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

Are You Doing This Important Step After Using Your Inhaler?

If you use an inhaler for a breathing condition, like asthma, you may have been told by your doctor that you will need to rinse your mouth with water and spit after you use your inhaler. It may seem like a cumbersome additional step, especially since it already takes time out of your day to use your inhaler, so why is it important to spend time to rinse and spit after using your inhaler?

Not All Inhalers Require You to Rinse and Spit

Just to clarify, you don’t need to rinse and spit with every inhaler. There are numerous inhalers on the market with different active ingredients and different purposes (For more on this, refer to this post on the difference between rescue and controller inhalers: (https://news.wellrx.com/2016/08/18/breathing-condition-meet-lifesaver/).

However, a common type of inhaler that does require you to rinse your mouth after each use is called an inhaled corticosteroid (ICS) inhaler. ICS inhalers contain small amounts of steroids to help people breathe easier. Other types of inhalers have different active ingredients (e.g., albuterol, formoterol, tiotropium), so it is not necessary to rinse your mouth after using those.

Common ICS Inhalers

Examples of common ICS inhalers, or combination inhalers that contain a corticosteroid, are:

  • Advair Diskus & Advair HFA (fluticasone/salmeterol)
  • Aerobid (flunisolide)
  • Alvesco, Omnaris, Zetonna (ciclesonide)
  • Arnuity Ellipta (fluticasone furoate)
  • Asmanex (mometasone)
  • Azmacort (triamcinolone)
  • Dulera (mometasone/formoterol)
  • Flovent, Flovent HFA (fluticasone)
  • Pulmicort, Rhinocort (budesonide)
  • Qnasl, Qvar (beclomethasone)
  • Symbicort (budesonide/formoterol)

If you are using one of these inhalers or have been told that your inhaler contains a steroid in it, you will need to rinse your mouth with water and spit after each use.

Why do I Have to Rinse and Spit with ICS Inhalers?

ICS inhalers have a small amount of corticosteroid medication that reduces inflammation in your bronchial tubes and ultimately open your airways to help you breathe easier.1 These medications can be delivered through metered dose inhalers, dry powder inhalers, or through a nebulizer. When you breathe in your steroid inhaler medication, a small amount of steroid can stick to your mouth and throat as it makes its way into your lungs to help you breathe. If this small amount of steroid is not rinsed out from the inside of your mouth or throat, it can cause a fungal infection known as thrush.2

What You Need to Know About Thrush3

Oral thrush in adults generally looks like thick, white or cream-colored spots inside the mouth. The inside lining of your mouth may appear swollen and slightly red and may feel uncomfortable or a burning sensation. The good thing is that thrush is a treatable infection. Your doctor will prescribe an antifungal medicine in the form of a tablet, gel, lozenge, or mouthwash to help treat it. The better news is that this condition is preventable with proper rinsing and spitting.  

What You Can Do

Make sure to rinse your mouth with water and spit after using your ICS inhaler to prevent thrush. Another way to make it easier for you to incorporate rinsing your mouth after using your ICS inhaler is to brush your teeth after using your inhaler. As a friendly reminder, your ICS inhaler should be used on a routine basis, unless your doctor tells you otherwise, even when your breathing seems better. These inhalers will help maintain your breathing over time to prevent breathing-related complications and keep you out of the hospital.

References:

  1. Barnes PJ. Inhaled Corticosteroids. Pharmaceuticals (Basel). 2010;3(3):514-540. Published 2010 Mar 8. doi:10.3390/ph3030514
  2. Shuto H, Nagata M, Terashi Y, Yamaguchi M, Takizawa T, Shuto C, Watanabe K, Tosaka K, Okano M, Noguchi H. Esophageal candidiasis as complication of inhaled steroid therapy. Arerugi 2003; 52(11)1053–1064
  3. Oral thrush – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/oral-thrush/symptoms-causes/syc-20353533. Published March 8, 2018. Retrieved February 22, 2019.

