immunization changes for 2018 - scriptsave wellrx blog image

by Samantha McKinnon, PharmD Candidate 2019
University of Arizona College of Pharmacy

With flu season right around the corner, what better time to talk about vaccines than right now?  We talk and hear about vaccines a lot, but what exactly is a vaccine, and which vaccine is right for you?

What is a vaccine?

In the simplest terms, a vaccine is medicine created from weakened or dead disease-causing germs given to you to help prevent you from getting sick or prepare your body in case you are infected.1 Vaccines can be created using different strategies, depending on who the vaccine is intended for and what disease is trying to be prevented.  There are live, inactivated, recombinant and toxoid vaccines; each serves a different purpose and treats a different germ.1 The way they work is to expose you to a small and safe amount of the germ so your body will recognize it in the future by creating antibodies.  Antibodies are what allow your body to fight off infections or you experience a much milder version of the illness.2   You may sometimes see terminology like “trivalent” or “quadrivalent” when you’re looking at different flu vaccines.3 Trivalent vaccines contain three different strains of virus whereas quadrivalent vaccines contain four different strains of virus.  There also “high-dose” flu vaccine formulations, these formulations contain extra amount of virus material to help people create more antibodies.1

Live vaccines

Live vaccines are also called sometimes called “attenuated” – which is a fancy term for “weakened”. Some examples of live vaccines you or children may have received would be measles, mumps, rubella (MMR), chickenpox or even smallpox.  Live vaccines take the entire virus and weaken it so that it can’t get you as sick as the regular beefed-up virus.  Imagine you have two runners getting ready to run a marathon, but one of the runners has 20-pound boots on, who will win the race?  It’s going to be much harder for the runner with boots to cross the finish line, this is essentially what attenuating viruses do.  Live vaccines do come with some risks, especially to people with weaker immune systems such as someone that had an organ transplant or someone with cancer.

Inactivated vaccines

Vaccines that inactivate the virus also use the entire virus but instead of being weakened like a live vaccine, it is completely dead.  Inactivated vaccines are the typical flu shots, polio and rabies.  Because these germs are completely dead you will not get sick, but this means you will also not be immune and need more frequent shots.3 This is one reason for an annual flu shot.

Recombinant vaccines

Recombinant is technical term that basically means mixed up, it would be like switching some letters around in the alphabet to be CBADEFG instead of ABCDEFG, it’s still the alphabet but not in the exact order it used to be.  These vaccines use only very specific pieces of the germ, a “target”, which will create a strong response in the person receiving the shot.  The bonus is that the vaccine does not have the entire germ, so you won’t get sick and they can be used on more people than live or inactivated vaccines – a big plus for patients with weaker immune systems.  Some recombinant vaccines currently used are for Hepatitis B, meningitis, shingles and whooping cough.

What changed for this year?

Now that you know about all the different kinds of vaccines we can talk about the new changes for this year.  Besides the World Health Organization (WHO) and the Centers for Disease Control (CDC) there is also another government body called The Advisory Committee on Immunization Practices (ACIP) that provides recommendations for what immunizations are needed and when.  Previous flu seasons did not have very good coverage against H1N1 so live viruses were not recommended for children.  That has changed this year, ACIP has recommended that eligible patients receive the FluMist intranasal spray, a live attenuated vaccine, this is good news for parents and kids as there is no needle and no shot.4 The recombinant flu shot called Flublok is recommended for pregnant women. For the older population there has been a change to the zoster vaccination recommendation.  ACIP recommends the recombinant Shingrix vaccine for prevention of shingles in adults over the age of 50.4 Shingrix is a two-dose vaccine just like the previous shingles vaccination Zostavax but has been found to be more effective than Zostavax, most especially in patients over the age of 80.5 The final changed recommendation is in regard to the live MMR vaccine.  Traditionally it has been a two-dose vaccine and that covered you for life.  With recent measles outbreaks, patients living in an area with an outbreak are recommended to receive a third dose of MMR.5

What vaccine is right for you?

The CDC releases an immunization schedule for all patient populations and revises it as new evidence comes to light.  The recommendations from ACIP have allowed the CDC to release a newly revised immunization schedule effective for 2018.  Based on your age and your health you may get different versions of vaccines or vaccinated at different times in your life than other people.  Your provider or pharmacist would be happy to let you know which vaccines are right for you and when, since some vaccines are age-specific.  It is especially important to let health professionals treating you know your health status and social history such as if you smoke tobacco or drink alcohol, if you’ve recently been sick or had a fever, what kind of environment you work in, if you’ll be around newborns or elderly people, your HIV status or if you have liver problems or blood factor issues as well as any allergies.  If you travel outside of the US, especially to an area that requires you to use antivirals, let your prescriber know as this may affect your vaccinations.  Some countries also require special immunizations before you may be allowed to enter, be sure to check these recommendations on the CDC website.

The importance of getting vaccinated

Diseases like polio, measles, whooping cough, flu can be prevented with vaccines.  Without vaccines people that caught these viruses could be paralyzed, blinded, lose their hearing, or even die.  In 2015 there were 710,000 people hospitalized for flu and over 56,000 of them died.  There are some patients that can not be vaccinated and depend on others to be vaccinated so they do not get sick.  This is called “herd immunity,” the more people that are vaccinated, the healthier everyone will be.  So don’t wait, get vaccinated today!

 

References

  1. www.vaccines.gov/basics
  2. www.newsinhealth.gov/nih/2016/07/safeguarding-our-health
  3. Felicilda-Reynaldo RF, “Types of flu vaccines for yearly immunization.” MedSurg Nursing, July-Aug. 2014, p. 256
  4. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices United States 2018-2019 influenza season. MMWR Morb Mortal Wkly Rep 2018.
  5. Kim DK, Riley LE, Hunter P. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older – United States, 2018. MMWR Morb Mortal Wkly Rep 2018; 67:158.

