hypothyroidism - dr. checking patient - scriptsave wellrx blog

by Jamie Voigtmann, PharmD Candidate

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

How Does the Thyroid Work?

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

thyroid process - diagram - scriptsave wellrx blog image

What are the Causes and Symptoms of Hypothyroidism?

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

What are the Treatment Options?

Synthetic T4 Replacement

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

Synthetic T3 Replacement

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

Synthetic Combination Therapy

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

Natural Desiccated Therapy

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

References

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

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

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

What are Nocturnal Leg Cramps?

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

Are Nocturnal Leg Cramps the Same as Restless Leg Syndrome? 

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

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

Causes of Nocturnal Leg Cramps

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

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

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

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

Management and Treatment of Leg Cramps

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

Prevention and Self-Care Strategies:

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

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

Resources:

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

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are canadian drugs legit - scriptsave wellrx - blog image

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

Many of us have had a relative, friend, or coworker who gets their medications from Canada. For many of us, this sparks a stream of questions: “Are Canadian medications legit? How are medications approved in Canada? Is it legal to buy prescription medications from Canada?” You may be surprised to discover that Canada and the United States (U.S.) are very similar in their drug approval process; some may even say they are near identical.

Similarities between the U.S. and Canadian drug approval process

Both Health Canada and the U.S. Food and Drug Administration (FDA) have processes which drug companies must follow in order to get medications approved. Both processes have three phases of clinical trials as well as a post-marketing phase.1 Even though the processes are so similar for prescription medication approval, it is still illegal to import drugs or devices into the U.S. for personal use.3 The FDA’s reasoning behind this is that they cannot ensure “safety and effectiveness” of the medications being imported. Many of you may then be asking, “What if it’s a medication like Lisinopril that is already approved in the U.S.?” This is a gray area and even the FDA is vague on the topic saying these are “circumstances in which the FDA may consider exercising enforcement discretion and refrain from taking legal action against illegally imported drugs.”4

Why are Canadian medications so much cheaper?

The Patented Medicine Prices Review Board (PMPRB) “protects and informs Canadians by ensuring that the prices of patented medicines sold in Canada are not excessive and by reporting on pharmaceutical trends.” Furthermore, Canada has a law that states the price of a new medication, first of its kind, cannot exceed the median price for the rest of the world.2 As discussed above, the Canadian drug approval process is just as rigorous as the U.S., therefore if you decide to purchase from a Canadian pharmacy, one way to verify that it is legit is to look for the pharmacy license number to be shown on the website.2 Unfortunately, the United States is the only industrialized country that doesn’t utilize price controls for pharmaceuticals resulting in astronomical drug prices. The U.S. federal government reported that in 2012, around 5 million Americans had purchased drugs outside the U.S.

Over-the-Counter Medications

Along with cheaper prescription medications, Canada also has cheaper over-the-counter (OTC) medications, too. However, unlike prescription medications, it is legal to buy OTC medications from Canada.5 To determine whether the product is legit, look for the product label to contain an 8-digit Drug Identification Number (DIN), which means it has met Canadian standards for safety, quality, and effectiveness.5

“The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices;”3 therefore the safest option is to obey the FDA regulations.

If you’re having trouble affording your medications, try the free ScriptSave WellRx price comparison tool to see if we can help you save. The ScriptSave WellRx program is freeto all patients, and the price-check tool is available 24/7, without the need for an account or any personal details. In other words, the program can be used risk-free and with nothing to lose. We even provide free medication management tools, refill reminders and an “Ask a Pharmacist” helpline. We’re doing our best every day to help patients get safe, hassle-free savings.

