In the past, there have always been two different concentrations of liquid Tylenol on the market -one for children and one for infants.  Now, with the transition in place, there will be only one concentration (160mg/5ml) for all OTC pediatric single-ingredient liquid Tylenol products.

What’s the reason for the change? Simply to decrease the chances for medication errors as parents were at times getting confused between the two infants’ and childrens’ acetaminophen products.

The recommended dose of Tylenol will remain the same at 10-15mg/kg.  The difference is the approriate Tylenol dose is being given in a larger volume of liquid.  Definitely read the label on the box to get the correct amount of Tylenol needed to dose your child!

Be very aware there may be a point in time where both the old and new concentrations of infants’ Tylenol liquid products will be available on store shelves.  Either product is fine to use, just make sure you know which one you have so you can dose your child correctly!

There will be no changes made to childrens’ Tylenol dosing.

Do not hesitate to stop in at your local pharmacy if you’re concerned about dosing issues related to infants’ tylenol products.  Better safe than sorry, right?!

Clonidine was actually synthesized in the early 1960’s for use as a nasal decongestant, and then by chance, researchers discovered it decreased blood pressure and heart rate and produced sedation at very low doses. Clonidine has been used in the United States since it was given approval from the FDA in 1974. It wasn’t until September 2010 that the FDA approved extended-release clonidine for the treatment of ADHD in pediatric patients.

Indications

Extended-release clonidine is indicated as monotherapy or as adjunctive therapy to stimulant medications for the treatment of ADHD. It would be used as an add-on to a child’s drug therapy when they have not reached an optimal response to a stable regimen of a stimulant medication. 

Because extended-release clonidine is so new, it has not been systematically evaluated in clinical trials for effectiveness of long-term use. Based on studies, we know the medication is effective for the short-term, but beyond 5 weeks, we have no proof of how well it will work!

Interestingly enough, this extended-release clonidine formulation also exists in the world under the name Jenloga, which is approved for the treatment of hypertension in adults.

How the drug works

Extended-release clonidine is a central alpha-2-adrenergic agonist just like the immediate-release clonidine, so its mechanism of action is the same.  It decreases the release of norepinephrine from nerve cells in the brain leading to a lower firing rate of nerve cells that are responsible for arousal.  The result, a decrease in excessive stimulation found in patients with ADHD.

The controlled-release nature is what makes extended-release clonidine different from its predecessor. It is designed to produce slow, constant absorption for at least 8 hours, unlike the immediate-release formulation. Potential advantages of extended-release preparations are a decrease in frequency of administration, which may lead to improved patient compliance and a therapeutic effect that can be maintained overnight. Also, the peaks in drug concentration that occur after taking an immediate-release dosage form are eliminated, thereby decreasing the occurrence and/or intensity of side effects.    

Side effects and precautions

Extended-release clonidine comes with the same side effects as the immediate-release formulation, but side effects appear to be less intense because the medication’s peak concentration in the bloodstream does not get as high. Side effects to look out for are decreased heart rate and blood pressure, sedation, depression, irritability, constipation, dry mouth and eyes, headache, upper respiratory tract infection, sore throat, ear pain, nightmares, and nasal congestion.

Precautions are similar too! Abrupt discontinuation should be avoided due to the risk of withdrawal effects like increased heart rate, palpitations, tremors, anxiety, insomnia, sweating, and agitation. Parents will still have to follow the advice of the American Heart Association and have their child be carefully screened and monitored for any cardiovascular abnormalities as extended-release clonidine has the potential to cause toxic cardiac effects too. Also, children with kidney insufficiency will need their dose adjusted based on the degree of kidney impairment.

Extended-release clonidine has not been studied in children younger than 6 years old, so it may be best to avoid using this medication in children 5 years of age or younger. 

Similar medications

We’ve already determined that extended-release clonidine is very much like immediate-release clonidine. Guanfacine and extended-release guanfacine (Intuniv) are also central alpha-2-adrenergic agonists commonly used as alternative or add-on treatments for ADHD. They may actually be better options compared to the clonidine alternatives because they have a lower incidence of side effects and appear to stay in the body longer.

Administration guidelines  

Extended-release clonidine is available as 0.1mg and 0.2mg tablets. It should not be crushed, chewed, or broken, but it can be taken with or without food. When starting this medication, it should be initiated at 0.1mg at bedtime. Until the desired response is achieved, dosages should be adjusted in increments of 0.1mg per day at weekly intervals. Doses should be given twice a day, in the morning and at bedtime, with the equal or higher split dosage being given at bedtime. For example, if your child’s total daily dose is 0.3mg, your child would take a 0.1mg tablet in the morning and a 0.2mg tablet at bedtime.

