Serotonin Syndrome - WellRx blog image

by Bhargavi Jayaraman, PharmD Candidate

A Challenging Diagnosis, but What is Serotonin1?

The varying symptoms of Serotonin Syndrome can be difficult to diagnose. Early serotonin syndrome symptoms, including diarrhea, high blood pressure, anxiety and agitation, can be easily confused with less serious conditions. Serotonin is a chemical produced by the nerve cells that acts on almost every part of the body. It’s helps with sleeping, eating, digestion, and is considered to be a natural mood stabilizer. It also helps reduce depression and anxiety, heal wounds, stimulate nausea and maintain bone health. When your serotonin levels are normal, you should feel happier, more calm, emotionally stable, less anxious, and more focused. A deficiency of serotonin would make you experience anxiety and/or insomnia. Many people who experience depression, anxiety, or need mood stabilizers take medications that help to increase serotonin levels in the body.

Medications That Increase Your Serotonin Levels2

With the proliferation of antidepressant drugs on the market, there is an increasing number of medications that can raise your body’s serotonin levels. But it’s not just antidepressants that can have this impact. Medications that increase serotonin levels in the body include:

Too Much of Something is Never Good

If serotonin has so many benefits to the mood and can help everyone in their daily functioning, shouldn’t we all want to take as many serotonin increasing medications as possible? The answer is no. Too much of any chemical compound in our body is never a good thing. Serotonin syndrome occurs when medications cause an accumulation of a high level of serotonin in the body. Symptoms of too much serotonin in the body can range from mild to severe, and severe serotonin syndrome can be fatal if not treated1.

What are the Symptoms of Serotonin Syndrome2?

There are no tests to diagnose serotonin syndrome1. Instead, your doctor might perform a physical exam and ask you some questions to diagnose serotonin syndrome. Due to the lack of diagnostic criteria, the exact prevalence of serotonin syndrome is unknown, however, it is known to be an extremely rare condition. So if you are experiencing any of the symptoms listed below, it’s important that you don’t stop taking any of your medications, but rather, make an appointment to see your doctor to rule out serotonin syndrome.

Mild symptoms of serotonin syndrome may include:

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate
  • High blood pressure
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • Muscle rigidity
  • Heavy sweating
  • Diarrhea
  • Headache
  • Shivering
  • Goosebumps

More severe symptoms of serotonin syndrome may include:

  • High fever
  • Seizures
  • Irregular heartbeat
  • Loss of consciousness

Prevention is Key2

Taking more than one drug that increases serotonin levels, or increasing the dose of one of these medications, can increase the risk of serotonin syndrome. Make sure your doctor is aware of all the medications you are taking, and discuss any risks and concerns with your doctor or pharmacist to make sure you understand how the medications can interact.

How Can You Naturally Increase Your Serotonin Levels1?

Since serotonin offers so many benefits to your mood and health, you may want to consider ways to naturally increase your serotonin levels. Some ways to stimulate natural production of serotonin include:

  • Exposure to light: sunshine or bright light to treat seasonal depression can raise your serotonin levels.
  • Exercise: getting regular exercise can help to elevate your mood and offers other health benefits!
  • A healthy diet: including foods that can help to increase serotonin levels, like eggs, cheese, turkey, salmon, nuts, tofu, and pineapple, can elevate your natural serotonin supply.
  • Meditation: helps to relieve stress and promotes a positive outlook on life, thereby increasing your serotonin levels.

References:

  1. Scaccia A. Serotonin: What You Need to Know. Healthline Newsletter. https://www.healthline.com/health/mental-health/serotonin. Published May 18, 2017. Accessed February 10, 2018.
  2. Serotonin syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758. Published January 20, 2017. Accessed February 10, 2018.

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

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asthma inhaler image

by Tek Neopaney

What is Asthma?

Asthma is a chronic disease that affects the airway tubes of the lungs. During asthma attacks, the walls inside of the airway become sore, swollen, and red and produce mucus, making it harder to breathe. The airway tubes become very sensitive when they are inflamed and may react strongly to allergens. Air movement in and out of the lungs is constricted when inflammation is present, resulting in shortness of breath.

What Makes Asthma Worse?

