back pain and muscle relaxants - wellrx blog image

By Rosanna Sutherby, PharmD

Muscle relaxants are widely used to treat muscle pain and muscle spasms due to conditions ranging from cerebral palsy and spinal cord injuries to muscle strains. Although muscle relaxants are effective in alleviating pain and uncontrolled movements, there are potential side effects you should be aware of before taking muscle relaxants.

What Are Muscle Relaxants?

Muscle relaxants are medications generally used to relieve pain, stiffness, or uncontrolled movements caused by muscle spasms. Muscle spasms happen when a muscle or a group of muscles contract uncontrollably and cannot relax. The muscle hardens, resulting in symptoms that range from mild twitching to severe pain.

Muscle relaxants work in your brain and spinal cord or directly in your muscles to help the muscles relax.

List of Muscle Relaxants

Muscle relaxants are categorized into two categories based on how they work and what symptoms they treat most effectively. They are classified as antispasticity drugs, antispasmodic drugs, or both.

Antispasticity muscle relaxants are generally used to treat involuntary muscle movements caused by cerebral palsy, multiple sclerosis, or spinal cord and brain injuries.

Antispasmodic drugs are better for relieving muscle pain due to uncontrolled muscle contractions.

The following are muscle relaxants classified as antispasticity drugs:

The following muscle relaxants are considered antispasmodic drugs:

The following medications are classified as both antispasticity and antispasmodic medications:

What Are the Side Effects of Muscle Relaxants?

The side effects of muscle relaxants may vary based on where they work in the body. Some work in your brain, while others work on your spinal cord or directly in the muscle.

Side Effects of Cyclobenzaprine

Cyclobenzaprine works in your brain to help relieve pain and stiffness caused by muscle injuries. Common side effects associated with cyclobenzaprine include:

  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Dizziness
  • Drowsiness
  • Dry mouth

Cyclobenzaprine may cause an irregular heartbeat. Before taking this medication, be sure to let your doctor know if you have heart problems.

Side Effects of Tizanidine

Tizanidine works in your brain to relieve muscle spasms caused by multiple sclerosis, stroke, or brain and spinal cord injuries. Common side effects seen with tizanidine include:

  • Blurred vision
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Nervousness
  • Upset stomach

Tizanidine may cause an irregular heartbeat, especially if you have heart problems, or if you take any the following medications:

  • cimetidine (Tagamet)
  • ciprofloxacin (Cipro)
  • famotidine (Pepcid)
  • fluvoxamine (Luvox)
  • medications to regulate heart rhythm
  • some birth control pills

Side Effects of Baclofen

Baclofen works in your brain to reduce involuntary movements caused by multiple sclerosis or spinal cord injuries. The most common side effects seen with baclofen include:

  • Dizziness
  • Insomnia (difficulty falling asleep or staying asleep)
  • Tiredness
  • Weakness

Abruptly stopping baclofen may cause the following side effects:

  • Confusion
  • Hallucinations
  • Seizures
  • Worsening of muscle spasms

To stop baclofen safely, your doctor may reduce your dose gradually over a few weeks.

Side Effects of Metaxalone

Metaxalone is a central nervous system (CNS) depressant used to relieve muscle pain associated with muscle injuries. Common side effects seen with metaxalone include:

  • Dizziness
  • Drowsiness
  • Nausea
  • Vomiting

The following side effects are rare but serious.

  • Hemolytic anemia (a condition in which your red blood cells are destroyed faster than your body can replace them)
  • Jaundice (yellowing of the skin or eyes)
  • Leukopenia (low white blood cell count)

Contact your health care provider if you experience any of the following symptoms:

  • Confusion
  • Excessive dizziness
  • Fever
  • Heart palpitations
  • Pale skin
  • Yellow skin or eyes

You should not take metaxalone if you have severe liver or kidney problems. Your doctor may check your liver enzyme levels while you are taking metaxalone.

Side Effects of Methocarbamol

Methocarbamol works in your brain to relieve muscle spasms. Common side effects of methocarbamol include:

  • Dizziness
  • Drowsiness
  • Lightheadedness

Methocarbamol generally causes less drowsiness than other muscle relaxants. It is a good alternative if you cannot tolerate other muscle relaxants due to excessive sleepiness.

Side Effects of Carisoprodol

Carisoprodol acts in your brain to relieve pain caused by muscle spasms. Common side effects seen with carisoprodol include:

  • Dizziness
  • Drowsiness
  • Fast heartbeat
  • Headache
  • Upset stomach

Use carisoprodol cautiously, especially if you have liver or kidney problems. The side effects of carisoprodol may increase if you take the medication for a long time or if medication levels accumulate in your body.

Side Effects of Orphenadrine

Orphenadrine is related to diphenhydramine (Benadryl), and many of its side effects are similar to those seen with diphenhydramine. Common side effects of orphenadrine include:

  • Confusion
  • Constipation
  • Difficulty urinating
  • Drowsiness
  • Dry mouth

Orphenadrine may also cause heart palpitations or rapid heartbeat. Talk to your doctor or pharmacist before taking orphenadrine if you have a heart condition.