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shingrix on backorder - scriptsave wellrx blog image

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

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

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

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

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

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

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

While you wait….

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

 

References:

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

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Tucson, AZ. January 23, 2019 – It’s a fact – prescription medications don’t work if patients don’t take them, or fail to take them correctly. Taking medications as prescribed by your physician can help improve the quality and length of your life. The latest release of the ScriptSave® WellRx app can help.

Importance of Taking Your Medications

According to the Centers for Disease Control and Prevention (CDC), nearly 50% of Americans have used at least one prescription within the last 30 days. If you fall into this half of the country, you’ve probably already had the discussion with your doctor & pharmacist about the importance of following instructions, with insights on why it matters. One recent study, for example, shows that patients who were compliant with taking their statin medications for at least two years had a 30% reduction in the risk of hospitalization for heart attacks.1

Even with all the benefits medications can have on a patient’s health, there is still an issue with adherence to medication therapy.

scriptsave wellrx medication reminders - app imageThe ScriptSave WellRx App

 

Not only does the new ScriptSave WellRx app release provide prescription price transparency, it also allows patients to set alerts for when they’re due to take their next pill, as well as when it’s time to order their next refill from the pharmacy. Meanwhile, built in functionality helps patients track side-effects that they might want to share with their doctor (using the ScriptSave WellRx Mood Log, which can be launched from the virtual Medicine Chest).

In addition, the newest enhancement for users of the WellRx platform also provides free access to some potentially life-saving functionality:

  • Drug Interaction Warnings: Patients can receive and share warnings 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.

The new release also caters to users who wish take advantage of the added security afforded by biometric login. Users can set up fingerprint password management for the app, making signing in quick, easy and secure.

About ScriptSave WellRx

ScriptSave WellRx, owned by parent company Medical Security Card Company, LLC (MSC) and a member of the MedImpact, Inc. family of companies, offers savings on prescription medicines at more than 62,000 local and chain pharmacies, nationwide. ScriptSave WellRx is an online resource that makes prescription medicines more affordable and easier to manage for people who are uninsured, underinsured, or insured with high deductible plans.

References:

  1. Lansberg, P., Lee, A., Lee, Z., Subramaniam, K. and Setia, S. (2018). Nonadherence to statins: individualized intervention strategies outside the pill box. Vascular Health and Risk Management, Volume 14, pp.91-102.

 

 

————–Addendum (13 Mar, 2019)————–

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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Do ARBs cause cancer - scriptsave wellrx - blog image

by Mitchell Welton, PharmD Candidate 2019
University of Arizona

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

Evaluation of Cancer Risk

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

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

The Impact of Impurities

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

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

What Should You Do?

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

 

References

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

 


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For most Americans, chances are good you’re spending too much on your prescription medications. The increasing cost is staggering. And with so many companies offering discounts on prescriptions, it can sound like a scam. As the saying goes, if it sounds too good to be true, it probably is.

ScriptSave® WellRx is part of Medical Security Card Company, LLC; bringing some of the most advanced technology, pharmacy expertise and customer service in the industry for more than 20 years.

While we can tell you what we do and how we really can help you save on your prescription costs, we’d rather let you see what folks who have saved, some who were skeptics, have to say.

get the best rx savings card free - scriptsave wellrx - blog image find the best rx price - scriptsave wellrx - blog image







And, yes. We even help with the cost of some pet medications!

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Get your free Rx discount card!

If you need assistance affording your prescriptions, sign up for a free ScriptSave WellRx card or download the free prescription savings app, and save on your medications next time you visit the pharmacy.

 

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what to tell the dentist about medicine you take - scriptsave wellrx - blog image

by Heather Lee, PharmD Candidate
University of Arizona

A Guide to Medication Warnings

When you visit the dentist, you expect to answer typical questions regarding your oral health, such as how often you are brushing your teeth or the infamous question of whether or not you floss. It may surprise you when your dentist asks what medications you take at home. Why would it matter if the dentists knows what you’re taking? Many medications, which includes prescriptions, over-the-counter, and even herbal medications, can affect your oral health and it is important for the dentist to know what you take so they can determine the best course of action for your oral health.