There are many triggers of asthma. Common inhaled allergens that you may encounter at a daycare, home, school or work can trigger an asthma attack. Some avoidable allergens include mold, excretions from dust mites, cockroaches, and mice.

It’s common for many patients with high blood pressure to also have asthma. Some of the most effective and proven blood pressure medications are known to cause negative effects in people with asthma, so care is required in developing effective treatment plans.

Of the many different drugs available for treating hypertension, beta blockers and angiotensin-converting enzyme (ACE) inhibitors have the most potential to cause problems for asthma patients.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications commonly used for pain. However, NSAIDs, like naproxen (Aleve), and ibuprofen (Motrin) can sometimes make asthma symptoms worse. Other body reactions, including upper airway illness, hormonal fluctuation, and extreme emotions, can trigger asthma attacks.

How Can You Control Your Asthma?

Influenza can worsen asthma symptoms and cause complications, so it’s important to get a flu vaccine annually. The best way to treat asthma is identifying and avoiding triggers, taking medication regularly in order to prevent symptoms, and treating asthma episodes as they occur. Home monitoring of the peak expiratory flow rate (PEFR) can be very helpful, because it measures the airflow through airway and thus the degree of obstruction of airways. A peak flow meter is inexpensive and an easy way to assess asthma control.

Symptoms of Uncontrolled Asthma

If you have any of the following symptoms it’s considered uncontrolled asthma:

  • Coughing, wheezing, rapid breathing, or tightness of the chest experienced daily
  • Nighttime awakening more than twice a week
  • Need to use a short acting inhaler more than twice a week
  • If the asthma symptom is interfering with normal activities

Medications Used in Asthma Treatment

Long acting anticholinergic agents or beta agonists are the mainstay of asthma therapy. Common medications include:

These medications should be used regular for asthma control. Often, these medications can be combined. For example, in case of severe asthma, patients are often prescribed Acidinium and formoterol fumarate to use together on a regular basis.

Short acting inhalers, sometimes called rescue inhalers, are used for immediate symptomatic control:

How Do Asthma Medications Work?

Long acting anticholinergic agents work by competitively inhibiting the action of airway constriction. Short acting inhalers help to open up the airways by relaxing muscles of airway tubes.

Making an Asthma Action Plans

When you have asthma, your goal is to have a normal active life, and good control of your asthma. If your asthma is not well controlled, you may need to increase your medication and learn more about what triggers your asthma attacks. Your physician and pharmacist can provide you with information and an action plan to take care of your condition, so you can continue to be active and healthy.

References:

  1. Bateman, Eric D., et al. “Overall asthma control: the relationship between current control and future risk.” Journal of Allergy and Clinical Immunology 125.3 (2010): 600-608.
  2. Kew, K. M., & Dahri, K. (2016). Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA/ICS) versus LABA/ICS for adults with asthma. Cochrane Database of Systematic Reviews, (1).
  3. Friedman, B. C., & Goldman, R. D. (2010). Influenza vaccination for children with asthma. Canadian Family Physician56(11), 1137-1139.
  4. Zheng, T., Yu, J., Oh, M. H., & Zhu, Z. (2011). The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy, asthma & immunology research3(2), 67-73.

Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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

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Controlling Your Fibromyalgia

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

Dull, aching pain throughout your entire body. Trouble sleeping. Irritable mood. What could possibly be going on? Is it just in your head? Does anyone else feel like this? Well, if you experience some of these symptoms, one potential cause could be fibromyalgia, which affects the lives of almost 4 million Americans.

Fibromyalgia is a chronic pain condition that, while common, is not entirely understood or easy to manage.  Because the exact cause of this condition is not known, effective treatments are difficult to come across, and it’s common for patients to find themselves spending a lot of money trying to find a cure. Often times the suggested treatment is a combination of both lifestyle changes and medications. Ideally, by following the recommendations of your health care team and putting effort into your treatment plan, you will be in a good position to prevent your fibromyalgia from controlling your life and emptying your wallet.

Lifestyle Changes Can Help Fibromyalgia Symptoms 

First and foremost, physical therapy as well as certain daily exercises may be the key to keeping your symptoms at bay.  Suggested exercises include yoga, tai chi, walking, swimming, biking, and other low impact activities. Exercise has the potential to increase quality of life and reduce severity of pain over time.

