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by Cindy Cho, PharmD Candidate Class of 2019,
The University of Arizona College of Pharmacy

In short, no. You cannot get pneumonia from the pneumonia vaccine. With all of the news coverage about vaccines, it is important to equip yourself with the knowledge on what vaccines are, how they work, and why they don’t cause disease, so you can make an informed decision on your health.

What is a vaccine?

A vaccine is a substance that contains very small amounts of weakened or dead germs to stimulate your body to produce immunity against certain diseases. Before the invention of vaccinations, the only way a person’s body can gain immunity to certain diseases is to (hopefully) survive an infection from the germ that causes the disease. For example, if a person gets pneumonia, an infection of the lung, from a certain germ and survives, their body will remember that specific germ if it were to come across it again. By remembering the germ, the body can protect itself and fight off the infection more efficiently to prevent sickness in the future. Vaccines provide a similar immune system response to help the body create immune system cells to remember disease-causing germs to protect your body, but the best part is that vaccines don’t come with the risks of getting the actual disease or its associated complications. Some vaccines can provide protection against multiple types of germs that cause the same disease to better protect against epidemics.1

What are pneumonia vaccines?

Now that you understand how vaccines work, let’s talk about the pneumonia vaccines! There are two pneumonia vaccines intended for use in the United States by the Food and Drug Administration (FDA), which includes the pneumococcal conjugate vaccine (PCV13 or Prevnar 13) and the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23).2 Both of these pneumonia vaccines contain inactivated, or dead, germs. Because these vaccines contain dead germs, they cannot replicate in the body or cause disease.1 The differences between the two pneumonia vaccines are shown below:

  • Prevnar 13: this is a conjugated vaccine, which means it contains a protein that is joined to a part of dead bacteria to improve the protection the vaccine provides. Doctors give this vaccine to children at 2, 4, 6, and 12 through 15 months old. Young children need multiple doses of this vaccine to boost their protection since their immune system is not yet mature. Adults who need this vaccine only get a single dose. The vaccine has 13 in its name because it helps protect against 13 types of pneumococcal bacteria that most commonly causes serious infections in children and adults.2
  • Pneumovax 23:  this is a polysaccharide vaccine, which means it is made to look like the surface of certain bacteria in order to help the body build protection against that germ. Doctors give a single dose of this vaccine to people who need it. CDC recommends one or two additional doses for people with certain chronic medical conditions. The vaccine has 23 in its name because it helps protect against serious infections caused by 23 types of pneumococcal bacteria.2

 So, who needs the pneumonia vaccines?

Great question! Pneumonia disproportionately affects the young, the elderly, and the immunocompromised, so the CDC recommends these vulnerable patient populations to receive the pneumonia vaccines.3 The CDC created an immunization schedule that outlines when the two pneumonia vaccines should be received.

CDC recommends vaccination with the pneumococcal conjugate vaccine (PCV13 or Prevnar 13®) for:2

  • All children younger than 2 years old
  • All adults 65 years or older
  • People 2 through 64 years old with certain medical conditions*

CDC recommends vaccination with the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax23®) for:2

  • All adults 65 years or older
  • People 2 through 64 years old with certain medical conditions*
  • Adults 19 through 64 years old who smoke cigarettes

*Certain medical conditions such as: chronic heart disease, lung disease, liver disease, diabetes, HIV, or certain cancers warrant some adults to receive the pneumonia vaccines before the age of 65.4

What are the side effects of the pneumonia vaccines?

Reactions to the pneumonia vaccine can occur, such as cold-like symptoms, but it is important to realize that those are adverse reactions to the vaccine and not pneumonia itself. Talk to your doctor if you have allergies to any ingredients in vaccines. Below are common adverse reactions to the pneumonia vaccines:

Mild side effects reported with Prevnar 13 can include:2

  • Reactions where the shot was given
    • Redness
    • Swelling
    • Pain or tenderness
  • Fever
  • Loss of appetite
  • Fussiness (irritability)
  • Feeling tired
  • Headache
  • Chills

Mild side effects reported with Pneumovax23 can include:2

  • Reactions where the shot was given
    • Redness
    • Pain
  • Fever
  • Muscle aches

Why are the pneumonia vaccines important?

Vaccines, like the pneumonia vaccines, can prevent or decrease the severity of diseases. Unfortunately, around 50,000 people die from pneumonia in the United States each year.3 It is passed along through airborne droplets, such as from a cough or sneeze, so it is a highly contagious infection.2 It is crucial to receive the pneumococcal vaccine to not only protect yourself but to protect your loved ones around you. Especially if you have a breathing condition like asthma or COPD, it is important to have the pneumonia vaccines to prevent respiratory infections that can potentially make your breathing worse. Talk to your provider or local pharmacy if you are due for your pneumonia vaccine today.

References:

  1. Principles of Vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/pinkbook/prinvac.html. Published September 8, 2015. Accessed February 14, 2019.
  2. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html. Published December 6, 2017. Accessed February 14, 2019.
  3. Top 20 Pneumonia Facts (2018). American Thoracic Society.  https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf. Accessed February 14, 2019.
  4. Recommended Adult Immunization Schedule for ages 19 years or older, United States, 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#note-pneumo. Published January 2019. Accessed February 14, 2019.

 


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hypothyroidism - dr. checking patient - scriptsave wellrx blog

by Jamie Voigtmann, PharmD Candidate

Your body has a number of glands, but the thyroid gland is the small gland at the base of your neck that makes hormones to regulate your metabolism. This impacts your body’s metabolic rate (how you burn calories) as well as heart and digestive function, mood, and more. But what happens if something impacts the thyroid?

How Does the Thyroid Work?

First, the hypothalamus releases TRH which activates the pituitary to release TSH.1 This in turns activates the thyroid to produce and release T4 and T3 into the body but at an approximately 14:1 ratio, with T4 being 14 and T3 being 1.2 Then T4 and T3 bind to proteins and travel to other tissues in the body. There, the T4 will be changed to T3 by removing one molecule iodine.1 This is important because T3 is the active thyroid hormone unlike T4, which is inactive; T3 allows the body to control metabolism, temperature, and heart rate.1 Finally, the T4 and T3 in the body cause a negative feedback loop to the hypothalamus and pituitary. This can make the hypothalamus and the pituitary produce more hormones when T4 and T3 are low or produce less hormones when T4 and T3 are high.1

thyroid process - diagram - scriptsave wellrx blog image

What are the Causes and Symptoms of Hypothyroidism?

