prescribed for high cholesterol and can reduce the risk of cardiovascular disease and stroke.

Why do foods or beverages interact with medications?

A medication-food interaction occurs when food alters the absorption, effect, or breakdown of a medication. In the case of statins, the most likely issues are decreased breakdown of the medication or increased effect. Statins are usually metabolized by the liver, and foods that are also metabolized by the liver can slow this process. This can cause the statin to stay in your body much longer, and possibly even allow the drug to build up above normal levels. Another possible problem are foods that contain statins or statin like medications. Both issues result in increased concentrations of the statin medication in your body, leading to an increased risk for side effects, such as muscle pain, soreness, dark urine, or liver damage.

What foods or beverages should I avoid?

The most discussed interaction is the grapefruit. Grapefruits can slow or halt some liver enzymes and should generally be avoided while taking statins. This includes grapefruit juice and other derivatives of grapefruits. The severity of this interaction varies greatly between people and is difficult to predict. Red yeast rice is another potential problem because it contains small amounts of the medication lovastatin. Taking this supplement at the same time as a statin medication may raise your statin levels. Always talk to your healthcare providers before taking supplements.

A well-known food that has many medication interactions is alcohol. Alcohol can interfere with metabolic processes; especially, those that involve the liver. Other articles on WellRx.com have discussed the side effects of drinking alcohol with prescription medications and have links to resources from the National Institute of Health.  Alcohol should be avoided or limited while taking any prescription medication. If you are worried about a medication interaction, ask your pharmacist for more information.

References:

  1. Lee, Jonathan W., et al. “Grapefruit Juice and Statins.” The American Journal of Medicine, vol. 129, no. 1, 2016, pp. 26–29., doi:10.1016/j.amjmed.2015.07.036. https://www-sciencedirect-com.ezproxy3.library.arizona.edu/science/article/pii/S0002934315007743
  2. Bailey, D. G. “Predicting Clinical Relevance of Grapefruit-Drug Interactions: a Complicated Process.” Journal of Clinical Pharmacy and Therapeutics, vol. 42, no. 2, 2016, pp. 125–127., doi:10.1111/jcpt.12463. https://www-embase-com.ezproxy3.library.arizona.edu/a/#/search/results?subaction=viewrecord&rid=6&page=1&id=L613295722
  3. Merck. Prescribing Information for Zocor. 1999. https://www.merck.com/product/usa/pi_circulars/z/zocor/zocor_pi.pdf
  4. Grieco, A., Miele, L., Pompili, M., Biolato, M., Vecchio, F. M., Grattagliano, I., and Gasbarrini, G. Acute hepatitis caused by a natural lipid-lowering product: when “alternative” medicine is no “alternative” at all. J Hepatol 2009;50(6):1273-1277. https://www-ncbi-nlm-nih-gov.ezproxy3.library.arizona.edu/pubmed/19398239?dopt=Abstract

caffeine, alcohol, and medications - wellrx blog image

By Jacob Silvers, PharmD Candidate, Class of 2020
University of Arizona

Caffeine and alcohol are two widely consumed products. Over 85% of people in the U.S. consume at least 1 caffeinated drink per day, and according to the CDC over 50% of adults are regular alcohol drinkers. Most people know not to mix alcohol and Tylenol, but both alcohol and caffeine can interact with other prescription medications in unpredictable ways.

What is a Medication Interaction?

A medication interaction occurs when two or more medications are taken at the same time, and they alter each other’s effects. Medications can act on the same part of the body or be broken down by the same enzyme. If the medications are trying to occupy the same metabolic or body process they can compete, synergize, or act unexpectedly. Many interactions with caffeine and alcohol are based results that increase the effect and side effects of your medications.

What Should I Know About Caffeine?

Caffeine is a stimulating agent. It can raise your heart rate and promote wakefulness. Medications that have stimulating effects can be enhanced with caffeine and become overwhelming for your body. This occurs because these both the medication and caffeine activate your sympathetic nervous system also known as sympathomimetic drugs. Common stimulants that may interact with caffeine include:

  • Adderall
  • Vyvanse
  • Ephedrine
  • Sudafed

Another type of interaction between a medication and caffeine might occur if both are metabolized by the same enzyme in the liver. For example, taking a medication like givosiran (used for Porphobilinogen synthase deficiency) may lower your breakdown of caffeine. Medications that might interact with caffeine through liver enzymes include:

  • Depression and anxiety medications known collectively as SSRIs or SNRIs
  • Medications for irregular heartbeat
  • Antipsychotics
  • Some asthma and COPD medications
  • Broad spectrum antibiotics known as quinolones.

What You Should Know About Alcohol

Alcohol is known to interact with a wide variety of medications, including over the counter medications. Alcohol can make you sleepy or drowsy and excessive amounts of alcohol can suppress or alter bodily functions. Medications like Xanax and Percocet (which also has Tylenol) in combination with alcohol can result in serious side effects like respiratory depression or death. The National Institute of Health has an extensive guide on mixing medications with alcohol. The list has medications from almost every category including

  • Colds
  • Anxiety
  • Epilepsy
  • Arthritis
  • Blood clots
  • Depression
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Seizures
  • Pain
  • Many others

Key Takeaways

Caffeine will interact with most stimulant medications and should be closely monitored if you are taking any stimulants. Caffeine only has a few enzyme-based interactions and is fine with most medications after a discussion with your healthcare provider. Alcohol will interact with most medication and has a handful of life-threatening interactions. Bottom line, medications and alcohol do not mix.