Side Effects of Chlorzoxazone

Chlorzoxazone is used to relieve stiffness and pain related to muscle injuries. Common side effects of chlorzoxazone include:

  • Dizziness
  • Drowsiness
  • Lightheadedness

On rare occasions, chlorzoxazone may cause severe liver toxicity. Immediately inform your healthcare provider if you experience symptoms such as:

  • Dark urine
  • Fever
  • Rash
  • Yellowing of the skin or eyes

Side Effects of Dantrolene

Dantrolene works directly in the muscle to slow muscle contractions. Common side effects of dantrolene include:

  • Diarrhea
  • Dizziness
  • Drowsiness
  • Muscle weakness

Dantrolene may cause liver damage if used for a long time. You should not use this medication to treat chronic pain.

How to Get the Lowest Prescription Price for Your Muscle Relaxants

Before heading to a pharmacy near you, be sure to compare prescription prices for your muscle relaxant. You can use a prescription discount card to get the lowest prescription 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.wellrx.com/health-conditions/about/health-condition/sprains-and-strains/~default/

https://my.clevelandclinic.org/health/diseases/15466-muscle-spasms

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/

https://www.wellrx.com/health-conditions/about/health-condition/multiple-sclerosis/~default/

https://www.nhlbi.nih.gov/health-topics/hemolytic-anemia#:~:text=Hemolytic%20anemia%20is%20a%20blood,than%20they%20can%20be%20replaced.

https://www.mayoclinic.org/symptoms/low-white-blood-cell-count/basics/when-to-see-doctor/sym-20050615

breastfeeding mother - wellrx blog image

By Rosanna Sutherby, PharmD

There is no doubt that breastfeeding has numerous benefits for both you and your baby. As you strive to provide the best for your baby’s health and development, you consider everything that goes into your baby’s body. When you are breastfeeding, this includes what goes into your own body.

When you need to take medications, keeping yourself healthy and your baby safe may require balancing the potential benefits of the medicine for you against the potential risks for your baby. Read on to learn about the benefits of breastfeeding and the safe use of medications while nursing.

What Are the Benefits of Breastfeeding for Your Baby?

Besides being an inexpensive and convenient way to feed your infant, breastfeeding offers many health benefits for your baby. Research shows that breastfeeding can lower your baby’s risk of the following conditions:

  • Adolescent and adult obesity
  • Asthma
  • Celiac disease
  • Childhood inflammatory bowel disease
  • Childhood leukemia and lymphoma
  • Diabetes
  • Ear infections
  • Eczema
  • Necrotizing enterocolitis (NEC), an inflammation of the intestines that most commonly affects premature babies
  • Respiratory tract infections
  • Stomach and intestine related infections
  • Sudden infant death syndrome (SIDS)

Furthermore, colostrum, the early milk you make during the first few days of your baby’s life, is packed with nutrients and antibodies that protect your baby from infections. As your child grows, your milk changes to suit your baby’s nutritional needs.

What Are the Benefits of Breastfeeding for You?

In addition to providing numerous benefits for your baby, breastfeeding is also beneficial for mothers.

Nursing your baby:

  • Helps you return to your pre-pregnancy weight quicker
  • Helps your uterus return to its normal size quicker
  • Decreases bleeding and delay menstrual periods
  • Decreases your risk of breast and ovarian cancers

Is It Safe to Take Medications While Breastfeeding?

For many women, the answer is yes. According to the American Academy of Pediatrics, most medications are safe to use while breastfeeding. However, you should consider a few factors when determining if you should continue taking medication while nursing:

  • The benefits of the medication for the mother versus the potential effects of the drug on the baby
  • The potential effects of the medicine on milk supply
  • How much of the drug passes into the mother’s milk
  • How much of the medication may be absorbed orally by the nursing baby
  • The age of the baby
  • How often the baby nurses

Generally, you should avoid extended-release formulations or medications with long half-lives. They are more likely to concentrate in breastmilk.

Always check with your pediatrician or your pharmacist before taking medications if you are breastfeeding. Although many medicines are safe to use while nursing, each baby is different. The effect certain drugs can have on your baby may depend on his or her kidney development and the age of your baby.

Generally, medications present in breastmilk are more likely to affect premature babies, newborns, and babies with unstable medical conditions or diminished kidney function. Babies who are six months and older with no critical medical conditions are less likely to be affected by medications in breastmilk.

What Medications Are Safe to Use While Breastfeeding?

The majority of medications will transfer from your bloodstream into your breastmilk. However, with a few exceptions, most do so at low levels and are generally safe to use while breastfeeding.

The following is a short list of medications that are considered safe to use while breastfeeding:

Pain medications

  • acetaminophen (Tylenol)
  • celecoxib (Celebrex)
  • naproxen (Naprosyn, Aleve): Naproxen is not recommended for long-term use while breastfeeding because of its long half-life.

Antibiotics and antifungals

Antihistamines

  • fexofenadine (Allegra): Fexofenadine passes into breastmilk in small amounts and generally does not cause drowsiness for your baby. However, fexofenadine and other antihistamines may decrease your milk supply.
  • loratadine (Claritin, Alavert): Loratadine passes into breastmilk in small amounts and generally does not cause drowsiness for your baby. However, loratadine and other antihistamines may decrease your milk supply.

Birth control

Antidepressants

This list does not include all medicines that are safe to use while breastfeeding. For more information about the safe use of your medications while you are nursing, you can refer to LactMed, a database with information about how drugs and other substances may affect breastmilk.