Another way to improve your symptoms is sleep hygiene, which involves evaluating and making changes to some of your day time habits that may keep you from getting a good night’s sleep.  Some things to try include avoiding caffeine too late in the day and removing screens (phones, computers, televisions) from the bedroom.  By getting more quality sleep at night, you have the potential to majorly improve your symptoms.

In addition to exercising and changing your sleep habits, certain types of therapy may also be beneficial for some patients. This could include both group sessions and one-on-one sessions to address any potential underlying problems that may be making your symptoms worse.

Medications for Fibromyalgia

When it comes to medications, there are multiple options available, and occasionally, combinations may be necessary.  Many of the medications used for fibromyalgia can also be used to treat other things, such as depression, seizures, muscle spasms, and more.  Your doctor may prescribe one or more of the following medications to help control your symptoms:

It is important to keep in mind that with fibromyalgia, there is no miracle cure.  Some people may wonder whether or not opiates or narcotics (such as oxycodone, morphine, etc,) can be used to help with their pain, but these do not have proven benefit with fibromyalgia and are generally not recommended. Trying medication after medication can become costly, especially if you need to start taking multiple medications.  By working on lifestyle changes and giving the medications a chance to work, you will be on the right track to saving money and energy as well as getting back to a normal life.

 

References

  1. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm
  2. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/home/ovc-20317786
  3. Goldenberg DL. Initial treatment of fibromyalgia in adults. In: UpToDate, Schur PH (Ed), UpToDate, Waltham, MA

Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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

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shop around to save on medications

For those who are new to the ScriptSave WellRx prescription savings program, you may not realize just how long our company has been in the business of saving patients money on their prescriptions. It’s actually well over 20 years – we date back to 1993.

As such, it’s certainly nothing new to us to encounter people ‘paying it forward’ and helping to spread the word. That said, in all that time, it had never occurred to us to open our website to guest bloggers – until now.

Shell Roush is a Saturday Soccer Mom who lives in North Carolina and author of the extremely popular “Things I Can’t Say” blogsite. To simply refer to her as a “Mommy Blogger” doesn’t quite do her justice but, as she states, “I’m a mommy and I blog.” However, as her audience of ~30,000 unique visitors every month will attest, you’ll find that she writes so much more than just posts about parenting … including the following, which she wrote about us…

“The Easiest Way to Shop Around for the Best Prices on Prescriptions”
by Shell Roush

The pharmacy assistant was typing away at her monitor when she paused and looked up at me to ask “You are aware of the cost of this medication?” with a note of apology in her voice.

I sighed and responded that unfortunately, I was and that yes, I still needed the prescription filled.

She hesitated and very quietly told me that if I needed a prescription filled and I didn’t have insurance, I’d be better off going to the pharmacy across the street because it had better prices.

Until that moment, I had no idea different pharmacies charged different amounts for the same medication. I’m not sure why it was such a surprise since everything, from milk to gas, has a price that varies from place to place.

But there are so many pharmacies that it would be extremely time-consuming to check all of them, especially since the prices aren’t clearly listed in store. It would require me to either, call and inquire about a specific medication, or even show up in store to ask.

But by using the ScriptSave® WellRx website and mobile app, I can access their fast, easy, and free price-check tool. I put in my zip code here in Jacksonville, NC and I quickly see the specific prices for all of the pharmacies near me. It’s so much more convenient than having to make all of those phone calls.

Not only does the cost of the same medication vary from one pharmacy to the next, it can vary greatly. When I pay out of pocket for one of the medications for my son, it costs around $300. The ScriptSave WellRx app shows me the discounts available near me, making the current cost anywhere from $156.92 all the way up to $274.99.

That’s such a huge difference in price of the same medication, saving me over $100 every month. I like how easy ScriptSave WellRx makes the price check. With three growing boys, I can take those savings and apply them to the rest of the things they need, like soccer dues, 5k race registrations, and computer coding classes.