References:

  1. Age-Adjusted Percent Distribution (with Standard Errors) of Alcohol Drinking Status among Adults Aged 18 and over, by Selected Characteristics: United States. CDC, 2018, ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2018_SHS_Table_A-13.pdf.
  2. Mitchell, Diane C, et al. “Beverage Caffeine Intakes in the U.S.” Food and Chemical Toxicology: An International Journal Published for the British Industrial Biological Research Association, U.S. National Library of Medicine, Jan. 2014, www.ncbi.nlm.nih.gov/pubmed/24189158
  3. “Dangers of Mixing Alcohol with Caffeine and Energy Drinks.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 Feb. 2020, www.cdc.gov/alcohol/fact-sheets/caffeine-and-alcohol.htm.
  4. “Harmful Interactions.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, 5 June 2019, www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines.

celebrex-vs-mobic - wellrx blog image

By Rosanna Sutherby, PharmD

Over 54 million people in the United States have arthritis, and about one in four adults with arthritis have severe joint pain. Arthritis is a chronic degenerative disease of the joints that occurs when the lining that prevents the bones in your joints from rubbing together breaks down. The result is pain, swelling, stiffness, and decreased mobility of the affected joint.

The drugs most commonly used to treat symptoms of arthritis are nonsteroidal anti-inflammatory drugs (NSAIDs), two of which are Celebrex (celecoxib) and Mobic (meloxicam).

What Are Celebrex and Mobic?

Celebrex and Mobic are NSAIDs used to relieve symptoms of arthritis and to treat other conditions. Celebrex is available in 50 mg, 100 mg, 200 mg, and 400 mg capsules. Mobic is available in 7.5 mg and 15 mg tablets.

How Do Celebrex and Mobic Work?

Celebrex and Mobic both work by inhibiting the enzymes that promote the release of substances (prostaglandins) in your body that produce pain and inflammation. The difference is that Celebrex only inhibits the enzyme cyclooxygenase-2 (COX-2), and Mobic inhibits both COX-1 and COX-2.

The COX-1 enzyme protects the lining of your stomach from acid. By selectively inhibiting COX-2, Celebrex is less likely to cause stomach bleeding than Mobic.

What Conditions Do Celebrex and Mobic Treat?

Celebrex can be used to treat the following conditions:

  • osteoarthritis
  • rheumatoid arthritis
  • juvenile rheumatoid arthritis in patients two years and older
  • arthritis of the spine (ankylosing spondylitis)
  • acute pain
  • menstrual pain (dysmenorrhea)

Mobic is indicated to treat the following:

  • osteoarthritis
  • rheumatoid arthritis
  • juvenile rheumatoid arthritis in children who weigh 60 kg (132 pounds) or more

How Fast Do Celebrex and Mobic Work?

Celebrex can reach peak concentration levels in your blood about 3 hours after taking a dose. Peak concentrations of Mobic are reached up to 5 hours after taking the medication. However, a second peak occurs about 12 to 14 hours after the first dose. This means that Celebrex works faster than Mobic, but the effects of Mobic may last longer than that of Celebrex.

What Are the Side Effects of Celebrex and Mobic?

The most common side effects seen with Celebrex include:

  • stomach pain
  • upset stomach
  • diarrhea
  • gas
  • swelling of the hands, feet, and ankles
  • accidental injury
  • runny nose
  • sinus problems
  • upper respiratory tract infection
  • rash

The most common side effects seen with Mobic include:

  • upset stomach
  • diarrhea
  • upper respiratory tract infection
  • flu-like symptoms

Although both Celebrex and Mobic have the potential to cause cardiovascular problems, including heart attack and stroke, one study showed that Celebrex is less likely to cause cardiovascular issues than Mobic.

Additionally, due to its mechanism of action, Celebrex is less likely to cause stomach bleeding and ulcers than Mobic.

What Medications Interact with Celebrex and Mobic?

You should not take Celebrex if you are taking any of the following medications:

  • cidofovir (Vistide)
  • ketorolac (Toradol)
  • thioridazine (Mellaril)

Do not take Mobic if you are taking:

  • cidofovir (Vistide)
  • ketorolac (Toradol)

You should not take aspirin or other NSAIDs while taking Celebrex or Mobic. All NSAIDs, including Celebrex and Mobic, should be stopped if you are taking blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), enoxaparin (Lovenox), and rivaroxaban (Xarelto).

This list does not represent all possible drug interactions for Celebrex and Mobic. Be sure to discuss any concerns you have about your medication with your pharmacist.

Which Is Better — Celebrex or Mobic?

The choice between Celebrex and Mobic depends on several factors, including which condition you are treating, what other medications you are taking, and the side effects of the drugs.

If you are seeking faster relief from your arthritis pain, Celebrex may be a better option; however, if you are looking for longer-lasting effects, Mobic may be the better choice.

If you are treating rheumatoid arthritis in children, Celebrex can be used in children as young as two years old without regard to a minimum weight.

How Much Do Celebrex and Mobic Cost?