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does sunscreen cause cancer - scriptsave wellrx blog image

by Pattiya Wattananimitgul

According to the Centers of Disease Control and Prevention (CDC), approximately 5 million Americans are treated with skin cancer each year.1 Overexposure of ultraviolet (UV) rays from the sun is proven to be a major cause of skin cancer.2 In fact, approximately 90% of all skin cancers are associated with exposure to the sun’s harmful rays.3 One way to protect your skin from the harmful UV rays is wearing a sunscreen. However, you may have heard that ingredients in sunscreens can cause cancer, and not just skin cancer but also breast, prostate, and other types of cancer.4 But is it true? Does sunscreen, which is supposed to protect us from skin cancer, actually lead to cancer and other health problems?

Oxybenzone

Oxybenzone is a common active ingredient in sunscreens that absorbs the UVA and UVB radiation and then dissipates it as heat.5 Oxybenzone penetrates through the skin, and then gets metabolized and excreted through urine and feces.6 Some studies suggest that oxybenzone may have an impact on the endocrine system, disrupting hormone levels and potentially causing hormone-related cancer. These studies were actually done on rats. A human study suggested that oxybenzone, even at a high concentration, does not cause hormone disruption. The conclusion is that oxybenzone is an FDA-approved chemical to protect your skin from the sun’s radiation, and currently there is not enough evidence to prove or suggest that oxybenzone causes hormone disruption and cancer in humans.3,7,8

Retinyl Palmitate

Retinyl palmitate is another ingredient commonly added to sunscreens as a skin conditioner. It is a form of vitamin A, known to help slow down premature skin aging. There is some concern, based on a small number of studies, that the free radicals generated from retinyl palmitate may cause changes to our cells and cause skin cancer. However, no studies suggested that these changes are cancerous or increase cancer risks.3,7,8 In fact, a form of vitamin A called retinoids has been used for decades to help protect people with high risk of developing skin cancers from getting skin cancer, according to the American Academy of Dermatology.9

Zinc Oxide and Titanium Dioxide

Zinc oxide and titanium dioxide are nanoparticles that physically protect your skin from UVA and UVB radiation. Some studies indicated that these active ingredients can be absorbed in the skin and cause cells damage. However, according to current studies, these nanoparticles stay on the skin’s surface and do not penetrate the skin when applied.3

Protect Yourself from UV Rays

The main takeaway is that you should always wear sunscreen when going outside, even when it’s cloudy. The known benefits of regular sunscreen use outweigh the unproven risks of potential toxicity. The type of sunscreen you use is up to you, whether it is chemical or physical. However, make sure the ingredient protects both UVA and UVB radiation (broad-spectrum) with SPF of at least 30. Below is a chart by the Skin Cancer Foundation of US Food and Drug Administration (FDA)-approved active ingredients that can be found in sunscreen and their UV action spectrum.3 When using sunscreen, make sure to cover all the exposed skin and reapply the sunscreen every two hours, or right after swimming or sweating. Other ways to protect yourself from the harmful UV rays are9:

  • Seeking shade between 10 a.m. to 2 p.m., when the sun’s rays are strongest
  • Wearing protective clothing such as lightweight long sleeve shirt, pants, broad-brimmed hat, and UV-protection sunglasses
  • Avoiding tanning beds

active ingredients in sunscreen - scriptsave wellrx blog image

Warwick, M. L., MD, MB, & Wang, S. Q., MD. (2011, November 11). Suncreens: Safe and Effective?
Retrieved August 6, 2018, from https://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-safe-and-effective

Resources

  1. Cancer Prevention and Control. (2015, September 03). Retrieved August 6, 2018, from https://www.cdc.gov/cancer/dcpc/research/articles/sunscreen-use.htm
  2. The Facts About Sunscreen. (2018, January 11). Retrieved August 6, 2018, from https://www.melanoma.org/understand-melanoma/preventing-melanoma/facts-about-sunscreen
  3. Warwick, M. L., MD, MB, & Wang, S. Q., MD. (2011, November 11). Suncreens: Safe and Effective? Retrieved August 6, 2018, from https://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-safe-and-effective
  4. Do Sunscreens Cause Cancer? (2018, June 12). Retrieved August 6, 2018, from https://sciencebasedmedicine.org/do-sunscreens-cause-cancer/
  5. How does sunscreen work? (2017, August 14). Retrieved August 6, 2018, from http://www.loc.gov/rr/scitech/mysteries/sunscreen.html
  6. Jiang, R., Roberts, M. S., Collins, D. M., & Benson, H. A. E. (1999). Absorption of sunscreens across human skin: an evaluation of commercial products for children and adults. British Journal of Clinical Pharmacology, 48(4), 635–637. http://doi.org/10.1046/j.1365-2125.1999.00056.x
  7. Janjua, N. R., Mogensen, B., Andersson, A., Petersen, J. H., Henriksen, M., Skakkebæk, N. E., & Wulf, H. C. (2004). Systemic Absorption of the Sunscreens Benzophenone-3, Octyl-Methoxycinnamate, and 3-(4-Methyl-Benzylidene) Camphor After Whole-Body Topical Application and Reproductive Hormone Levels in Humans. Journal of Investigative Dermatology,123(1), 57-61. doi:10.1111/j.0022-202x.2004.22725.x
  8. Can the chemicals in sunscreen cause cancer – Canadian Cancer Society. (n.d.). Retrieved August 6, 2018, from http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/be-sun-safe/can-the-chemicals-in-sunscreen-cause-cancer/?region=on
  9. Is sunscreen safe? (n.d.). Retrieved August 6, 2018, from https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/prevent/is-sunsceen-safe

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medications can increase your fall risk - scriptsave wellrx blog image

by Roxanna Orsini
PharmD Candidate Class of 2019, University of Arizona

Falls Happen More Often Than You Think

Every year there are millions of falls occurring in the older population, aged 65 and older.2 About 1 out of 4 older people fall each year, with less than half reporting it to their doctor.2 Your chances of a recurrent fall doubles after your first fall. The emergency department (ED) treats about 3 million older individuals for fall injuries each year.2 The most common injuries seen in the ED after a fall includes fractures, superficial injuries, and head injuries.(2,3) Patients have reported a reduction in their quality of life up to 9 months after being admitted in the ED for a fall.3

After a fall you may develop a fear of falling. This can cause negative health effects including:3

  • Recurrent falls
  • Reduced physical activity
  • Restriction or avoidance of social activities
  • Depression/anxiety

Are You at Risk for a Fall?

