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

What is a ‘Statin’?

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

Why do foods or beverages interact with medications?

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

What foods or beverages should I avoid?

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

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

References:

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

caffeine, alcohol, and medications - wellrx blog image

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

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

What is a Medication Interaction?

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

What Should I Know About Caffeine?

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

  • Adderall
  • Vyvanse
  • Ephedrine
  • Sudafed

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

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

What You Should Know About Alcohol

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

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

Key Takeaways

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

References:

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

zoloft and ibuprofen interaction - blog image

By Elizabeth Binsfield BA, RN

Helpful for Many

Many people receive health benefits from taking the selective serotonin reuptake inhibitor (SSRI) Zoloft to manage specific conditions. Zoloft, also known by its generic name sertraline, is prescribed as treatment for conditions such as depression, panic attacks, obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and a severe form of premenstrual syndrome called premenstrual dysphoric disorder. Having such a medication available to treat the symptoms of these disorders is a tremendous relief to those affected. But it’s very important to be aware of any potential interactions with other medications, both those prescribed and those purchased over the counter.

Get a free ScriptSave WellRx prescription savings card.

Side Effects of Zoloft

As with all medications, Zoloft, or sertraline, has potential side effects that you should be mindful of, especially when taking other medicines. If you take Zoloft, it’s important to check the possible side effects and interactions when preparing to take any other medications. Your doctor and pharmacist are important resources to call on to ensure you aren’t combining medications inappropriately.

Zoloft and other medications like it can make your blood somewhat thinner than it was before you began taking it. It can cause you to have nosebleeds or to bruise more easily. You might even find that scrapes and cuts take a little longer to stop bleeding while you’re on Zoloft. This is why it’s so important to learn more about the side effects of other medications to ensure you don’t make your blood even thinner still.

Side Effects of Ibuprofen

When we have headaches, general aches and pains, or even arthritis pain, we usually reach for what are called anti-inflammatory medications. One of the most commonly known is ibuprofen. Ibuprofen is a very helpful over the counter medication for a variety of ailments, but it also has potential side effects and interactions that are important to consider.

One of the primary concerns with the use of anti-inflammatory medications is their association with stomach upset. They are well known to cause stomach discomfort because they can disrupt the chemistry in our stomachs and cause ulcers with regular use. They also cause the blood to thin, and can lead to excessive bleeding with continuous use.

Dangers of Taking Zoloft and Ibuprofen Together

The health concerns related to thinner blood becomes more likely when you take multiple medications known to cause your blood to thin. The danger of thinner blood is that we are that much more likely to easily bleed. Nosebleeds can be one common occurrence, but of greater concern is the increased risk for bleeding in the brain, which can be extremely dangerous. If you frequently take ibuprofen for pain and you also take Zoloft, you’re at a greater risk for bleeding issues. In addition, if you are elderly, or have kidney or liver disease, your risk for bleeding is even greater.

Safer Pain Relief Options with Zoloft

For over-the-counter pain relief without the risk of thinning the blood, acetaminophen (Tylenol) is a safer choice because it does not have the same side effects. However, you may want to discuss other options with your doctor. There may be topical medications or patches that the doctor determines are safe for you to use in addition to Tylenol. You may also be able to save as much as 80% on your Zoloft prescription and others by using ScriptSave ® WellRx. The WellRx website also offers free helpful tools for managing, tracking, and refilling your medications.

Elizabeth Binsfield, RN is a Richmond, Virginia-based registered nurse and freelance healthcare writer, who has more than 20 years of experience in medical-surgical acute care nursing, wound care, geriatrics, and home and hospice care. She received her nursing degree from Northern Virginia Community College.

References

https://www.drugs.com/sfx/zoloft-side-effects.html

http://www.nbcnews.com/id/22298763/ns/health-health_care/t/common-pill-combos-can-put-you-risk/#.XknErhNKjOQ

https://www.drugs.com/drug-interactions/ibuprofen-with-zoloft-1310-0-2057-1348.html

https://www.webmd.com/pain-management/news/20150714/antidepressant-painkiller-combo-may-raise-risk-of-brain-bleed#1

https://www.health.harvard.edu/newsletter_article/commentary-can-painkillers-cap-antidepressant-effect

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

https://www.healthline.com/health/pain-relief/ibuprofen-advil-side-effects#common-side-effects

https://www.webmd.com/digestive-disorders/digestive-diseases-gastritis#1https://www.wellrx.com/



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by Stephanie Forbes, PharmD

We’ve all gone to the pharmacy to pick up a new medication and been counseled on interactions with other drugs. But, what about foods that might interact with the new medication?