 

References:

  1. “Comparison: Canada and United States.” National Institute of Allergy and Infectious Diseases, U.S. Department of Health and Human Services, 8 Feb. 2018, clinregs.niaid.nih.gov/country/canada/united-states#_top.
  2. Kirschner, Chanie. “Why Are Pharmaceuticals Cheaper in Canada?” MNN – Mother Nature Network, Mother Nature Network, 5 June 2017, https://www.mnn.com/health/fitness-well-being/questions/why-are-pharmaceuticals-cheaper-in-canada
  3. Office of Regulatory Affairs. “Import Basics – Personal Importation.” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, 3 Aug. 2018, https://www.fda.gov/forindustry/importprogram/importbasics/ucm432661.htm
  4. Osterweil, Neil. “Buying or Importing Prescription Drugs: Laws and Regulations.” WebMD, WebMD, www.webmd.com/healthy-aging/features/letter-and-spirit-of-drug-import-laws.
  5. Canada, Health. “Regulation of Non-Prescription Drugs.” ca, Innovation, Science and Economic Development Canada, 21 Feb. 2018, https://www.canada.ca/en/health-canada/services/self-care-regulation-non-prescription-drugs.html

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best-statin-prices - scriptsave wellrx - blog image

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

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

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

Praluent

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

Repatha

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

What to Ask Your Provider and/or Pharmacist

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

References:

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

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flu booster shot - scriptsave wellrx - blog image

by Heather Lee, University of Arizona PharmD Candidate

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

What is the flu?

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

Some common flu symptoms include:

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

More serious complications of flu include:

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

Who Needs It?

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

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

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

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

Side Effects of Flu Shot

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

Sign Me Up

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

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

Resources:

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

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obesity in the U.S. - scriptsave wellrx blog image

by Randall Flores, PharmD Candidate 2019
University of Arizona

In the past few decades, there has been an alarming and steady increase in obesity rates in the U.S. This affects people of all races and ages. More Americans live with obesity than breast cancer, Alzheimer’s, Parkinson’s and HIV all together. The medical community has been aware of the rising epidemic for many years, yet its response has not been effective at addressing the problem.

What is a Healthy Weight (BMI)?

Obese or overweight is defined as weight that is higher than what is considered a healthy weight for a given height measured as Body Mass Index (BMI)1. The levels of weight measured by BMI are listed below:

  • BMI < 18.5 = underweight
  • BMI 18.5 to <25 = within normal weight
  • BMI 25 to <30 = overweight
  • BMI >30 = obese

The Facts About Obesity

With an estimated population of 328.73 million people in the U.S.,6 the prevalence of obesity was 39.8% between 2015-2016, affecting nearly 93.3 million people.1 The estimated health care cost of obesity was $147 billion in 2008 which was $1,429 higher than those of normal weight. Obesity seems to have a racial/genetic link as Hispanic and non-Hispanic blacks had the highest prevalence with 47% and 46.8% respectively.2 Much of the obesity seen in the U.S. starts at a younger age and transcends into adulthood with a prevalence of 18.5% (ages 2-19) nearly affecting 13.7 million children.2 Similar to adults, obesity in children is more common in certain populations; Hispanics having the highest prevalence (25.8%) followed by non-Hispanic blacks (22%).2

Obesity-Related Health Conditions

The most common obesity-related diseases that result in premature deaths include type 2 diabetes, heart disease, stroke, and certain types of cancers such as colorectal, pancreatic, and endometrial cancer.1,4 People who have obesity are also at increased risk for serious diseases including the following;3

High blood pressure Low quality of life
High levels of bad cholesterol &
low levels of good cholesterol
Sleep apnea & breathing problems
Gallbladder disease Mental illness, depression, anxiety, &
other mental disorders
Osteoarthritis Body pain & difficulty with physical functioning

A Push for Prevention

The epidemic of overweight and obese citizens in the nation is complex and has no simple solution. There are many factors that play a role in obesity. Due to its complexity, the epidemic of obesity needs to be approached through multiple outlets, with tactics in local, state, and federal organizations as well as professional health organizations.5 The long-term goal to decreasing obesity is shifting to norms of a healthy lifestyle, which include healthy eating and regular physical activity.5 Healthcare should also shift more of its efforts towards preventing obesity. Another key player in reversing the obesity epidemic is implementing community efforts that support a healthy lifestyle, such as food services, schools, childhood care, and clinics/hospitals.

Obesity and being overweight affects millions of people in our nation and worldwide. Obesity is associated with an increased risk of many serious diseases that are otherwise preventable. We must shift our efforts to the epidemic of obesity to halt its progression and strive towards a healthier future for younger generations to come.