Hypothyroidism is most commonly caused by an autoimmune disorder which is when the body’s immune system attacks its own tissues rather than infections. Because of this, the autoimmune disorder causes a decreased amount of T4 and T3 being made.3 Other causes, although unlikely, include a low amount of iodine through diet, removal of the thyroid, radiation therapy for cancer treatment, and certain drugs (amiodarone, lithium, iodine, and rifampicin). Signs and symptoms of hypothyroidism are commonly dry skin, sensitivity to the cold, constipation, poor memory, fatigue, weight gain, puffiness around the eyes, and a slowed heart rate. These signs and symptoms are highly suggestive of hypothyroidism, but alone cannot diagnose this condition. Diagnostic measures most commonly include high TSH levels and low T4 levels.

What are the Treatment Options?

Synthetic T4 Replacement

The most common T4 replacement medication is levothyroxine, and it is recommended as the first treatment option for hypothyroidism.2 Although it is not the active form (T3), it can be made into T3 in the body’s tissues and is generally well-tolerated by many patients. Benefits of levothyroxine include normalizing thyroid function, once daily dosing, few side effects, low cost, and safety in pregnancy.2 But one thing that is very important and specific about levothyroxine is how it is taken. Levothyroxine must be taken on an empty stomach so that it can be appropriately absorbed by the body.3 This is easiest to accomplish in the morning right after waking up, at least 30 minutes before eating breakfast; but, it is possible to take levothyroxine before bedtime as long as it is 4 hours after eating.2 Levothyroxine must also be taken separately (approximately 4 hours before or after) from products such as calcium, iron, and antacids that contain aluminum or magnesium in order to optimize its absorption and efficacy.3 These products are commonly in the form of vitamins or supplements, as well as Tums, Mylanta, Milk of Magnesia, Alka-Seltzer, Maalox, and Rolaids.

Synthetic T3 Replacement

Hypothyroidism therapy also can consist of liothyronine, which is the active form of thyroid hormone: T3. Liothyronine has some disadvantages for the treatment of hypothyroidism when compared to levothyroxine. Currently it is only approved for once daily dosing, but this does not mimic the true release pattern of T3 from the thyroid.4 One small, randomized study showed an improvement in weight loss and decreased lipid profile compared to levothyroxine, but only if liothyronine was taken three times daily.4 Because of this, liothyronine is not currently recommended over levothyroxine because it’s once daily dosing does not provide better results.2 But, it is possible an extended-release formulation of liothyronine can prove to be clinically beneficial in the future.2 Overall, liothyronine has some disadvantages for the treatment of hypothyroidism when compared to levothyroxine such as unknown dosing schedule for best effect and increased cost.

Synthetic Combination Therapy

Some medications used to treat hypothyroidism have a mixture of T4 and T3. Unfortunately, there are many differing studies with different T4:T3 ratios and have unclear results.3 But, many of these clinical trials do not show benefit of T4 and T3 over T4 alone (levothyroxine).2 It has been reported that few patients taking levothyroxine alone still experienced signs and symptoms of hypothyroidism, although their TSH level was corrected to its normal value; and it has been discussed that these patients could potentially benefit from combination T4 and T3 therapy, but evidence is limited.2,3 Overall, levothyroxine remains the standard of care when treating hypothyroidism, with combination therapy of T4 and T3 only being considered after a patient tries levothyroxine and it does not work effectively.2

Natural Desiccated Therapy

This type of hypothyroid medication is also a combination of T4 and T3 but instead of being synthetic (made from chemicals), it is naturally obtained. This is because it is derived from thyroids of animals, particularly domesticated pigs.2,5 The common name of this type of medication is Armour Thyroid.5 The T4:T3 ratio is always 4:1, unlike the natural body’s ratio of 14:1.2 This can lead to an increased level of T3 at once and can result in adverse effects including increased heart rate and anxiety.2 But, there was one minor study completed that reported results of patients preferring desiccated therapy over levothyroxine due to decreased symptoms of hypothyroidism.5 Because this study was small, did not use appropriate questionnaires, and did not assess safety, it does not warrant its use over levothyroxine for hypothyroidism.2 Natural desiccated therapy falls into the same category of combination therapy . It should only be considered for patients who have tried levothyroxine and did not correct his/her thyroid function.2

References

  1. Yen PM. Physiological and molecular basis of thyroid hormone action. Physiol Rev. 2001; 81(3): 1097-1142.
  2. Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014; 24(12): 1670–1751.
  3. Chakera AJ, Pearce SHS, Vaidya B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Devel Ther. 2012; 6: 1–11.
  4. Celi FS, Zemskova M, Linderman JD, et al. The pharmacodynamic equivalence of levothyroxine and liothyronine. a randomized, double blind, cross-over study in thyroidectomized patients. Clin Endocrinol (Oxf). 2010; 72(5): 709–715.
  5. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol Metab. 2013; 98(5): 1982-1990.
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probiotics - yogurt image - scriptsave wellrx blog

by Terra Leon, PharmD Candidate 2019

Bacteria in food might not sound like a good thing, but probiotics are good bacteria that mimic the natural bacteria you have in your gut. The bacteria that naturally occurs in the gut supports proper gastrointestinal health and digestion. Different strains of probiotics can also support other functions in the body such as reduce vaginal infections, prevent autoimmune disease, reduce urinary tract infection rate, and ease skin ailments2.

Sources of Probiotics

Probiotics can be taken in several ways. As supplements, much like vitamins, or in dairy products, like yogurt, cheese, lactobacillus milk or kefir.

When choosing a dairy product like yogurt for your intake of probiotics it is important to choose a yogurt that has “Live and Active Cultures” on the product label. This statement means that the yogurt has at least 100 million active cultures per gram of yogurt1.  If you choose to use supplementation in the form of a capsule you should try and choose a product with a strain of probiotic that aids in the reason you are taking it. To start, most patients use a probiotic supplement that has both species of Bifidobacterium and Lactobacillus because these species are most commonly found in the gastrointestinal tract and aid in digestive health1. A commonly prescribed probiotic is VSL #3. Ask your doctor or pharmacist if this could be right for you.

What are Antibiotics

Antibiotics are widely used when a patient has a bacterial infection in the body. They work by inhibiting growth and replication of the bad bacteria that has infected your body. Different antibiotics target different bad or foreign bacteria in your body. Some even have a wide spectrum of activity and can wipe out the bad bacteria and the beneficial.

