What to do now?   There are no other OTC inhaler options.  All other options are prescription only.  Most likely, an albuterol inhaler (by prescription) will be the most appropriate alternative.  Here are some options to help with paying for the inhalers: Proair assitance program, Proventil coupon,  Xopenex coupon and Ventolin assistance program.

HFA inhaler switch: HFA inhalers feel quite different then the old inhalers.  The old (CFC) inhalers had a propellent in them so people could “feel” the drug when using it.  The new HFA inhalers have a finer mist so often patients complain they can’t taste/feel the medicine going in….be assured, the medicine is still being delivered! 

If you think your HFA inhaler is broken -please see the article My HFA Inhaler is Broken

How do you feel about Primatene Mist inhalers being taken off the market?  How do you feel about the new HFA inhalers? We would love to hear from you –please leave a comment!

Atorvastatin is now the strongest generic available.  It lowers LDL (bad cholesterol) more then any other generic available.  The most used statin medications are simvastatin (generic), Crestor (brand) and Lipitor.  If you physician switches you from one of the other statin drugs, expect a change in the strength of the medications.  For example,  simvastatin 40mg =atorvastatin 20mg and Crestor 5mg =atorvastatin 20mg.

Just a heads up, the price won’t change drastically for at least 6 more months.  This is because only one manufacturer releases a generic to begin with.  We have to wait for a few manufacturers to come out with the generic to drive down the price.  The Lipitor $4 co-pay card can continue to be used at least through 2012…currently Lipitor.com states that it will be usable through 12/31/2012. 

Have you used the $4 Lipitor co-pay card?  Or generic atorvastatin?  Please leave a comment, we would love for you to share your experience!

The current options on the market for oral treatment of erectile dysfunction include:

1) Staxyn (vardenafil -oral disintegrating) -10mg 60 minutes before sexual activity.  Don’t chew, crush or break.  Best to take it without liquids; lasts ~4 hours

2) Levitra(vardenafil)-5-20mg 60 minutes before sexual activity; best to take on empty stomach; lasts ~4 hours

3) Viagra(sildenafil) -the original “blue pill”; 25-100mg 60 minutes before sexual activity; best to take on empty stomach; lasts ~4 hours (for some men it may lasts as long as 8-12 hours)

5) Cialis(tadalafil)-10-20mg 60minutes before sexual activity OR 2.5-5mg daily; take without regard to food; lasts ~36 hours

Common side effects for all of the medications: headache, flushing, runny nose, belly ache and back pain.  There are lots of drug interactions so first check with your physician and pharmacist.  They interact with drugs used to treat BPH and all of these meds should not be used if you are being treated with nitrates.

Studies show that they all work equally well and share most of the side effects.  Cost, ease of use, duration and patient preference help you and your physician decide what drug will work best for you.

Finally, what is the whole 4 hour erection thing all about?  Well, it is called priapism(which if you are a True Blood fan, Jason had a case of priapism during the first season).  It is a prolonged, painful erection lasting more then 4 hours without sexual stimulation.  It is due to blood being trapped and unable to drain from the penis.  It can be permanently damaging to the penis if not treated.  Priapism must be treated by a physician immediately.  Fun fact, priapism can also be caused by scorpion bites!

We would love some comments about which medication you feel works best!  So if you have any questions or comments please contact us!

First some background…

Vancomycin is an antibiotic that is most commonly used IV to treat methicillin resistant staphylococcus aureus.  However it can also be used orally to treat clostridium difficile (c.diff). 

C.diff is an intestinal infection that occurs most often in hospitalized patients after treatment with broadspectrum antibiotics.

Treatments for C.diff  include Flagyl (metronidazole) and oral vancomycin.  Typical dose of oral vancomycin is 125mg four times a day for 10 -14 days.

Cost? Vancocin capsules cost about $1,800 for a 14 day treatment -pricey no?!  That is the cash price but even with insurance the copay is typically wicked high!  Well, good news -there is an alternative.  A  hospital outpatient pharmacy (yes, most hospitals have outpatient pharmacies) can provide the IV vancomycin liquid that can be used orally and is much less expensive because it is available in generic.  How less expensive….about $40 for a 14 day treatment (cash price) -that is a savings of about 1,760 bucks!