Oral medicines are absorbed into the bloodstream through our gastrointestinal tract (GI tract). For this reason, food or drinks can sometimes interact with the absorption of the medicines we take.  In some cases, food can actually help with absorption, but in other instances it can be a hinderance, and cause less of our medicine to be taken up into the bloodstream.

Some antibiotics, like amoxicillin/clavulanate extended release (Augmentin) and cefuroxime (Ceftin) are better absorbed when we take them with food. Lovastatin is another example of a medicine that has improved absorption when taken with food. In contrast, some medicines (bisphosphonates like alendronate, antibiotics like ampicillin) are absorbed less when taken with food, and should be taken on an empty stomach.

Foods That May Interact With Drugs

Below are some foods and environmental aspects that can interact with the frequently prescribed medications .

Calcium Rich Foods

When we think of calcium, we tend to think of dairy products. In addition to milk, cheese, and yogurt, calcium supplements and some antacids containing calcium can interact with some medicines. Most commonly interacting with calcium are antibiotics, like ciprofloxacin, tetracycline, and doxycycline. The calcium may bind to the antibiotics creating a substance that prevents them from being absorbed.

Grapefruit

Grapefruit and grapefruit juice an affect the metabolism of drugs through a pathway called CYP450, a metabolism pathway through the liver. The impact of grapefruit (and juice) on this can increase the effects of some drugs to a dangerous level.  Furanocoumarin chemicals, compounds found in grapefruit, can interact with enzymes in the liver and small intestine. Some examples of medicines that interact with grapefruit are simvastatin, felodipine, and ticagrelor.

Vitamin K Rich Foods

Patients who are prescribed the blood thinner warfarin are likely familiar with this drug-food interaction. Anticoagulants like warfarin inhibit vitamin K, which an essential component in the process that makes clotting factors, which help prevent bleeding. A frequent misconception with this interaction is that vitamin K rich foods should be avoided; however, that is not the case. Most important is to keep a consistent intake of vitamin K in your diet, and avoid adding in new foods like kale, spinach, or other leafy greens.

Key Takeaways

Keep in mind, this is not a comprehensive list and other foods and beverages may interact with medications (alcoholic beverages, pickled, cured, and fermented foods, etc.). Always check with your pharmacist or doctor for any dietary considerations when starting a new medication. For additional help between doctor & pharmacy visits, it may be possible to turn to technology. For example, by searching for a given prescription drug on the ScriptSave WellRx website (or mobile app), a patient can click through to the “Lifestyle Interactions” tab, where upon they will see details of known dietary interactions for that drug (the example linked to here is for Atorvastatin/Lipitor, and shows details of the aforementioned MAJOR interaction with grapefruit juice).

Technology tools like ScriptSave WellRx are not just able to flag dietary/lifestyle interactions. They can also highlight potential interactions between the different medications in a patient’s personal prescription regimen. Patients are able to create a free account either on the ScriptSave WellRx website or through the mobile app and, by unlocking the free virtual Medicine Chest, they are able to load details of their own medication to a secure account. The medicine chest is then able to flag not just the known food/dietary interactions with the patient’s own specific drug list, but also potential interactions between the different prescription medications themselves.

References:

  1. Gilchrist, Allison. 5 Dangerous Food-Drug Interactions. Pharmacy Times. September 17, 2015. https://www.pharmacytimes.com/news/5-dangerous-food-drug-interactions. Accessed November 25, 2019.
  2. Technician Tutorial, Drug Interactions 101. Pharmacist’s Letter/Pharmacy Technician’s Letter. October 2016.
  3. Avoid Food-Drug Interactions: A Guide from the National Consumers League and U.S. Food and Drug Administration. April 4, 2017. https://www.fda.gov/downloads/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/GeneralUseofMedicine/UCM229033.pdf. Accessed November 25, 2019.
  4. Bushra, R., Aslam, N., & Khan, A. Y. (2011). Food-drug interactions. Oman medical journal26(2), 77–83. doi:10.5001/omj.2011.21


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Studies have confirmed that the more medications you take, the more likely you are to have a potentially life-threatening drug interaction. Check out the latest story from CBS News – New York for the latest interview with ScriptSave’s own Dan Johnson.