Purpose of Combined Use

When a patient receives a new antibiotic from their doctor, they are often told at the pharmacy that this medication has the potential to cause stomach upset or diarrhea for up to a month after use. The reason this happens is the antibiotic taken for an infection is powerful enough to kill off most bacteria in the body during the period it is being consumed. This includes the normal flora in your gut which helps with digestion and stool formation. Taking a probiotic with the species Bifidobacterium and/or Lactobacillus can greatly help reduce the likelihood of prolonged diarrhea and stomach pain. Once the antibiotic is consumed it will wipe out the bacteria in your stomach (good and bad) so taking a probiotic to help replace the good digestive bacteria can help reduce stomach upset. When using probiotics with antibiotics it is important to separate the two by 2 hours to ensure the antibiotic doesn’t wipe out the probiotic you just consumed. Using probiotics during antibiotic treatment and up to 3-7 days after antibiotic treatment can reduce the likelihood of stomach upset5. Always check with your doctor or pharmacist to ensure the use of probiotics is appropriate.

Risk vs Benefit

Probiotics are great in aiding in digestive health and preventing unwanted disorders. However, for those who are immunocompromised the risk can out weigh the benefit. Since the majority of probiotics work in the digestive tract side effects like gas and bloating are a possibility. Patients who have a compromised immune system, have certain bowel problems or are severely ill need to consult their doctor before starting a probiotic. Pregnant women and young children need to consult their doctor before starting probiotics.

Common Species/Strains of Probiotics Available

Species

  • Bifidobacteria (B.): commonly used in food and supplements to support your immune system, decrease growth of harmful bacteria in gut, and help breakdown lactose into nutrients2.
  • Lactobacillus (L.): produces lactase to breakdown lactose and produce lactic acid. Lactic acid helps reduce the amount of harmful bacteria and can fuel the body’s absorption of minerals2. This species of bacteria is commonly found in the mouth, vagina and small intestines.

Strains

  • animalis: helpful in supporting digestion, supporting immune health and fighting food borne bacteria2.
  • breve: works in the digestive tract and vagina to reduce yeast and ferments sugars to help your body absorb the nutrients2.
  • lactis: improves digestion, lower cholesterol and enhances immunity and fights tumor growth3.
  • longum: found in the GI tract and aids in the breakdown of carbohydrates and has antioxidant properties2.
  • acidophilus: found in the small intestines and the vagina. Helps to improves blood pressure and cholesterol, fights off bacterial/viral/fungal infections, aid in digestion and even reduce allergy severity3.
  • reuteri: found in the mouth and intestines. It helps fight off gingivitis by reducing oral bacteria that causes tooth decay and can help re-establish the pH of the vagina and aid in the digestive system2,3.
  • rhamnosus gg: boost immune system, reduce allergies and inflammation and can aid in digestive support by decreasing constipation, leaky gut symptoms and IBS symptoms3.
  • plantarum: can improve your overall health by improving your digestion and immunity. This strain of probiotic has a growing temperature that is very close to our body temperature allowing it to thrive3.
  • gasseri: found in the digestive and vaginal tract. This strain can assist with weight loss by possibly suppressing dietary fat absorption in the small intestines and in turn inhibiting calorie intake4.
  • casei: improves immunity, allergies (pollen), digestion (fights diarrhea) and can improve cholesterol levels3.
  • brevis: can reduce mouth ulcers and periodontal disease. This strain has also been seen to reduce urinary oxalate levels (kidney stones) and decrease H. pylori colonization3.
  • salivarius: found in the colon, vagina, small intestines and mouth. This strain can improve dental health, immunity and digestion3.

Resources:

  1. “What are probiotics?” Mayo Clinic. 14 Apr. 2017. Mayo Foundation for Medical Education and Research. 23 Jan. 2019 <https://www.mayoclinic.org/what-are-probiotics/art-20232589>.
  2. “6 Most Common Types of Probiotics.” Healthline. Healthline Media. 23 Jan. 2019 <https://www.healthline.com/health/types-of-probiotics#benefits>.
  3. Jerkunica, Evan. “About Top 15 Most Researched Probiotic Strains.” Lactobacillus plantarum Benefits & Side Effects – Probiotics.org. 2014. 23 Jan. 2019 <http://probiotics.org/strains/>.
  4. Leech, Joe. “Probiotics and Weight Loss Review: Microscopic Miracle or Mirage?” DIET vs DISEASE. 17 Dec. 2018. 23 Jan. 2019 <https://www.dietvsdisease.org/probiotics-and-weight-loss-review/>.
  5. Sherman, Max. “Probiotics and Microflora.” U.S. Pharmacist – The Leading Journal in Pharmacy. 17 Dec. 2009. 23 Jan. 2019 <https://www.uspharmacist.com/article/probiotics-and-microflora>.

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nocturnal cramps - scriptsave wellrx blog image

by Katie Tam, PharmD Candidate
Class of 2019, University of Arizona

Do you wake up in the middle of the night feeling as if your lower legs are paralyzed and cramped? Do your lower leg muscles feel as if they are hard to the touch and tight? If you experience these symptoms, you may have nocturnal leg cramps.

What are Nocturnal Leg Cramps?

Nocturnal leg cramps (leg cramps at night), also called Charley horses, are involuntary contractions or spasms of the muscles in the legs that usually occur during the night. These leg cramps often involve the posterior calf muscles, but can also involve the feet or thigh muscles. Because the muscles are tightened and knotted, nocturnal leg cramps are extremely painful sensation. Symptoms of straining, tightening, cramping, and knotting may last up to 10 minutes per episode.1 Since leg cramps can last for a while, the patient may experience muscle tenderness and soreness for up to a day after symptoms are gone. Nocturnal leg cramps are more common in women and in adults over the age of 50.1 Laboratory evaluation and specialized testing are usually not necessary to confirm diagnosis.

Are Nocturnal Leg Cramps the Same as Restless Leg Syndrome? 

In a word, no. Nocturnal leg cramps are not the same as RLS (Restless Leg Syndrome).

Nocturnal Leg Cramps Restless Leg Syndrome
Usually occurs at night or at rest Usually occurs at night or at rest
Cause pain and cramping Cause discomfort and crawling sensation
Stretching the muscle relieves pain Moving the legs relieves discomfort

Causes of Nocturnal Leg Cramps

The exact cause of nocturnal leg cramps is often unknown. However, there are several factors that may increase your risk of leg cramps:

  • Sedentary lifestyle
  • Over-exertion of the muscles from exercise
  • Standing for long periods of time
  • Improper sitting position, like crossing your legs1

The following medical conditions are also known to cause nocturnal leg cramps:

  • Pregnancy
  • Endocrine disorders (diabetes, hypothyroidism)
  • Structural issues (flat feet, spinal stenosis)
  • Neurodegenerative disorders (Parkinson’s disease)
  • Neuromuscular disorders (myopathy, peripheral neuropathy)
  • Medications (diuretics, intravenous iron sucrose, raloxifene, statins, naproxen, conjugated estrogens, beta agonists)
  • Dehydration/electrolyte imbalances2

