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by Emily Ross, PharmD Candidate,
Class of 2020

Improving Medication Adherence and Management

Managing several different medications can be overwhelming, confusing and time-consuming. Without effective medication management, errors and missed doses may happen easily. This can lead to ineffective drug therapy and not getting results from taking medications. One key to proper medication management is organization. There are simple ways to create organizational systems into your daily routine to get the most benefit from your drug therapy.

Medication Management Tools

  • Pill Box: One of the simplest ways to keep medications organized is to use a daily or weekly pill box. There are a variety of sizes and colors to fit your needs. These range from simple ones that have a compartment for each day to more complex ones that have dividers for each dosage time (ex: morning, afternoon, evening).
  • Medication List: Keeping and maintaining a current list of all the medications you take is very useful to keep up to date on your treatment. It is important to include all over the counter drugs, supplements, and herbals that you may take as well. Taking this to your doctor appointments and the pharmacy ensures all your providers are aware of your medications and can help prevent duplicate drug therapies and potentially harmful drug interactions.
  • Medication App: There is an app for about anything – including managing your medications! There are several apps available to download to your phone or mobile device. Read about the different features of each one and then choose one that best meets your needs. These are available for both android and apple devices. Some examples are:
    • MyMeds: Connects patients, caregivers, and providers to help have better understanding of current medications
    • MyMedSchedule Plus: Simple and easy to use, offers reminders, pictures of medications and tracks how often the medication is taken
    • The ScriptSave WellRx App: In addition to providing prescription price transparency, the ScriptSave WellRx app allows patients to set Take Your Pill reminders, as well as when it’s time to refill prescriptions.

      The WellRx platform also provides free access to some potentially life-saving functionality:
      • Drug Interaction Warnings: Patients can receive and share warnings with their caregivers when drugs in their personal in-app Medicine Chest might interact with each other.
      • Lifestyle Interaction Warnings: This includes warnings about potential drug interactions with certain foods patients eat, or activities they might engage in.
      • Expanded Drug Information: Patients can view detailed information, images, and videos for drugs within the Medicine Chest. Much of this information is available in English and Spanish.

Tips for Managing Your Medications

Now that you have all your medications organized, the next step is remembering to take them! It is easy to forget or miss a dose of your medication but with a few helpful tips – you can minimize the amount of times this happens and improve adherence.  

  • Reminders: This can be as simple as programming a daily reminder or alarm into your phone that alerts you when it is time to take your medication. You could go the more classic route and have a note that is posted in a spot that you see it every day such as the bedside table, bathroom mirror or fridge. You can also set reminders in the ScriptSave WellRx mobile app.
  • Timers: If a device separate from your phone is more your style, there are several options that can provide an alarm or noise to help remind you that it is time to take medication. Likely, there are many items you already own, such as an alarm clock or kitchen timer, that can be set to the time you need to take medication. E-pill® offers several medication alarms and even has devices that combine pill boxes with reminder alerts.
  • Routine: Include taking medications into a daily routine. First, think of a task you do every day, such as brushing your teeth. Make a point to take your medication at the same time you brush your teeth. By joining the tasks together, taking your medications will become part of your daily routine and decrease the chance of missing a dose.
  • Medication Synchronization: Many pharmacies offer medication synchronization programs that allow you to pick up all your medications at one time. This not only cuts down on trips to the pharmacy but also lessens the chance of allowing a prescription to run out before returning to the pharmacy for more refills.
  • 90-Day Supply: If allowed by your insurance, obtaining a 90-day supply of medication is a good way to have adequate stock and minimize pharmacy trips. Similar to the idea of syncing your medications, there is less of a chance of running out of medication and missing doses.

With all these organization and adherence tips, you’ll be a pro at knowing your medication and taking them on time! There are many benefits that come from organization, such as reducing the stress of managing and taking multiple medications. Additionally, it may decrease health care cost by saving the need for more doctor appointment or medications due to gaps in drug therapy.

These are easy steps that can be done to increase how well your medicines work for you. By using the tools for a good organization system and following the adherence tips, you can improve your overall health and well-being.