You want what is best for your baby, and that includes keeping yourself healthy. When deciding if taking medications is safe while nursing, you must consider whether the potential benefits for you outweigh the potential risks to your baby. Always check with your health care provider to determine if it is safe to continue to take your medication while breastfeeding. If it is not, your doctor may recommend alternative medications that would allow you to continue nursing.

Remember, there is no one right way to raise a healthy baby. Only you and your doctor know what is best for you and your baby.

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/health-conditions/about/health-condition/breast-feeding-support/vitamins-and-supplements/

https://pediatrics.aappublications.org/content/129/3/e827

https://my.clevelandclinic.org/health/diseases/10026-necrotizing-enterocolitis

https://www.wellrx.com/health-conditions/about/health-condition/eczema/~default/

https://www.wellrx.com/health-conditions/about/health-condition/celiac-disease/~default/

https://www.womenshealth.gov/breastfeeding/making-decision-breastfeed#9

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Breastfeeding/Pages/Benefits-of-Breastfeeding.aspx

https://pediatrics.aappublications.org/content/132/3/e796

https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/breastfeeding-and-medications/art-20043975https://www.ncbi.nlm.nih.gov/sites/books/NBK501922/

restless legs - wellrx blog image

By Hunter Rojas, PharmD Candidate Class of 2021,
University of Arizona College of Pharmacy

For most people, signs of RLS (restless leg syndrome) occur at night and before they are going to sleep. If you think you are suffering from restless leg syndrome, you are not alone. RLS is the most common reported sleep-related movement disorder and studies estimate 5-10% of the adult population in the U.S. experience symptoms related to RLS.2

What is Restless Leg Syndrome?

Also called Willis-Ekbom Disease, Restless Leg Syndrome (RLS) is a condition that affects the brain and its ability to prevent muscle contraction.  The common symptoms of RLS include the overwhelming urge to move the legs, unpleasant sensations that may occur in the arms and legs, and involuntary jerking movements that occur during times of rest.1

Fortunately, researchers and providers have worked together to further their understanding of what can improve and worsen RLS symptoms.

What Might Make RLS Worse?

Many factors may increase a person’s risk of developing RLS. Lifestyle choices may negatively impact RLS, such as smoking nicotine, consuming caffeine, and avoiding physical activity.3 These lifestyle choices may contribute to a worsening of symptoms, but these risk factors are the most preventable.

Health conditions may also play a role in the presence of RLS. Commonly documented conditions in RLS patients include iron deficiency, end-stage renal disease, sleep deprivation, and obesity.4 Newer studies have suggested that an individual’s genetics may also influence risk of developing RLS.3 While this element is not preventable, understanding this genetic component may be important for the future of RLS treatment.

Medications could also be a culprit. Research has uncovered that antidepressants, antipsychotics, antihistamines like diphenhydramine, and anti-nausea medications such as promethazine have all been associated with higher rates of RLS symptoms. Before your provider prescribes any medication for RLS, they should determine if you meet any of these risk factors.

What Might Make RLS Better?

If it turns out that there are not preventable circumstances causing or worsening RLS, medication may be the next step.  Medications backed by research to support their use for the treatment of RLS include Dopamine Agonists, Alpha-2-Delta Calcium Channel Ligands, and in some cases iron supplementation.5

Dopamine agonists prescribed for RLS symptoms include ropinirole, pramipexole, and rotigotine. These medications are the preferred therapy for individuals with severe RLS but tend to have more side effects associated with long term use compared to other treatment options.5 Alpha-2-Delta Calcium Channel Ligands include pregabalin, gabapentin, and gabapentin enacarbil and may the drug of choice for individuals who do not tolerate dopamine agonists or who suffer from chronic pain.5 However, calcium channel ligands can also cause side effects. The most important side effects include increased risk of suicidal thoughts, medication dependence, and worsening of breathing caused by some drug-drug interactions.

Iron levels in the body have been suspected to play a role in the management of RLS and may be worth discussing with your provider if you think you are suffering from RLS.6 All of the these medications have demonstrated benefit in managing RLS symptoms but you provider should choose your therapy based off the severity of your symptoms, your age, and other conditions you may have.

Are You Suffering From RLS?

If you think you are suffering from RLS, your provider will need to ask you the following questions:7

  1. Do you have an uncomfortable urge to move your legs?
  2. Do these urges to move worsen during periods of rest or inactivity?
  3. Do your symptoms get better with movement?
  4. Do your symptoms occur mostly at night?
  5. Do you have any other medical conditions that may be contributing to your symptoms?

If you have answered yes to all the above questions, speak to your provider regarding your symptoms. If you’re looking for more information regarding RLS, you can visit www.rls.org (Restless Leg Syndrome Foundation) or yoursleep.aasmnet.org (American Academy of Sleep Medicine).