Here are a few questions to help you determine if you are at risk of a fall:5

  • Do you rush to use the bathroom?
  • Do you take a medication to help you sleep or improve your mood?
  • Do you take a medication that sometimes makes you feel light-headed or more tired than usual?
  • Do you use or have been advised to use a cane or walker?
  • Have you lost some feeling in your feet?
  • Do you feel unsteady when walking at times?
  • Have you had a previous fall?

Answering yes to any of these questions should warrant a conversation with your doctor about getting screened for your risk of falling.

There are certain chronic medical conditions that can contribute to your chances of a fall such as arthritis, dementia, stroke, cataracts, Parkinson’s disease, and urinary incontinence.1 Some of the medications used for these health conditions can increase your risk of a fall. However, falls can be caused by almost any medication that effects your brain or blood circulation.

Some Medications Can Increase the Risk of a Fall

A few medications that can increase your risk of a fall include:3

Most of these medications can decrease your alertness, cause fatigue, dizziness, and drop your blood pressure when you stand up (also referred to as postural hypotension).1

Postural hypotension occurs in about 30% of older adults and may experience one of these symptoms within 1 minute to several minutes of standing up:4

  • Lightheadedness
  • Blurred vision
  • Headache
  • Fatigue
  • Weakness

If you are taking any of these medications, experiencing any of these symptoms or taking more than 6 medications, talk to your doctor about your risk for a fall.4 Your doctor may need to reduce or change your medication to help reduce your symptoms and fall risk, never make any changes to your medication without consulting your doctor first.

Balance, medications, and home safety should be addressed in everyone at high risk.4 To help maintain the highest level of mobility and reduce your chances of falling or risk of injury, follow up with your doctor. Your doctor can provide tips and recommend exercises designed to prevent falls and help avoid unnecessary trips to the Emergency Department.

 

References:

  1. Berg, R. and Cassells, J. (1992). Falls in Older Persons: Risk Factors and Prevention. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK235613/ [Accessed 18 Jul. 2018].
  2. gov. (2018). Important Facts about Falls | Home and Recreational Safety | CDC Injury Center. [online] Available at: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html [Accessed 20 Jul. 2018].
  3. de Jong, M., Van der Elst, M. and Hartholt, K. (2013). Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety, 4(4), pp.147-154.
  4. Phelan, E., Mahoney, J., Voit, J. and Stevens, J. (2015). Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 99(2), pp.281-293.
  5. Sri‐on, J., Tirrell, G., Kamsom, A., Marill, K., Shankar, K. and Liu, S. (2018). A High‐yield Fall Risk and Adverse Events Screening Questions From the Stopping Elderly Accidents, Death, and Injuries (STEADI) Guideline for Older Emergency Department Fall Patients. Academic Emergency Medicine.

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imprtance of iodine - scriptsave wellrx blog image

by Marcus Harding
PharmD Candidate Class of 2019, University of Arizona

What is Iodine and why is it important?

You may be wondering, “Why do I need iodine in my salt or other food?” Iodine is an essential element our bodies need that we cannot produce on our own, and therefore need to get it from food sources1. Iodine is needed to produce the thyroid hormone, which is important for bodily functions related to metabolism and how our cells use the energy they are given1. Iodine is found in foods such as cheese, milk, eggs, ice cream, saltwater fish, iodized table salt and some multivitamins1. Most people get their daily intake of iodine from iodized table salt1. There is, however, a large population of people who have heart disease or high blood pressure, who are asked by their doctors to not consume as much salt as others.

Who should reduce their salt intake and by how much?

iodized salt - scriptsave wellrx blog image

Heart disease and high blood pressure afflict a large percent of the U.S. population today. The American Heart Association’s (AHA) Heart disease and Stroke Statistics of 2018 estimates that 31.1% of the world’s population has high blood pressure, and they predict that by 2035, more than 45% of the US population will have some form of cardiovascular disease2. It is because of these abnormally high numbers that the AHA has diet and lifestyle recommendations for being “heart healthy,” that they recommend to everyone, not just people who have heart disease or high blood pressure.

One such recommendation is to reduce the amount of sodium consumed each day. Sodium can cause water retention in your body, increasing blood pressure and making your heart work harder than it needs to3. The average American consumes more than 2,400 milligrams of sodium per day. The AHA recommends having less than 1,500 milligrams per day3. For reference, 1 teaspoon is about 2,300 mg of salt. The AHA reports that the body really only needs about 500 milligrams per day, so eating a heart healthy diet will still get you enough sodium to meet the daily requirements3.

How do I get enough Iodine on a low sodium diet?

So, what can you do to make sure you get enough iodine daily, while eating a heart healthy diet?  It is simple. The body needs 150 micrograms of iodine per day1. For reference, a teaspoon of iodized salt contains about 400 micrograms of iodine1. If you wanted to cut out salt in your diet and be under 1500 milligrams of salt per day, that is still at least 260 micrograms of iodine per day, which is greater than the 150 micrograms a day that your body needs. Keep in mind that the majority of people in the US are getting such large amounts of sodium through salty snacks, processed meats, and the typical “unhealthy foods” that the AHA is trying to help people avoid. Make sure that the sodium you do consume is iodized so that you are reaching that 150-microgram daily recommendation.

Overall, there is no need to fear not getting enough iodine while restricting sodium in your diet, as long as you make sure the salt you eat is iodized, and not coming from processed meats, potato chips and other salty snacks. Following the American Heart Association’s recommendations, you should still be getting more than the recommended daily amount of iodine. If you are concerned about the amount of iodine in your diet, there are multivitamins out there that contain 150 micrograms that can be taken daily.  As always, if you have any questions or concerns, your local pharmacist is well equipped to answer your questions and help guide you in the right direction.

 

References

  1. “Iodine Deficiency.” American Thyroid Association, http://thyroid.org/iodine-deficiency/.
  2. Benjamin, Emelia J, et all. “Heart Disease and Stroke Statistics— 2018 Update: A Report From the American Heart Association.” American Heart Association, 2 Mar. 2017, http://circ.ahajournals.org/content/137/12/e67.
  3. “How Much Sodium Should I Eat per Day?” Sodium Breakup, http://sodiumbreakup.heart.org/how_much_sodium_should_i_eat.