 

References:

  1. Adult Obesity Facts | Overweight & Obesity | CDC. (2018). Retrieved from https://www.cdc.gov/obesity/data/adult.html
  2. Children Obesity Facts | Overweight & Obesity | CDC. (2018). Retrieved from https://www.cdc.gov/obesity/childhood/index.html
  3. Adult Obesity Causes & Consequences | Overweight & Obesity | CDC. (2018). Retrieved from https://www.cdc.gov/obesity/childhood/index.html
  4. Obesity and Cancer. (2018). Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet
  5. Strategies to Prevent Obesity. (2015). Retrieved from https://www.cdc.gov/obesity/strategies/index.html
  6. S. and World Population Clock. (2018). Retrieved from https://www.census.gov/popclock/

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Pharmacy Gag Clause - pharmacist perspective - ScriptSave WellRx blog image

by Mitchell Welton, PharmD Candidate 2019
University of Arizona

After the much anticipated release of the 2016 Gallup poll, which had Americans assign a rating of honesty and ethical standards in professions, Pharmacists found themselves in a top-three ranking for the 14th straight year.1 In last year’s poll however, it seems the general public’s opinion of pharmacists had shifted slightly. With increased news coverage and scrutiny over rising drug prices, it seemed harder for patients to be able to separate the practices of big pharmaceutical companies with the copay price that the pharmacists were asking for at the drug counter.

Pharmacy Gag Clauses

Although the community pharmacist was unable to control the inflating cost from the manufacturers, there was a more insidious practice taking place that kept their hands tied and mouths shut, even though patients might have been paying more for their prescription medications than they needed to. This was due to pharmacy gag clauses, written into the contracts between the pharmacy and pharmacy benefit managers (PBM). These clauses prevented a pharmacist from telling the patient at the point of sale if the cash price was lower than their insurance copay. To violate such a gag order would mean risking the pharmacy’s network contracts with its PBMs and facing other sanctions.2

An example of this practice will help explain why the opinion of pharmacy ethics and honesty were not found in the top-three ranking in last year’s poll: A patient’s spouse went to pick up her generic medication, telmisartan, from their local pharmacy. He paid $285 for a 90-day supply. Before the 90-day period he and his wife decided to go on a trip and would run out of her previous fill before returning home. He went to go purchase another 90-day refill out of pocket and found out the cash price was $40. While a spokesperson for the PBM involved in this event confirmed that the $285 copay was correct he was unable explain why that dollar amount was so much higher than the cash price of the medication.3 Overpayments like this, known as “clawbacks”, have unfortunately not been isolated events, and the occurrence was recently quantified by the University of Southern California’s Schaeffer Center for Health Policy and Economics.

[ Read more about PBM Pharmacy Clawback’s ]

The study which was completed in March of this year looked at available pharmacy claim data from 2013. The study analyzed over nine million claims in which they found close to a quarter of them to involve overpayment. The average amount patients overpaid was $7.69 and overpayments on a brand name medication were significantly higher although not as frequent. 4

States Take the Lead

Between 2016 and August 2018 at least 26 states have enacted laws prohibiting “gag clauses” in pharmacy contracts. The most recent action came from the White House on October 10, 2018, when President Donald Trump signed into law the “Know the Lowest Price Act” and the “Patient’s Right to Know Drug Prices Act” which banned gag clauses immediately upon signature. This has represented a major victory for pharmacists who have had to remain silent while they watched the patients they care about struggle to pay for their medications. 2

How Pharmacists Feel About Gag Clauses

Pharmacists and law makers alike are disturbed that such practices have been allowed to exist. Senator Susan Collins, Republican of Maine, said, “I can’t tell you how frustrated these pharmacists were that they were unable to give that information to their customers, who they knew were struggling to pay a high co-pay.” Senator Martin M. Looney, Democrat of Connecticut said, “This is information that consumers should have, but that they were denied under the somewhat arbitrary and capricious contracts that pharmacists were required to abide by.” 5 Pharmacist Robert Iacobucci Jr., who owns White Cross Pharmacy in North Providence, Rhode Island expressed his frustration,” There’s no other profession in the world where you can’t tell your customer how to best utilize their money.”  When you see a 98-2 vote from the senate in such a divisive political climate to eliminate these gag clauses, it is telling that change was long overdue.