The cost of Celebrex and Mobic varies based on your insurance coverage, where you live, and where you shop. As of the time this article was written, the average retail prescription cost for 30 celecoxib (generic for Celebrex) 200 mg capsules is about $190. The average retail prescription cost for 30 meloxicam (generic for Mobic) 15 mg tablets is about $26.

Remember to consider several factors when deciding which medication is right for you. Your healthcare provider will prescribe medicine according to your symptoms and medical conditions. If your insurance does not cover your mediation, you can use a prescription discount card to get the lowest price at a pharmacy near you.

How Do Prescription Discount Cards Work?

Prescription discount cards, or prescription savings cards, help you obtain the lowest prescription price for your medication. If your insurance does not cover your medication or the cost is too high on insurance, a free Rx savings card may save you up to 80% or more off the retail price. You can use the ScriptSave® WellRx discount card for the best prescription savings at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.cdc.gov/chronicdisease/resources/publications/factsheets/arthritis.htm

https://www.wellrx.com/hn/us/assets/health-condition/osteoarthritis/~default/

https://www.wellrx.com/celebrex/drug-information/

https://www.wellrx.com/mobic/drug-information/

https://www.wellrx.com/hn/us/assets/health-condition/rheumatoid-arthritis/~default/

https://www.wellrx.com/hn/us/assets/health-condition/dysmenorrhea/~default/

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8d52185d-421f-4e34-8db7-f7676db2a226#S5.2

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=676e73fb-51d2-449a-8749-1a7bcc257b11

https://link.springer.com/article/10.2165/00002018-200629030-00009

https://www.wellrx.com/prescriptions/celebrex/houston,%20tx%2077023,%20usa

https://www.wellrx.com/prescriptions/mobic/houston,%20tx%2077023,%20usa

https://www.wellrx.com/

https://www.wellrx.com/rx-discount-card/enroll/

https://www.wellrx.com/prescriptions/https://www.wellrx.com/prescription-discount-card

depression from coronavirus - wellrx blog image

By Rosanna Sutherby, PharmD

The current COVID-19 pandemic has affected the physical health and the mental health of millions worldwide. Nearly half of American adults report in a recent poll that their mental health has been negatively affected by stressors related to COVID-19, and the use of support hotlines and other mental health resources has drastically increased compared to a year ago.

If you are experiencing new or resurgent symptoms of anxiety or depression due to the current global crisis, you are not alone. Reaching out to a healthcare provider can help you obtain the care and support needed during these difficult times.

A conversation with your provider will help you determine if you need medication to help relieve your symptoms. The following are some common medicines used to treat anxiety and depression.

Medications That Treat Anxiety

The American Psychological Association defines anxiety as “an emotion characterized by feelings of tension, worried thoughts, and physical changes, like increased blood pressure.” If you need medication to treat your anxiety, your doctor may prescribe any of the following:

  • antidepressants
  • buspirone (Buspar)
  • benzodiazepines

Antidepressants

Antidepressants are the first line of treatment for anxiety disorder. Two types of antidepressants used to treat anxiety are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs and SNRIs work by increasing the amount of chemicals in your brain that help regulate your mood. SSRIs increase the amount of serotonin in your brain, and SNRIs increase both serotonin and norepinephrine.

SSRIs used to treat anxiety include the following:

SNRIs used for anxiety include the following:

There are some common side effects seen with antidepressants, including:

  • nausea
  • dizziness
  • dry mouth
  • headache
  • restlessness
  • changes in appetite
  • problems with sleep
  • problems with orgasms or decreased interest in sex

If you are taking antidepressants to treat your anxiety, let your healthcare provider know if your symptoms worsen or if you do not feel better. It may take a few weeks before you feel the effects of SSRIs or SNRIs. Call your doctor if you suddenly feel agitated, anxious, or aggressive while taking your medication.

You should avoid drinking alcohol while taking antidepressants because it can interfere it the action of the medication.

Buspirone

Buspirone (Buspar) is an antianxiety medication that your doctor may prescribe for long-term treatment of anxiety. The most common side effects reported by those taking buspirone include:

  • dizziness
  • nausea
  • headache
  • nervousness
  • lightheadedness

Be sure to maintain your regular appointments with your healthcare provider to evaluate your progress while taking this medication.

Benzodiazepines

Benzodiazepines are generally used for short-term treatment of anxiety symptoms. They work quickly at reducing anxiety but should not be used regularly or long-term since they can be habit-forming.

Benzodiazepines used to treat anxiety include:

Side effects related to benzodiazepines include the following:

  • drowsiness
  • blurred vision
  • headache
  • dizziness
  • nausea or vomiting
  • confusion

You should not drive or engage in activities that require alertness while you are taking benzodiazepines. Do not drink alcohol or take other medications that cause drowsiness if you are taking benzodiazepines.

Medications That Treat Depression

According to the World Health Organization (WHO), depression is a leading cause of disability around the world. Over 264 million people worldwide, including 16 million Americans, are living with depression.

Depression is a condition that causes prolonged feelings of sadness, hopelessness, and loss of interest. Treatment for depression includes several modalities of psychotherapy and, in some cases, medication.