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pharmacy technician - scriptsave wellrx blog image

by Robert “Jed” Swackhammer, Ohio State University

Many patients think that only pharmacists work at pharmacies. However, there is much more that goes on behind the pharmacy counter. In fact, most pharmacies include a team of trainee technicians, registered technicians, certified technicians, student pharmacists, and pharmacists. A common question is, what are the differences between technicians and why they are important? This answer is an essential reason why pharmacies can run safely, effectively and efficiently.

More Than Just a Cashier

A pharmacy’s foundation starts with the development of its technicians. To initiate the process, an individual must have, at minimum, a high school diploma or equivalent to become a technician. But we should also consider the required skills. In Florida, for example, The Rasmussen Pharmacy Technician College states that skills required of technicians and are “frequently defined as clerical, customer service, critical thinking and basic medical knowledge.”[1]

Preceding the application process, an individual must first complete pharmacy training, and is titled as a technician in training or a trainee technician. So to be considered a registered technician, most states require trainee technicians to register with their state board of pharmacy.[2] However, it’s always important to check your states requirements, as they may change. Lastly, to become a certified pharmacy technician, one must take and pass the national certification exam provided by the Pharmacy Technician Certification Board (PTCB). After passing the exam, a pharmacy technician is entitled to apply to any available pharmacy technician position within the nation.

Providing Optimal Care

Knowing what it takes to become a pharmacy technician, it is also reasonable to recognize their value to the pharmacy team. The Bureau of Labor Statistics states that the need for pharmacy technicians will continue—specifically an increase in 12% from 2016-2026, due to the number of pharmacy schools and graduating pharmacists. As a result, it is vital that we meet this balance, so that pharmacists within pharmacies can continue to provide optimal patient care. Especially, by utilizing pharmacy technicians, as they always help to relieve pharmacists of certain tasks and responsibilities.[3]

Recognizing Value

For this reason, it is vital that current and future pharmacists recognize the value of their pharmacy technicians. Moreover, it is important that pharmacists challenge technicians and their knowledge, skills, abilities and other characteristics (KSAOs) to keep them engaged and up-to-date.[4]

For example, in 2017, the Journal of the American Pharmacists Association published a summary article of the Pharmacy Technician Stakeholder Consensus Conference. This article stated that more than “44,000 pharmacy technicians answered 1 of 2 surveys related to job analysis, which assessed how frequent specific tasks were being performed. Additionally, the PTCB stated that they will continue to analyze job analyses to help develop better pre-certification requirements and future certification programs in advanced community pharmacy and sterile compounding.”[4]

It is vital that student pharmacists and pharmacists recognize their technicians to drive the profession forward and continue to deliver optimal patient care.

 

References

[1] Koehler, T.C., Research in Social and Administrative Pharmacy (2018), https://doi.org/10.1016/j.sapharm.2018.06.017

[2] Pharmacy Technician License Requirements by State. Pharmacy Times. https://www.pharmacytimes.com/technician-news/pharmacy-technician-license-requirements-by-state#wa. Published 2015. Accessed August 6th 2018.

[3] Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Pharmacy Technicians, on the Internet at https://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm. Accessed August 6th 2018.

[4] Zellmer W, McAllister E, Silvester J, Vlasses P. Toward uniform standards for pharmacy technicians: Summary of the 2017 Pharmacy Technician Stakeholder Consensus Conference. Journal of the American Pharmacists Association. 2017;57(5):e1-e14. doi:10.1016/j.japh.2017.06.014


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Epidiolex: A new CBD epilepsy drug

by Roxanna Orsini,
PharmD Candidate Class of 2019, University of Arizona

Treatments are available that can successfully control seizures for most people with epilepsy. However, there’s a soon-to-be-released medication, recently approved by the FDA, called Epidiolex.

What is Epidiolex?

Epidiolex (cannabidiol) is a new FDA-approved epilepsy medication that is derived from Cannabis Sativa plant (marijuana). Cannabidiol (CBD) does not create feelings of euphoria or intoxication, the “high” that is often experienced with Cannabis, which comes mainly from the compound tetrahydrocannabinol (THC), which is also found in marijuana.

Which forms of epilepsy does Epidiolex treat?

The FDA approved Epidiolex for treatment of seizures associated with two rare and severe forms of epilepsy, in patients two (2) years and older.5

  • Lennox-Gastaut Syndrome
    • Begins in childhood and continues to adulthood with some changes in presentation with age.3
    • Often characterized by multiple types of seizures (particularly tonic and atonic) and an intellectual disability.
    • An EEG (electroencephalogram) can display a classic pattern of background slowing and spike-wave bursts with frequencies less than 2.5 per second. 2
    • Found in 2-5% of childhood epilepsies.2
  • Dravet Syndrome
    • Begins during the first year of life and is a lifelong disease.3
    • This is a rare genetic epileptic brain disease.
    • Infants will have normal development up until an increase in seizure frequency occurs after the first seizure which is often associated with a fever. 1
    • Most children develop some level of developmental disability.
    • Seizures can be triggered by various factors such as body temperature, emotional stress or excitement, and photosensitivity.1

Coming Soon!

While Epidiolex has been approved for release, the expected time to market is September 2018. A few things to know about the medication before it is released:

Effectiveness

The study for Epidiolex involved 3 randomized, double-blind, placebo controlled clinical trials which included 516 patients who had either Lennox-Gastaut Syndrome or Dravet Syndrome.3 Results showed that patients taking Epidiolex along with other anti-epileptic drugs (AEDs) showed a decrease in seizure frequency when compared to the placebo.3

Precautions

Side effects (3,5) are often something to be aware of before starting a new medication. A few reported side effects to Epidiolex include:

  • Elevated liver enzymes
  • Sedation
  • Lethargy
  • Sleep Disorders
  • Diarrhea
  • Rash
  • Increase in suicidal thoughts
  • Decrease in appetite
  • Abdominal discomfort
  • Abdominal pain

Cost

The company has not release any official information about cost for Epidiolex, however NY Times analysis estimates a cost of $2,500 to $5,000 a month.4 It is possible that this medication may be approved by insurances so make sure to discuss options with your provider.