For more than a decade pharmacists have consistently been thought of as the pinnacle of honesty and ethical behavior when evaluating professions. The recent ban on these gag clauses will allow pharmacists to maintain that respected title and get back to what they do best; Improving the health and outcomes of their patients.

 

References

  1. Gallup, Inc, and Jim Norman. “Americans Rate Healthcare Providers High on Honesty, Ethics.” com, 19 Dec. 2016, news.gallup.com/poll/200057/americans-rate-healthcare-providers-high-honesty-ethics.aspx.
  2. Snyder, Lynn S, and John S Linehan. “New Federal Laws Banning ‘Gag Clauses’ in the Pharmacy.” The National Law Review, 30 Oct. 2018, natlawreview.com/article/new-federal-laws-banning-gag-clauses-pharmacy.
  3. Thompson, Megan. “Why a Patient Paid a $285 Copay for a $40 Drug.” PBS, Public Broadcasting Service, 19 Aug. 2018, pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug.
  4. Van Nuys, Karen, et al. Overpaying for Prescription Drugs: The Copay Clawback Phenomenon. USC Schaeffer, Mar. 2018, http://healthpolicy.usc.edu/wp-content/uploads/2018/03/2018.03_Overpaying20for20Prescription20Drugs_White20Paper_v.1-2.pdf.
  5. Pear, Robert. “Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8.” The New York Times, The New York Times, 24 Feb. 2018, nytimes.com/2018/02/24/us/politics/pharmacy-benefit-managers-gag-clauses.html.
  6. Povich, Elaine S., and Tribune News Service. “The ‘Gag Clause’.” The Lewiston Tribune, 1 July 2018, lmtribune.com/business/the-gag-clause/article_8c269796-7d54-5116-86ca-f3e59da23fae.html.
  7. Cauchi, Richard. “Ncsl.org – Legislative News, Studies and Analysis.” Prohibiting PBM “Gag Clauses” That Restrict Pharmacists from Disclosing Price Options: Recent State Legislation 2016-2018, 22 Aug. 2018, pm, ncsl.org/.
  8. Gallup, Inc, and Megan Brenan. “Nurses Keep Healthy Lead as Most Honest, Ethical Profession.” com, 26 Dec. 2017, news.gallup.com/poll/224639/nurses-keep-healthy-lead-honest-ethical-profession.aspx.

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keep an eye on diabetes - scriptsave wellrx - blog image

by Pawel F. Kojs
University of Arizona College of Pharmacy

Living with diabetes is not an easy task, however, you are not alone. Roughly 415 million people across the world are affected with this disease. If you have diabetes, you should consider several things, such as lifestyle, medication adherence, and check-ups with your healthcare provider. These are important to make sure that your diabetes is controlled and doesn’t lead to a deterioration in your overall health. Keeping blood sugars controlled can prevent serious problems like diabetic cardiomyopathy, stroke, and atherosclerosis4. An ounce of prevention is worth a pound a cure.

Tests to Keep Your Diabetes in Check

According to Kaiser Permanente, there are several exams that a person living with Diabetes should consider1:

Weight and blood pressure: checked at every doctor’s visit.1

A1C (Glycosylated hemoglobin): This is a test that is meant to be done every three months. Blood test that shows your average blood sugar for the past two to three months. This is done by measuring the amount of glucose attached to your blood cells1.

The A1c target is usually less than 7% for people with diabetes. However, your provider will decide the ideal A1c target for you3.

Urine check: This annual test is done to look for small proteins which show signs of early kidney damage1.

Lipid blood test: This test performed once every two years checks the level of your triglycerides, total ( “good” and “bad” cholesterol)1.

The following tests are recommended to be checked every 2 years if you have Type 2 Diabetes with no symptoms, or had Type 1 Diabetes for more than 5 years1

Eye Exam: Diabetes can affect your vision. Exams checks for any nerve damage of the eye. If you have nerve damage of the eye then it is recommended to see the doctor yearly1.