Blood Thinners

Many patients are currently on blood thinners or antiplatelet therapy to prevent the risk of blood clots. Common examples of blood thinners include warfarin (Coumadin), dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto), and edoxaban (Savaysa). Common examples of antiplatelet medications include clopidogrel (Plavix), ticlopidine (Ticlid), prasugrel (Effient), ticagrelor (Brilinta), and/or aspirin. Taking these medications is important to prevent blood clots, but they can also increase the risk of bleeding, especially during a dental procedure. The risk increases if you are taking multiple medications to prevent clots.  It is important for the dentist to know if you are taking these medicines so they can take extra precautions to prevent bleeding, such as stopping the medication temporarily or controlling the bleeding through local measures. They can control the bleeding through various methods, such as mechanical pressure, agents that stop the bleeding, or suturing. The dentist can make a more informed decision with what they want to do with the medication when they have a better knowledge of the type of medication you’re taking, your bleeding risk, and what procedure you’re going in for.1

Dry Mouth

Having a dry mouth can be caused by a variety of different factors, such as a medication’s side effect, having a certain medical condition, or personal habits (mouth breathing and alcohol/tobacco use).

Saliva plays an important role in maintaining your oral health through multiple ways by:

  • Reducing the population of bacteria in the mouth
  • Neutralizing acid caused by bacteria, which damages your teeth
  • Repairing tooth enamel that may have been damaged by acid
  • Washing food particles away2

A lack of saliva can cause dry, cracked lips, bad breath, infections in your mouth, and cavities. Medications that can cause this include medications used to control allergies, asthma, blood pressure, pain, and depression.

Your dentist can help by:

  • Recommending a special gel or rinse to keep your mouth moist
  • Prescribing or applying a fluoride containing toothpaste or mouthwash to prevent cavities3

Other ways to relieve this symptom can include:

  • Chewing sugar-free gum or sucking on sugar-free hard candies to increase the flow of saliva
  • Sucking on ice chips
  • Drinking water with meals to help with chewing and swallowing food
  • Using alcohol-free mouthwash
  • Avoiding carbonated drinks, caffeine, tobacco, and alcohol
  • Using a lanolin-based lip balm to soothe dry lips3

Enlarged Gum Tissue

There are some medications that may increase your risk of getting enlarged gum tissue, which is also known as “gingival overgrowth”. This is usually associated with antiseizure medications (phenytoin), immunosuppressive drugs (cyclosporine), and calcium channel blockers (including nifedipine, verapamil, diltiazem, and amlodipine). If your dentist is aware you are taking these medications, they may encourage you to do professional cleaning more often throughout the year and educate you on how to improve your brushing technique.4

Jaw Pain

There have been some reports of individuals who had difficulty healing or jaw pain after going through invasive dental procedures or even a tooth extraction. This can be due to bone death caused by a lack of blood supply (osteonecrosis). The common factor in these individuals were that they were taking a medication from the bisphosphonate class. Bisphosphonates are usually used to prevent bone weakening or destruction and are commonly prescribed to treat osteoporosis. Examples include risedronate (Actonel), zoledronate (Zometa), alendronate (Fosamax), and ibandronate (Boniva).