Future Opportunities

Even though this medication is only currently approved for these two forms of seizures, it does open the door to future possibilities.  Always keep communication open with your healthcare provider so they can help guide you on therapy options as more clinical studies arise with new information.

 

References:

  1. Epilepsy Foundation. (2018). Dravet Syndrome. [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/dravet-syndrome [Accessed 11 Jul. 2018].
  2. Epilepsy Foundation. (2018). Lennox-Gastaut Syndrome (LGS). [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs [Accessed 11 Jul. 2018].
  3. FDA.gov. (2018). FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [online] Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm [Accessed 10 Jul. 2018].
  4. Kaplan, S. (2018). D.A. Panel Recommends Approval of Cannabis-Based Drug for Epilepsy. [online] Nytimes.com. Available at: https://www.nytimes.com/2018/04/19/health/epidiolex-fda-cannabis-marajuana.html [Accessed 5 Jul. 2018].
  5. Micromedexsolutions.com. (2018). Micromedex Products: Please Login. [online] Available at:
    http://www.micromedexsolutions.com/micromedex2/librarian/CS/B42F8E/ND_PR/evidencexpert/ [Accessed 5 Jul. 2018].

 


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Employers and preventive care - blog image - ScriptSave WellRx

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Every year, employers are paying more to have their employees insured. A study on the annual growth rate of health care costs found that employers are experiencing 5%-to-6% increases in healthcare costs per year.Early estimates suggest employers will spend over $730 billion on health benefits in 2018 alone.

Curbing Healthcare Costs

Growing health care costs can impact both employees and companies:

  • Employees are becoming more concerned because some of the costs are being passed on by the employers.
  • Increasing costs are pushing large employers to be more involved in healthcare, instead of relying on insurers.
  • As companies grow and costs increase, the amount spent on health benefits will follow suit.  

Saving Money While Providing Better Care

Companies are tackling the increases in health care costs by negotiating with healthcare providers without going through a middleman. By skipping the insurer, large employer groups are spending less and creating a direct path to health care services for  their  employees. These new plans are becoming more prevalent in areas such as the Silicon Valley, where large employee populations can be monitored day-to-day in the work environment.

Healthcare providers are being stationed inside the work space for enhanced patient monitoring, and clinics are being built into the work environments to create better access to healthcare services. The new patient-focused  care plans strive to prevent health conditions, rather than treating problems after they appear. Monitoring employees with  routine check-ups generally costs less than rushing them to the hospital for emergency services.

In California, a partnership between a large employer and a hospital offers a plan that requires healthcare providers to track multiple health indicators on a consistent schedule to prevent unexpected healthcare costs.Many employees are reluctant to switch to a plan that further restricts where they can receive health benefits, but employers are providing incentives to lower the costs to employees.

Some of the incentives include lower monthly premiums and copays. Clinics within the workplace often include necessary amenities for healthcare providers to perform general check-ups, physical therapy, and promote an all-inclusive body, mind, and spirit preventative healthcare approach.

What Can We Learn from Large Employers?

Current healthcare plans that support constant monitoring have allowed employers to save money by reducing high-cost services. Many employers are trying to move towards preventing health conditions rather than treating them after they appear. They are also addressing the inherent conflict for providers, where prevention of expensive healthcare costs reduces the number patients taking part in more profitable care such as emergency services. As we watch these new health plans continue to grow we can observe the benefits of constant monitoring and prevention. If employers continue to promote these plans due to improved health outcomes and costs savings, we may want to take a more preventative approach to our own healthcare.

References

  1. Barnes, K., Judy, R., & Isgur, B. (2018, June 15). Medical Cost Trend. Retrieved from PWC: https://www.pwc.com/us/en/health-industries/health-research-institute/behind-the-html
  2. Caspani, M. (2018, June 15). Soaring costs, loss of benefits top Americans’ healthcare worries: Reuters/Ipsos poll. Retrieved from Reuters: https://www.reuters.com/article/us-usa-healthcare-worries/soaring-costs-loss-of-benefits-top-americans-healthcare-worries-reuters-ipsos-poll-idUSKBN1JB1FD
  3. Humer, C. (2018, June 11). Fed up with rising costs, big US firms dig into health care. Retrieved from Reuters: https://www.reuters.com/article/us-usa-healthcare-employers-insight/fed-up-with-rising-costs-big-u-s-firms-dig-into-healthcare-idUSKBN1J70ZZ

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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Your child's medication during school hours - ScriptSave WellRx blog image

by Pattiya Wattananimitgul

How to Handle Your Child’s Medication During the School Year

In the United States, more than 263 million prescriptions are dispensed each year for pediatric patients.1 Chances are, your child may need to take their medications at school. If your child has a medication that they need to take during school hours, whether it is a long-term, short-term, or emergency medication, here are some helpful tips for parents and guardians:

Prior to the School Year1,2

  • Ask the pharmacist to put your child’s medications into two different bottles, each with its’ own label. One to be kept at home and one to be kept at school, if school policy allows.
  • Make sure all the prescription medications kept at school are in an original container (ie., no zip-top bags or foil) and labeled by a pharmacist.
  • Make sure all over-the-counter medications (including supplements) kept at school are in the original containers. Some states require a physician’s written consent and a parent written permission for over-the-counter medications. Be sure to check with your school.
  • It is also important for your child to play active roles in their medication. They should be educated about the effective and safe use of their medicine to help avoid improper administration, dosing errors, and non-adherence.

At the Beginning and During the School Year2,3

  • Provide the school with a full list of your child’s medications, including over-the-counter medicines and supplements. Be sure to update the school with any changes throughout the school year.
  • Talk to the school nurse or teacher ahead of time to make sure your child’s medication will be administered correctly (icorrect medication, dosage, route, frequency). Define who will administer the medication, and who will carry the medications during field trips.
  • School staff are not allowed to determine when to administer “as needed” medications. Be sure that your child’s medication includes specific instruction on when to administer and for what indication (ie., every 6 hours as needed for headache).
  • All medications should be transported by adults to adults. DO NOT let your child carry the medications unless they are capable and responsible to self-administer their medication to carry their own medications, especially for emergency medications that need immediate access, as deemed appropriate by the school.