According to the American Diabetes Association (ADA) guidelines, pregnant women with preexisting type 1 or type 2 diabetes, the exam should be done in the first trimester. Patients should then be monitored at every trimester and for 1 year after giving birth2.

Foot Exam: Diabetes can affect your feet. This test performed at least annually is to examine the feet. Tests are done more often if you have any positive findings1. This checks for any numbness, sores, infections, and calluses1,3.

Vaccines: According to the ADA, vaccines are recommended for diabetic patients. The flu vaccine is recommended for all people greater than 6 months of age. A 3-dose series of Hepatitis B vaccine should be given to people ages 19-59. People over the age of 60 should be considered for a 3 dose Hepatitis B vaccine. A PPSV23 Vaccine is recommended for people between the ages of 2-64 years of age and after age 65, the PPSV23 vaccine is necessary even if you had a vaccine in the past2.

Diabetes management does not end in the doctor’s office. It all starts with the goals that you have set out for yourself. Whether it’s controlling your blood pressure or reducing your weight, this requires small and achievable goals. Set a goal too big and you will become overwhelmed. Talk over your goals with your healthcare provider. Putting in a consistent effort to maintain or achieve your diabetic goals will produce worthy results.

 

References:


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food allergies and medicine -scriptsave wellrx blog image

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

Nearly 20% of Americans have self reported an allergy to a medication and roughly 4% of the nation suffers from some form of food allergy.1 While it would seem obvious to avoid something if you’re allergic to it, you’d first have to know you’re allergic. When it comes to medications this can be challenging.

There are different grades to an allergic reaction. It could be as mild as some pesky itching or a cough; a more serious fever, rash or painful blisters; or very serious blood irregularities, difficulty breathing or death.2,3 Allergic reactions can occur within many different classes of medications such as antibiotics, antidepressants, anesthetics, narcotics, nonsteroidal anti-inflammatory drugs (NSAIDs), among others.1

Excipients – Crucial for Drug Delivery

When you take medication, there is more than just an active drug inside the tablet, capsule, spray or syrup; these additional “inert” products are called excipients4. Excipients play a variety of roles in medications. They are used to stabilize the active drug, bind the active drug(s), increase the solubility, enhance or delay absorption (such as enteric coated tablets), and provide flavor or sweetness.4 Some excipients come from foods that people have an allergy to. The most common food allergies in the United States are milk, egg, peanut, soy, fish, and gluten.5 The Food Allergen Labeling and Consumer Protection Act (FALCPA) was enacted to inform patients if a major allergen was in their food, even in trace amounts. This carries over to medications, however, this information comes and stays with the original bottle, it will not be transferred to the prescription label. These food and drug allergies are why the pharmacy will ask for your allergy information when creating your profile and before dispensing any medications. Different manufacturers use different excipients in their preparations, so you may be allergic to one brand and okay to take a different brand. If you would like to know if an allergen is in your prescription, ask your pharmacist.

Milk: Milk allergy, sometimes called lactose intolerance causes discomfort in the digestive tract whenever dairy products are consumed. There are other enzymes in milk that people may be allergic to such as casein. Lactose is used as a stabilizer in some asthma inhalers and as a filler (excipient) in some tablets. Other milk products can be found in TUMS smoothies, as well as some vaccines, so be sure to ask your doctor or pharmacist to avoid an allergic reaction.5,6

Egg: Those with an egg allergy should be cautious of vaccines that use egg as a stabilizer and certain hospital drugs for intravenous use as some patients have had an anaphylactic reaction. The CDC has said that the Flu vaccine is safe, even in people with an egg allergy but there are egg-free versions of the vaccine available. IV Benadryl and the sedative propofol are two medications that contain egg. Again, make sure any health care professional that considers you a patient knows your allergy history as it is important for your safety.5,6

Peanut: Peanut is a well-recognized allergy alert and as such is not found in many medications. The package inserts for progesterone capsules and valproic acid capsules have peanut as an ingredient. Dimercaprol lists peanut oil and there is peanut oil in some asthma inhalers and the topical medication fluocinolone.6  There are alternatives to any of these medications for anyone with a peanut allergy that would also need one of these medicines.