References:

Fayed, L. (2019, June 24). How to Manage and Organize Medication for Your Safety. Retrieved from https://www.verywellhealth.com/ways-to-manage-your-medication-514511

MyMeds: Redefining the Medication Experience. (n.d.). Retrieved from https://my-meds.com

MyMedSchedule: Free medication schedules, reminders, and health tracker. (n.d.). Retrieved from https://secure.medactionplan.com/mymedschedule/

Pill Timers. (n.d.). Retrieved from https://www.epill.com/alarms.html

ScriptSave WellRx App Makes Medication Management Easier: https://news.wellrx.com/2019/01/23/scriptsave-wellrx-app-makes-medication-management-easier/



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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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humalog blog image - scriptsave wellrx

by Ryan Lowe, PharmD Candidate,
The University of Arizona College of Pharmacy

For many patients with diabetes, insulin has become a mainstay of their therapy. Despite the addition of newer drugs on the market (like the exciting GLP-1 agonists such as Victoza (liraglutide), insulin remains a popular choice among physicians for its numerous benefits. The dose of insulin can be easily adjusted; if your blood sugars are running high then simply try taking two more units and reevaluate in a couple of days. Insulin is also a great drug when used in combination with other medications such as metformin; these combinations allow for greater control of a patient’s diabetes. According to a study from the CDC, the percent of patients taking both insulin and an oral medication increased between 1997 and 2011. This suggests the importance of both types of medication in diabetes management. 1

What are the different types of Insulin available?

Insulin can be divided up into two categories: long acting and short acting. Most patients start out with a long acting insulin before a short acting insulin is added. The most common long acting insulin is Insulin Glargine, or Lantus. Another long acting insulin you may see is Insulin Detemir, or Levemir. These insulins are normally dosed once a day, and they work to keep your fasting sugars (your blood sugar when you’re not eating any food) within normal limits.  The most common side effect of long acting insulin is hypoglycemia, or low blood sugar. When you take too much insulin your body eats up too much glucose, resulting in low blood sugar levels. If you are hypoglycemic then you may start shaking, feeling dizzy or faint, and feel confused or anxious. The quickest remedy for this is eating a high sugar snack or drink, such as a glass of orange juice. As noted earlier, one of the main benefits of long acting insulin is being able to adjust the dose more frequently to find the perfect dose for you. With a tablet medication it is harder to find the perfect middle ground; you either take one tablet or you take two. Insulin doesn’t work that way; since insulin is a liquid injection you can easily take a little more or a little less than you were previously to account for your blood sugar levels.

Short acting insulin works much quicker than the long acting insulins, hence the name. There are two common short acting insulins: Insulin Lispro, or Humalog and Insulin Aspart, or Novolog. These insulins are commonly taken after a meal. The idea behind this is that the insulin will counteract a large spike in blood sugar gained by eating a large meal. However, these insulins are rarely taken alone; rather they are normally used in combination with long acting insulin to combat both types of sugars: fasting and post-prandial, or post-eating sugars. Hypoglycemia is still a risk with these short acting insulins, but it isn’t as great a risk as with the long acting insulins. One consideration that has been on many patient’s mind, however, is the rising cost of insulin – and Humalog specifically has been in the news lately.

Why is Humalog making headlines?

Humalog is a short acting insulin manufactured by Eli Lilly, a drug company responsible for numerous popular medications. Eli Lilly released some pricing information about Humalog, and the numbers are raising some eyebrows among patients, healthcare providers, and even politicians. An insured patient will typically pay around $135 a month for Humalog (which is a decrease of 8.1% from 2014). When you don’t factor in the rebates typically covered by an insurance company, the monthly price of Humalog rises to $549.2 These differences have gotten a lot of people talking. Eli Lilly hopes that the information they released will help shed some light on the often-muddled issue of rising drug costs. Politicians on both sides seem to agree that drug costs need to come down in America, but the solution to this issue is not an easy one. Eli Lilly themselves hope to improve the situation by releasing a “half-price” Humalog under the generic name Insulin Lispro. The cost will be $137.35 per vial, which should significantly improve the annual cost for those uninsured patients with diabetes.3

In response to the Eli Lilly price drop for Humalog, Sanofi recently announced a program that they hope will make a difference in the cost of insulin.4 They unveiled a Netflix-like program that takes that model directly to patients, supplying insulin products for a flat monthly rate instead of the usual cost per prescription or refill. The drugmaker will use its Insulin Valyou Savings Program to deliver insulin products for $99 per month. For that monthly fixed price, Sanofi will offer up to 10 boxes of insulin pens and 10 mL vials per month, regardless of a patient’s income. The new $99-per-month price could be as little as one-tenth of the amount patients would have paid previously.