Medicines that your doctor may prescribe to treat depression include the following:

  • SSRIs
  • SNRIs
  • Atypical antidepressants
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors (MAOIs)

SSRIs

Healthcare providers usually begin medication treatment of depression with SSRIs. These newer medications have fewer side effects than older drugs and are generally safer to use.

Drugs in the class of SSRIs include the following:

SNRIs

SNRIs are similar to SSRIs; they work by increasing the amount of norepinephrine as well as serotonin in your brain. Examples of SNRIs include:

  • venlafaxine (Effexor)
  • duloxetine (Cymbalta)

SSRIs and SNRIs have similar side effects, which include the following:

  • nausea
  • dizziness
  • dry mouth
  • headache
  • restlessness
  • changes in appetite
  • problems with sleep
  • problems with orgasms or decreased interest in sex

You may not feel the effects of SSRIs or SNRIs during the first few weeks of treatment. This is normal. It generally takes at least two weeks before the medication starts working. Seek immediate help if your depressive symptoms worsen or if you have feelings or thoughts of hurting yourself.

Atypical Antidepressants

Other antidepressants work by different pathways and are sometimes added to treatment with SSRIs or SNRIs. Some atypical antidepressants include:

Tricyclic Antidepressants

Tricyclic antidepressants include medications such as:

  • imipramine (Tofranil)
  • nortriptyline (Pamelor)
  • protriptyline (Vivactil)

These are older antidepressants that have been largely replaced by SSRIs.  Due to the high incidence of severe side effects, these medications are generally used only if treatment with SSRIs was unsuccessful.

MAOIs

MAOI antidepressants, such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan), are used rarely because they have dangerous interactions with foods and other medications. MAOIs cannot be combined with SSRIs or SNRIs.

How to Get the Lowest Prescription Price for Your Anxiety and Depression Medication

Whether you are taking one prescription or several to treat your symptoms of anxiety or depression, always compare prescription prices before heading to a pharmacy near you. You can use your prescription savings card to obtain the best price for your medication.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/

https://news.wellrx.com/2020/05/18/may-is-mental-health-awareness-month/

https://www.apa.org/topics/anxiety/

https://www.wellrx.com/escitalopram%20oxalate/drug-information/

https://www.wellrx.com/paroxetine%20hcl/drug-information/

https://www.wellrx.com/duloxetine%20hcl/drug-information/

https://www.wellrx.com/venlafaxine%20hcl%20er/drug-information/

https://www.wellrx.com/buspirone%20hcl/drug-information/

https://www.wellrx.com/alprazolam/drug-information/

https://www.wellrx.com/clonazepam/drug-information/

https://www.wellrx.com/lorazepam/drug-information/

https://www.who.int/news-room/fact-sheets/detail/depression

https://www.nami.org/nami/media/nami-media/infographics/generalmhfacts.pdf

https://www.wellrx.com/hn/us/assets/health-condition/depression/~default/

https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

https://www.wellrx.com/fluoxetine%20hcl/drug-information/

https://www.wellrx.com/citalopram%20hbr/drug-information/

https://www.wellrx.com/sertraline%20hcl/drug-information/

https://www.wellrx.com/bupropion%20xl/drug-information/

https://www.wellrx.com/mirtazapine/drug-information/

https://www.wellrx.com/nefazodone%20hcl/drug-information/

https://www.wellrx.com/trazodone%20hcl/drug-information/

https://www.wellrx.com/prescriptions/

https://www.wellrx.com/rx-discount-card/enroll/

By Michelle Koh, PharmD Candidate 2020
Ohio State University College of Pharmacy

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. Nearly 80 million people are currently infected with HPV in the U.S and about 14 million people, including teens, become newly infected with HPV each year.1

The good news is that there are HPV vaccines available that can protect against diseases caused by HPV.

How Does HPV Spread?

HPV is usually spread during vaginal or anal sex, if you have sex with someone who has the virus.3 The virus can be even passed when an infected person has no signs and symptoms. Because the symptoms sometimes develop years after, it may be difficult to know when you first became infected.1

In most cases, HPV goes away on its own and does not cause any health problem in healthy individuals. However, it can cause other health problems, such as genital warts, which usually appear as a group of bumps in the genital area.1,3

Does HPV Cause Cancer?

Yes, HPV can cause cervical and other cancers, including cancer of vulva, vagina, penis, or anus. Rarely, it can also cause cancer in the back of the throat, including the base of the tongue and tonsils.3

Who Should Get the HPV Vaccine?

HPV vaccination is recommended for girls and boys at age 11 or 12 years. Women are recommended to get the vaccine until they are 27 years old and men up until they are 22 years old.2

Centers for Disease Control and Prevention (CDC) recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart.1  Whereas, young adults who start the series later, at ages 15 through 26 years, should get three doses of HPV vaccine.The benefit of HPV vaccine is minimal with limited evidence in adults aged 27 to 45 years and should consult with their doctors first.7

Is the HPV Vaccine Safe and Effective?

HPV vaccines generally have no side effects, but some commonly reported side effects are:3

  • Pain, redness, or swelling at the injection site
  • Fever
  • Headache or feeling tired
  • Nausea
  • Muscle or joint pain

The HPV vaccine has been studied for many years and shown to be highly effective and offer long-lasting protection. Clinical research has shown that HPV vaccine is nearly 100% effective in preventing HPV infections, especially in young individuals.4,5 Moreover, ever since the HPV vaccine is recommended, there has been a significant reduction by 86% in HPV infections among teens.1

Where Can I Get the Vaccine?