Emergency Medications2

  • Be sure your child is able to get instantaneous access to emergency medications, like epinephrine injections for allergic reaction, glucagon for low blood sugar, or albuterol for an asthma attack.
  • Acetaminophen, ibuprofen, antihistamines are usually available at school in case your child experiences sudden pain or fever such as headaches, toothache, or menstrual cramps. It is important to sign a waiver granting the school permission to administer these medications in case your child experiences these symptoms.

Lastly, most schools and school districts have policies regarding student’s medication handling. It is important for you to check with your school for specific protocols that you need to follow to make sure that your child is getting the proper care.

 

References

  1. Abraham, O., Brothers, A., Alexander, D. S., & Carpenter, D. M. (2017). Pediatric medication use experiences and patient counseling in community pharmacies: Perspectives of children and parents. Journal of the American Pharmacists Association, 57(1), 38-46. doi:10.1016/j.japh.2016.08.019
  2. Administering Medication at School: Tips for Parents. (2016, December 19). Retrieved July 25, 2018, from https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Administering-Medication-at-Child-Care-or-School.aspx
  3. Guidelines for the Administration of Medication in School. (2003). American Academy of Pediatrics, 112(3), 697-699. doi:10.1542/peds.112.3.697

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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Cost of not taking your medications image - ScriptSave WellRx

by Roxanna Orsini

It’s a fact. Medications don’t work if patients don’t take them. Taking your medications as prescribed by your physician can help improve the quality and length of your life.

Importance of taking your medications

According to the Centers for Disease Control and Prevention (CDC), nearly 50% of Americans have used at least one prescription with in the last 30 days. One recent study shows that patients who were compliant with taking their statin therapy medications for at least two years had a 30% reduction in the risk of hospitalization for acute myocardial infarctions (heart attacks).1

Even with all the benefits medications can have on a patient’s health, there is still an issue with adherence to medication therapy.

After a patient visits their doctor

  • 20% – 30% of new prescriptions never reach the pharmacy.2
  • Of those prescriptions that do get filled, 50% of the time they are not taken as prescribed by the doctor.2
  • After six months of treatment for a chronic condition, patients tend to reduce the amount of medication they are taking, or stop treatment altogether.

Annual results of medication nonadherence

  • 125,000 deaths and at least 10% of hospitalizations.2
  • Costs the United States health care system between $100 billion and $289 billion annually.2,3

Most common reasons medication treatments are adjusted

Patients often discontinue or alter how they are taking their medications due to a variety of factors. A patient may no longer be adherent to their prescription therapy due to:

  • Cost of the medication
  • Experiencing a potential side effect
  • The patient no longer felt they needed the medication, and,
  • The patient feeling they are currently taking too many medications.

If a medication is too costly, ask your provider if they have any samples to provide, or even ask about possible generic alternatives. Prescription discount services, like ScriptSave WellRx, can often help reduce the cost. You may be surprised to find our cash prices is even lower than your insurance copay! Visit our website to check your medication prices.

When you’re considering an adjustment to your medication therapy, it’s important to follow up and discuss the decision with your healthcare provider. Some medications, if discontinued suddenly, can cause more harm than good.

Ways to improve the way you take your medications

Complications from medication nonadherence are 100% preventable. Here are a few tips to help you remember to take your medications:

  • Using an alarm or calendar
  • Filling a weekly pillbox
  • Taking the medication at the same time every day, create a routine
  • Ask your pharmacy about getting a 90-day supply
  • Ask your insurance provider if mail order provides prescription benefits.

Make sure to keep open communication with your healthcare provider. There are times a patient does not report a side effect or concern with the medication until the next appointment. Try reaching out to your provider right away. They are there to help you find a medication that can help improve your health condition.

References:

  1. Lansberg, P., Lee, A., Lee, Z., Subramaniam, K. and Setia, S. (2018). Nonadherence to statins: individualized intervention strategies outside the pill box. Vascular Health and Risk Management, Volume 14, pp.91-102.
  2. Rosenbaum, L. and Shrank, W. (2013). Taking Our Medicine — Improving Adherence in the Accountability Era. New England Journal of Medicine, 369(8), pp.694-695.
  3. Viswanathan, M., Golin, C., Jones, C., Ashok, M., Blalock, S., Wines, R., Coker-Schwimmer, E., Rosen, D., Sista, P. and Lohr, K. (2012). Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States. Annals of Internal Medicine, 157(11), p.785-95.

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash discount price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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Genomics impact on your medicine - ScriptSave WellRx blog image

by Sterling Harpst
2019 PharmD Candidate

Testing Your DNA May Actually Help Make Your Medicines Work Better

Many patients have heard of the personal genetic testing kits available for purchase from websites such as 23AndMe or AncestryDNA. There are currently over 250 Direct-to-Consumer (DTC) companies providing services to analyze saliva samples and create customized reports on what your genetic information says about you.1 Advertising for these companies often include claims that DNA testing can be used to determine an individual’s ancestry, risk for getting certain diseases, or even athletic ability.

What is of interest for many patients, however, is the claim that genetic information can be used to make their medicine more effective. With all of the information being presented, it can be easy for patients to become overwhelmed and unsure of how to make sense of it all. Here’s what consumers should know about the evolving field of Pharmacogenomics.

What are genes?

Inside your body there are millions of cells carrying chromosomes. Chromosomes makes up what is referred to as your “genetic blueprint.”  These are passed on to you from your parents and are made of unique information (genes) which code for specific traits. It is thought that there are nearly 30,000 genes in the human body which determine things like eye color, skin tone, height, and even the likelihood you may get a certain disease.2

What is Pharmacogenomics?

Pharmacogenomics is a relatively new field that looks at how a person’s unique genetic material affects their response to drugs. Imagine that three people get the same disease. Conventional medicine would often recommend they be prescribed the exact same medication. This may make one patient well again very quickly but have no impact on the other two. Essentially, pharmacogenomics aims to explain why changes in genetic information cause some drugs to work differently in different people. This new and exciting field hopes to make personalized medicine a reality, resulting in better diagnoses, earlier treatment decisions, more effective medication use, and customized therapy. By combining an understanding of drugs and genes, there is hope that one day all medicine can be personalized based on a patient’s DNA.