Dan discusses how the ScriptSave WellRx app can help you potentially avoid those dangerous drug, supplement, and lifestyle interactions.

Concerned About Safely Mixing Meds? There’s An App For That

CBSNewYork – Health Watch

CBS News Health Watch
CBS2’s Dr. Max Gomez interviews Dan Johnson, VP ScriptSave, about the ScriptSave WellRx app helping patients better manage their medications.

 

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$10 billion in prescription savings - scriptsave wellrx blog image

ScriptSave WellRx Marks Silver Anniversary –
25 Years of Prescription Savings, Totaling $10 Billion, and a Brand New Innovation to Help Patients Who View Food as Medicine

A new analysis from the prescription discount program, ScriptSave WellRx, has revealed the savings from the company’s pioneering efforts to lower out-of-pocket costs for millions of patients paying cash for their prescriptions. The results: more than $10 billion dollars of savings, as the company marks its Silver Anniversary with the release of a brand new module that can assist patients with their grocery choices.

Founded in 1994, ScriptSave has been a pioneer and innovator, leading the way in terms of creating tools and programs designed to help un- and under-insured patients better afford their medications. Working in close collaboration with many of the nation’s pharmacy and grocery chains, ScriptSave has created incredible savings opportunities for patients.

With the latest update to the ScriptSave WellRx mobile app, ScriptSave has announced a new wellness-focused tool that provides grocery guidance. Using the new tool, consumers can check:

  • ensure the foods they are eating are consistent with their goals for general wellness
  • choose foods better aligned for pregnancy
  • select appropriate foods for other health conditions, including heart health and diabetes.

Users of the app can even find similar food options that are better aligned with their needs. As with most other programs and offerings from ScriptSave, the ScriptSave WellRx app (and the new grocery guidance toolset) is available to users at no cost.

Prescription Savings - ScriptSave WellRx

ScriptSave Never Stops Innovating

scriptsave wellrx food index imageOther pioneering innovations that are also available (free) in the latest app release include:

  • geo-targeted price-drop alerts for prescriptions medications, allowing users to see when the prices for their own medications come down at nearby pharmacies;
  • medication refill and ‘take your pill NOW’ reminders, helping to ensure prescribed medication adherence, and;
  • medication interaction alerts, to flag possible life-threatening drug or lifestyle interactions.

The newest release of the ScriptSave WellRx app, can help guide shoppers while they browse the aisles at the grocery store or as they take stock of their pantry. It’s a clear expansion outside of ScriptSave’s traditional domain. Moving beyond just pharmacy and prescription medications, the grocery guidance module can guide users towards more health-conscious food selections. It’s designed to help users concerned with chronic conditions like diabetes or heart health, and can help identify appropriate food selections for pregnant women.

These latest innovations to the app’s features are the result of more than two years of ongoing product development. Along the way, the team even managed to pick up a few awards for prototype versions of the app (including as a category winner at the 2017 National Association of Chain Drug Stores’ Product Showcase). ScriptSave’s Vice President of Product & Technology, Shawn Ohri, noted that the timing of this release to coincide with ScriptSave’s Silver Anniversary could hardly seem more fitting or rewarding to the team.

$10 Billion Saved

Meanwhile, an in-depth analysis of the traditional prescription savings programs that ScriptSave has been evolving throughout the course of its 25 years of innovation, shows how the business has helped an estimated 85 million patients in the US save a total of $10 billion on their prescription medication costs. In 2018 alone, the prescription discount program saved consumers $450 million on medications.

ScriptSave WellRx’s free savings cards and prescription coupons—which can be found online or in the mobile app—can help save patients up to 80% on their medications, with average savings of around 60%. In terms of dollars and cents, the average cash saved by patients using ScriptSave WellRx in 2018 was $30.85 per prescription.

Ohri noted that with the ever-increasing prices of medication in the US, ScriptSave WellRx is helping patients pay for the medications they need to not only get over a cold or fever but, in some cases, survive.