The HPV vaccine is available at your doctor’s office, health care clinics, or even your pharmacy, depending on which states you live in (be sure to check with your pharmacy!).  Also, you can contact your insurance plan to find out if the vaccine will be covered.

Vaccines for Children Program

The Vaccines for Children6 (VFC) Program provides vaccines to children ages 18 years and younger at no cost if they meet at least one of the following criteria:

  • Medicaid eligible
  • Uninsured
  • American Indian or Alaska Native
  • Underinsured

To learn more, visit State VFC Web Site or call 1-800-CDC-INFO.

References:

  1. HPV Vaccination & Cancer Prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Reviewed 2016. Accessed February 17, 2020.
  2. Schiller, JT, Castellsague X, Garland SM. A Review of Clinical Trials of Human Papillomavirus Prophylactic Vaccines. Vaccine. 2012 Nov 20; 30(0 5): F123–F138. doi: 10.1016/j.vaccine.2012.04.108.
  3. Gardasil [package insert]. Whitehouse Station, NJ: Merck; 2011.
  4. Vincenzo RD, Conte C, Ricci, C, et al. Long-term efficacy and safety of human papillomavirus vaccination. Int J Womens Health. 2014; 6: 999–1010.  doi: 10.2147/IJWH.S50365
  5. HPV Vaccine is effective, safe 10 years after it’s given, study shows. Science Daily. 2017. https://www.sciencedaily.com/releases/2017/11/171129131400.htm. Accessed February 17, 2020.
  6. Vaccines for Children Program (VFC). CDC. https://www.cdc.gov/vaccines/programs/vfc/  index.html. Reviewed 2016. Accessed February 18,2020.
  7. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2019;68:698–702. DOI: http://dx.doi.org/10.15585/mmwr.mm6832a3external icon

neurontin-vs-lyrica - wellrx blog image

By Rosanna Sutherby, PharmD

Neurontin and Lyrica are medications used to treat seizures, nerve pain, and other conditions. You may wonder how they are different and why a doctor would prescribe one over the other. Although these medications are similar in some ways, a few differences distinguish them.

What Are Neurontin and Lyrica?

Neurontin is the brand name for gabapentin, which is an anticonvulsant (antiseizure medication) used to treat seizures and other conditions. Lyrica is the brand name for pregabalin, and it is similar to Neurontin in structure. Pregabalin is an anticonvulsant and analgesic (pain medication) used to treat neuropathic (nerve-related) pain and other conditions.

What Conditions Do Neurontin and Lyrica Treat?

Neurontin is approved by the Food and Drug Administration (FDA) to treat the following conditions:

Neurontin is also used off-label (not FDA-approved) to treat the following conditions:

  • nerve pain related to conditions other than shingles
  • fibromyalgia
  • bipolar disorder
  • hot flashes related to menopause
  • essential tremors (involuntary shaking that is not associated with Parkinson’s disease)
  • anxiety and other mood issues
  • irritable bowel syndrome
  • alcohol withdrawal
  • pain relief after surgery
  • prevention of migraine headaches
  • nausea and vomiting
  • bladder problems
  • social phobia
  • itching
  • insomnia (difficulty sleeping)
  • post-traumatic stress disorder
  • chronic cough not controlled by other methods

Lyrica is approved by the FDA to treat the following conditions:

  • nerve pain related to diabetes
  • nerve pain related to spinal cord injury
  • nerve pain related to shingles
  • fibromyalgia
  • seizures

Additionally, Lyrica is used off-label to treat the following conditions:

  • anxiety
  • social anxiety disorder
  • bipolar disorder
  • insomnia
  • chronic pain

What Are the Side Effects of Neurontin and Lyrica?

Although Neurontin and Lyrica have similar chemical structures, some side effects are different. The most common side effects of Neurontin include the following:

  • dizziness
  • loss of muscle control and coordination
  • headache
  • back pain
  • blurred vision
  • double vision
  • weakness
  • trembling
  • cold or flu-like symptoms
  • swelling in the hands, lower legs, or feet
  • weight gain

Lyrica has relatively fewer side effects than Neurontin. The most common side effects of Lyrica include the following:

  • drowsiness
  • dizziness
  • blurred vision
  • trouble concentrating
  • dry mouth
  • abnormal thoughts
  • swelling in the hands, lower legs, or feet
  • weight gain

This list does not represent all possible side effects for Neurontin and Lyrica. Be sure to discuss any concerns you have about your medication with your pharmacist.

What Medications Interact with Neurontin and Lyrica?

Several medications can interact with both Neurontin and Lyrica. Be sure to discuss all your medicines with your doctor or pharmacist for possible drug interactions.