References:

  1. “Age-Adjusted Percentage of Adults with Diabetes Using Diabetes Medication, by Type of Medication, United States, 1997–2011.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Nov. 2012, www.cdc.gov/diabetes/statistics/meduse/fig2.htm.
  2. Lovelace Jr., Berkeley. “Eli Lilly Sheds Light on Confidential Pricing, Discloses Charges for Popular Diabetes Drug Humalog.” CNBC, CNBC, 25 Mar. 2019, cnbc.com/2019/03/25/eli-lilly-discloses-pricing-data-for-its-popular-insulin-humalog.html.
  3. “Lilly to Launch a Half-Price Version of Insulin.” CNBC, CNBC, 4 Mar. 2019, www.cnbc.com/2019/03/04/lilly-to-launch-a-half-price-version-of-insulin.html.
  4. “Sanofi provides unprecedented access to its insulins for one set monthly price” Sanofi, 10 Apr. 2019   http://www.news.sanofi.us/2019-04-10-Sanofi-provides-unprecedented-access-to-its-insulins-for-one-set-monthly-price 

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2019 generics - scriptsave wellrx blog image

by Haley Stenquist, PharmD Candidate Class of 2019
The University of Arizona College of Pharmacy

A new group of generic medications are hitting the prescription drug market in 2019. At ScriptSave, we get a lot of questions about generic medications vs. brand name prescription drugs. “A” rated generics meet the same quality standards as brand name prescription drugs and so they provide the same medical benefits. A drug that is “A” rated by the FDA as a generic equivalent contains identical active ingredients as the brand name drug, the same dosage as the brand name drug, and delivers the same concentrations of drug to the bloodstream within the same amount of time. So what are the differences and what’s coming to a pharmacy near you?

Are Generic Drugs the Same as Brand Name?

Yes, generic drugs are “copies” of the brand name medication that was developed by a company other than the one that originally brought the branded medication to market. Generic drugs are available for a fraction of the price of brand name medications, so consumers are naturally eager for the generics to hit the market. Per the FDA guidelines, a generic drug application must first display the following parameters:

  • The generic drug is “pharmaceutically equivalent” to the brand
  • The manufacturer is capable of making the drug correctly
  • The manufacturer is capable of making the drug consistently
  • The “active ingredient” is the same as that of the brand
  • The right amount of the active ingredient gets to the place in the body where it has effect
  • The “inactive” ingredients of the drug are safe
  • The drug does not break down over time
  • The container in which the drug will be shipped and sold is appropriate
  • The label is the same as the brand-name drug’s label
  • Relevant patents or legal exclusivities are expired2

How Long Does It Take for a Drug to Become Generic?

After an application for a patent of a new drug is filed with the United States, it is granted patent exclusivity for 20 years.  The path to generic drugs coming to market was made cheaper, easier, and faster after the introduction of the Drug Price Competition and Patent-Term Restoration Act of 1984 or known as the Hatch-Waxman Act. This allowed companies to submit an abbreviated new drug application (ANDA). About one year before the expiration of the patent drug, companies that are wanting to manufacture the generic drug will submit the ANDA to the FDA. Generally, after that patent has expired and the ANDA is approved, a generic counterpart can be introduced into the market.1

First Generic Drug Approvals for 2019

Currently, the FDA has approved 16 first-time generics in 2019 between different manufacturers (each manufacturer must submit their own ANDA). These include:

  • pyridostigmine bromide syrup—Mestinon Syrup
    • Improves muscle strengths in patients with myasthenia gravis
    • Novitium Pharma LLC—03/08/2019
  • levofloxacin ophthalmic solution, 1.5%—Iquix Ophthalmic Solution
    • Treatment of corneal ulcer caused by certain bacteria
    • Micro Labs Limited, India—02/27/2019
  • deferiprone tablets, 500mg—Ferriprox Tablets
    • Treatment of transfusional iron overload due to thalassemia syndromes
    • Taro Pharmaceuticals Industries Limited—02/08/2019
  • sevelamer hydrochloride tablets, 400mg, 800mg—Renagel Tablets
    • Control of serum phosphorus in patient with chronic kidney disease
    • Glenmark Pharmaceuticals Limited—02/08/2019
  • levomilnacipran extended-release capsules, 20mg, 40mg, 80mg, 120mg—Fetzima
    • Treatment of major depressive disorder (MDD)
    • Amneal Pharmaceuticals Company GmbH—02/04/2019
  • acyclovir cream, 5%—Zovirax Cream
    • Treatment of recurrent cold sores in immunocompetent patients over 12 years of age
    • Perrigo UK FINCO Limited Partnership—02/04/2019
  • Wixela Inhub (fluticasone propionate and salmeterol inhalation powder, USP) 100mcg/50mcg, 250mcg/50mcg, 500mcg/50mcg—Advair Diskus
    • Treatment of asthma in patient over 4 years of age and COPD maintenance (250mcg/50mcg)
    • Mylan Pharmaceuticals Inc.—01/30/2019
  • sirolimus oral solution, 1 mg/mL—Rapamune
    • Prophylaxis of kidney organ rejection in patient over 13 years of age
    • Novitium Pharma LLC—01/28/2019
  • vigabatrin tablets USP, 500mg—Sabril Tablets
    • Treatment of refractory complex partial seizures (CPS) in patients over 10 years of age that have failed multiple alternative treatments
    • Teva Pharmaceuticals USA, Inc.—01/14/2019
  • ingenol mebutate gel, 0.05%, 0.015%—Picato Gel
    • Treatment of topical acne
    • Perrigo UK PINCO Limited Partnership—01/07/2019 (0.015%) and 01/09/2019 (0.05%)
  • lurasidone hydrochloride tablets, 20mg, 40mg, 60mg, 80mg, 120mg—Latuda Tablets
    • Treatment of schizophrenia and depressive episodes associated with bipolar disorder in adults
    • Torrent Pharmaceuticals Limited, Accord Healthcare Inc., Lupin Limited, InvaGen Pharmaceuticals, Inc., Amneal Pharmaceuticals Company GmbH—01/03/20193

Newest Generics of 2019

  • As of 03/12/2019, the FDA approved a new generic of Diovan (valsartan) among the vast recalls from multiple manufacturers, this was granted to Alkem Laboratories Limited.4
  • Lannett announced FDA approval for aspirin and extended-release dipyridamole capsules, 25mg/200mg—Aggrenox Capsules for secondary prevention of stroke and transient ischemic attacks (TIA) on 03/27/2019.5

Forecasted Generics for the Remainder of 2019

The Impact of Generics

It is a long, grueling process for a brand name medication to finally be released to the market as a generic, taking in excess of 20 years. Generic medications are instrumental in helping alleviate the financial burden of prescription medication costs in patients. Each year, the effect continues to grow. In the first quarter 2019, there is already a large impact with new generic medications coming to market. This impact is forecast to continue throughout the year, especially with the possibility of heavy hitters such as Lyrica and Restasis.

References:

  1. “S.1538 – 98th Congress (1983-1984): An Act to Amend the Federal Food, Drug, and Cosmetic Act to Revise the Procedures for New Drug Applications, to Amend Title 35, United States Code, to Authorize the Extension of the Patents for Certain Regulated Products, and for Other Purposes.” gov, 24 Sept. 1984, www.congress.gov/bill/98th-congress/senate-bill/01538.
  2. Center for Drug Evaluation and Research. “Generic Drugs – What Is the Approval Process for Generic Drugs?” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/genericdrugs/ucm506040.htm .
  3. Center for Drug Evaluation and Research. “First Generic Drug Approvals.” U S Food and Drug Administration Home Page, Center for Drug Evaluation and Research, fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/DrugandBiologicApprovalReports/
    ANDAGenericDrugApprovals/default.htm
    .
  4. Office of the Commissioner. “Press Announcements – FDA Provides Update on Its Ongoing Investigation into ARB Drug Products; Reports on Finding of a New Nitrosamine Impurity in Certain Lots of Losartan and Product Recall.” U S Food and Drug Administration Home Page, Office of the Commissioner, fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm632425.htm.
  5. “Generic Drug for Stroke Prevention Granted FDA Approval.” Pharmacy Times, pharmacytimes.com/news/genericdrug-granted-fda-approval.
  6. “Pipeline Report Generic Drugs .” Welldynerx. welldynerx.com/content/uploads/2019/02/Generic-Drugs-Feb-2019-2-12-19.pdf.
  7. “Upcoming Generic Drugs.” Corporate Pharmacy Services, corporatepharmacy.com/page/upcoming_generic_drugs.

 

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income and medication adherence image - scriptsave wellrx blog

by Jamie L. Voigtmann, PharmD Candidate 2019
Saint Louis College of Pharmacy

There are many aspects in life that can decrease prescription fill rates. This in turn causes medication non-adherence, where patients are unable to take their medications regularly as prescribed by a physician. It’s a common and costly problem across America.

What Prevents Patients from Filling Prescriptions?

Barriers to medication adherence include lifestyle preferences, fear or uncertainty about the effectiveness of new medications or adverse reactions, The complexity of instructions and or drug regimens, personal beliefs, and insufficient funds also come into play.1 Patients who have insufficient funds to pay for medications include, not only decreased socioeconomic status, but also all patients that qualify as low-income based on age, gender, race, location, and family size. Patients who have financial restrictions will commonly delay prescription refills, as well as subsequent copays, by splitting pills, taking pills every other day, or even discontinuing medications on their own. This is because many chronic conditions require multiple medications for treatment and many medications are expensive even with insurance.1

The Low-Income Populations Includes Elderly Patients

As mentioned previously, low-income patients not only include race, location, and family size, but also age. As patients become ≥ 65 years old they are most likely dependent on Medicare for health insurance coverage, since it is offered through the government. Elderly patients who experience decreased prescription fill rates have been associated with having increased out-of-pocket costs with prescription medication coverage, lower net worth, and lower household incomes.2 This is important to consider because as patients age their health often declines, indicating more need for medications. It is also imperative to think about this aspect as many Baby Boomers fall into this category, increasing the number of patients sharing Medicare benefits.

Which Types of Medications Do Low-Income Patients Struggle To Get?

A common misconception is that patients with low-income only have trouble affording newer novelty medications, such as HIV, Hepatitis C, and oncology medications. With these types of medications, many patients including the middle and upper economic classes struggle to pay for the medications due to the outstanding drug cost dictated by the manufacturers. Low-income patients also struggle with common health conditions such as asthma, diabetes, and high cholesterol. Patients who are in a lower socioeconomic class experience significantly less control over their asthma and commonly experience increased exacerbations compared to patients who belong to a higher economic class.3

When considering Type-2 Diabetes Mellitus, patients with high-incomes had increased compliance to treatment regimens including diet, exercise, and medications.4 The high-income patient’s also checked their A1c more often and were associated with higher self-care ability.4 Finally considering cholesterol medications, a recent study showed that low-income patients were willing to give up their cholesterol medications if a copay was present because the benefits are not commonly felt unlike insulin for diabetes or lisinopril for increased blood pressure.5

Low-Income vs. High-Income Prescriptions

It is interesting to realize what types of medications low-income patients are filling at the pharmacy, compared to high-income patients. According to The New York Times, high-income patients receive more cosmetic medications to treat baldness, erectile dysfunction, wrinkles, and eyelashes.6 These patients were also more likely to purchase medications to treat mental health.6 They also had more prescriptions for birth control pills due to a consistent prescription from a regular doctor.6 Medications that are more commonly received by low-income patients include HIV and Hepatitis C, most likely due to lack of education in transmission and poor access to healthcare.6

Lowering Overall Drug Costs

Overall, the relationship between income and prescription fill rates at the pharmacy is much more complicated than low-income patients having decreased prescription adherence.6 Different patients are more likely to develop certain diseases or illnesses that would increase healthcare costs. Patients also differ on when they seek medical attention, resulting in a significant cost even before a physician writes a prescription.6 Regardless of income, it’s important to treat patients with as few medications as possible while still treating chronic conditions to help lower overall drug costs for all patients.