Management and Treatment of Leg Cramps

  1. Stretch: The best method to relive pain and cramps is to stretch the affected muscle and hold the stretch for one minute.
  2. Exercise: Walking around sends a signal to the muscle that it needs to relax after contracting, which will help ease the leg muscle.
  3. Massage: Kneading, rubbing, and massaging the affected muscle can also relieve the cramps.
  4. Apply heat: Other methods that have shown some benefit include taking warm baths and showers, and applying a hot towel or pad to the affected area to relax the tight muscles.2
  5. Over the counter medications: No current medications have shown safe and effective results in patients with nocturnal leg cramps. However, calcium channel blockers (diltiazem), vitamin B12 complex, carisoprodol (Soma) have some good evidence and may be considered in some patients.3 Magnesium have some benefit in pregnant patients and mixed results in non-pregnant patients with leg cramps. No evidence supports the use of nonsteroidal anti-inflammatory drugs (naproxen), potassium, or calcium.3

Prevention and Self-Care Strategies:

  1. Hydration: Drink lots of water and fluids every day to keep your body hydrated and help your muscles contract and relax more. Men should drink 15.5 cups (3.7 liters) of fluids and women should drink 11.5 cups (2.7 liters) of fluids a day.
  2. Stretch before bed: If you experience nocturnal leg cramps, stretch your calf muscles for a few minutes before bed.
  3. Doing light exercise: Walking around your neighborhood or house before bedtime may help prevent leg cramps at night.
  4. Wearing comfortable shoes: Wearing shoes that support your feet can help prevent leg spasms.
  5. Untucking the covers: Loosening the bed covers at the foot of the bed will give your legs more space to move and prevent cramps.1

The next time you experience nocturnal leg cramps, identify the cause. Then, try one of the treatment methods to relieve your leg cramps. After resolving your leg cramps, use the self-care strategies to help prevent future leg cramps. However, if your leg cramps persist for long periods of time and occur every day, talk to your physician to determine whether or not you have leg cramps or other alternative medications that are appropriate.

Resources:

  1. Leg Cramps at Night. https://my.clevelandclinic.org/health/diseases/14170-leg-cramps-at-night. Accessed January 10, 2019.
  2. American Academy of Family Physicians. Nocturnal Leg Cramps. Accessed January 10, 2019.
  3. Abdulla AJ, Jones PW, Pearce VR. Leg cramps in the elderly: prevalence, drug and disease associations. Int J Clin Pract. 1999;53(7):494–496.

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alternatives toSudafed for HBP patients - allergy image - scriptsave wellrx

by Katie Tam
PharmD Candidate Class of 2019, University of Arizona

It’s allergy season and you can’t breathe the fresh air because your nose is congested and stuffed. You visit the pharmacy and purchase a box of Sudafed. Your pharmacist asks if you have a history of high blood pressure, and you answer “yes.” The pharmacist replies that she does not recommend Sudafed for you, but why?

What you need to know about Pseudoephedrine:

Brands of common over-the counter decongestants that contain pseudoephedrine: Allegra-D, Alka Seltzer Plus Cold Medicine Liqui-Gels, Aleve Cold and Sinus Caplets, Benadryl Allergy and Sinus Tablets, Claritin-D Non-Drowsy 24 Hour Tablets, Robitussin Cold Severe Congestion Capsules, Sudafed 24 Hour Tablets, SudoGest, Wal-phed 12 hour, Suphedrine.2

Indications: nasal congestion, sinus congestion, and Eustachian tube congestion

Adverse side effects of pseudoephedrine:

  • Common: insomnia, nervousness, excitability, dizziness, and anxiety
  • Infrequent: tachycardia (rapid heart beat) or palpitations
  • Rare: dilated pupils, hallucinations, arrythmias (irregular heartbeat), high blood pressure, seizures, inflammation of the large intestine, and severe skin reactions

Contraindications for pseudoephedrine:

  • Diabetes mellitus
  • Cardiovascular disease
  • Severe or uncontrolled high blood pressure
  • Severe coronary artery disease
  • Prostatic hypertrophy
  • Hyperthyroidism
  • Closed angle glaucoma
  • Pregnant women

Pseudoephedrine and High Blood Pressure Interaction

In 2005, a study showed that pseudoephedrine increased systolic blood pressure and heart rate, but had no effect on diastolic blood pressure.1 They also found that higher doses and immediate-release formulations of pseudoephedrine were associated with higher blood pressures.1 In addition, the study revealed that patients with well controlled hypertension had higher systolic and diastolic blood pressures after taking immediate release pseudoephedrine formulations.1

What are safe alternatives to pseudoephedrine in patients with high blood pressure?

There are a few safe and effective alternatives to pseudoephedrine in patients with high blood pressure that can relieve nasal or sinus congestion symptoms. Placing a humidifier in the bedroom keeps moisture in the air, which helps prevent your nasal passages from drying out. Humidifiers can also help break up mucus and soothe inflamed nasal passageways.3 In addition, propping your head up on 2 pillows may help the mucus flow out of your nose and relieve some congestion. Saline sprays are also another safe option that can loosen congestion and improve drainage.3 If a patient with high blood pressure insists on taking a medication that includes pseudoephedrine, their pharmacist or physician will recommend the patient to monitor their blood pressure and take a sustained-release formulation to reduce the risk of increasing blood pressure.3

Next time you have sinus or nasal congestion, ask your physician before using pseudoephedrine if you have high blood pressure. Your local pharmacist can also help manage nasal congestion symptoms, provide valuable information regarding safer alternatives, and ensure optimal drug selection in patients with high blood pressure.

Resources:

  1. Salerno SM, Jackson JL, Berbano EP. Effect of Oral Pseudoephedrine on Blood Pressure and Heart Rate: A Meta-analysis. Arch Intern Med. 2005;165(15):1686–1694. doi:10.1001/archinte.165.15.1686.
  2. Radack  KDeck  CC Are oral decongestants safe in hypertension? an evaluation of the evidence and a framework for assessing clinical trials.  Ann Allergy 1986;56396- 401.
  3. High Blood Pressure and Cold Remedies: Which Are Safe? Mayo Clinic.  https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/high-blood-pressure/faq-20058281. Published January 09, 2019. Accessed January 20, 2019.

 

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shingrix on backorder - scriptsave wellrx blog image

by Katy Winkel, PharmD Candidate Class of 2019
University of Kansas School of Pharmacy

Shingrix was approved in October 2017, nearly 10 years after Shingles Zostavax came to market. Shingrix is an inactivated, 2-dose series that anyone 50 years or older is eligible to receive. With the 2-dose series you will receive the first vaccine, then 2 to 6 months later you’ll receive the second vaccine. The Shingrix series is proven to be up to 90% effective unlike Shingles Zostavax, which is only 51% effective.