“This is our 25th anniversary, and during those years we’ve helped patients save $10 billion on prescriptions they need to get and stay healthy,” said Ohri. “Our prescription discount programs help consumers save money they can use on other critical expenses, like keeping the roof over their heads, putting food on the table for the family and buying school supplies for their kids. We continue to operate with a start-up mentality, bringing new and innovative solutions to help people manage their health and wellness.”

WellRx Mobile App Helps Consumers Find Lowest Prices at the Pharmacysrciptsave wellrx price drop alerts - image

At its core, ScriptSave WellRx negotiates drug prices in bulk with pharmacies across the nation, giving it access to pricing information for most prescription drugs being sold at independent and chain pharmacies. Consumers can access this data at no cost with the free ScriptSave WellRx mobile app and website.

This provides a fast, easy, free way for patients (and physicians) to get a second opinion on what an out-of-pocket cost might be. Patients can price-check all their family’s medications at most pharmacies in any zip code with just one click.

The price-check tool is available for free—no sign-up necessary—and features savings on medications at over 65,000 retail pharmacies across the U.S. In 2018, the program delivered average savings of 60%, with potential savings of 80% or more (relative to the cash price of those prescriptions being filled).

Patients can download the free ScriptSave WellRx mobile app (for iPhone and Android) or visit the website for more information.


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marijuana interactions with prescription drugs - scriptsave wellrx

During the current coronavirus pandemic, many national celebrations of 420 day have been canceled or scaled back, and there’s a growing concern that smoking marijuana may raise risks associated with COVID-19. But with many states on lockdown, there’s been a run on supplies as people stock up to stay home5.

With the growing legalization of marijuana, which has been approved for recreational use in 11 states and for medical use in 33 states1, there’s naturally a lot of buzz around the medical benefits. Emerging research suggests it may be a safer substitute for opioids to treat pain. But what about potential drug interactions?

Limited Research

But as research continues into possible benefits of using marijuana for treatment, questions remain about how cannabis might interact with prescribed or over-the-counter (OTC) medications a person may also be taking.

Some states have legalized the use of marijuana for medical purposes, as well as for recreation to varying degrees, however, the federal government has not. The tight federal restrictions create a challenge in researching how marijuana interacts with other products, either OTC or prescribed.

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Interactions With Medications or Lifestyles

Some examples of medication types and common interactions include:

Drug Type Lifestyle Interaction
Tricyclic antidepressants May result in adverse cardiovascular effects, such as tachycardia and cardiac arrhythmias.
Nonsteroidal antiinflammatory drugs (NSAIDs) Administering nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with marijuana may limit some of marijuana’s pharmacologic activities.
Benzodiazepines Using marijuana with benzodiazepines may result in an exaggerated sedative effect.
Amphetamines Using marijuana and amphetamines together may cause adverse cardiovascular effects, such as tachycardia and cardiac arrhythmias.
Beta-blockers Concurrent use may result in decreased beta-blocker efficacy, significantly increased heart rate and cardiac output lasting for 2-3 hours, myocardial infarction and cardiac arrhythmias.

Visit www.wellrx.com for more information on drug and lifestyle interactions.

Synthetic Marijuana (Marinol)

In addition to tetrahydrocannabinol (THC), cannabidiol (CBD) is found in high concentrations in marijuana. CBD does not produce any of the psychoactive responses and appears to block some of the effects of THC by acting as an antagonist at the cannabinoid receptors. Cannabinol is weakly psychoactive and appears to be primarily formed from the metabolism of THC. Another metabolite of THC is thought to contribute to the tachycardia and appetite-stimulating effects of cannabis.2,3

An FDA-approved synthetic form of marijuana uses a chemical compound similar to those found in cannabis. Marinol (drobinol) is approved to help with nausea induced by chemotherapy as well as anorexia caused by AIDS.

The Takeaway

For most patients, cannabis:

  • Is relatively safe
  • Well-tolerated, and;
  • Carries fewer risks of adverse drug interactions than many commonly prescribed drugs.