Soy: Soy can be listed as soy or as one of its derivatives – lecithin. Again, it can be found in some inhalers and propofol5. Some over the counter products I’ve discovered that have soy are Advil liquid-gels, TUMS smoothies, and black cohosh (an herb sometimes used to treat perimenopause and menopause symptoms). Be sure to read the ingredient list when choosing an over the counter medication or ask your pharmacist if you are unsure if an allergen is in a product.

Fish: Fish products can be found in some (not all) multi-vitamins and supplements, which highlights the importance of reading labels. A reversal agent for the anti-coagulant heparin called protamine contains some derived fish products. NPH insulin also contains some fish oil, so diabetic patients with a fish allergy needing a short acting insulin could choose a different insulin.3,5 There are case reports of patients with a fish allergy trying fish oil and not experiencing a reaction, if you would like to try the fish oil test then ask your doctor.

Dyes: One final excipient that causes a reaction in some patients is medical dye. Most specifically FD&C Blue 1, Blue 2, Red 4, and FD&C Yellow 5. These colors can be used in many different medications, your doctor or pharmacist would need to check to ensure these dyes aren’t in any of your medications7.

This is not a complete list of possible allergens or medications that may contain allergens. If you have ever experienced a reaction to a food, medicine, or dye be sure to inform your primary care doctor, pharmacist, and any specialists that you see. Document your reaction so that you can remember what happened if a health professional asks you about your allergy. Questions about possible allergens can be answered by your prescriber, pharmacist, poison control center, or manufacturer of your medication so never hesitate to call and ask. Any patient that has ever experienced an anaphylactic reaction should wear a bracelet advertising the allergy.

 

References

  1. Macy E, Ho NJ. Multiple drug intolerance syndrome: Prevalence, clinical characteristics, and management. Ann Allergy Asthma Immunol2012; 108:88–93
  2. Stevenson, DD. Sanchez-Borges M. Szczeklik, A. Classification of allergic and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes. Ann Allergy Asthma Immunology 2001; 87:177
  3. Demoly P, Adkinson NR, Brockow K, et al. International Consensus on Drug Allergy. Allergy 69:420-437, 2014
  4. Lesney, Mark S. More than just the sugar in the pillToday’s Chemist at Work. 10(1): 30–6, 2001
  5. Kelso JM, Davis C. Food Allergy Management. Immunology and Allergy Clinics of North America 2018; 38:53-64
  6. Kelso JM. Potential food allergens in medications. Journal of Allergy and Clinical Immunology. Jun 2013; 133(6):1509-18
  7. Swerlick RA, Campbell CF. Medication dyes as a source of drug allergy. Journal of Drugs in Dermatology. Jan 2013; 12(1):99-102

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rising insulin costs - scriptsave wellrx blog image

by Eli Kengerlinski, 2019 PharmD Candidate
University of Florida College of Pharmacy

Over the years, insulin prices have increased in accordance with newly developed insulins that have come to market. Traditional insulins, short and intermediate acting, as compared to newer rapid and long acting insulins, are less expensive in market value.1 Biosimilar traditional insulins with expired patents (some since 2000) may be a better option for some patients, as their market price has significantly dropped over the years. However, many patients are still having trouble affording their monthly Lantus or Humalog due to their high copays.

Why is insulin important?

Insulin plays an important role in managing patients with Diabetes Mellitus (DM). Patients with Type 1 DM have limited ability to produce endogenous insulin due to their pancreas’s inability to properly function. Patients with Type 2 DM can also have increased dependence on insulin therapy use as their disease state progresses. It is crucial for certain diabetic patient populations to have insulin at hand as they cannot control their sugar levels with just oral medications (eg. Metformin) that have no effect on insulin production. Type 1 DM population, there’s a greater need for basal (intermediate or long acting) as well as mealtime (rapid or short acting) insulin.

What options do you have?

Lifestyle modifications towards a healthier diet and exercise can be the most important changes any diabetic can make, and help ensure proper management of your condition. Monitoring your daily sugar levels, managing your weight via carb counting or following the plate method2, as well as exercising 30 minutes a day, five times a week, are all great habits to ensure effective DM management.