Because the ScriptSave WellRx card/app is free to download, requires no credit card information to be entered, and has no membership fee, it’s definitely worth trying. Maybe you’ll get a better deal by using your insurance or without ScriptSave WellRx, but it is so quick and easy to compare prices that I always check it before I call my son’s doctor for a refill on his prescription.


For the best Rx price on
prescription medications,
visit www.WellRx.com.
Compare prices at more than
62,000 pharmacies nationwide.

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Pharmacist help manage epilepsy drugs

by Jenny Bingham, PharmD

Choosing the correct medication to treat epilepsy is a multifaceted process. Pharmacists can have a huge impact on the patient’s therapeutic response as a valued member of the healthcare team. 1

Medications used to treat seizures are called anti-epileptic drugs. Pharmacists review reams of information to ensure medication safety and suitability. The three primary concepts involved in this evaluation include:

  1. Pharmacogenetics – the role of genetic differences on an individual’s response to a drug.
  2. Pharmacokinetics – how a drug moves through the body.
  3. Pharmacodynamics – an individual’s therapeutic response to a drug.

It is important to assess for drug interactions

When medications interact with one another it is called a drug-drug interaction. Medications can enhance the effects of another drug (agonize). They can also block the effects of another drug (antagonize).

Monitoring for kidney or liver function

Medications are either metabolized in the liver or kidneys. If an individual has impaired organ function or damage, it changes how the body responds to that drug. Some medications, like Carbamazepine and Phenytoin may have more of an impact than Gabapentin.

Medications that are metabolized in the liver have an affinity for certain enzymes:

  • If a medication induces a particular enzyme, it can increase the body’s metabolism of it. The result is decreased serum concentration levels, or decreased effects.
  • If a medication inhibits, it can decrease the body’s metabolism of it. The result is an increased serum concentration level. Individuals might experience increased side effects when this happens.

What to expect for the duration of treatment

The goals of treating seizures are:

  1. Improve the patients quality of life; and,
  2. Decrease seizure frequency.

An individual’s type of seizure and previous medical history dictate how long they must take anti-epileptic drug. Patients should only make changes to their medication as directed by their provider.

In general, there is no one size fits all approach to treating seizures. However, pharmacists can prevent medication-related issues by performing a comprehensive safety evaluation as a member of the healthcare team.

References:

  1. Koshy S. Role of pharmacists in the management of patients with epilepsy. Int J Pharm Pract. 2012 Feb; 20 (1):65-8.
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noacs - warfarin alternatives

by Kali Schweitzer, PharmD candidate 2018
University of Arizona College of Pharmacy

Not so long ago, a diagnosis of atrial fibrillation (AFib), deep vein thrombosis (DVT), or pulmonary embolism (PE) meant that a prescription for the blood thinner, warfarin (Coumadin), was likely coming your way. In recent years, multiple other blood thinners have become available, and you may have wondered if any of them could be right for you.

What are NOACs?

The NOACs, or novel oral anticoagulants, are a new breed of blood thinner that have arrived on the market within the last ten years. This class of medications includes:

How are NOACs Different from Warfarin?

Multiple clinical trials comparing these alternative warfarin medications have all shown that the NOACs are just as effective as warfarin, and that they have a similar (or lower) risk of bleeding. Warfarin has been around for decades and has been proven to be both safe and effective at preventing blood clots, but it’s no secret that it has its problems. Here are some key differences to note when comparing the newer anticoagulants with warfarin and when deciding what is right for you:

  1. Warfarin requires frequent trips to the lab to have your INR (international normalized ratio) checked. Also referred to as PT time, Prothrombin time is a blood test that measures how long it takes blood to clot, or how well the medication is working. You may potentially need to change your dose to increase or decrease the clotting time. NOACs do not require lab monitoring or frequent dose changes.
  2. NOACs do not have the high potential to interact with food or other medications like warfarin does, meaning there are fewer restrictions. This means no more worrying about how much salad you can eat on a day-to-day basis, or if you are allowed to have that glass of grapefruit juice in the morning. It is still recommended, however, to check with your doctor or pharmacist before starting any new medications, as there are still some medications that may increase your risk of bleeding when taken with the NOACs.
  3. NOACs begin working quickly, while warfarin may take up to a week to start working. Because of this, patients with a DVT or PE starting warfarin may require “bridge” therapy with heparin or enoxaparin (other fast acting blood thinners) to prevent clots while waiting for the warfarin to take effect. This “bridge” therapy is not necessary with the NOACs.
  4. Unlike warfarin, not all of the NOACs have a reliable reversal agent if you were to begin bleeding. With warfarin, if your INR becomes too high or if you are having signs of bleeding, you may be given vitamin K, or phytonadione, to reverse its effects. Currently, Pradaxa is the only NOAC that has an approved reversal agent, called Praxbind (idarucizumab). While bleeding is rare while on the NOACs, the lack of reversal agent is something to keep in mind when deciding which medication may be right for you.
  5. NOACs may not be appropriate if you have decreased kidney and/or liver function. Your doctor will review your labs and information to determine if your kidneys/liver are functioning well enough for you to take one of these medications.

The recent approval of the NOACs has provided prescribers and patients with more options to choose from when a blood thinner is necessary. Because these medications are still relatively new, there is a lot left to learn about their use and limitations, so they may not be appropriate for everyone. It is always important to discuss any questions or concerns with your doctor when starting any of these medications or when switching from one to another.

 

References

Leung LLK, Direct oral anticoagulants and parenteral direct thrombin inhibitors: Dosing and adverse effects. In: UpToDate, Mannucci PM (Ed.), UpToDate, Waltham, MA.

Hanley CM, Kowey PR. Are the novel anticoagulants better than warfarin for patients with atrial fibrillation? Journal of Thoracic Disease. 2015;7(2):165-171. doi:10.3978/j.issn.2072-1439.2015.01.23.


Download the free WellRx app from the iOS app store or the Google Play Store,
and get registered to take advantage of our free medication adherence tools.

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

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WNCT9 prescription savings story

GREENVILLE N.C. (WNCT) – Pharmacy prices can differ from store to store and should be treated like buying a car.

Most people think of just going to the pharmacy closest to them instead of looking around for their medication.

When in reality, it can differ by sometimes a significant amount.

There are different ways that you can go about finding these prices.

Certain apps will bring up every pharmacy within a number of miles of your current location.

From there, you type in the medication that you’re looking for and all of the prices will come up right in front of you.

A creator of one of those apps says he looks for the cheapest prices for everything else – so why not do it for our medication.

“Any pharmacies have an in store savings program for low cost drugs,” said Shawn Ohri, creator of ScriptSave WellRx. “But it doesn’t mean all drugs are low cost at that pharmacy, they’re bringing in a good number of prescriptions at a low cost but there may be others that don’t have a low cost.”

You can find apps like this in the Apple Store or the Google Play Store.

Some are free and others require a subscription.

9 On Your Side looked up some of the top medications used in Greenville and found a difference of almost $30 in some of the different locations, showing it really does work to look before you shop.

Top 10 Drugs (non-controls)  Greenville, NC
Reporting Period: Jan 2017 – June 2017
Date Prepared: 07/27/2017
Rank Drug     Lowest Pharmacy
1 AMLODIPINE BESYLATE     Harris Teeter Pharmacy
2 Generic form of Norvasc (High blood pressure, chest pain)

ATORVASTATIN CALCIUM

    Hometown Discount Pharmacy of Greenville
3 Generic form of Lipitor (High Cholesterol)

HYDROCHLOROTHIAZIDE

    Harris Teeter Pharmacy
4 Waterpill/Diuretic (High blood pressure and fluid retention)

METOPROLOL SUCCINATE

    Rite Aid Pharmacy
5 Generic form of Toprol (High blood pressure, chest pain, and heart failure)

GABAPENTIN

    Rite Aid Pharmacy
6 Generic form of Neurontin (Nerve pain medication – very common)

METOPROLOL TARTRATE

    Walmart Pharmacy
7 Generic form of Lopressor (High blood pressure, chest pain, and heart failure)

LEVOTHYROXINE SODIUM

    Walmart Pharmacy
8 Generic form of Synthroid (Thyroid hormone)

SERTRALINE HCL

    Harris Teeter Pharmacy
9 Generic form of Zoloft (Anxiety/Deperession)

LISINOPRIL

    Harris Teeter Pharmacy
10 Very common heart failure / high blood pressure medication.