Given its therapeutic versatility, one of the best arguments for cannabis is that it can actually reduce the need to combine multiple medications, therefore lowering the potential risk of adverse interactions.4

References:

  1. https://www.businessinsider.com/legal-marijuana-states-2018-1
  2. https://health.usnews.com/health-care/patient-advice/articles/2018-03-08/how-does-marijuana-interact-with-medications
  3. https://www.pharmacytimes.com/publications/issue/2014/december2014/drug-interactions-with-marijuana
  4. https://www.leafly.com/news/health/cannabis-cannabinoids-drug-interactions
  5. https://www.leafly.com/news/health/cannabis-coronavirus-covid-19-facts 

If you’re struggling to afford your medications,
visit www.WellRx.com to compare the cash price at pharmacies near you.
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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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ScriptSave WellRx app pill refill reminders - blog image

by Dan Johnson, RPh and PharmD,
Vice President of Network Strategy, ScriptSave

If you take a prescription medication, you need to be aware of potential interactions. More than 2 million patients are hospitalized every year after they inadvertently mix their prescription drugs, while another 100,000 die annually. And the statistics get worse with age. The chance of an adverse drug reaction for people over 50 jumps 33 percent versus younger people. Here’s what you need to know to keep yourself safe.

What Are Drug Interactions?

An interaction occurs when two substances are taken together and one affects the other’s function. One substance could lower the effectiveness of the other or completely block it from functioning. This can be dangerous for someone with a serious medical condition that needs to be managed with a precise dose of medication. Other substances could increase the concentration of medication in your blood. This increases the risk of overdose.

What Can Interact with My Medications?

Any of these substances can interact with prescription medications:

  • Other Rx medications
  • Over-the-counter drugs
  • Alcohol
  • Recreational or illegal drugs
  • Certain foods and beverages
  • Supplements

You may be aware of drug-drug interactions. The more drugs you take, the greater the risk that some of them will interact with each other. However, many people don’t realize how the things they consume every day could impact their medications. 

For example, people who take Lipitor or Zocor with grapefruit juice may experience muscle pain and other side effects. This is an example of a food-drug interaction. Alcohol can be deadly when combined with sleeping pills. And since supplements are not regulated by the FDA, they may not have drug interactions listed on the label.

With all of these potential interactions, you may be feeling overwhelmed. Luckily, there are ways you can stay informed and safe.

How Patients Can Protect Themselves From Drug Interactions

Your healthcare providers are a great resource for your questions about your medications and they will often summarize potential interactions for you. However, there are some steps you can take yourself. Use these strategies to protect against interactions.

Fill All Your Prescriptions at the Same Pharmacy

Ideally, patients should go to the same pharmacist and discuss any other drugs they’re taking. This conversation should include all prescriptions, over-the-counter drugs, supplements, and alcohol or other recreational drugs. If you do go to several different pharmacies or transfer a prescription to a new pharmacy, be sure to have a list of all drugs you take so you can share that with each pharmacist.

Organize your prescriptions with WellRx app

Schedule a Comprehensive Medication Review

Some health plans include coverage for medication therapy management services (MTM). These services are provided by a pharmacist to maximize medication effectiveness and safety. MTM may include a comprehensive medication review, which gives patients the chance to sit down with a pharmacist and discuss all the medications and substances they are taking. During this time, you can ask any questions you have about potential side effects and interactions. 

Thoroughly Read All Drug Information for Your Prescriptions

Whenever you receive a new prescription, be sure to read the entire label and Medication Guide. This will tell you about any potential interactions. You can also ask your pharmacist about interactions when you fill your Rx.

It’s a good idea to regularly review the information for every drug you’re taking, especially when you start a new prescription.

Know How and When to Take Each Rx

It’s important to take your medications the way your doctor instructed. Sometimes, interactions can be minimized by adjusting your medication schedule. Talk to your doctor and pharmacist about how and when each drug should be taken. If there are any potential interactions, your healthcare providers can find a solution by either tweaking your medication schedule or prescribing a different drug.

Share Information Between Providers

If you see multiple doctors and specialists, your primary care provider may not be getting a complete picture of your health. Be sure to talk to each of your providers about all drugs and supplements you take. Also be sure each provider is authorized to share your medical information with all other providers. This may require you to sign release forms due to the Health Insurance Portability and Accountability Act (HIPAA).