References:

  1. Aurora, R. N., Kristo, D. A., Bista, S. R., Rowley, J. A., Zak, R. S., Casey, K. R., Lamm, C. I., Tracy, S. L., Rosenberg, R. S., & American Academy of Sleep Medicine (2012). The treatment of restless legs syndrome and periodic limb movement disorder in adults–an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline. Sleep, 35(8), 1039–1062. https://doi-org.ezproxy2.library.arizona.edu/10.5665/sleep.1988
  2. Koo BB. Restless Leg Syndrome Across the Globe: Epidemiology of the Restless Legs Syndrome/Willis-Ekbom Disease. Sleep Med Clin. 2015;10(3):189‐xi. doi:10.1016/j.jsmc.2015.05.004
  3. Mitchell U. H. (2011). Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome. Neuropsychiatric disease and treatment7, 251–257. https://doi-org.ezproxy2.library.arizona.edu/10.2147/NDT.S19177
  4. Silber, M. H., Becker, P. M., Earley, C., Garcia-Borreguero, D., Ondo, W. G., & Medical Advisory Board of the Willis-Ekbom Disease Foundation (2013). Willis-Ekbom Disease Foundation revised consensus statement on the management of restless legs syndrome. Mayo Clinic proceedings88(9), 977–986. https://doi-org.ezproxy2.library.arizona.edu/10.1016/j.mayocp.2013.06.016
  5. Garcia-Borreguero D, Silber MH, Winkelman JW, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med. 2016;21:1‐11. doi:10.1016/j.sleep.2016.01.017
  6. Trotti LM, Becker LA. Iron for the treatment of restless legs syndrome. Cochrane Database Syst Rev. 2019;1(1):CD007834. Published 2019 Jan 4. doi:10.1002/14651858.CD007834.pub3
  7. Diagnostic Criteria. (2020). Retrieved June 11, 2020, from http://irlssg.org/diagnostic-criteria

proper use of opiods

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

Pain management has become a national issue with the opioid epidemic. Deaths from opioids have been on the rise; especially, synthetic opioids (fentanyl). According to the Centers for Disease Control and Prevention (CDC), the age-adjusted overdose death rate with synthetic opioids (not including methadone) increased from 0.3 per 100,000 people in 1999 to 9.9 per 100,000 people in 2018.

Opioid Use Outside of the Hospital

Despite this growing concern, opioids still have a place in pain management. For chronic or nerve pain, opioids should only be considered after other options including lifestyle changes, exercise, and other medications.

Acute Pain

Acute pain, or short-term pain, can occur from sudden damage or risk of damage to tissue. For example, a minor surgery or a sports injury would be considered acute pain. The risks of using opioids in acute pain is generally considered to be low.

In most cases, addiction and psychological factors will not be a major concern, and opioids can be prescribed for a short course of pain treatment in severe cases. The expectation of treating this pain with opioids would be a single short course of opioids; less than 14 days.

Chronic Pain

Chronic pain, or long-term pain, can occur from permanent or lasting damage to tissue.  This type of pain is often described as burning, throbbing, or aching. It includes conditions like arthritis and back pain. Chronic pain may or may not have an identifiable cause, and it can last indefinitely. This type of pain usually results in long term increased sensitivity in the area where the pain is, and it can be difficult to treat.

Opioids are generally not preferred for treating chronic pain, and the goals of treatment are different from acute pain.  The expectation of fully relieving the pain or healing back to full health can be unrealistic.  Instead, we try to achieve a “functional” level of control for that individual. Exercise, lifestyle changes, and other medications should all be considered prior to long term opioids. Other medications used are anti-inflammatories (e.g. ibuprofen, naproxen, Celebrex), Tylenol, and many others.

Nerve Pain

Nerve pain and be closely related to chronic pain. Permanent damage to nerves can result in pain that feels like burning or tingling. This type of pain is common among diabetics and as a side effect of some medications. Nerve pain is often managed with medications like gabapentin (a medication that can decrease nerve pain signals), or other medications that can modulate nerve signals, like duloxetine.

Opioids are very rarely used to treat nerve pain. For patients with certain medical conditions, like diabetes, lifestyle changes can be effective for treating or preventing nerve pain. Attaining a healthy weight, getting regular exercise, eliminating smoking, and limiting alcohol are some of the recommendations from the CDC for nerve pain.

Key Takeaways

Various types of pain are caused by different processes within the body, and opioids are not effective treatment for all of them. Opioids are commonly used after severe acute pain and are only used for a few days. Opioids should mostly be avoided in chronic or nerve pain, and if they are used, should be at the lowest possible dose.

References:

  1. CDC, “Prevent Complications.” Centers for Disease Control and Prevention, 1 Aug. 2019.
  2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
  3. Hedegaard, Holly, et al. “Drug Overdose Deaths in the United States, 1999–2018.” NCHS Data Brief No. 356, CDC, Jan. 2020.
  4. Herndon, Chris M., et al. “Pain Management.” Pharmacotherapy: A Pathophysiologic Approach, 10e Eds. Joseph T. DiPiro, et al. New York, NY: McGraw-Hill.
  5. Schumacher, Mark A., et al. “Opioid Agonists & Antagonists.” Basic & Clinical Pharmacology, 14e Ed. Bertram G. Katzung. New York, NY: McGraw-Hill.
  6. Yaksh, Tony, and Mark Wallace. “Opioids, Analgesia, and Pain Management.” Goodman & Gilman’s: The Pharmacological Basis of Therapeutics, 13e Eds. Laurence L. Brunton, et al. New York, NY: McGraw-Hill.

psoriasis treatment - wellrx blog image

By Rosanna Sutherby, PharmD

August is Psoriasis Awareness Month.  According to a recent study, 7.4 million adults in the United States are living with psoriasis. It affects women and men equally and typically begins between the ages of 15 and 25.

Psoriasis is not only a health problem. This condition can also affect your self-esteem and interfere with your social interactions. Fortunately, you do not have to live with the discomfort and embarrassment of psoriasis flare-ups. Advancements in psoriasis treatment make it possible to effectively manage your symptoms and significantly improve your quality of life.