PREDNISONE  Steroid used for inflammation.

    Walmart Pharmacy
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prescription savings pill-splitting - wellrx

by Hayde Blanco, PharmD Candidate
University of Arizona College of Pharmacy

Pill splitting refers to breaking a pill down to obtain a smaller amount of the whole pill. Your doctor can write a prescription that is usually double the dosage of what you should take in one day. You can then cut the pill in half, making the smaller dose that should actually be taken. For instance, a medication might be prescribed for 40 mg, but then the pill is split so you actually end up taking 20 mg.

Why Split Pills?

Pill splitting can be a huge help in cost savings if the same amount of the larger and smaller doses are sold at a similar price. Some of the most common reasons for pill splitting are:

  • Reduce the costs associated with a medication
  • Take a dosage of a drug that is not already available.

These methods can be useful to help some people save on their prescription medications, but are not suitable for everyone or for every type of pill. There are some risk factors that should be taken into consideration before splitting any pills.

Pill Splitting Concerns

When a pill is split, there may be different amounts in each half of the pill. Since the active ingredient in each pill is not usually evenly distributed throughout the pill, this may lead to one half containing more of the active ingredient than the other, giving it more potency. Some pills may be hard to split due to having an unusual shape, being too hard, or crumbling easily. There are also some medications that should never be split.

Pharmaceutical companies create some pills that are scored, meaning that they have a line down the middle to make it easier to split.

pill splitting sertaline
This pill is generic sertraline 100mg (an antidepressant) with a line down the middle. Generic pricing for 30 tablets of 100mg averages about $11.50. Generic pricing for 30 tablets of 50mg averages about $10.00. By cutting the 100mg dose in half, you would save close to half of the cost.

Some of the risk of pill splitting is related to the individual, instead of being related to the pill. A common issue is forgetting to split a pill, which could lead to taking double the amount of the prescribed dose. The directions might also be unclear if the bottle says to take one daily, but your doctor says to take one-half daily. You should always verify with your doctor if you are not sure about the prescription dosage you should be taking.

​Although there are risks involved with pill spitting, it can be an appropriate cost saving technique for some people. If pills are being split, there are some recommendations that should be followed to reduce the risks.

What are the Risks?

Some of the risk can be related to the individual instead of being related to the pill. A common issue is forgetting to split a pill, which could lead to taking twice or more of the needed dose. The directions might also be unclear if the bottle says to take one daily, but your doctor says to take one-half daily. Always verify with your doctor if you are not sure how much you should be taking.

​Although there are risks involved with pill spitting it can be an appropriate cost saving technique for some people. If pills are being split, there are some recommendations that should be followed to reduce the risks.

Splitting Pills Safely

  1. Always discuss your choices with a pharmacist or doctor before deciding to split a pill.
  2. Have a general understanding of which pills are appropriate to split and which are not.
  3. Use an appropriate pill cutter. Using a pill cutter instead of a knife or other object cuts the pill more evenly and leads to better distribution of the active ingredient.
  4. Cut the pills right before taking them instead of cutting them all at the same time. Since the distribution of the active ingredient is often not the same on both sides, taking both halves on consecutive days allows for a more even intake of the active ingredient. Additionally, a medication might not be as effective at treating your symptoms when it is broken down and exposed to air and moisture over time.
  5. Make sure you are can put this into practice safely or have someone help you if you can’t. If you have any problems with memory, trouble using your hands, or do not think you would be able to split the pills on an ongoing basis this will not be an appropriate technique to use.

These medications are usually appropriate to split, but always check with your pharmacist or doctor if it is okay to split your medication:

  • High blood pressure medications
  • High cholesterol medications (statins, like Lipitor, Crestor, or Zocor)
  • Depression medications.

These pills should not be split:

  • Capsules
  • Enteric-coated medications
  • Extended release or long acting medications
  • Combination pills containing more than one drug
  • Prepackaged pills, like birth control
  • Certain classes of medications, such as chemotherapy drugs
  • Pills with a small therapeutic index (these pills need to be taken at a very precise dose because they can lead to side effects more easily if more than the prescribed dose is taken or they might not be as effective if too little is taken).