Over 90% of cases were in patients receiving an IV form of the drug. The risk is thought to be less than 1% of patients receiving an IV form, but they were at least ten times more likely to be affected than those who took the oral form. If you are on this medication, your dentist can discuss ways to minimize the risk of needing invasive procedures, such as tooth extractions and surgery. They may consider more conservative treatments, such as a root canal procedure. They can provide preventative advice regarding whether you need professional cleaning more often, how to observe any changes in your mouth, and how to be more careful with taking care of your teeth and gums.5

The following may increase your risk of developing jaw pain:

  • Older age (greater than 65 years)
  • Treatment with chronic corticosteroids
  • Long-term use of bisphosphonates
  • Gum infection that damages the gum and can destroy the jawbone (periodontitis)6

Signs to watch out for:

  • Gum wounds that heal very slowly or do not heal for six weeks or more after a procedure
  • Exposed bone
  • ”Roughness” on gum tissue
  • Pain if the open wound becomes infected
    • Pus or swelling
    • Numbness, especially in the lower jaw, if the infection lasts long enough5

Current treatment options include:

  • Antiseptic rinses to help prevent the growth of bacteria
  • Antibiotics
  • Cleaning/removal of dead bone from the affected area
  • Possible referral to a specialist or a surgeon for further evaluation5

Updating Your Dentist Regarding Medications

These are just a few of the reasons of why it is important to inform your dentist regarding what medications, over-the-counters, and herbal supplements you take. Your dentist can take extra precaution when you come in and educate you as to the best way to maintain your oral health when they are aware of what medications may be affecting it. The next time you go in, bring an updated medication list so your dentist is on the same page as to what you are taking at home.

References:

  1. Anticoagulant and Antiplatelet Medications and Dental Procedures. https://www.ada.org/en/member-center/oral-health-topics/anticoagulant-antiplatelet-medications-and-dental-. Accessed October 31, 2018.
  2. Department of Health & Human Services. Teeth and drug use. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/teeth-and-drug-use. Published June 30, 2014. Accessed November 1, 2018.
  3. Managing dry mouth. The Journal of the American Dental Association , Volume 146 , Issue 2 , A40
  4. Staff SBI. Gingival Enlargement. The American Academy of Oral Medicine. http://www.aaom.com/index.php?option=com_content&view=article&id=132:gingival-enlargement&catid=22:patient-condition-information&Itemid=120. Accessed November 2, 2018.
  5. Staff SBI. Bisphosphonate Therapy. The American Academy of Oral Medicine. http://www.aaom.com/index.php?option=com_content&view=article&id=78:bisphosphonate-. Accessed November 2, 2018.
  6. Dental management of patients receiving oral bisphosphonate therapy. The Journal of the American Dental Association. 2006;137(8):1144-1150. doi:10.14219/jada.archive.2006.0355.

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and get registered to take advantage of our free medication adherence tools.

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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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Epidiolex: A new CBD epilepsy drug

by Roxanna Orsini,
PharmD Candidate Class of 2019, University of Arizona

Treatments are available that can successfully control seizures for most people with epilepsy. However, there’s a soon-to-be-released medication, recently approved by the FDA, called Epidiolex.

What is Epidiolex?

Epidiolex (cannabidiol) is a new FDA-approved epilepsy medication that is derived from Cannabis Sativa plant (marijuana). Cannabidiol (CBD) does not create feelings of euphoria or intoxication, the “high” that is often experienced with Cannabis, which comes mainly from the compound tetrahydrocannabinol (THC), which is also found in marijuana.

Which forms of epilepsy does Epidiolex treat?

The FDA approved Epidiolex for treatment of seizures associated with two rare and severe forms of epilepsy, in patients two (2) years and older.5

  • Lennox-Gastaut Syndrome
    • Begins in childhood and continues to adulthood with some changes in presentation with age.3
    • Often characterized by multiple types of seizures (particularly tonic and atonic) and an intellectual disability.
    • An EEG (electroencephalogram) can display a classic pattern of background slowing and spike-wave bursts with frequencies less than 2.5 per second. 2
    • Found in 2-5% of childhood epilepsies.2
  • Dravet Syndrome
    • Begins during the first year of life and is a lifelong disease.3
    • This is a rare genetic epileptic brain disease.
    • Infants will have normal development up until an increase in seizure frequency occurs after the first seizure which is often associated with a fever. 1
    • Most children develop some level of developmental disability.
    • Seizures can be triggered by various factors such as body temperature, emotional stress or excitement, and photosensitivity.1

Coming Soon!