Extended-release clonidine is not to be used interchangeably with the immediate-release clonidine formulation due to lack of clinical data from studies and because they absorb at different rates in the body. 

Recommendations

Extended-release clonidine may sound like a great idea because it’s part of some cutting edge happenings taking place in the pharmaceutical industry nowadays, but it’s also one of the most expensive options for the treatment of ADHD.  Extended-release preparations come with a price! Since it is not first-line treatment for ADHD and because data on its long-term use does not exist yet, I would hold off on giving your child this medication unless you have exhausted all other options.

Up against cheaper, safer, and more effective medications for the treatment of ADHD, extended-release clonidine is going to have an uphill battle in making a difference in the world of pharmacy.  Will the drug make a name for itself?  Only time will tell!

Don’t get me wrong, I think Allegra and its counterparts, Claritin and Zyrtec are great options to treat allergies, but the intranasal corticosteroids are the most effective monotherapy (single-drug therapy) for allergic rhinitis (aka allergy symptoms).

Intranasal means you take the medication through your nose, and corticosteroids are a class of drugs that decrease inflammation and are similar to the natural corticosteroid hormones produced by the body.

Examples are generic fluticasone (Flonase), Nasonex, Rhinocort, Nasacort, and Beconase. 

These nasal sprays are more effective than antihistamines (i.e. Allegra) in relieving sneezing, itchy nose, nasal blockage, runny nose, and post nasal drip.

There appear to be no significant differences in efficacy among the various nasal sprays, but I’m strong on the fluticasone (see title!) because it is the only one that comes in generic (cheaper) and it’s the one I use to control my seasonal allegies!

The intranasal corticosteroids are especially helpful in patients with severe, persistent allergy symptoms and nasal blockage.

Just a little blurb on fluticasone and the other nasal sprays of its kind.  Stay tuned for more info on these nasal sprays!

Don’t forget, we still have our free course on how to save money on prescription meds available…here it is.  Tell us what you think!

Nova put up a great post last week, “Juice and Allegra.”  It answers the many different questions and comments we received in response to my “Orange Juice with Allegra” piece.  Check it out!

Here’s some extra details on Allegra and its buddies Claritin and Zyrtec. 

Congestion -which OTC allergy medication is the best for this problem? 

Well, studies have shown that Allegra  may have some anti-inflammatory properties (decreases swelling) that may help to relieve nasal congestion.

Apparently Allegra can block the release of  mast cell and basophil inflammatory mediators, resulting in the whole decrease in nasal swelling and congestion.  Neat, huh?

Claritin and Zyrtec do not appear to have these same anti-inflammatory properties, making them not a great choice to help with stuffy nose/sinuses due to allergies. 

Just thought this would be interesting and helpful to those who’s major symptom is nasal congestion! 

In case you’re curious, I suffer from some serious allergies (I think!) here in Charlotte just during the Spring season (end of March to mid-May).  I believe I have found the most effective treatment regimen for myself!  I take Allegra at night (pretty much at bedtime) and fluticasone nasal spray (Flonase) in the morning. 

My very irritating itchy nose, constant sneezing, and nasal/sinus congestion are under control. 

I still notice some post-nasal drip and my eyes are still crazy itchy if I put my contacts in, but I’m at the point where I’m not miserable.  I’m not a fan of wearing my glasses (mostly because I don’t see as well out of them and they make me sleepy), but my eyes seem to hardly itch when I’m not wearing my contacts. 

I’m not sure which medication is doing the best job, and I’m not really up for doing a trial run without one of them to figure it out.  I do know that my symptoms were not well controlled with just Allegra and Sudafed.  When I added fluticasone nasal spray and took off the Sudafed, my quality of life increased dramatically! 

No need to worry, I’ll be posting about my new friend fluticasone nasal spray next. :)

**This is Cate from the future…check out this bit of info about fluticasone nasal spray by clicking here**

Please keep leaving your comments and questions below…it’s fun! 

You can also e-mail me at Cate@getpharmacyadvice.com.

Have a great Sunday!

This is a very fascinating concept to me and one of the reasons why I chose clonidine as the topic of this discussion. The other reason is because an extended-release form of clonidine has recently been approved and will be promoted to help in the treatment of ADHD. Instead of focusing on this new medication called Kapvay (extended-release clonidine), we’re going to stick with the old and learn about the role immediate-release clonidine has in treating ADHD. This will allow us to compare the older version of clonidine to the new extended-release form in our next discussion. 

 Indications

Clonidine has FDA approval for all the conditions mentioned above except for the treatment of ADHD and nicotine withdrawal symptoms in adults, which means it is used as off-label treatments for these purposes. Clonidine is generally used as either an alternative or an add-on to other medications for the treatment of ADHD, so it’s not the top choice for this condition. 