Shingrix is given intramuscularly, which means it will be given in your upper arm muscle much like where the flu vaccine is given. The most common side effects from Shingrix are pain, redness, and swelling at the injection site. Also, flu-like symptoms following the vaccine are common such as muscle pain, tiredness, fever, and upset stomach.1

The pharmacy tells me it’s on “backorder.” What does that mean?

The term “backorder” in terms of pharmacy simply means that the pharmacy went to place an order on a specific item and the wholesaler, or company that sells the item, cannot fulfill the order due to shortages. The manufacturer producing Shingrix is now experiencing shipping delays for their vaccine due to the high levels of demand putting it on “backorder.”3 Unfortunately, the Centers for Disease Control and Prevention (CDC), is unsure of the exact date when Shingrix will be available again, and they predict that the manufacturer will continue to only release small amounts through 2019.2

What if I’ve already received the first dose of Shingrix and I’m past the 6-month mark for the second vaccine?

Per the CDC, once the Shingrix vaccine becomes available again you will get the second dose and do not need to restart the series. If you have not received any of the Shingrix series, but are wanting immediate vaccination, the old vaccine, Shingles Zostavax, is still available for use per the CDC. You should wait a minimum of 8 weeks after getting Shingles Zostavax before you receive Shingrix.3

While you wait….

Many pharmacies have started a waiting list for the Shingrix vaccine and prioritize customers who have already had the first dose. Also, any time you are in your local pharmacy be sure and ask if there are any updates on the availability of Shingrix. Pharmacists are here to help!

 

References:

  1. “Healthcare Providers / Professionals.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 19 Nov. 2018, www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html.
  2. “Shingles Vaccine.” SHINGRIX, Apr. 2018, www.shingrix.com/index.html.
  3. “Vaccines and Preventable Diseases.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Nov. 2018, www.cdc.gov/vaccines/vpd/shingles/hcp/shingrix/faqs.html.

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by Terra Leon, PharmD Candidate 2019

With all the new diet and detoxification trends arising from celebrities and the media, it’s hard to know harmful from helpful. Activated charcoal has been portrayed as the new “magic bullet” for multiple health issues. Activated charcoal’s popularity is quickly spreading and turning up in supplements, juices, hangover remedies, face masks and even toothpaste. The media and celebrities promise it will reduce bloating, clear skin, whiten your teeth, and detox your organs for a healthier life. But does it work?

What is Activated Charcoal

Charcoal is a fine black powder made from bone char, coal, saw dust, olive pits, coconut shells or petroleum coke4. The charcoal becomes activated when it is heated at a high enough temperature the structure changes and provides a higher surface area for substances to bind to4. Activated charcoal’s oldest use is in medical practice in the Emergency Room as a treatment to detox patients who over dose on certain medications. When a patient over doses on a medication like Tylenol or Aspirin, activated charcoal is utilized to help trap toxins and gases in the gut. Since activated charcoal is not absorbed by the body it carries the toxins bound to its surface area out of your body through feces like a big drug sponge. Due to its highly negatively charged surface, activated charcoal attracts positively charged molecules for excretion, like toxins and gases but it can also have an effect on other medication and lead to lower absorption4.

Alternative Options

An alternative to activated charcoal to reduce gas and bloating, is to stick to a whole food plant-based diet, avoid products with artificial sweeteners, avoid carbonated drinks, and beer, which can release carbon dioxide gas, Also, be sure to eat and drink slowly1. Taking your time eating and drinking can help you swallow less air and reduce gas. Consult your health care provider for other alternative over-the-counter options, such as Gas-X, if natural options still don’t provide relief.

For clear skin try over the counter or prescription products that help reduce oils and clear bacteria on the skin surface. Make sure you wash your face every day and avoid high in oil foods to reduce surface oil1. Consult your healthcare professional if blemishes continue to arise.

If its whiter teeth you seek, try over the counter whitening kits that have hydrogen peroxide. Rinse your mouth after consuming coffee, soda or teas. Activated charcoal lacks published studies on being beneficial for teeth whitening. In fact, the fine black charcoal powder can potentially become embedded into cracks or small holes in the teeth producing the opposite effect1. Consult your dentist for alternative whitening procedures.

Not So Harmless?

Using activated charcoal supplement as a detoxification method is not as harmless as some may think.  Activated charcoal does not have the ability to suck out toxic chemicals from your body, its effects are limited to the GI tract3. Furthermore, it does not discriminate against helpful chemicals in food you consume and can remove beneficial nutrients such as Vitamin C, B6, Thiamine, Biotin and Niacin from the body3. In line with this, there are also concerns that activated charcoal can make medications less effective. In short, to “detox” or cleanse the body make sure to drink plenty of water each day and eat a high in fiber diet to help naturally remove waste from the body.

Medication Interactions

Activated charcoal can reduce the absorption and interrupt the circulation of certain medications and should only be used under the supervision of a health care professional2. If you are taking any prescription medication consult your doctor before using charcoal as a supplement or any other oral ingestible form. Due to its possibility of decreasing absorption of other medication it is recommended to take activated charcoal at least 1 hour before or 2 hours after taking other drugs if approved by your doctor2.

Bottom Line

With all the new health fads and trends offering a one supplement solve all solution or “magic bullet” it is easy to get sucked into the excitement of this new trend. When it comes to activated charcoal there are no strong studies supporting these benefits and weaker studies are not supported by science. Always consult your doctor or health care professional to gain all the information you need about a new product to determine if this product will be helpful or harmful to your personal health.

References:

  1. Calderone, Julia. “Activated Charcoal Isn’t a Magic Health Bullet.” Product Reviews and Ratings – Consumer Reports, Apr. 2017, consumerreports.org/dietary-supplements/activated-charcoal-fad-not-a-magic-health-bullet/.
  2. Charcoal Oral, Facts & Comparisons, 2018, https://fco.factsandcomparisons.com/lco/action/search?q=activated%2Bcharcoal&t=name&va=activated%2Bchar.
  3. Gavura, Scott. “Activated Charcoal: The Latest Detox Fad in an Obsessive Food Culture.” Science-Based Medicine, 28 Jan. 2016, sciencebasedmedicine.org/activated-charcoal-the-latest-detox-fad-in-an-obsessive-food-culture/. https://sciencebasedmedicine.org/activated-charcoal-the-latest-detox-fad-in-an-obsessive-food-culture/
  4. Petre, Alina. “What Is Activated Charcoal Good For? Benefits and Uses.” Healthline, Healthline Media, June 2017, www.healthline.com/nutrition/activated-charcoal#section10.