While Epidiolex has been approved for release, the expected time to market is September 2018. A few things to know about the medication before it is released:

Effectiveness

The study for Epidiolex involved 3 randomized, double-blind, placebo controlled clinical trials which included 516 patients who had either Lennox-Gastaut Syndrome or Dravet Syndrome.3 Results showed that patients taking Epidiolex along with other anti-epileptic drugs (AEDs) showed a decrease in seizure frequency when compared to the placebo.3

Precautions

Side effects (3,5) are often something to be aware of before starting a new medication. A few reported side effects to Epidiolex include:

  • Elevated liver enzymes
  • Sedation
  • Lethargy
  • Sleep Disorders
  • Diarrhea
  • Rash
  • Increase in suicidal thoughts
  • Decrease in appetite
  • Abdominal discomfort
  • Abdominal pain

Cost

The company has not release any official information about cost for Epidiolex, however NY Times analysis estimates a cost of $2,500 to $5,000 a month.4 It is possible that this medication may be approved by insurances so make sure to discuss options with your provider.

Future Opportunities

Even though this medication is only currently approved for these two forms of seizures, it does open the door to future possibilities.  Always keep communication open with your healthcare provider so they can help guide you on therapy options as more clinical studies arise with new information.

 

References:

  1. Epilepsy Foundation. (2018). Dravet Syndrome. [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/dravet-syndrome [Accessed 11 Jul. 2018].
  2. Epilepsy Foundation. (2018). Lennox-Gastaut Syndrome (LGS). [online] Available at: https://www.epilepsy.com/learn/types-epilepsy-syndromes/lennox-gastaut-syndrome-lgs [Accessed 11 Jul. 2018].
  3. FDA.gov. (2018). FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [online] Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm [Accessed 10 Jul. 2018].
  4. Kaplan, S. (2018). D.A. Panel Recommends Approval of Cannabis-Based Drug for Epilepsy. [online] Nytimes.com. Available at: https://www.nytimes.com/2018/04/19/health/epidiolex-fda-cannabis-marajuana.html [Accessed 5 Jul. 2018].
  5. Micromedexsolutions.com. (2018). Micromedex Products: Please Login. [online] Available at:
    http://www.micromedexsolutions.com/micromedex2/librarian/CS/B42F8E/ND_PR/evidencexpert/ [Accessed 5 Jul. 2018].

 


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

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

 

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Cost of not taking your medications image - ScriptSave WellRx

by Roxanna Orsini

It’s a fact. Medications don’t work if patients don’t take them. Taking your medications as prescribed by your physician can help improve the quality and length of your life.

Importance of taking your medications

According to the Centers for Disease Control and Prevention (CDC), nearly 50% of Americans have used at least one prescription with in the last 30 days. One recent study shows that patients who were compliant with taking their statin therapy medications for at least two years had a 30% reduction in the risk of hospitalization for acute myocardial infarctions (heart attacks).1

Even with all the benefits medications can have on a patient’s health, there is still an issue with adherence to medication therapy.

After a patient visits their doctor

  • 20% – 30% of new prescriptions never reach the pharmacy.2
  • Of those prescriptions that do get filled, 50% of the time they are not taken as prescribed by the doctor.2
  • After six months of treatment for a chronic condition, patients tend to reduce the amount of medication they are taking, or stop treatment altogether.

Annual results of medication nonadherence

  • 125,000 deaths and at least 10% of hospitalizations.2
  • Costs the United States health care system between $100 billion and $289 billion annually.2,3

Most common reasons medication treatments are adjusted

Patients often discontinue or alter how they are taking their medications due to a variety of factors. A patient may no longer be adherent to their prescription therapy due to:

  • Cost of the medication
  • Experiencing a potential side effect
  • The patient no longer felt they needed the medication, and,
  • The patient feeling they are currently taking too many medications.