The following drugs can have additive drowsiness and dizziness side effects with Neurontin and Lyrica:

  • alcohol
  • some antihistamines, including cetirizine (Zyrtec), diphenhydramine (Benadryl), and chlorpheniramine (Chlor-Trimeton)
  • some medications that treat anxiety, including alprazolam (Xanax) and hydroxyzine (Atarax, Vistaril)
  • drugs used for sleep, including eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)
  • some antidepressants, including amitriptyline (Elavil), mirtazapine (Remeron), and trazodone (Desyrel)
  • muscle relaxers, including carisoprodol (Soma) and cyclobenzaprine (Flexeril)
  • some pain medication, including oxycodone, hydrocodone, and tramadol (Ultram)

If you are using Neurontin or Lyrica to treat seizures, the following medicines can increase the likelihood of a seizure occurring:

  • medications that treat certain mental disorders (e.g., schizophrenia), including chlorpromazine (Thorazine), prochlorperazine (Compazine), and thioridazine (Mellaril)
  • amphetamine drugs that treat attention deficit and hyperactivity disorder (ADHD), including amphetamine salts (Adderall)

Neurontin and Lyrica have similar drug interactions with a few exceptions:

  • Antacids: Antacids decrease the availability of Neurontin in your body. You should wait two hours after taking an antacid before taking Neurontin.
  • Angiotensin-converting enzyme (ACE) inhibitors: Taking certain blood pressure medications known as ACE inhibitors (e.g., lisinopril, enalapril) with Lyrica has caused life-threatening swelling of the face, mouth, and throat.
  • Diabetic medication: Some medications used to treat diabetes, including pioglitazone (Actos) and rosiglitazone (Avandia), can cause weight gain, swelling, and fluid retention if taken with Lyrica.

The list above does not include all possible drug interactions with Neurontin or Lyrica. Your pharmacist can help you decide if Neurontin and Lyrica are safe to take with your other medications.

Which Works Better? Neurontin or Lyrica?

When choosing between Neurontin and Lyrica, you must consider several factors, including side effects and interactions with medicines you already take. The answer to the question of which works better depends on what condition you are treating. Both Neurontin and Lyrica have several indications as well as off-label uses. Neurontin is used more frequently for seizures and mood disorders, but both drugs are used to treat nerve pain. Lyrica, however, is approved by the FDA to treat fibromyalgia, and it is prescribed more often than Neurontin for this condition.

review of studies shows that Lyrica (pregabalin) is more effective in treating fibromyalgia than Neurontin (gabapentin). On the other hand, a 2019 clinical trial shows that gabapentin works better than pregabalin at treating chronic sciatica (nerve pain that radiates from the lower back down the back of one leg).

A discussion with your healthcare provider will help you determine which medication is right for you.

How Much Do Neurontin and Lyrica Cost?

The cost of Neurontin and Lyrica varies based on your insurance coverage, where you live, and where you shop. Generally, Neurontin costs less than Lyrica. At the time of this article, the average retail prescription cost for thirty gabapentin 300 mg capsules is about $27. The average retail prescription cost for thirty 75 mg pregabalin capsules is about $203.

Remember to consider several factors when deciding which medication is right for you. Your healthcare provider will prescribe medicine that is appropriate for your symptoms and condition. If your insurance does not cover your medication, you can use a prescription discount card to get the lowest prescription price at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.wellrx.com/gabapentin/monographs/

https://www.wellrx.com/hn/us/assets/health-condition/epilepsy/~default/

https://www.wellrx.com/hn/us/assets/health-condition/fibromyalgia/~default/

https://www.wellrx.com/pregabalin/monographs/

https://www.wellrx.com/hn/us/assets/health-condition/shingles-and-postherpetic-neuralgia/~default/

https://www.ncbi.nlm.nih.gov/books/NBK78947/

https://jamanetwork.com/journals/jamaneurology/fullarticle/2707478

https://www.wellrx.com/prescriptions/gabapentin/houston,%20tx%2077023,%20usa

https://www.wellrx.com/prescriptions/pregabalin/houston,%20tx%2077023,%20usahttps://www.wellrx.com/family-prescription-savings

allergy and blood pressure meds - wellrx blog image

By Rosanna Sutherby, PharmD

Allergy season is in full swing in many parts of the country. For some, that means battling symptoms, such as sneezing, congestion, runny nose, itching, and watery eyes. If you are among the over 50 million Americans who suffer from allergies each year, you may be headed to a pharmacy near you for relief of your allergy symptoms. Choosing allergy medication that is right for you may be tricky if you have hypertension (high blood pressure). Read on to learn how some allergy medicines may affect your blood pressure and your blood pressure medication.

What Are Different Types of Allergy Medicines?

Today, multiple products are available to treat several allergy symptoms. Antihistamines are used for relief of runny nose, sneezing, itching, and watery eyes. Second-generation antihistamines are used more often for seasonal allergies because they do not cause as much drowsiness as older antihistamines, and their effects last longer. Medications in this category include the following:

Oral decongestants, such as the following, are available for relief of congestion or stuffy nose:

Steroid nasal sprays, such as the following, are also effective at relieving nasal congestion:

Antihistamine nasal sprays, such as the following, can target allergy symptoms directly in the nose and sinuses:

Saline nasal sprays and rinses are also effective at clearing nasal passages and relieving congestion. Common names for saline nasal sprays and rinses include the following:

  • Ocean
  • Ayr
  • Simply Saline
  • Neti Pot

Antihistamine eye drops can be beneficial for treating itchy and watery eyes. The following products are commonly used for long-lasting relief:

Which Allergy Medications Affect My Blood Pressure?