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drug recalls - patient guide - scriptsave wellrx - blog image

by Jenny Bingham, PharmD, BCACP
SinfoníaRx

Have you ever experienced the unsettling feeling when you hear a drug recall announcement for a prescription that you take every day? The United States Food & Drug Administration (FDA) recalled over seven different products in December 2018 due to impurities, mislabeling, or performance defects. The FDA works closely with drug manufacturers to recall and remove any defective medications from the consumer market.  They also have laws that require organizations to contact patients subject to the recall.

If you do find yourself not knowing what next steps to take after a drug recall, here are some useful tips to guide you throughout the process.

Step 1: Resources for Recalled Medications

The FDA publicly shares a current listing of all recalled products on their website. If you receive a phone call, email, mailer, or any type of communication from your dispensing pharmacy and/or organization that administers your medication to you, you can use this website to learn more information about the recall and the reason for it.

Patients can also contact their dispensing pharmacy to confirm whether their medication was subject to the recall. Most pharmacies keep a digital log of the lot number, expiration date, and NDC. They can compare it to the FDA’s drug recall tracking information (as shown below), along with product photos on their website.

NDC Manufacturer Product
Description
Lot/Batch Expiration
Date

The FDA classifies drug recalls based on their severity. Class I Recalls pose a risk for serious health problems and death. Class II Recalls pose a risk of temporary or reversible health problems. Class III Recalls are not likely to cause an adverse health problem, but it violated FDA laws. Only your provider can determine what is the best course of action to take in response to the recall.

Step 2: Contact Your Provider

Whether your provider is an ambulatory care pharmacist, nurse practitioner, or a medical doctor, it is imperative that you contact them once you learn about your drug’s recall. Do not abruptly stop therapy without consulting your provider. Some medications pose severe risks if you suddenly stop taking them.

Your provider can work with you to develop a plan. Your pharmacy might be able to refill the medication from a different manufacturer that is not related to the recall. If they are not able to substitute with a different manufacturer, your provider will work with you to determine what is an appropriate alternative therapeutic regimen.

Step 3: Disposing of Your Medication

If your medication is recalled and your provider advises you to discontinue therapy and stop taking it, it is important to properly dispose of your medicine. The Drug Enforcement Agency (DEA) announces National Prescription Drug Take-Back events on their website. The FDA also has a website that shares useful tips on how to safely dispose of medicine.

 

Resources:

https://www.fda.gov/Drugs/DrugSafety/DrugRecalls/default.htm

https://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm#1


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Do ARBs cause cancer - scriptsave wellrx - blog image

by Mitchell Welton, PharmD Candidate 2019
University of Arizona

As with all cause and effect scenarios it is always best to cover the basics. Before we ask if ARBs cause cancer let’s discuss what an ARB actually is. An ARB is a family of medications taken by mouth to lower blood pressure. The acronym stands for angiotensin II receptor blocker (ARB) and its name implies its function. This medication blocks angiotensin II from binding to its respective receptor. When angiotensin II binds to its receptor it causes the blood vessel to contract which increases the blood pressure.1 A patient taking an ARB would have less binding of the receptor and thus no contraction of the blood vessels causing lower blood pressure. Aside from its intended purpose, do ARBs also cause cancer?

Evaluation of Cancer Risk

In 2016 an analysis was done to evaluate the incidence of cancer in patients treated with ARBs for high blood pressure. The review concluded that ARBs had no effect in the incidence of cancer which was consistent with the findings of a similar study conducted in 2011.2 In other words, to say that ARBs as a drug class cause cancer would not be correct. However, in June of 2018 Valsartan, a commonly prescribed ARB, was recalled by the manufacturer citing an impurity found in the medication. The impurity, N-Nitrosodimethylamine (NDMA), is a probable cancer-causing agent.

Since then the United States Food and Drug Administration (FDA) launched an investigation into the affected Valsartan products. That investigation found a second impurity known as N-Nitrosodiethylamine (NDEA) also a probable human carcinogen. Further investigation and testing on other ARBs revealed that some irbesartan and losartan products contained NDEA as well. All affected products have been recalled. Not all ARBs are affected by this recall, however a list of all affected products can be found on the FDA website. It is also important to note that the drugs candesartan, eprosartan, olmesartan, and telmisartan belong to the ARB drug class and have not been identified as containing either of the previously mentioned impurities.3

The Impact of Impurities

The effect that these impurities have on cancer rates is difficult to assign a number to. Professionals at the FDA estimate that there would be one additional case of cancer out of 8,000 people taking valsartan contaminated by NDMA.3 This estimate assumes the patient was taking the highest daily valsartan dose of 320 mg over a period of 4 years. Prescribed dosages of valsartan range from 40 mg to 320 mg daily and lower strength tablets would contain less NDMA respectively than a higher strength tablet.3 This estimate also assumes that every tablet taken over the four-year period contained NDMA. Not all batches affected by the recall actually contained the impurities and over a four year period of refilling the prescription it is unlikely that a patient was exposed to the amount of NDMA calculated in the 1 in 8,000 risk.

With that being said, even if the risk of getting cancer is smaller than 1 in 8,000 it doesn’t take into account the emotional toll this recall can have on a patient that has taken a potentially affected blood pressure medication. NDEA was discovered after NDMA and the FDA does not yet have a risk estimate for the later impurity but will update the information as soon as it becomes available.3

What Should You Do?

If you or someone you know is taking an ARB for the treatment of high blood pressure, check the FDA website regularly. A list of affected medication with their lot and expiration dates can be found for all valsartan, irbesartan, and losartan included in the recall. Again, not all ARBs are affected, and if you are unsure how to match the lot and expiration dates on the medication you picked up from the pharmacy, call and talk to your pharmacist. If you are taking a medication affected in the recall, your pharmacist may be able to recommend or provide you with an unaffected medication by a different manufacturer. The FDA recommends you take your current medication as prescribed until you can get a replacement from your pharmacist or doctor.3

 

References

  1. Ogbru, O. (n.d.). Angiotensin II Receptor Blockers (ARBs) Drug Facts, Side Effects and Dosing. Retrieved from https://www.medicinenet.com/angiotensin_ii_receptor_blockers/article.htm
  2. Zhao, Y., Li, P., Zhang, J., Wang, L. and Yi, Z. (2018). Angiotensin II Receptor Blockers and Cancer Risk. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863811/
  3. Center for Drug Evaluation and Research. (n.d.). Drug Safety and Availability – Questions and Answers: Impurities found in certain generic angiotensin II receptor blocker (ARB) products. Retrieved from https://www.fda.gov/Drugs/DrugSafety/ucm626122.htm

 


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best-statin-prices - scriptsave wellrx - blog image

by Jenny Bingham, PharmD, BCACP; Heather Lee, PharmD Candidate; Mitchell Welton, PharmD Candidate

In such a competitive cholesterol medication market, manufacturers have been forced to make drastic cuts to their medication costs. Amgen lowered its product by 60%, followed by a 45-70% reduction from Regeneron. The price reductions occurred in response to the national consumer’s options to trial a multitude of more affordable options for cholesterol management, based on their clinical goals.