If a medication is too costly, ask your provider if they have any samples to provide, or even ask about possible generic alternatives. Prescription discount services, like ScriptSave WellRx, can often help reduce the cost. You may be surprised to find our cash prices is even lower than your insurance copay! Visit our website to check your medication prices.

When you’re considering an adjustment to your medication therapy, it’s important to follow up and discuss the decision with your healthcare provider. Some medications, if discontinued suddenly, can cause more harm than good.

Ways to improve the way you take your medications

Complications from medication nonadherence are 100% preventable. Here are a few tips to help you remember to take your medications:

  • Using an alarm or calendar
  • Filling a weekly pillbox
  • Taking the medication at the same time every day, create a routine
  • Ask your pharmacy about getting a 90-day supply
  • Ask your insurance provider if mail order provides prescription benefits.

Make sure to keep open communication with your healthcare provider. There are times a patient does not report a side effect or concern with the medication until the next appointment. Try reaching out to your provider right away. They are there to help you find a medication that can help improve your health condition.

References:

  1. Lansberg, P., Lee, A., Lee, Z., Subramaniam, K. and Setia, S. (2018). Nonadherence to statins: individualized intervention strategies outside the pill box. Vascular Health and Risk Management, Volume 14, pp.91-102.
  2. Rosenbaum, L. and Shrank, W. (2013). Taking Our Medicine — Improving Adherence in the Accountability Era. New England Journal of Medicine, 369(8), pp.694-695.
  3. Viswanathan, M., Golin, C., Jones, C., Ashok, M., Blalock, S., Wines, R., Coker-Schwimmer, E., Rosen, D., Sista, P. and Lohr, K. (2012). Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States. Annals of Internal Medicine, 157(11), p.785-95.

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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Opioids and alternatives image

by Benjamin Liang
PharmD Candidate Class of 2019, University of Arizona

Opioids and Their Risks

Opioids are a class of medication used to manage short-term and long-term pain. This medication class is well known to healthcare providers, but also to anyone keeping up with local and national news. The current opioid crisis affects thousands of people every year. When taken inappropriately, opioids can result in inadequate pain relief, drug tolerance, addiction, overdose, and even death. A majority of opioid overdoses that result in death are accidental or unintentional.4 Due to the side effects and risks associated with opioids, healthcare providers are being urged to change opioid prescribing habits to meet new opioid regulations and to keep patients safe.

Changing Opioid Regulations

Prescribers are currently facing new opioid regulations at the state and federal levels. The Centers for Medicare and Medicaid Services (CMS) have implemented a maximum daily limit for opioids and some states are also cracking down by regulating the amount of days allowed on initial prescriptions. Arizona restricts initial opioid prescriptions to 5 days and sets an opioid dose limit per day.1 New laws and regulations are changing prescribing habits in hopes of reducing the thousands of opioid related overdoses every year. If you are starting or currently taking opioids, ask your healthcare providers if there are any new rules and regulations specific to your state.

Alternatives to Opioids

There are many alternative medications that can be used to manage acute and chronic pain. Medication selection is based on identifying the cause of the pain. A sprained ankle might be treated with a nonsteroidal anti-inflammatory drug (NSAID) to reduce swelling and inflammation, but the same NSAID would not have benefit for pain caused by nerve damage.

Potentially useful medications for pain include:

Nociceptive pain

  • Non-opioid analgesic agents (aspirin, acetaminophen, NSAIDs)
  • Tramadol
  • Topical analgesic agents
  • Muscle Relaxants

Neuropathic pain

  • Gabapentinoids
  • Antidepressants (venlafaxine, duloxetine, amitriptyline)
  • Topical analgesic agents

Opioid Non-responsive cancer pain

  • Alpha 2 adrenergic agonists

The listed medications and classes are a general list not intended to help in your personal medication selection. The ideal approach to pain management identifies the underlying cause of the pain and selects the appropriate treatment.4  Please consult your healthcare providers for pain identification and medication selection.