You should avoid decongestants if you have high blood pressure or heart problems. Decongestants constrict (narrow) blood vessels to open nasal passages and facilitate breathing. Because decongestants constrict blood vessels throughout your body, they can worsen hypertension. Additionally, decongestants stimulate the release of norepinephrine in your body, which raises your blood pressure and your heart rate.

When choosing an allergy medication, be aware of combination products that contain decongestants. Products that contain a decongestant typically have the words sinuscoldcongestion, or decongestant on the label. They may also be labeled with the letters D, PD, or PE after the name.

Examples of allergy medicines that contain decongestants include the following:

  • Allegra D (fexofenadine and pseudoephedrine)
  • Benadryl D (diphenhydramine and pseudoephedrine)
  • Clarinex D (desloratadine and pseudoephedrine)
  • Claritin D (loratadine and pseudoephedrine)
  • Sudafed Sinus and Allergy (chlorpheniramine and pseudoephedrine)
  • Zyrtec D (cetirizine and pseudoephedrine)

The list above is a small sample of allergy medications that contain decongestants. Always check with your pharmacist before choosing allergy medications.

Do Allergy Medicines Interact with My Blood Pressure Medication?

Most antihistamines are generally safe to take with your blood pressure medication. However, keep in mind the following drug interactions if you are taking medication for your blood pressure:

  • fexofenadine (Allegra): Carvedilol (Coreg) may increase the effects of fexofenadine. Use fexofenadine cautiously if you are taking carvedilol.
  • cetirizine (Zyrtec) and levocetirizine (Xyzal): You may experience increased drowsiness if you take cetirizine or levocetirizine in combination with methyldopa (Aldomet).
  • diphenhydramine (Benadryl): Any product containing diphenhydramine may counteract the effects of many of your blood pressure medications. Be sure to talk with your pharmacist before taking any diphenhydramine products.

What Allergy Medicines Can I Take if I Have High Blood Pressure?

Although some allergy medicines affect your blood pressure or interact with your blood pressure medication, safe options for treating your allergy symptoms exist if you have high blood pressure.

Second-generation antihistamines that are not combined with decongestants are generally safe to use if you are not taking the blood pressure medicines listed in the drug interaction section above. Second-generation antihistamines include the following:

  • Allegra (fexofenadine)
  • Clarinex (desloratadine)
  • Claritin (loratadine)
  • Xyzal (levocetirizine)
  • Zyrtec (cetirizine)

If your symptoms include nasal congestion, the following options are generally safe to use as decongestants:

  • steroid nasal sprays, such as Flonase (fluticasone), Nasacort (triamcinolone), and Rhinocort (budesonide)
  • antihistamine nasal sprays, such as Astelin (azelastine) and Patanase (olopatadine)
  • saline nasal sprays or rinses, such as Ayr, Ocean, Simply Saline, or Neti Pot

Antihistamine eye drops, such as Pataday (olopatadine) and Zaditor (ketotifen), are safe options for itchy watery eyes.

Can I Compare Prescription Prices before Filling My Allergy Medicine?

The majority of allergy medications are now available over the counter. This means that many insurance plans no longer cover your allergy medicine. If your insurance does not cover your medication, you can use a prescription savings card to get the lowest prescription price. You can save up to 80% or more off the retail price by using the ScriptSave® WellRx discount card at a pharmacy near you.

Rosanna Sutherby is a freelance medical writer who has been a practicing pharmacist in her community for close to 20 years. She obtained her Doctor of Pharmacy from Nova Southeastern University in Ft. Lauderdale, FL. She utilizes her clinical training in the pharmacy, where she helps patients manage disease states such as asthma, diabetes, heart disease, hypertension, and many others. Dr. Sutherby reviews and recommends drug regimens based on patients’ concurrent conditions and potential drug interactions.

References:

https://www.aafa.org/allergy-facts/

https://www.wellrx.com/fexofenadine%20hcl/monographs/

https://www.wellrx.com/desloratadine/drug-information/

https://www.wellrx.com/loratadine/drug-information/

https://www.wellrx.com/levocetirizine%20dihydrochloride/drug-information/

https://www.wellrx.com/cetirizine%20hcl/drug-information/

https://www.wellrx.com/pseudoephedrine%20hcl/monographs/

https://medlineplus.gov/druginfo/meds/a606008.html

https://www.wellrx.com/flonase%20allergy%20relief/drug-information/

https://www.wellrx.com/nasacort/drug-information/

https://www.wellrx.com/rhinocort%20allergy/drug-information/

https://www.wellrx.com/beconase%20aq/drug-information/

https://www.wellrx.com/astepro/drug-information/

https://www.wellrx.com/patanase/drug-information/

https://www.wellrx.com/pataday/drug-information/

https://www.wellrx.com/zaditor/drug-information/

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/high-blood-pressure/faq-20058281

https://www.wellrx.com/cetirizine%20hcl/monographs/

https://www.wellrx.com/diphenhydramine%20hcl/monographs/

https://www.wellrx.com/

https://www.wellrx.com/prescription-discount-card/

diuretics - wellrx blog image

By Libby Pellegrini MMS, PA-C

Diuretics are medications prescribed to help manage certain medical conditions, such as high blood pressure and heart failure. They can also be used for other conditions, including abnormal body fluid regulation (due to liver or kidney disease), abnormal cerebrospinal fluid levels, glaucoma, or hormonal conditions.