Other off-label or investigational uses include alcohol dependence, heroin withdrawal, vasomotor symptoms due to menopause (i.e. hot flashes), diabetes-associated diarrhea, painful menstrual cycles, and the prevention of migraines. Obviously some of these uses are not so kid specific, but it just goes to show how unique clonidine is with all of its potential roles in the medical field!

Clonidine is available by prescription only in the form of a tablet, transdermal patch, or injection for epidural administration. The tablet form is generally used for ADHD treatment and the epidural is the dosage form used for pain management. 

How the drug works

Clonidine is a central alpha-2-adrenergic agonist that decreases the release of norepinephrine from nerve cells in the brain. Norepinephrine is a chemical that naturally occurs in the nervous system. When the release of this chemical is decreased, the firing rate of nerve cells is reduced within a specific part of the brain that is responsible for arousal, thereby decreasing excessive stimulation found in patients with ADHD.    

Side effects and precautions

Even though clonidine is intriguing in its ability to serve many purposes, it does not come without warning. The American Heart Association recommends that all children should get a thorough cardiovascular exam before initiating clonidine therapy. This recommendation is based on reports of serious cardiovascular adverse events in both children and adults who were also taking normal doses of stimulant medications. Most of these affected patients had underlying structural heart disease. Examples of stimulant medications include methylphenidate, dextroamphetamine, and mixed amphetamine salts (i.e. Adderall), which are considered the first-line treatment of ADHD.

Clonidine therapy should not be abruptly discontinued because your child may experience a rapid increase in blood pressure and overactivity of the central nervous system, which includes increased heart rate, palpitations, tremors, anxiety, agitation, insomnia, and sweating. If your child needs to stop taking oral clonidine, they should be tapered off the tablet gradually over more than 1 week.

Other side effects of clonidine your child may experience include decreased heart rate, decreased blood pressure, sedation, depression, constipation, dry mouth, dry eyes and headache. Also, dosing adjustment may be needed in children with kidney disease.

Similar medications

Guanfacine is also a central alpha-2-adrenergic agonist that is commonly used as an alternative or add-on treatment for ADHD. It actually may be a better option for your child as it stays in the body longer and has fewer side effects than clonidine. There is also an extended-release guanfacine (Intuniv) on the market that is approved for children and adolescents aged 6 to 17 years for once-daily treatment of ADHD.

 Administration guidelines

All things considered, clonidine therapy is pretty straightforward. The tablet can be given with or without food, but if it seems to be bothering your child’s stomach, giving it with food is advisable.

When your child is started on clonidine treatment, their dose should be initiated on the low side and then gradually increased every 3 to 7 days until the target dose is reached. Doses are usually given 3 to 4 times per day. If a dose is missed, give your child the missed dose as soon as possible. If it is almost time for your child’s next dose, skip the missed dose and return to their regular dosing schedule. Definitely do not give them a double dose!      

Recommendations

Clonidine is a less effective option than the stimulant medications for single drug therapy of ADHD, but it is being more frequently prescribed as an add-on to control aggression or to improve sleep. This means you may want to reserve clonidine as an alternative if the stimulant medications are not tolerable or as an add-on if more control of an overaroused, highly active, more aggressive, or easily frustrated child is needed. I would even go a step further by choosing guanfacine over clonidine because it has fewer side effects and because it has the potential of being dosed fewer times per day.   

If your child is started on clonidine and complains of dry eyes, you may offer them relief by giving them artificial tears. Constipation may be avoided by giving them a diet high in fiber, having them drink more liquids, and keeping them active. Lastly, dry mouth may cause cavities so help your child take good care of their teeth and be sure they see a dentist on a regular basis.

Any questions, comments, or concerns?  Let us know by leaving a comment below or e-mail me at Cate@getpharmacyadvice.com. 

Also, definitely grab our free video course on how to save money on your prescription meds by clicking on this link!

I was taking a rare moment to relax last night (usually I’m running around with my head cut off!), and while I was watching TV (American Idol to be more specific) a Zyrtec commercial came on. 

I think it was a Zyrtec commercial!  All I know is the producers of said commercial were clearly putting Allegra down because somewhere on the Allegra labeling it says you shouldn’t drink orange juice while taking this medication (or something along those lines!). 

The reason why this statement about Allegra is true is because fruit juices like apple, orange, and grapefruit juice can decrease the amount of Allegra that is absorbed by about 36%!

This doesn’t mean you have to avoid the fruit juices for the whole day.  Just give the Allegra enough time to get into your system and you can drink all the orange juice you want!  

How much time does that take?  To be on the super safe side, I’d say wait 4 hours before drinking your fruit juice after taking Allegra. 