Questions for Healthcare Providers

All of the drugs and drug classes listed above can help in pain management depending on the underlying issue. Classification of the cause and level of pain is something that should be handled by healthcare providers. Asking for your pain classification will assist doctors and pharmacists in identifying the correct pain management therapy.

There are some steps you should take before making changes or starting a new medication. When starting or changing medications, please consult your doctor and pharmacist regarding what to expect. Changes should not be made without consulting a healthcare provider because of potential medication interactions and repercussions of abruptly starting or stopping medications. Your healthcare provider should review your medication dose, route, and time to take your medication. The potential side effects and expected outcomes should also be reviewed.3

If you have any concerns with taking opioid medications, talk to your doctor and pharmacist to help identify if opioids or alternative medications are appropriate.

References
1. Ducey, O. o. (2018). ArizonaOpioid Epidemic Act. azgovernor.gov
2. Rosenquist, E. W. (2017). Overview of the treatment of chronic non-cancer pain. UpToDate
3. Rosenquist, E. W. (2018). Evaluation of chronic pain in adults. UpToDate
4. SAMHSA. (2015). Behavioral Health Trends. Rockville, MD: RTI International


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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Anxiety medications and children photo

by Jenny Bingham, PharmD

Across the United States, the rate of antidepressant use in children is rising. It has led to prescription costs exceeding $100,000 in the four states with the highest antidepressant prescription rates for children: Colorado, Florida, Pennsylvania, and Texas.

As the number of antidepressant prescriptions rise, it’s only natural that parents will have a growing number of questions about those medications. Here’s a list of common questions other parents have had when starting pharmacotherapy for their child’s anxiety and/or depression:

How many pills will my child have to take?

The simplest answer is, it depends. Pharmacists are trained to know FDA approved indications for mental health medications. By incorporating pharmacists into the healthcare team, they can help find medications that have dual purposes and decrease the amount of pills in the regimen. Talk to your pharmacist about the medications and if there are alternatives.

How will pharmacotherapy affect my child?

Each patient responds differently to medications. Whereas some patients that are prescribed a common first-line antidepressant (fluoxetine) and tolerate it well, others may have an entirely different reaction. Certain medications can have negative side effects, including:

  • shaking
  • drowsiness
  • weight gain
  • insomnia
  • dizziness
  • dry mouth
  • blurred vision
  • bleeding, and,
  • constipation.

These side effects can be extremely detrimental to a child’s quality of life. It’s important to have open communication with your healthcare provider to ensure that side effects don’t get in the way of medication adherence, school performance, or self-esteem. Current literature provides clinicians a wide variety of information about which side effects are more prominently reported in individual cases. This database of knowledge helps further individualize therapy and avoid potential side effects.

What risks are associated with pharmacotherapy?

Parents should be aware of the potential for abuse, especially with commonly prescribed anxiety medications (ex. alprazolam) that are rated as controlled substances.

Adolescents are at an increased risk of suicidal ideation when initiating certain medications. Family members must be educated on how to monitor, identify, and report these to the provider.

One must also consider the risks of not seeking appropriate treatment, like self-medication with illicit drugs, tobacco, and alcohol. Self-medication can unfavorable effects on one’s mental and physical health.

Are there alternatives to pharmacotherapy?

If a parent decides against using medications, trained therapists can provide alternative options, if appropriate. Cognitive behavioral therapy is a common tool that incorporates education, relaxation exercises, coping skills, stress management, and assertiveness training.1

Other approaches include: interpersonal therapy, motivational interviewing, dialectical behavior therapy, supportive therapy, and family therapy. These tools can also be used in combination with medication to improve depression and anxiety. Parents should work closely with their physician to determine if this is a safe option as monotherapy.