Always remember to talk to your healthcare provider to be sure it’s appropriate for you to split a certain pill before using this cost saving technique. When done correctly, pill splitting can be a safe and effective method to reduce prescription medication costs.

 

References:

https://www.linkedin.com/pulse/tablet-splitting-risky-practice-stuart-silverman

https://www.consumerreports.org/drugs/is-it-safe-to-split-pills-in-half/

https://www.consumerreports.org/drugs/get-the-right-pill-splitter-and-save-money-on-your-medication/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827917/


For the best Rx price on statins and other medications,
visit www.WellRx.com.

Compare prices at more than
62,000 pharmacies nationwide.

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Role of vitamin d and statin induced muscle pain

by James Ketterer, PharmD

Statins are a class of drugs used to lower cholesterol and decrease the risk of cardiovascular events. They work by inhibiting an enzyme from completing an early step in the body’s process of synthesizing cholesterol. Statins are among the most commonly prescribed medications in the country. Approximately 1-2% of patients on statins report experiencing muscle pain. This pain can present itself in a variety of ways but most often results in flu-like aches and pains. The muscles may feel stiff or sore like the feeling after working out. This usually effects the larger muscles of the body such as parts of the back or thighs. This side effect is often responsible for patients discontinuing the use of these drugs.

Does Vitamin D Play a Role in Statin-induced Muscle Pain?

Do statins cause muscle pain? The exact cause of this phenomenon is not completely understood, but many researchers have hypothesized that vitamin D levels may play a role. Vitamin D is mainly produced in the skin from sun exposure. However, this source is not active. The liver and kidneys are responsible for activating the vitamin D which then plays a role in facilitating intestinal absorption of essential nutrients as well as balancing bone health homeostasis. Vitamin D deficiencies often present with similar muscle pain as those found as a side effect in statins.

Some researchers have theorized that statins could reduce vitamin D levels because certain types of cholesterol carry vitamin D and when the cholesterol is reduced, less vitamin D could be transported. On the other hand, many have theorized that since both vitamin D and statins are metabolized by the same enzyme in the liver, the use of statins could delay metabolism of vitamin D, thus increasing levels in the blood.

Muscle Pain in Clinical Trials

Clinical trials and various other studies and reports have yielded mixed results on muscle pain in statin users with low compared to high levels of vitamin D. A large analysis of these trials showed that more studies resulted in statin users having higher levels of vitamin D on average. One retrospective study divided statin users into 4 groups, 1 being the lowest vitamin D levels and 4 being the highest. Group 1 was 1.21 times more likely to develop muscle pain than group 4. Another study showed statin users with vitamin D levels of less than 15 ng/mL were 1.9 times more likely to experience muscle pain compared with non-statin users. The statin users with higher levels of vitamin D did not have higher risk for muscle pain compared with non-statin users.

When a patient experiences what is believed to be the side effect of a drug, they are often taken off of the drug to see if the symptoms resolve. If they do resolve, sometimes the patient is started back on the drug to see if the symptoms return. This a referred to as a “rechallenge”. One chart review showed that returning vitamin D levels to a sufficient level before a rechallenge in statin users who had experienced muscle pain, increased their tolerability to statins.

Do Vitamin D Supplements Help Reduce Statin-induced Muscle Pain?

Some studies have given vitamin D supplements to statin users experiencing muscle pain. While these studies were uncontrolled, they did show improvement in muscle pain in nearly 90% of patients.

These are just a few of the examples of research looking at the correlation between stain use and vitamin D levels as a possible cause of muscle pain. While nothing is definitive at this point, patients on statins that are experiencing muscle pain may want to explore vitamin D supplementation as a possible resolution plan. The benefits of statins are well documented in patients with heart risks. Any side effects should be attempted to be overcome before giving up on the statin and assuming it is the cause.

References:

Gregory, Philip J. ” Vitamin D and Statin-Related Myalgia”. Medscape. 2017. Web. 10 Mar. 2017.

Simvastatin.  Micromedex Solutions.  Truven Health Analytics, Inc. Ann Arbor, MI.  Available at: https://www.micromedexsolutions.com.  Accessed March 20, 2017.