What Is Psoriasis?

Psoriasis is an autoimmune disease that affects your skin. If you have an autoimmune disease, your immune system, which normally protects your body from infection, instead attacks healthy cells.

Psoriasis causes red, itchy patches of skin that are covered with thick scales. These patches are the result of skin cells that grow abnormally quickly. The most commonly affected areas are the knees, elbows, trunk, or scalp; however, psoriasis can occur on any part of the body.

Although no cure exists for psoriasis, several forms of treatment can alleviate symptoms and improve your quality of life. The goal of psoriasis treatment is to slow cell growth and remove scaly skin.

The type of treatment that you receive for psoriasis depends on the severity of your symptoms and how you respond to treatment. The following are methods of psoriasis treatment commonly used today:

  • Topical treatment
  • Light therapy
  • Oral systemic medications
  • Biologics or targeted treatment
  • Oral targeted treatment

Topical Treatments for Psoriasis

Topical treatments are medications applied to the affected skin. Topical treatments for psoriasis are available as creams, ointments, lotions, gels, foams, sprays, or shampoos. Common topical medications used to treat psoriasis include the following:

  • Corticosteroids: Corticosteroids are the most commonly used medications to treat mild to moderate psoriasis. Your doctor may use a mild steroid, such as hydrocortisone, for sensitive areas like your face or skin folds. More potent steroids, such as triamcinolone, (Acetonide, Trianex) or clobetasol (Temovate), can be used on less sensitive skin or areas that are difficult to treat.
  • Vitamin D analogs: Synthetic vitamin D products, such as calcipotriene (Dovonex, Sorilux) and calcitriol (Vectical), may be used alone or combined with corticosteroids. They work by slowing down the growth of skin cells.
  • Retinoids: Drugs in this category include tazarotene (Tazorac, Avage).
  • Calcineurin inhibitors: Medications in this class, including Elidel (pimecrolimus) and Protopic (tacrolimus), help reduce plaque buildup.

Light Therapy for Psoriasis

Light therapy may be used alone or in combination with other therapies to treat moderate to severe psoriasis. Your doctor may recommend controlled amounts of exposure to natural sunlight or artificial light. Ultraviolet B (UVB) rays can slow the growth of skin cells.

Oral Systemic Treatment for Psoriasis

If topical products or light therapy does not adequately control your psoriasis, your doctor may prescribe oral medications. Commonly prescribed oral medications for psoriasis include the following:

Biologics or Targeted Therapy for Psoriasis

The newest advancements in psoriasis treatment include biologic medications. These medicines are cytokines, or proteins, that are made from living cells and target specific pathways that promote inflammation. They work by blocking immune system cells, such as T cells, or proteins, such as tumor necrosis factor-alpha (TNF-alpha), interleukin 17-A (IL-17A), or interleukins 12 and 23 (IL-12/23). Blocking these cells and proteins that are responsible for inducing the inflammatory process that promotes rapid cell growth in psoriasis helps reduce the cycle of inflammation.

Biologics are typically used in people with moderate to severe psoriasis who have not seen improvement with other treatments. Many people who use biologics notice an improvement in their symptoms within weeks.

Be sure to ask your doctor if biologics are safe for you. These drugs must be used with caution because they can suppress your immune system and increase your risk of infection.

Injectable biologics used to treat psoriasis include the following:

TNF-alpha inhibitors

IL-12/23 and IL-23 inhibitors

IL-17 inhibitors

T-cell inhibitor

New Oral Targeted Treatment for Psoriasis

Researchers have developed other treatments for psoriasis that selectively target immune cells in a way that is similar to biologics. However, these new drugs are smaller molecules and are available as tablets that can be taken orally.

These medications are typically taken daily and continuously, if well tolerated, to keep your psoriasis symptoms under control.

Oral targeted treatments for psoriasis include the following:

Be sure to talk to your doctor or pharmacist about the possible side effects and risks of taking these medications.

Biosimilars and the Future of Psoriasis Treatment

Although biologics offer significant advantages in psoriasis treatment, their high cost may be a barrier to access. Drug manufacturers have developed products called biosimilars to increase the availability and reduce the cost of effective therapy for patients with psoriasis.

Biosimilars are similar to biologic drugs on the market, but they are not exact replicas. To be approved by the FDA, biosimilars must be highly similar to the compared product, treat the same conditions, work in the same way, and come in the same form and dosages.

The following are currently FDA-approved biosimilars for psoriasis treatment:

  • Amjevita (adalimumab-atto) is biosimilar to Humira
  • Cyltezo (adalimumab-adbm) is biosimilar to Humira
  • Erelzi (Etanercept-szzs) is biosimilar to Enbrel
  • Inflectra (infliximab-dyyb) is biosimilar to Remicade
  • Renflexis (infliximab-abda) is biosimilar to Remicade

Further research is currently underway to develop and introduce other biosimilars in the future. These drugs can offer savings for some of the expensive psoriasis therapies.