The Limitations of Genetic Tests

Although companies make a number of claims about what information their tests can provide, there are a few limitations to consider before completing any genetic test.

Interpretation

Perhaps the biggest limitation to pharmacogenomics is our ability to fully interpret what genetic information means. Modern technology allows us to analyze tens of thousands of genes, however truly understanding that information is another challenge entirely. Imagine a dictionary full of words, except only a few pages have a definition listed for each word. This dictionary could be used to describe where pharmacogenomics currently stands. Although we have advanced tremendously in recent years, we are still far from fully understanding of the meaning of every gene.

Ability to Make Changes

While there are certain therapies that require genetic testing before use, most do not. Many of the DTC genetic tests are designed to report only information related to drug metabolism. For example, if you do not make specific chemicals necessary to break down a drug, the drug may stay in your system longer and result in side effects. If you make those same chemicals in very high amounts, that drug may not reach the intended effect because your body removes it too quickly. For the purpose of making medication changes, this is often the only result tests can provide.

Minimal Regulation

Although there are many tests available today, there is little regulation when it comes to making sure companies are producing accurate results. Claims that you will know your chances for developing diseases such as Alzheimer’s are based on likelihood, not certainty. Many companies advertise tests that can be used to customize your diet and lifestyle as well. Without well documented clinical studies to provide evidence of these statements, the Centers for Disease Control and Intervention (CDC) and Food and Drug Administration (FDA) are often hesitant to agree.3

For some of the newer or less well-known companies, there are significant concerns with the privacy of your genetic information. The Genetic Information Nondiscrimination Act (GINA) was signed into law in 2008, preventing health insurances and employers from discriminating based on genetic information.4 However, with patient permission it is still legal to sell this data, making it very important to read the privacy policies on how they will use your information before taking a test.

If You’re Considering a DTC Genetic Test

It is important to know that the FDA and CDC do not approve genetic testing in place of traditional health care evaluation. The results may provide a likelihood regarding your chance to benefit from certain medications, but the tests are not final. Often the results may not be significant enough to change anything about your medicine. Here are a few points to keep in mind:

  • Talk with your doctor first before completing any genetic test. It is important to know what they would recommend based on your specific circumstance.
  • Ask your doctor if they would be able to interpret the test with you. Some reports can be complicated and very difficult for patients to understand. Genetic counselors are healthcare professionals that are specifically trained to help interpret the meaning of genetic testing results.
  • Before making any changes to medications or lifestyle, ask the opinion of your doctor. Since test results can be challenging to understand, changes could result in dangerous consequences if made incorrectly.
  • Understand your rights regarding privacy. Before sending your DNA to anyone, it is best to know what your information will be used for. Your genetic information is personal, and you may not want companies to share that information for personal gain.

References

  1. Phillips, Andelka M. “Only a Click Away – DTC Genetics for Ancestry, Health, Love and More: A View of the Business and Regulatory Landscape.” Applied & Translational Genomics, vol. 8, 2016, pp. 16–22., doi:10.1016/j.atg.2016.01.001.
  2. “Human Genome Project Completion: Frequently Asked Questions.” National Human Genome Research Institute (NHGRI), 30 Oct. 2010, genome.gov/11006943/human-genome-project-completion-frequently-asked-questions/.
  3. “Regulation of Genetic Tests.” National Human Genome Research Institute (NHGRI), 17 Jan. 2018, genome.gov/10002335/.
  4. Su P. Direct-to-Consumer Genetic Testing: A Comprehensive View. The Yale Journal of Biology and Medicine. 2013;86(3):359-365.

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash discount price at pharmacies near you.
You may find prices lower than your insurance co-pay!

 

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health information technology - PHI - ScriptSave WellRx image

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Changes in Health Information Technology (HIT)

Technology in our daily lives is increasing at an astounding pace. Each day, our lives are becoming more connected to technology, but more specifically, to information technology. Recent news events related to personal information have brought some concerns to light. Companies that provide technology services are storing user data and potentially using the data for their own purposes. Technology users are becoming savvier about the data they produce, which companies have access to the data, and how the data is being used. There are government regulations set in place for protecting your health information.

Let’s look at how healthcare providers are using health information and what you can do to protect and use your information effectively.

What are healthcare providers are doing?

The impact healthcare providers have on you is dependent on the amount of information available. Access to health information can help in patient care. Healthcare providers are trying to get connected and stay connected with patients. Consistent, scheduled care can allow healthcare providers to prevent problems or treat them before they take a toll on daily activities.2

Some ways pharmacists are using health information technology is through medication therapy management, clinical decision support, chronic care management, and annual wellness visits. Medication Therapy Management (MTM) utilizes prescription medication claims and information from the patient to find problems with medications, costs, and adherence. Clinical decision support connects patient health information to a knowledge base to guide therapy and reduce medication errors. Using standardized records systems, pharmacists can manage chronic conditions by using data from multiple sources such as pharmacies, hospitals, and clinics.

The progression of a chronic disease can be tracked through the records from multiple sources, thus allowing pharmacists to adjust medication therapy as needed. Access to health information through multiple sources also allows providers to have a better picture of patients’ health during annual wellness visits.1

How can I stay safe?

Healthcare providers are required to provide patients with a Health Insurance Portability and Accountability Act (HIPAA) consent form. Signing this form allows the healthcare facility to utilize your health information for therapy and billing. The healthcare facilities also follow the guidelines set by HIPAA to secure your information and to use it only when necessary. If you are concerned about health information practices you can ask if the facility follows HIPAA guidelines. Most facilities can provide a report on why your information was used and to whom it was shared. You can also request a copy of your health records and make corrections to them, if appropriate.3

What can you do to help your healthcare providers?