From January 2014 to July 2018, short and intermediate acting insulins have dropped in price equaling less than half of rapid and long acting insulins in the market today.1 Even if newer insulins offer better sugar control, their high prices make it difficult for patient access. For these specific patient populations, traditional insulins should be considered to ensure patient adherence to DM therapy and prevent patients using less of their insulin. If you’re having trouble paying for your insulin, then ask your provider if short and intermediate acting insulins would be right for you. Also contact your insurance company to see if you qualify for additional programs (eg. Medicare, Medicaid).

Furthermore, ask your provider if there are generic alternatives to your rapid or long acting insulin. For example, Admelog costs 12 to 15% less than Humalog while Basaglar costs about 15% less than Lantus on a per insulin unit basis.3 Therefore, it is important to ask for biosimilar generics that have the same active ingredient as they are usually cheaper.

Another affordable alternative to ensure access to insulin would be switching patients on high cost insulin pens to vials. Even though pens are more convenient and patient friendly, vials should be considered, especially if you’re having trouble affording your insulin. However, do ensure that you are instructed on how to properly inject your insulin.

If you’re still having trouble affording your insulin, ask your local pharmacist for a manufacturer savings card. If you need help with diabetic medications, visit www.wellrx.com for substantial prescription savings at pharmacies throughout the U.S. and Puerto Rico.

REFERENCES:

  1. Eisenberg Center at Oregon Health & Science University. Premixed Insulin Analogues: A Comparison With Other Treatments for Type 2 Diabetes. 2009 Mar 25. In: Comparative Effectiveness Review Summary Guides for Clinicians [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2007-. [Table], Price of Insulin. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45287/table/clininsulin.tu1/
  2. Lara Hamilton. “How to Create Your Plate.” Diabetes Forecast, Nov. 2015, diabetesforecast.org/2015/adm/diabetes-plate-method/how-to-create-your-plate.html
  3. “Sanofi Launches Follow-On Insulin Lispro, Admelog.” The Center for Biosimilars Staff, 9 Apr. 2018, www.centerforbiosimilars.com/news/sanofi-launches-followon-insulin-lispro-admelog.

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morning sickness - scriptsave wellrx blog image

By Pawel F. Kojs, PharmD Candidate Class of 2019,
University of Arizona College of Pharmacy

Morning sickness or nausea and vomiting in pregnancy (NVP) occurs in 70-80% of pregnant women.  In the United States, roughly 4 million women are affected each year.  This is more common in women that live in Western countries.1 A small percentage of women are affected each year with the more extreme form of morning sickness called hyperemesis gravidarum (HG).1

To help with this condition, there are many remedies to consider with your provider.

How can diet help with morning sickness?

With respect to diet, it is best to avoid large meals and eat smaller meals more often throughout the day.  Eating more protein and less fat is advised as well.2

Even though it’s difficult, eating foods that do not have a high flavor profile and ones that are low in fat helps reduce the time it takes for food to leave the stomach.  This in turn helps with reducing the amount of symptoms one would have with morning sickness.2

Which options can help me with morning Sickness?

There are different options to help treat morning sickness. Avoid smells, foods, tastes, and smells that trigger that nauseous feeling. Talk to your healthcare provider before taking any new prescription or over-the-counter (OTC) medications, and nutritional/herbal supplements.

Prescription Options

Disclaimer: Always consult with your provider before taking any medication during pregnancy.

OTC Options

These options for pregnancy related nausea and vomiting are commonly used. The types of medications are available at your neighborhood pharmacy, but it is recommended to monitor for drowsiness or sedation.

Disclaimer: Always consult with your provider before taking any medication during pregnancy.

Prenatal Supplements

It is advisable to talk to a doctor regarding getting a proper prenatal supplementation. You and your provider can discuss how much folic acid you should take. US Department of Health & Human Services Office of Women’s Health (DHHS) recommends taking at least 400 – 800 micrograms of folic acid daily, starting at least three months before conception.3 Prenatal supplements should be taken on an empty stomach. If you experience stomach upset, try taking it before bed with a light snack.

References:


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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