References:

  1. Mishra SI, Gioia D, Childress S, Barnet B, Webster RL. Adherence to medication regimens among low-income patients with multiple comorbid chronic conditions. Health Soc Work. 2011; 36(4): 249–258.
  2. Zivin K, Ratliff S, Heisler MM, Langa KM, Piette JD. Factors influencing cost-related nonadherence to medication in older adults: a conceptually based approach. Value Health. 2010; 13(4): 338-45.
  3. Bacon SL, Bouchard A, Loucks EB, Lavoie KL. Individual-level socioeconomic status is associated with worse asthma morbidity in patients with asthma. Respir Res. 2009; 10: 125.
  4. Habib F, Durrany AM. Effect of age and socio-economic status on compliance among type 2 diabetic patients. Curre Res Diabetes & Obes J. 2018; 7(3): 555714.
  5. Watanabe JH, Kazerooni R, Bounthavong M. Association of copayment with likelihood and level of adherence in new users of statins: a retrospective cohort study. J Manag Care Pharm. 2014; 20(1): 43–50.
  6. Quealy K, Sanger-Katz M. The prescription drugs that rich people buy. The New York Times. February 7, 2019. https://www.nytimes.com/2019/02/07/upshot/income-strong-predictor-drug-purchases-serious-diseases.html. Accessed March 9, 2019.

 


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

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

 

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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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ScriptSave WellRx app pill refill reminders - blog image

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

The risk for medication interactions dramatically increases as patients take multiple drugs. ScriptSave’s own Dr. Dan Johnson recently had an article published on the Living Better 50 website on steps you can take to protect yourself from dangerous drug 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.

Even over-the-counter medications and supplements can incite dangerous health risks.For example, patients with high blood pressure should avoid taking cough medicines with decongestants and should consult their pharmacist on the best options to seek relief from cold and flu symptoms. Patients taking prescriptions for depression, chest pain, ADHD, gout, arthritis and other common ailments can frequently be at more risk for dangerous reactions if they don’t keep track of their prescription regimen.

How Can Patients Protect Themselves From Drug Interactions?

  1. Ideally, patients should go to the same pharmacist and discuss any other prescriptions they may be taking. This conversation should include over-the-counter and supplements – in addition to any medications.
  2. Be aware of how common household foods can impact medications. People who take Lipitor or Zocor with grapefruit juice may experience muscle pain and other side effects.
  3. As we age, our bodies metabolize drugs slower and at different rates. Because of this, patients should monitor any reactions to any new or existing drugs.
  4. There are many user friendly, free mobile apps that keep track of a patient’s regimen – alerting them to potential dangerous interactions. ScriptSave WellRx has a new “Virtual Medicine Cabinet” that warns patients of hazardous drug interactions. It also sends reminders when patients need to take their next pill, or need a refill.

Read the full story on living50better.com.

 

————–Addendum (13 Mar, 2019)————–

…and check out what Dr Max Gomez had to say on CBS News, including an interview with ScriptSave’s Dr Dan Johnson.

 

 


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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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by Terra Leon, PharmD Candidate 2019

Tamiflu (oseltamivir) is a prescription medication used in the treatment of influenza in patients 2 weeks and older. It can also be indicated as prophylaxis treatment from the flu and reduce the chances of getting the flu in patients 1 year and older1.

tamiflu package-flu shot image - scriptsave wellrx blog

How does Tamiflu work?