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ScriptSave WellRx - Statins and Liver Damage

by: James Ketterer, PharmD Candidate
University of Arizona College of Pharmacy

If your doctor has said you have high cholesterol, it’s likely that you’ve heard or read about the potential side effects of statin drugs and their impact on liver.

Doctors often prescribe statins for people with high cholesterol levels to lower their total cholesterol and reduce their risk of a heart attack or stroke. While statins are highly effective, they have been linked to muscle pain, digestive problems and mental fuzziness in some people and may rarely cause liver damage.

Cholesterol and triglycerides are lipids (fats) that are stored in the body and serve as a source of energy. Lipids, together with proteins and carbohydrates, are the main components of living cells. When lipid levels in the bloodstream are too high or low, this condition is called dyslipidemia. The most common types of dyslipidemia are:

  • High levels of low-density lipoprotein (LDL or “bad”) cholesterol
  • Low levels of high-density lipoprotein (HDL or “good”) cholesterol
  • High levels of triglycerides

You may have heard stories of people who have experienced devastating liver damage from their use of drugs like atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor). Less than 3% of patients on statins report muscle pain while less than 0.5% report rhabdomyolysis (A breakdown of muscle tissue that releases a damaging protein into the blood).

Recently, the risk of statin-induced liver injury has become a hot topic, since this class of drugs is metabolized by enzymes in the liver. Liver injury has a broad definition, but generally includes, at minimum, highly elevated liver enzymes which are directly correlated with liver function and often a precursor to various liver diseases.

Statin Studies

While studies on the safety of these drugs have included thousands of patients, it’s difficult to determine if something like liver injury is one of the side effects of statin drugs, or happening for some other reason. Drug-induced side effects are more commonly identified after a drug hits the market and patients and physicians begin reporting problem cases to the drug manufacturers.

There have been a few studies around the world that have looked at drug-induced liver injury. A study in Iceland identified 96 patients with drug-induced liver injury. Three of those 96 were due to statins (1 with simvastatin and 2 with atorvastatin). During the trial, over 27,000 people were treated with simvastatin and over 7,000 with atorvastatin. That means that 1 out of 27,000 people on simvastatin and 1 out of 3,500 people on atorvastatin had drug-induced liver injury in Iceland over that 2 year period. Of all statins, simvastatin and atorvastatin are responsible for most reported incidents of liver damage, but this is likely just due to the fact that they are prescribed the most.

The Spanish Hepatotoxicity Registry identified 858 cases of drug-induce liver injury. Of those cases they attributed 47 (5.5%) of them to statin use. The total number of patients on statins was not available.

One of the latest studies from the USA ran from 2004 to 2014, examining drug-induced liver injury identified 1188 cases. They determined that about 2% could be contributed to statin use.

A Swedish study compared the reported statin-induced liver injuries to the total number of statin users (based on sales) and found that 1.2 people experience liver injury due to statins per 100,000 users of statins.

A Rare Occurrence

Outside of these large studies, there have been case reports of patients experiencing liver injury following an increase in dosage of their statins. These are few and far between, and are corrected by decreasing or discontinuing the medication. Some of these patients have been restarted on statins and experienced the same liver problems, confirming the drug as the cause. People that experience statin induced liver injury have a generally positive prognosis. These injuries are usually short-term and reversible. One study of interest that looked at 298 patients whom had experienced drug-induced liver injury and found that only 7 of them had any signs of liver problems one year later.

While there’s a lot of information on the safety of statins in the media, the truth is that side effects of statin drugs, including livery injury, are very rare. That’s not to say that they don’t occur, but rather that the benefits in patients with cardiovascular risk, even those with underlying liver problems, substantially outweigh the potential risks.

 

References

Björnsson, Einar S. “Hepatotoxicity Of Statins And Other Lipid-Lowering Agents”. Medscape. N.p., 2017. Web. 9 Mar. 2017.

Simvastatin.  Micromedex Solutions.  Truven Health Analytics, Inc. Ann Arbor, MI.  Available at: https://www.micromedexsolutions.com.  Accessed March 2, 2017.

 

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