To better understand each product, a comparison should be made between each medication’s indication, effectiveness, and price.

Praluent

Praluent is an adjunct for patients who have uncontrolled cholesterol levels despite the presence of high intensity statin therapy.1 It is indicated for patients with atherosclerosic cardiovascular disease (ASCVD) who would benefit from an additional reduction of low-density lipoprotein (LDL) cholesterol. Praluent has been reported to reduce cholesterol levels by >=40% of patients who taking a maximally tolerated dose of statin.2 It was also reported to be effective at reducing cardiovascular outcomes and all-cause death by 15% in patients who have acute coronary syndrome.3 The primary patient population that would obtain the most benefit from Praluent are patients who have high LDL cholesterol levels.3 A recent price reduction by Regeneron and Sanofi occurred in May 2018. The price decreased from $14,600/year to a range of $4,500 to $8,000/year via rebate.4

Repatha

Repatha is indicated for the treatment of hyperlipidemia and has been reported to reduce the risk of heart attack and stroke.6 Evidence demonstrates the potential for plaque reduction if used with statin therapy. Amgen recently followed suit with lowering the price of Repatha after competitors Regeneron and Sanofi lowered the price of their competing product as mentioned above. Prior to the lowered cost in October the annual price of Repatha was $14,100/year. Amgen initially offered a prescription savings card for eligible patients, however patients with federal, state, or government-funded healthcare insurance were excluded. The new cost is $5,850/year, a nearly 60% decrease in cost. Amgen recently announced new opportunities for Medicare patients to benefit from therapy as the result of the price cut. 7

What to Ask Your Provider and/or Pharmacist

With the new, more affordable prices, you might be curious if these medications are best for your cholesterol management and cardiovascular health. It’s important to maintain routine appointments with your provider to ensure your cholesterol levels are monitored appropriately. Based upon your lab results and medication history, your provider and/or pharmacist may deem it appropriate to trial one of the above noted medications. However, it’s also important to adhere to provider recommendations about lifestyle changes, like diet and exercise.

References:

  1. Accessdata.fda.gov: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/125559Orig1s000lbledt.pdf. Published 2018. (accessed 29 Nov 2018)
  2. Alirocumab (Praluent) to Lower LDL-Cholesterol. JAMA. 2015;314(12):1284. doi:10.1001/jama.2015.11372
  3. American College of Cardiology: https://www.acc.org/latest-in-cardiology/articles/2018/03/05/15/53/sat-9am-odyssey-outcomes-cv-outcomes-with-alirocumab-after-acs-acc-2018 (accessed 29 Nov 2018)
  4. CNBC. https://www.cnbc.com/2018/05/01/regeneron-sanofi-chop-cholesterol-drug-price-in-express-scripts-pact.html. Published 2018. (accessed 29 Nov 2018)
  5. Repatha (Evolocumab Injection, for Subcutaneous Injection): Side Effects, Interactions, Warning, Dosage & Uses. (n.d.): https://www.rxlist.com/repatha-drug.htm#indications.
  6. CBS News: https://www.cbsnews.com/news/drug-repatha-with-a-statin-could-help-reverse-heart-disease/ (accessed 4 Dec 2018)
  7. CNBC: https://www.cnbc.com/2018/10/24/amgen-cuts-price-of-cholesterol-drug-by-almost-60percent.html (accessed 4 Dec 2018).

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medical marijuana mmj - scriptsave wellrx - rx discounts -blog image

by Mitchell Welton, PharmD Candidate 2019
University of Arizona

The use of marijuana draws a wide range of strong opinions out of people. Its advocates will tout all of its potential benefits of medical marijuana, while its opponents try to draw from the negative stigma that surrounds it. As in all hotly contested topics, the truth usually falls somewhere in between the opposing viewpoints. While the use of marijuana still remains illegal at the federal level, there are many states that have approved its medical use for qualifying individuals to treat certain conditions, and even fewer states have approved its recreational use.

California was the first state to legalize marijuana for medical use in 1996 and since then many states have followed suit. About a dozen states have legalized marijuana for medical use. The difference between medical and recreational use warrants its own discussion and the disagreement can be seen at a legislative level with more leniency being extended to medical over recreational. This author would generalize medical marijuana in this article as containing a higher concentration of CBD over THC, for all intents and purposes, in order to discuss medical marijuana compared to FDA approved cannabinoids.

Medical Marijuana (MMJ) Uses

The two chemicals of interest found in marijuana are tetrahydrocannabinol (THC) and cannabidiol (CBD) although the plant itself may contain up to 400 different chemicals. A recreational smoker would be looking for a higher concentration of THC which is the psychoactive component delivering the “high” that users seek. 1 CBD is the cannabinoid that doesn’t produce the “high” and has recently been approved by the FDA as an oral solution, called Epidiolex, to treat seizures. There are currently only three FDA approved, cannabinoid medications on the market. 2

The first of these medications was approved in 1985 by the FDA known as Marinol or dronabinol. A synthetic form of THC first approved for the treatment of chemotherapy induced nausea and vomiting. Its indication was expanded to include the treatment of weight loss and anorexia in people with AIDS. Other studies have found efficacy in achieving pain relief in patients with multiple sclerosis (MS) and treating other neuropathic pain. 3 Cesamet, or nabilone, is another synthetic cannabinoid that mimics THC also approved in 1985 for the treatment of chemotherapy induced nausea and vomiting with off label use to treat fibromyalgia shown in a 2011 systematic review of cannabinoids for chronic pain. 4 The third, Epidiolex, has already been mentioned which is the first FDA approved drug derived from marijuana. The previous two drugs where synthetic. Epidiolex is used in the treatment of two rare, but severe forms of epilepsy. 2

MMJ Safety Factors

There are multiple factors to consider when thinking of safety between the two types of marijuana. First that comes to mind is the administration. Let’s take dronabinol for example as it has been around the longest from an FDA approval standpoint and such has been examined in multiple studies. This is a liquid filled capsule taken by mouth. Like many oral medications it may take some time for it to be absorbed which means a delay in its effect. This is something to keep in mind as a quick onset of action would be preferred when treating nausea and vomiting. Once the capsule is taken by mouth and absorbed the next consideration is its excretion from the body.