If you are concerned about the cost of your psoriasis medicine, be sure to compare prescription prices before heading to a pharmacy near you. A free Rx savings card can help you save as much as 80% off your prescription psoriasis 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.jaad.org/article/S0190-9622(13)01268-1/fulltext

https://www.wellrx.com/health-conditions/about/health-condition/psoriasis/~default/

https://www.psoriasis.org/research/science-of-psoriasis/immune-system#:~:text=Researchers%20agree%20that%20psoriatic%20disease,by%20an%20overactive%20immune%20system.

https://magazine.medlineplus.gov/article/psoriasis-on-the-road-to-discovery

https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845

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

https://www.wellrx.com/TRIAMCINOLONE%20ACETONIDE/drug-information/

https://www.wellrx.com/CLOBETASOL%20PROPIONATE/drug-information/

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

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

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

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

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

https://www.psoriasis.org/about-psoriasis/treatments/phototherapy

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

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

https://www.wellrx.com/CYCLOSPORINE%20MODIFIED/drug-information/

https://www.psoriasis.org/about-psoriasis/treatments/biologics

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

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

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

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

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

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

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

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

https://www.wellrx.com/COSENTYX%20SYRINGE/drug-information/

https://www.wellrx.com/TALTZ%20AUTOINJECTOR/drug-information/

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

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

https://www.psoriasis.org/about-psoriasis/treatments/oral-treatments

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

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

https://www.psoriasis.org/biologics

https://www.wellrx.com/pricing-basket/

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

https://www.wellrx.com/

juvenile arthritis - wellrx blog image

By Rosanna Sutherby, PharmD

July is Juvenile Arthritis Awareness Month. An estimated 300,000 children in the United States have some type of juvenile arthritis (JA). The most common of these is juvenile idiopathic arthritis.

What Is Juvenile Arthritis?

Juvenile arthritis is an autoimmune disorder that occurs in children 16 years or younger. This means that the body’s immune system attacks its own healthy cells. It is characterized by joint pain, swelling, stiffness, and loss of motion. Symptoms can range from mild to severe enough to cause joint or tissue damage.

Some children may have one or two flare-ups in their lifetime, while others may have symptoms for years. The most common type of JA is juvenile idiopathic arthritis. “Idiopathic” means that the cause is not known.

Scientists believe that some children have a gene that makes them more likely to develop JA. Exposure to environmental factors, such as a virus or bacteria, triggers the disease to appear. Most cases of JA are not hereditary, which means that it does not run in families.

Prescribed a medication for Juvenile Arthritis?

How Do You Diagnose Juvenile Arthritis?

Diagnosing JA can be tricky because the symptoms resemble other conditions. The following tests help your child’s doctor rule out other disorders:

  • Blood tests
  • X-rays
  • MRIs
  • Medical history
  • Physical exam

To diagnose JA, the child must have arthritis symptoms for six consecutive weeks, and the symptoms must have appeared by the age of 16.

What Are the Signs and Symptoms of Juvenile Arthritis?

Often, the first sign of JA is a morning limp that is caused by an inflamed knee. Other symptoms of the disease include:

  • Joint pain
  • Swelling
  • Stiffness
  • Tiredness
  • Loss of appetite
  • Eye inflammation
  • Difficulty doing daily activities, such as walking, dressing, or playing
  • Fever
  • Rash

How Do You Treat Juvenile Arthritis?

The goal of juvenile arthritis treatment is to help your child maintain normal physical activity and social functioning. To do this, your child’s doctor will use a combination of treatments that reduce pain and swelling, maintain full movement and strength of the joints, and prevent complications or joint damage.

The most significant part of treatment for JA is medication. Commonly used drugs include the following:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Typical NSAIDs used to relieve pain and swelling include ibuprofen (Advil, Motrin, and others) and naproxen (Naprosyn, Aleve).
  • Disease-modifying antirheumatic drugs (DMARDs): The most commonly used DMARD is methotrexate. Your child’s doctor may prescribe methotrexate if NSAIDs do not relieve his or her symptoms. Methotrexate may be used in combination with NSAIDs to slow the progression of the disease.
  • Biologic agents: Biologic agents, or biologic response modifiers, are a new class of drugs made from living cells. Some medications, such as Enbrel (etanercept) and Humira (adalimumab), work by blocking the action of tumor necrosis factor (TNF). TNF is a protein in your body that causes inflammation. Other biologic agents, such as Orencia (abatacept), Rituxan (rituximab), Kineret (anakinra), and Actemra (tocilizumab), work by suppressing your immune system.
  • Corticosteroids: Corticosteroids, such as prednisone, may treat severe symptoms, such as inflammation of the sac around the heart. Steroids can interfere with your child’s growth, so they should be used only for a short time.

What Can You Do at Home?

Family members and parents can play a significant role at home in helping children live with JA. The following are ways in which you can be involved in your child’s treatment:

  • Make sure your child gets regular exercise to build muscle strength and maintain joint flexibility. Encourage them to participate in physical activities and sports, especially during symptom-free periods. Be sure to adhere to recommendations from your child’s doctor or physical therapist.
  • Apply a hot pack or have your child take a warm bath or shower to relieve stiffness, especially in the morning.
  • Maintain a healthy diet for your child. Some children may lose their appetite, and others may gain weight due to medication side effects.
  • Treat your child as you would treat other children in your household. Treating your child as normally as possible encourages responsibility and independence on his or her part.
  • Allow your child to express their feelings about having JA. Explain to them that the disease is not their fault.
  • Work closely with teachers and administrators at your child’s school to help develop plans for the best way for your child to navigate classes and assignments.