Final Thoughts

Decisions about using medications to treat anxiety and/or depression in children must be catered specifically to the patient. It is imperative for health care providers to approach this sensitive topic as a group, including the patient and parents. Pharmacists are a great resource for optimizing medication effectiveness and reducing pill burden.

References:

  1. Beck JS. Cognitive Behavior Therapy: Basics and Beyond, 2nd ed, Guilford Press, New York 2011. p.391.

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

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

 

 

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organizing your medications photo

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

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

After years of working 12 hour days and living on a diet of frozen pizzas, diet soda and coffee, Ellen Christian decided that she’d had enough of being sick, tired and fed-up with everything. Taking matters into her own hands, she turned the tides and now writes about healthy living for busy women while also being a loving caregiver to her disabled husband. She lives in Castleton, VT and authors the extremely popular “Confessions of an Overworked Mom” blogsite. She reaches ~25,000 unique readers every month and we’re delighted that she also uses the ScriptSave WellRx program and that she agreed to write the following blog post for us…

“Be Prepared. Planning Pharmacy Visits Can Save Time As Well As Money”
by Ellen Christian

Now is the time to get organized for cold and flu season. Since my husband is disabled, he has a reduced immune system. Staying healthy during cold and flu season is even more important to us because of this reason. An illness that I can fight off or that lasts me only a day or two can last him a week or more or turn into something more serious.

How to Get Organized for Cold and Flu Season

Living in Vermont, it seems like our cold and flu season lasts quite a while. Winter is the time of year when we get sick most frequently. Unfortunately, it’s also the time of year when we have snow, sleet, and bad weather. Hazardous driving conditions are just another reason why we try to get organized for cold and flu season. I don’t want to have to run to the store to get tissues or fill a prescription in the middle of a snowstorm.

Right now, I’m stocking up on tissues, orange juice, cough drops, Vitamin C, elderberry syrup and, of course, Marty’s prescriptions. Since he’s disabled, he has several prescriptions he takes each month to manage his symptoms. It can be fairly time-consuming to check the prices for each one with several drug stores. Prescription prices can change regularly so I cannot just assume I’m going to find the best price for everything all in one place.

I’ve been using an app and website called ScriptSave WellRx to save money on Marty’s prescriptions. When I searched on pharmacies in the Castleton, Vermont area, I was surprised at the options. I didn’t realize that my insurance didn’t always have the lowest price for every prescription. Did you know that you may be able to save more money by paying cash and using ScriptSave WellRx? – (Learn more about paying cash for prescriptions here).

ScriptSave WellRx gives “Medicine Chest Pricing” that lets me enter the details of several of Marty’s prescriptions at the same time. Then, I can click the “Price-check” button to see EITHER, the one single pharmacy that gives me the lowest ‘one-stop price’ OR the specific combination of pharmacies that give the lowest individual price for every single prescription.

That means I can stop at one pharmacy with the lowest overall price when I’m pressed for time. Or, I can go from store to store to get each one at the most affordable price when I want to. I can even save all of Marty’s prescriptions in one secure place so I can price-check them each month instead of re-entering them. That’s a huge time saver when you have multiple prescriptions. I just don’t have time to call all the different pharmacies in my area every month for all his prescriptions.

The card is totally free to use and you can get the app in the iTunes store or on Google Pay for free. There’s nothing lost to give it a try and see what you can save. There are no fees and it doesn’t need your credit card information. Plus, there is no way you’ll pay more for your prescription than you do right now. You’ll either get a discount or you can use your insurance like you normally would. Just have the pharmacist check the price with the card and with your insurance.

Give it a try and download it today. On average, members save around 45%, but prescription prices change all the time so it’s always worth re-checking before each refill (…and, as mentioned previously, this is made so much easier by using the ScriptSave WellRx ‘Medicine Chest’).  It’s easy to find savings and every little bit helps. Plus, it has convenient reminders that help keep you on track when you’re busy.


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prescription medications,
visit www.WellRx.com.
Compare prices at more than
62,000 pharmacies nationwide.

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