Read on to learn more about diuretics and the differences between diuretic categories.

What Is a Diuretic?

A diuretic medication enhances a process called “diuresis,” which is the body’s natural method of removing water and salt from the circulation via urination. For this reason, diuretics are sometimes referred to as “water pills.”

During diuresis, blood filters through the kidneys, and water and other waste products are removed, siphoning out of the body through the ureters, bladder, and urethra. A diuretic medication, therefore, increases urinary output, which is why some people who take diuretics report having to make frequent trips to the restroom, especially at night.

Naturally occurring diuretics, which increase the amount of water filtered out of the kidneys, include common beverages such as coffee, tea, and alcohol. Prescription diuretics are typically taken in oral or intravenous form.

What Is the Difference in Diuretics?

All diuretics accomplish the same goal of removing excess fluid from the circulation by increasing urinary output. This has the indirect effect of lowering blood pressure, by removing fluid volume from the blood vessel network.

Some diuretics are more potent than others. The difference in diuretics stems from something called their “mechanism of action.” This refers to the specific ways in which diuretics act on the kidneys. The various sites in the kidneys where diuretics exert their effect can influence how powerful they are and also how quickly they produce increased urination.

The anatomy and physiology of the kidneys can get complicated, fast. However, you can break diuretics up into a few main categories, as follows.

Thiazide Diuretics

Medications in this category including hydrochlorothiazide (Microzide) (which is the 11th most prescribed drug in the United States), chlorthalidonemetolazone, and indapamide. These medicines work in a part of the kidney called the distal tubule. They prevent the kidney from reabsorbing sodium back into the blood stream, therefore increasing the amount of sodium that is excreted in the urine, and the amount of water as well, because water follows sodium into the urine. Thiazides are one of the “first-line” medications that are prescribed for high blood pressure management.

Loop Diuretics

Medications in this category include furosemide (Lasix)bumetanide (Bumex), and torsemide (Demadex). A loop diuretic gets its name because it interacts with a structure in the kidney known as the “thick ascending limb of the Loop of Henle.” Loop diuretics prevent absorption of sodium and chloride, which increase the overall amount of sodium and chloride that get excreted in the urine, and the amount of water as well. This can quickly and dramatically increase the output of urine from the body, depending on the dose and formulation. Loop diuretics tend to cause the most profound urinary water loss of any diuretic medication, so they are useful in conditions where water loss is favorable (such as heart failure).

Potassium-Sparing Diuretics

Because of the way that loop and thiazide diuretics interact with the kidneys, patients taking these medicines also excrete more potassium through their urine, which can result in abnormally low potassium levels. For this reason, healthcare providers typically keep a close eye on potassium levels and sometimes add a potassium supplement onto the diuretic regimen.

To get around the “potassium problem,” there is another category of diuretics called potassium-sparing that conserve the body’s excretion of potassium through the urine. Like thiazide diuretics, these diuretics work in kidney’s the distal tubule. One medication in this category, spironolactone (Aldactone), is used for certain hormonal conditions (such as acne and excessive hairiness) or fluid buildup due to liver failure, heart failure, and high blood pressure. Spironolactone can sometimes be combined with another diuretic, such as a loop diuretic, to decrease the amount of potassium that is lost through the urine. Other potassium-sparing diuretics include amiloridetriamterene (Dyrenium), and eplerenone (Inspra).

Other Diuretics

Acetazolamide (Diamox). This type of diuretic is used for conditions of excessive fluid that primarily occur outside of the circulatory system. Examples include high altitude sickness, glaucoma, and neurologic problems. It works by interacting with an enzyme called carbonic anhydrase in a part of the kidney called the proximal tubule, and also in the brain.

Mannitol (Osmitrol). This diuretic is a sugar alcohol that works in the proximal tubule of the kidney as well as in the Loop of Henle. It can also help with removing excess fluid from the brain, which is crucial in situations of increased intracranial pressure and brain swelling.

If you or a loved one are prescribed a diuretic medication, make sure to shop around for the best deal. You can use a ScriptSave® WellRx savings card to find the lowest price for your medications.

References

https://www.wellrx.com/prescriptions/hydrochlorothiazide/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025009/

https://www.wellrx.com/prescriptions/chlorthalidone/

https://www.wellrx.com/prescriptions/metolazone/

https://www.wellrx.com/prescriptions/indapamide/

https://www.wellrx.com/prescriptions/lasix/

https://www.wellrx.com/prescriptions/bumetanide/

https://www.wellrx.com/prescriptions/torsemide/

https://www.wellrx.com/prescriptions/spironolactone/

https://www.wellrx.com/prescriptions/amiloride%20hcl/

https://www.wellrx.com/prescriptions/triamterene/

https://www.wellrx.com/prescriptions/eplerenone/

https://www.wellrx.com/prescriptions/acetazolamide/

https://www.wellrx.com/prescriptions/mannitol

https://www.wellrx.com/rx-discount-card/enroll/

https://www.uptodate.com/contents/mechanism-of-action-of-diuretics?source=history_widget

Libby Pellegrini is a nationally certified physician assistant. She currently works in emergency medicine where she sees and treats a broad spectrum of illnesses across all age ranges. She holds a journalism degree from Northwestern University.