Will My Insurance Pay for My Child’s Juvenile Arthritis Medication?

Generic medications, such as methotrexate and prednisone, are generally covered by most insurance plans. Some plans may not cover medicines that are available over the counter, such as ibuprofen or naproxen. Biologic agents, such as Enbrel, Humira, Orencia, Rituxan, Kineret, and Actemra, may be costly. Your plan may require prior authorization before covering them.

If your insurance does not cover your child’s medication or the cost is too high, you can use a prescription savings card to get the lowest prescription price at a pharmacy near you. Be sure to compare prescription prices and use your free RX savings card before filling your child’s JA 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.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis

https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/symptoms-causes/syc-20374082

https://www.niams.nih.gov/health-topics/juvenile-arthritis/advanced#tab-overview

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

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

https://www.wellrx.com/METHOTREXATE/drug-information/?cultureCode=en-US

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

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

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

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

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

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

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

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

https://www.wellrx.com/find-a-pharmacy-near-me/

https://www.wellrx.com/

allegra or claritin - scriptsave wellrx blog image

By Rosanna Sutherby, PharmD

Antihistamines, or allergy medicines, come in all shapes and sizes. Nearly all are now available over the counter (OTC). With so many choices currently available, you may wonder what the differences are among them.

Antihistamines fall into two categories: first-generation antihistamines and second-generation antihistamines. First-generation antihistamines are older products that are shorter acting and are more likely to cause drowsiness, dizziness, and other side effects. Second-generation antihistamines were introduced in the 1990s and have minimal or no sedating side effects. These newer drugs are also longer acting and are generally dosed once a day. Allegra (fexofenadine) and Claritin (loratadine) fall into the category of second-generation antihistamines. The following is a comparison between the two.

Prescribed an allergy medication? Don’t pay full price.

How Do Allegra and Claritin Work?

Allegra and Claritin work by blocking the effects of histamine, a chemical that your body releases when exposed to allergens, such as pollen, ragweed, or pet dander. Histamine triggers symptoms such as sneezing, itching, runny nose, and watery eyes.

What Conditions Do Allegra and Claritin Treat?

Allegra is indicated for the treatment of seasonal and yearlong allergies in patients ages 2 years and older. It is also used to relieve chronic itching in patients ages 6 months and older.

Claritin is used to treat the symptoms of seasonal and yearlong allergies, as well as chronic itching in patients ages 2 years and older. Claritin has also been used off label (not FDA approved) to prevent exercise-induced asthma in patients with allergies.

How Long Do Allegra and Claritin Last?

Allegra generally starts working about 1 hour after you take it. The effects of a 60 mg dose last about 12 hours, and a 120 mg or 180 mg dose last about 24 hours.

Claritin begins to work about 1 to 3 hours after you take it, and the effects of a 10 mg dose last about 24 hours.

What Are the Side Effects of Allegra and Claritin?

The most commonly reported side effects for Allegra are the following:

  • Headache
  • Dizziness
  • Back pain
  • Pain in hands or feet
  • Stomach problems

The most common side effects associated with Claritin are the following:

  • Headache
  • Sleepiness
  • Tiredness
  • Dry mouth
  • Nervousness
  • Wheezing

If you have kidney problems, talk to your doctor about lowering your dose of Allegra or Claritin.

If you have liver problems, you can take the full dose of Allegra, but Claritin’s dose may need to be adjusted.

What Medications Interact with Allegra and Claritin?

If you are taking Allegra, be aware of the following potential interactions:

  • Antacids: You should not take Allegra within 15 minutes of taking antacids containing aluminum or magnesium
  • Ketoconazole: Ketoconazole may interfere with the metabolism of Allegra and cause the medication to build up in your body.
  • Erythromycin: Erythromycin may interfere with the metabolism of Allegra and cause the medication to build up in your body.
  • Fruit Juices: Fruit juices, such as grapefruit juice, orange juice, and apple juice, may reduce the effects of Allegra.

Claritin has fewer interactions than Allegra. You should not take Claritin with other antihistamines or allergy medications.

Can I Take Allegra or Claritin if I Am Pregnant or Breastfeeding?

Allegra is classified as pregnancy category C, which means that you should use it only if the potential benefits of taking the medication outweigh the potential risks to your baby. Be sure to discuss your options with your OB/GYN.

Claritin is classified as pregnancy category B, which means that the medication is generally safe to use during pregnancy if it is clearly needed. Other medicines in category B include prenatal vitamins and acetaminophen (Tylenol).

Claritin passes into breast milk, and you should not take it while you are breastfeeding. Researchers do not know if Allegra passes into breast milk. Given the lack of information, you should not use Allegra if you are nursing. Antihistamines, in general, tend to dry up breast milk. If you are breastfeeding, talk to your doctor or pharmacist about safe options to treat allergy symptoms.

Which Is Better — Allegra or Claritin?

The choice between Allegra and Claritin depends on several factors. Allegra can be used by patients as young as 6 months, and you do not need to adjust the dose if you have liver problems. However, Claritin has fewer drug interactions than Allegra, and it is a safer choice if you are pregnant.

2001 study that compared Allegra and Claritin for the treatment of seasonal allergy symptoms showed that Claritin was better at relieving symptoms and worked faster than Allegra. However, after seven days, the effects of the two drugs were similar. Participants of this study took 10 mg of Claritin once a day or 60 mg of Allegra twice a day.