Healthcare providers can make more informed decisions when your health information is accurate and complete. The best way to help providers reach informed decisions is to ensure your health records are up to date. These are some categories that should be up to date in your own health records:

  • Allergies
  • Current Medication List
    • Name of the medication
    • Strength of the medication
    • Schedule for taking the medication
    • Route of administration
    • Length of time on each medication
  • Current and Past Health conditions
    • When you were diagnosed
    • Surgical history

Shared decision making is a way for patients and their providers to work together to determine what is right for the patient in order for you, as the patient, to make an informed decision about your health care. When selecting treatments, screening tests, and care plans, it’s important to talk to your provider about your preferences and to fully understand how your personal health information is being used. After all, it is yours!

References

  1. Abubakar, A., & Sinclair, J. (2018). Health infromation tehnology in practice. Pharmacy Today, 58-65.
  2. Dullabh , P., Sondheimer , N., Katsh, E., Young, J.-E., Washington, M., & Stromberg, S. (2014). Improving the Health Records Request Process for Patients Insights from User Experience Research. Chicago: NORC at the Univeristy of Chicago.
  3. S. Department of Health and Human Services. (2017, February 1). Your Rights Under HIPAA. Retrieved from U.S. Health and Human Services: https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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Prescription options for allergy meds - scriptsave wellrx

by Marcus Harding
PharmD Candidate Class of 2019, University of Arizona

Seasonal allergies affect anywhere between 10-30% of people worldwide.1 Allergies to one or more common allergens are reaching upwards of 40-50% in school children.1 Allergies occur due to an immune response to something the body considers “foreign,” in other words, strange or unfamiliar. When in contact with the “allergen,” the body produces antibodies which release a chemical called histamine. Histamine and some other chemicals are what cause allergic reactions.1,3

Symptoms of a seasonal allergic response include but are not limited to:3

  • Sneezing and a runny nose
  • Itchy nose and throat
  • Itchy, watery eyes

Symptoms of a more severe allergic response include:

  • Shortness of breath
  • Rash
  • Welts
  • Swelling of mucous membranes

What to Do

When seasonal allergic symptoms occur, you should talk to your primary healthcare provider for help. While your physician can prescribe medications to minimize these symptoms, it is rare that they would be covered by your insurance. This is because most of the medications used for allergies are “over-the-counter” (OTC) medications. This means these medications can be purchased without a prescription, and can be easily found at your local drug store. If you are expecting a medication to be covered by your insurance, but find that it is not, there are options for you. Despite these medications being OTC, they can still be rather expensive, and if you need the medication consistently, the cost can add up. So, what are your options when it comes to these medications if your insurance won’t cover them?

There are many resources available to help you find the best price for OTC medications. The ScriptSave® WellRx app is free and can help you find the best price based on your location. If your physician writes a prescription for an OTC medication, you can use the ScriptSave WellRx app or discount card to get savings on that drug. You can visit www.WellRx.com to download a free card and find the cheapest cash price at a nearby pharmacy.

Lastly, your local pharmacist is a great resource when it comes to cost savings. They are a wealth of knowledge as it pertains to medication information and cost, and if they do not know the answer, they will know where and how to find the answer.

Allergy Medication Options

So now that you have the resources to find the best price, how can you decide which medication to choose? There are so many different types of medications for seasonal allergies, it is hard to know which is the best for you.

Antihistamines are the most common type of medication used for seasonal allergies.1 These are divided into two types, which are the first and second-generation antihistamines. The first-generation antihistamines are more likely to cause drowsiness and sedation compared to the second generation.2 The OTC first-generation antihistamines include:

The OTC second-generation antihistamines include

Second-generation antihistamines are not only less sedating, but also last longer, and are most often only needed once a day, whereas first-generation anti-histamines may need to be taken multiple times a day. All of these examples can be found as tablets, capsules, or suspensions.2

Some common side effects to look out for are:2

  • Dizziness/drowsiness (more common in first-generation)
  • Dry mouth
  • Blurred vision
  • Nausea/vomiting
  • Confusion

Another type of medication that can be used for seasonal allergies is nasal decongestants.1 These medications help to shrink the blood vessels in your nose to reduce the amount of leaking from your nose. These medications result in rapid relief of nasal congestion; however, they are only recommended for 3-5 days of use. Using these medications any longer than the recommendation can cause “rebound congestion,” basically making your symptoms worse. There are several different forms of these medications including topical, oral tablets and nasal sprays.4

Some of the side effects of these medications include:4

  • Rapid and irregular heartbeat
  • irritability
  • nasal dryness
  • high blood pressure
  • difficulty sleeping
  • loss of appetite
  • urinary retention
  • dizziness

Keep in mind that there are daily and monthly limits to the amount of Sudafed you can purchase based on state laws. Although these medications can act rapidly and help with symptoms right away, they should not be used for more than 5 days at a time.4

One last common type of OTC medication used for seasonal allergies is nasal corticosteroids1. These medications act to slow down the body’s immune response to the allergen, reducing the amount of inflammation. Although there are corticosteroids that work for the whole body, these are nasal sprays that are directed to the nose to help with symptoms that occur locally or in the general area, therefore, there are very few of the normal side effects of steroids because the medication is specifically targeted to the nose. Most of the side effects that can happen are in the nose/throat area, although they are not very common.4

The current nasal corticosteroids include:

The side effects of these medications can include:4

  • Nausea
  • Headache
  • Cough
  • Nose bleeds
  • Congestion
  • Throat swelling/irritation
  • Upper respiratory infection.

There are many options for treating your allergies with over the counter medications, including medications that are not antihistamines. If your doctor prescribes a medication and it is not covered by insurance, talk to your pharmacist about OTC alternatives and use the resources available to you to find the best price. That way you can treat your symptoms, feel better, and keep more money in your pocket.

 

References

  1. American Academy of Allergy, Asthma & Immunology. (2018). AAAA. Retrieved from http://www.aaaai.org/. Accessed on 5/16/2018.
  2. Carson S, Lee N, Thakurta S. Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet]. Portland (OR): Oregon Health & Science University; 2010 May. Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK50554/
  3. Jeffrey L. Kishiyama, M. (2014). Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e. Gary D. Hammer, MD, PhD, Stephen J. McPhee, MD.
  4. Platt, Michael. International Forum of Allergy & Rhinology. Sep2014 Supplement, Vol. 4, pS35-S40. https://www.ncbi.nlm.nih.gov/pubmed/25182353

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
You may find prices lower than your insurance co-pay!

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