Tell Your Doctor about Any Reactions

As we age, our bodies metabolize drugs slower and at different rates. Because of this, patients should monitor their reactions to any new or existing drugs. Even if you’ve been taking a drug for years without any issues, you could start metabolizing it differently at any time. Always report side effects to your doctor as soon as possible.

Use Technology to Help

Although technology can’t take the place of medical advice from your doctor or pharmacist, it can help you stay organized when it comes to your medical information.

There are many mobile apps that can keep track of your medication regimen and even alert you to potential interactions. The ScriptSave WellRx app includes this capability. Our virtual Medicine Chest warns patients of hazardous drug interactions. It also sends reminders when patients need to take their next pill, or need a refill. If you’re worried about potential drug interactions, we invite you to download our app today and see how it can help you stay informed.

Download Our Free Mobile App Today.

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2019 opioid guidelines - scriptsave wellrx blog image

by Katie Tam, PharmD Candidate,
University of Arizona College of Pharmacy

In October 2017, Acting Health and Human Services (HHS) Secretary Eric D. Hargan issued a statement declaring a nationwide public health emergency regarding the opioid crisis.1 The opioid epidemic in America has become a top priority in efforts to prevent opioid overuse.

Opioids are a drug class that includes heroin, oxycodone, hydrocodone, codeine, morphine, fentanyl, and many other prescription pain relievers. These medications can carry serious risks, like addiction, overdose, and even death.

The U.S. Department of Health and Human Services (HHS) reported that more than 42,000 people died from overdoses involving opioids and estimated 40% of opioid overdose deaths involved a prescription opioid.2

New Medicare Part D Opioid Overutilization Policies

To help you use prescription opioid pain medications more safely, the Centers for Medicare and Medicaid Services (CMS) has recently introduced new regulations in the Medicare part D prescription drug program. Using recommendations made by Centers for Disease Control and Prevention (CDC) on prescribing opioids for pain, CMS developed new safety measures. Here are some key points that are crucial to understand:

  1. New Opioid Users: Your Medicare drug plan and pharmacist will do safety reviews of your opioid pain medications when you fill a prescription. If you are a new opioid user, you may be limited to a 7 day supply or less. The hope is to reduce the risk of longer-term opioid misuse through closer management of opioid naïve patients.2 This policy will affect Medicare patients who have not filled an opioid prescription within the past 60 days and will prevent pharmacies from filling a new opioid prescription exceeding a 7 days supply.2
  2. Limited Opioid Amount: During the safety review, your pharmacist will also look for potentially unsafe opioid amounts and drug-drug interactions that may increase your risk of overdose. If your pharmacist decides that your total opioid prescription dose is not safe, the plan may limit your coverage of these drugs. This alert will identify patients that may benefit from closer monitoring and care coordination and encourage doctors to educate patients about opioid overdose risk and prevention.3
  3. High-Risk Opioid Users: This new regulation allows Medicare drug plans to implement a drug management program (DMP) that limits access to opioids and benzodiazepines (used for anxiety and sleep) for patients at high risk of opioid abuse.3 High risk patients will need to obtain their opioids from specified doctors or pharmacies. Before Medicare places you in a DMP, it will notify you by letter. The goal of this program is to identify potential at-risk patients and provide better care coordination for safer use of opioids and benzodiazepines.3

Opioid Policy Exclusions

The new opioid regulations do not apply to patients with cancer, those who get hospice, palliative, or end-of-life care, or who live in a long-term care facility. Also, patients who use the medication-assisted treatment (MAT) program will not be impacted by these new policy changes.2

About 115 patients die every day from an opioid overdose. Because opioid addiction is driving this epidemic, the hope is that these new regulations will reduce the negative impacts of the epidemic on Americans.4 If you suffer from severe or long-term pain, talk with your doctor about all your pain treatment options including whether taking an opioid is appropriate for you. There may be other ways to manage your pain with less risks.

Resources:

  1. HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html
  2. A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Polices for 2019. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/RxUtilization.html. Accessed January 20, 2019.
  3. CY 2019 Final Call letter. Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2019.pdf. Accessed January 20, 2019.
  4. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep. 2016;65:1-49, available at http://dx.doi.org/10.15585/mmwr.rr6501e1.

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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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activated charcoal image - scriptsave wellrx blog

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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