Another clinical trial in which participants took 10 mg of Claritin once a day or 120 mg of Allegra once a day showed that Allegra was better at relieving itchy, watery eyes, and nasal congestion. Allegra was also better at improving quality of life.

How Much Do Allegra and Claritin Cost?

Allegra and Claritin are both available OTC without a prescription. As of the time this article, the average retail cost for 30 fexofenadine (generic for Allegra) 180 mg tablets is about $15. The average retail cost for 30 loratadine (generic for Claritin) 10 mg tablets is about $11.

If your insurance does not cover Allegra or Claritin because they are available OTC, 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.ncbi.nlm.nih.gov/books/NBK538188/

https://www.wellrx.com/FEXOFENADINE%20HCL/monographs/

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3667286/#:~:text=A%20major%20advance%20in%20antihistamine,of%20the%20blood%E2%80%93brain%20barrier.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020872s018,021963s002lbl.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20641s7lbl.pdf

https://www.medscape.com/viewarticle/406235_1

https://pubmed.ncbi.nlm.nih.gov/10848909/

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

staying active during quarantine - wellrx blog image

By Lucas Rolwes, PharmD. Candidate 2021,
St. Louis College of Pharmacy

Being physically active can improve mood, reduce risk of chronic conditions, improve overall health, and help increase life expectancy.

In numerous areas, however, gyms and fitness centers are closed due to the current COVID-19 pandemic. Many people are also being required to work from home or cannot leave their house due to health concerns. Even though you may not be able to get to your usual gym, it’s still important that you stay active to maintain overall health and well-being.

How Much Activity Do You Need?

It is recommended that most adults get 150 minutes of moderate-intensity aerobic activity per week with 2 days of muscle-strengthening activity per week. Children and adolescents (ages 6-17 years old) need 60 minutes of exercise every day, as well as 60 minutes of bone and muscle strengthening activities at least 3 days a week.

Different Types of Exercise

Incorporating a wide variety of exercises benefits the body in different ways.

Getting Creative During Quarantine

Here are some ways you can stay active while social distancing:

  • Take short breaks throughout the day to stay active. Stand up and move around every 30 minutes throughout the day. Many web browsers have downloadable plugins that can help remind you to take breaks, rest your eyes, or even drink water.
  • Walk for brief periods around the house or in place. Even though you may not be covering much distance, even walking around the house or in place can be beneficial.
  • Utilize virtual classes and workout programs. There are many options for free virtual workouts through Amazon, YouTube, and mobile applications.
  • Exercise during commercials. Doing short workouts during commercial breaks is a good way to stay active in your down time.
  • Use household items for weight training. Items like, canned foods, laundry detergent, or loaded buckets can supplement free weights. Using a home scale can help determine how heavy certain objects are.
  • For the entire family: scavenger hunts, art shows, building forts, and playing outside with family members can provide activity to children and adolescents.
  • For pets: it is still safe to walk dogs if they are kept on a leash at least 6 feet away from others. Avoid crowded parks and do not cover your pets face with a face mask as this could harm them.
Related Topics:
- How to Watch Your Weight During a Quarantine
- COVID-19 Family Health Activities

Activities to Avoid

To help stay safe during the current pandemic, there are several activities the U.S. Department of Health and Human Services recommends avoiding.

  • Group workouts: participating in group workouts that require participants to be in close proximity should be avoided. Instead create virtual workouts with friends.
  • Team sports: group sports that require close personal contact should be avoided (Ex. Basketball, football, and soccer) Instead, practice personal skills in an open space.
  • Lifting weights at the gym: free-weights and machines may not be properly cleaned between uses which could lead to possible transmission. Instead, utilize household items for weight training.
  • Taking children to playgrounds: even though playgrounds may seem empty, they are used by many different people and are not regularly cleaned. Instead, create fun ways for children to be active at home.

It is always recommended to consult with your physician before beginning an exercise routine to ensure safety. To stay up to date on current social distancing guidelines check https://health.gov.

References:

  1. U.S. Department of Health and Human Services, Office of Disease Prevention and Human Health. (2020, April 7) Staying active while social distancing: questions and answers. Retrieved from https://health.gov/news/202004/staying-active-while-soial-distancing-questions-and-answers
  2. U.S. Department of Health and Human Services, Centers for Disease Control, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2020, April 10) Aerobic, muscle- and bone-strengthening: what counts for school-aged children and adolescents? Retrieved from https://www.cdc.gov/physicalactivity/basics/children/what_counts.htm
  3. World Health Organization Regional Office for Europe. (2020) Stay physically active during self-quarantine. Retrieved from http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/stay-physically-active-during-self-quarantine
  4. U.S. Department of Health and Human Services, National Institute of Health, Osteoporosis and Related Bone Diseases National Resource Center. (2018, October) Exercise for your bone health. Retrieved from https://www.bones.nih.gov/sites/bones/files/pdfs/exercisebonehealth-508.pdf
  5. Harvard Medical School, Harvard Health Publishing. (2019, September 25) The importance of stretching. Retrieved from https://www.health.harvard.edu/staying-healthy/the-importance-of-stretching
  6. U.S. Department of Health and Human Services, Centers for Disease Control, National Center for Immunization and Respiratory Diseases, Division of Viral Disease. (2020, June 2) COVID-19 and animals. Retrieved from  https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html

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/