So, this article led to a ton of comments and questions -thanks for all the feedback.  Please read the follow up article Juice and Allegra.  Have more questions/comments?  Keep ‘em coming!

Any questions?  E-mail me at Cate@getpharmacyadvice.com or leave a comment below. 

Happy Spring!

Allergy symptoms are starting to run rampant here in North Carolina.  Much to do with the fantastic weather we’ve been having as of late!  And with the full-blown allergy season fast-approaching, this OTC Allegra news comes just in time (covenient, right?) to help fight the slew of nasty allergy symptoms that will be affecting tons of people. 

According to the representative I talked to at Sanofi Aventis (the maker of this medication, but marketed by a company call Chattem), all strengths (30mg, 60mg, and 180mg) and forms (tablets, orally disentegrating tablets, oral suspension, and Allegra-D)  will be over-the-counter.  Yes, even the children’s orally disintegrating tablets and children’s oral suspension are going OTC!

You’ll still have to go to the pharmacy to purchase the Allegra-D 12 Hour or 24 Hour Allergy and Congestion products…just like you have to for any other Sudafed products!

If you’re getting Allegra by prescription, you’re probably used to getting the generic, fexofenadine.  As of right now, there does not appear to be a generic OTC Allegra hitting the market, but it probably won’t take long for that to happen. 

The only part of  Allegra that is not going OTC is the children’s oral suspension indicated to treat hives in children 6 months to 6 years of age.  So, the oral suspension itself is going OTC, but not for the aforementioned indication!  

That part may be confusing so feel free to send me an e-mail at Cate@getpharmacyadvice.com or comment below if you have any questions.

Happy March!

Well, just recently (as in yesterday, haven’t checked today) you could buy an emergency contraceptive called Nextime on Amazon.com for only $19.99.  That’s a savings of about $30.00! 

Only problem is I couldn’t figure out what ingredients are in Nextime to let you know if it works or not.  It’s not approved by the FDA, so it doesn’t have to be proven to be effective to be sold on the market! 

Nextime appears to be an all-natural/herbal supplement based on the little bit of research I did on the company that makes it, but I cannot say it is for sure without solid evidence! 

With such little details available on the advertised emergency contraceptive, Nextime, I would definitely spend the extra $30.00 or so for the Plan B One-Step or Next Choice, which have been proven to be about 85% effective.  I would not take my chances with a medication that I cannot find any info about!

If anyone has more info on Nextime, please send it our way…we’d love to learn more about it! 

Thanks for checking in, and be sure to grab our free video course on how you can save money on your prescription medications.  There are definitely some ways to save…about 90 of them in this video course!

Finally, my video on the good and the bad of Provigil.  I’ve been promising this one for a long time, but somehow I let my normally disorganized self get disorganized yet again.  I was on a roll there for a bit, then came the holidays and another side project and off I was, on the road to disarray. 

Reset!  No better time than this very moment to get back on track.  Here’s my video:

As you can tell, it was a long day at work!  No, it’s not the 1st day of the month, as stated in the video, but it was the first Monday of the month and the year…recipe for craziness. 

To go along with this video, I previously posted a clip called “Overview of Provigil.”  Check it out by clicking on the link!

Please comment below, let’s get a conversation started!  You can also e-mail me at Cate@getpharmacyadvice.com.

Good night.

Back to reality.

Here’s a pressing matter, not really, but let’s make believe for a second here!  I had to do a little investigation earlier today because the increasing number of phone calls from patients seeking the “OC” oxycontin as compared to the “OP” oxycontin was really starting to peak some serious interest.

It didn’t take me too long to figure out what all the fuss is about! 

Here’s the deal,  oxycontin (we’re talking brandname) has been reformulated…the old form was imprinted with “OC”, the new tablets are stamped with the letters “OP.”   The two tablets are said to be bioequivalent (meaning they have the same active ingredient and should absorb into your body at the same rate and extent). 

When you have two bioequivalent tablets, it would be unlikely that they would differ significantly in their therapeutic or adverse effects.  However, there are a couple of differences between the two oxycontin tablets, not counting the difference in what’s imprinted on the pills.

Difference #1: The new tablets take a little longer to get to peak levels in the body, which may make it seem less effective.

Difference #2: The new tablets reach a slightly higher peak level in the body, which can cause more side effects. 

Difference #3: The new tablets are harder to crush or chew .  It’s not easy to turn them into a powder to snort or to dissolve them to be drawn up into a syringe for injection.  Bottom line, they’re harder to abuse so they’ve lost their street value! 

For those who find the new oxycontin tablets are really not working for you, ask your doctor if you can titrate the dose or even switch to a different opioid of a long-acting nature.

Need more info or have some questions?  E-mail me at Cate@getpharmacyadvice.com or leave a comment below. 

Will be back soon!