Tamiflu (oseltamivir) is a prodrug, meaning that the drug is metabolized into the active drug after it is administered. Prodrugs are beneficial when the active drug itself has low availability in circulation and is not absorbed well in the stomach. Prodrugs are designed to not only increase the amount active drug in circulation, improve elimination but they also can reduce adverse effects or unintended side effects. Once Tamiflu is metabolized into the active drug, the active drug blocks replication of the virus in the body3. Tamiflu stops the replication process of the influenza virus in your body, it does not cure you of the flu rather it shortens the duration of flu like symptoms in the body by about 1-2 days.

Can everyone use Tamiflu?

Tamiflu (oseltamivir) is recommended in patients for treatment of influenza who are 2 weeks and older and is to be initiated within 48 hours of influenza symptom onset2. Tamiflu may also be prescribed for patients who were exposed to a confirmed flu diagnosis within 48 hours of close contact with the infected individual2. Patients who use Tamiflu >48 hours of symptom onset or exposure may still benefit from the medication, specifically children4. A study was done in children indicating that if Tamiflu was administered within 5 days of symptom onset that overall flu symptoms were reduced by 1 day when compared to placebo4.

Tamiflu side effects

The main side effects patients experience while using Tamiflu are headache, nausea and vomiting3. Please seek medical attention if you have any serious skin and hypersensitivity reaction.

Misconceptions about Tamiflu

Tamiflu will cure me of the flu

Most patients have the misconception that Tamiflu will cure them of the flu, when in reality the medication works by reducing the number of days with flu like symptoms. There is not direct cure for the flu since it is a viral entity, like the common cold. All we can do is treat our symptoms to ease the burden of the virus on the body. The most effective way to protect yourself from the flu is to receive your flu vaccination annually.

Tamiflu is a replacement for the flu shot

Tamiflu or any antiviral medication is not a replacement treatment for the flu vaccine itself. Receiving the flu vaccine is the primary defense to protect yourself from the flu. Antiviral medications are second line when the flu vaccine is not available or contraindicated for the individual4. Most insurance companies will cover the flu vaccine at little to no cost at all where Tamiflu (oseltamivir) can cost anywhere from $50-$135 depending on insurance and quantity needed5. That being said, receiving the flu vaccine protects you from the unwanted flu symptoms as well as the unwanted cost of medication, doctor office visits, and valuable time off work and school.

When I take Tamiflu I cannot get sick

There is no evidence that Tamiflu has any effect on any other illness in the body that does not contain influenza viruses, including bacterial infections. Some bacterial infections can initially present as influenza, it is important to be tested for influenza before starting Tamiflu as the sole treatment2. Always follow up with your doctor if you suspect a secondary bacterial infection in order to be treated appropriately.

Resources:

  1. “Fever, aches, chills. Check your symptoms and learn more about a prescription flu treatment.” Tamiflu.havaswwsfdev.com. 2019. 15 Jan. 2019 <https://www.tamiflu.com/>.
  2. Tamiflu Prescribing Information. 2018. 15 Jan. 2019 <https://www.gene.com/download/pdf/tamiflu_prescribing.pdf>.
  3. “Tamiflu (oseltamivir).” Facts & Comparisons. 15 Jan. 2019 <https://fco.factsandcomparisons.com/lco/action/search?q=tamiflu&t=name&va=>.
  4. “Influenza (Flu).” Centers for Disease Control and Prevention. 22 Nov. 2013. Centers for Disease Control and Prevention. 15 Jan. 2019 <https://www.cdc.gov/flu/news/flu-antiviral-benefits.htm>.
  5. “Tamiflu (oseltamivir).” ScriptSave Wellrx.  Feb 2019 https://www.wellrx.com/prescriptions/tamiflu/

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shingrix on backorder - scriptsave wellrx blog image

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

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

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

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

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

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

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

While you wait….

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

 

References:

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

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by Terra Leon, PharmD Candidate 2019

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

What is Activated Charcoal

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

Alternative Options

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

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

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

Not So Harmless?

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

Medication Interactions

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

Bottom Line

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

References:

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

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by Jenny Bingham, PharmD, BCACP
SinfoníaRx

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

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

Step 1: Resources for Recalled Medications

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

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

NDC Manufacturer Product
Description
Lot/Batch Expiration
Date

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

Step 2: Contact Your Provider

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

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

Step 3: Disposing of Your Medication

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

 

Resources:

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

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

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


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