Dronabinol has an elimination half life of 19 to 36 hours meaning there will be a therapeutic level of the medication in the blood for a significant period of time. Other considerations I would bring to attention of the reader is the environment in which the medication is produced. Part of the FDA requirement is the manufacturing standard the medication is subjected to. Conditions must be controlled in its production which would allow us to assume there would be little tainting or contamination. Lastly, this synthetic medication is a pure isomer of THC meaning the end user is not consuming the potential 400 other chemicals found in the marijuana plant which could account for less of a “high” from any other psychoactive cannabinoids. 5

Marijuana in contrast when smoked has a much more rapid onset of action however may be inappropriate for use in patients with asthma or COPD. Ingesting marijuana will have a slower onset and more unpredictable absorption. Once in the system the body would eliminate marijuana faster than dronabinol. Though its production is not regulated like the FDA approved medications, each state has its own laws limiting the cultivating of your own marijuana and licensing of larger cannabis farms. 5

No matter where you might stand on the issue, there is a place in healthcare for the use of marijuana. The question lies in the best way to regulate and manage it. It is important to always evaluate safety and efficacy with any treatment used. Patients should always be treated with evidence-based methods and in accordance to state and federal laws. For better or for worse marijuana, and its use, continues to garner support and opposition in larger numbers. This is a landscape that will continue to change as we look for developments in the application of its use.

 

References:

  1. What Is the Difference Between Medical and Recreational Marijuana? (2018, September 10). Retrieved from https://docmj.com/2017/06/05/difference-medical-recreational-marijuana/
  2. Office of the Commissioner. (n.d.). Press Announcements – FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. Retrieved from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm611046.htm
  3. Dronabinol: Marinol. (n.d.). Retrieved November 19, 2018, from Micromedex.
  4. Nabilone: Cesamet. (n.d.). Retrieved November 19, 2018, from Micromedex.
  5. Morrow, A. (n.d.). Marinol or Marijuana: Which Is Better? Retrieved from https://www.verywellhealth.com/is-marinol-better-than-smoked-marijuana-1132483

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flu booster shot - scriptsave wellrx - blog image

by Heather Lee, University of Arizona PharmD Candidate

With flu season upon us, make sure you pencil in a date to get your flu shot. You may wonder why this is so important, and why your healthcare providers are always asking whether you received it. Influenza (the flu) is a huge threat to public health. It has been shown that around 5 to 20 percent of the United States population get the flu during flu season.1 Hospitalization rates and death rates are quite high, with more than 200,000 people being hospitalized and around 36,000 deaths every year. Getting the flu vaccine not only lowers your risk of getting sick, but it also protects the people around you, too.2 With the risk of it turning into a serious and fatal threat, you should vaccinate against it to protect yourself and the ones you love.

What is the flu?

The flu is a disease that is caused by a virus. It is contagious, meaning it can be spread from person-to-person. It is spread when someone who has the flu sneezes, coughs, or talks and spread droplets. The droplets land on the noses or mouths of nearby people, or on surfaces that were near the sick person. If other people touch the surface and then touch their mouth, nose, or eyes, they can also get infected with the flu.2

Some common flu symptoms include:

  • Fever and chills
  • Cough
  • Sore throat
  • Runny/stuffy nose
  • Muscle/body aches
  • Headache
  • Feeling tired2

More serious complications of flu include:

  • Pneumonia
  • Inflammation of the brain or heart
  • Worsening of a health condition, such as asthma or heart failure
  • Sepsis (a life-threatening infection)2

Who Needs It?

It is recommended that everyone who is able to get the vaccine who is 6 months of age or older should receive the vaccine every season.3 There are some people who are at high risk of developing flu complications, so it is important to receive the vaccine if you fall into the following categories:

  • Children younger than 5 years, but especially children younger than 2 years
  • Adults 65 years and older
  • Pregnant women
  • Women up to 2 weeks postpartum
  • Residents of nursing homes and other long-term care facilities
  • American Indians and Alaska Natives
  • If you have certain medical conditions (asthma, heart disease, chronic lung disease, etc).4

Children who are between 6 months to 8 years require 2 doses of the vaccine if they are getting vaccinated for the first time or if they have only gotten one dose.5 Receiving two doses will provide children with a better immune response and more protection.5 The two doses should be separated by at least 28 days. For adults, only one dose per season is necessary. Research has shown no benefit in boosting immunity in adults who have received two doses in the same flu season, even in elderly people who have weakened immune systems.6

*There are some groups who should not get the vaccines. These include children younger than 6 months, if you have had a life-threatening allergic reaction to the flu vaccine or an ingredient it contains (eggs or gelatin), or if you have Guillain-Barrré Syndrome (an immune system disorder).2

Side Effects of Flu Shot

The most common side effects usually affect the area of injection, such as redness, pain, or swelling of where you received the shot.2 Other side effects are headaches, muscle aches, fever, or an upset stomach. These side effects usually go away in a few days. It is rare to get a serious side effect from the flu vaccine, but the person administering the vaccine can observe you for any serious side effects. The flu shot will not cause you to get the flu; it serves to boost your immune response to prevent the flu.

Sign Me Up

The benefits of getting the flu vaccines drastically outweigh the risks of the vaccine. Even though you may risk getting a sore arm or a headache, you still walk out with a lower chance of getting infected with the flu. Preventing the flu helps to keep you from developing the more serious complications, such as being in the hospital with pneumonia or even death. The best time to get vaccinated is usually the end of October, but you can still get vaccinated throughout the flu season.6

Receiving the flu shot in January or later is still better than nothing, since flu season can last as late as May. Your local pharmacy should have the flu vaccine available during flu season, and there is usually no appointment necessary. The next time you step into your local pharmacy, stop by and ask your pharmacist when you can get the flu vaccine so you can protect you and your loved ones.

Resources:

  1. NIH Fact Sheets – Influenza. National Institutes of Health. https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=133. Accessed November 28, 2018.
  2. S. Department of Health and Human Services. Flu (Influenza). Vaccines.gov. https://www.vaccines.gov/diseases/flu/index.html. Published October 11, 2006. Accessed November 28, 2018.
  3. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/professionals/vaccination/vax-summary.htm. Published September 6, 2018. Accessed November 28, 2018.
  4. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/disease/high_risk.htm. Published August 27, 2018. Accessed November 28, 2018.
  5. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/protect/children.htm. Published November 8, 2018. Accessed November 28, 2018.
  6. Influenza (Flu). Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/qa/misconceptions.htm. Published September 25, 2018. Accessed November 28, 2018.

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