I have c.diff -now what? Talk with your physician about the options -Flagyl (metronidazole) is a great option because it works well and is on the $4 list at Walmart and Target.  If your physician decides that oral vancomycin is what is needed, then call your local hospital and ask to speak with the outpatient pharmacy.  Typically, the pharmacy will dispense small syringes filled with clear fluid (vancomycin)…the largest amount should be 15mls (1 tablespoon).  Small warning, it doesn’t taste that great -so you may want a chaser after you take it but it does the job and at a fraction of the cost!

How to make it easy:

1) Ask your physician to write for “IV vancomycin fluid 10mg/ml -12.5ml by mouth four times a day for ____days”

2) Call local hospital and ask if they have an outpatient pharmacy -if so, have script filled there (retail/community pharmacies will most likely not be able to provide).

3) Take medicine as prescribed!  And take a deep sigh of relief that you didn’t have to pay $1,800!

Have you taken oral vancomycin?  What do you think -please leave a comment!

I LOVE juice -what do I do?  Take the Allegra at night!  It is actually best to take the daily antihistamines (Allegra, Zyrtec, Claritin) at night.  This is because it is best to take the antihistamine 2-5 hours before being exposed to allergens.  And guess when pollen levels are at their worse?  Usually between 5-10 AM!  So, if Allegra is taken at night, you wake up ready to fight off allergens and free to drink as much juice as you want!

Does it hurt me to drink juice and take Allegra at the same time?  No, nothing bad will happen to you if you drink juice and take Allegra at the same time.  However, drinking juice and taking Allegra at same time can actually decrease the amount of Allegra that is absorbed (up to 50% in one study) -this means the Allegra doesn’t work as well.

What about orange juice, cranberry juice, grapefruit juice, grape juice….? Most of the stuidies have been with grapefruit juice, however what causes the interaction is in all fruit juices -so no juice is “safe”.

How long must I separate drinking juice and taking Allegra?  It is best to separate drinking juice and taking Allegra by at least 4 hours.  It is time dependent -so, if you take it together up to 50% won’t be absorbed, if you wait 2 hours 25% won’t be absorbed, if you wait 4 hours mostly all of it will be absorbed.

Can I just take twice the prescribed dose in order to overcome the loss caused by the orange juice? Not a great choice for a couple of reasons.  First, because it is not an exact science of how much Allegra is absorbed so most likely too much Allegra will get into the body.  This increases the risk of side effects.  And because doubling the dose is not very cost effective!

Is it the vitamin C in the juice that causes the interaction? No it is not the vitamin C that causes the interaction.  It is most likely caused by fruit juices inhibiting an organic anion transporting peptide (OATP1A2).  By inhibiting OATP1A2, the absorption of Allegra is reduced.

Why would Zyrtec advertise for Allegra? I really don’t know…

Which is better -Zyrtec, Allegra or Claritin? All three -Zyrtec (cetirizine), Claritin (loratadine) and Allegra (fexofenadine) are now available OTC and all work well.   Studies show that Zyrtec and Claritin are more likely to cause drowsiness then Allegra.  I must admit I am slightly biased because I heart me some Allegra  but others claim Zyrtec or Claritin works better for them.  I would think about cost and what works best with the least side effects for you personally.

If you decide OTC Allegra is for you -go visit their website and get a coupon! 

I hope this clears some questions up!  Thank you for all your comments and questions -please keep them coming!

First, some background-what is gout all about?

It is a condition caused by chronically high blood levels of urate/uric acid.  Only 1/3 of patients actually develop symptoms.  Joints are the most commonly affected by the high uric acid -like the big toe!  Gout can also cause kidney stones. 

What kind of symptoms does gout cause?

Gout can cause swelling, redness and tenderness of the joint -which most people describe as “painful!”  The good news is that most gout attacks will eventually clear up (within a few days to a few weeks) even without treatment.

How is gout treated?

There are two ways to treat gout -by decreasing the amount of urate in the system by increasing clearing the urate from the system OR by decreasing the amount of urate produced by the body.

Typical treatments include allopurinol, colchicine and NSAIDs.

What are the new medications available to treat gout?

1.  Uloric (febuxostat) : This medication works like allopurinol -so it helps lower uric acid in the body.  It hasn’t really been proven to be any better then allopurinol with typical dosing.  So, with the price being about 20 times more then allopurinol (!)  go ahead and stick with allopurinol.  Uloric can be used IF allopurinol is not tolerated.

2.  Krystexxa (pegloticase): This medication works by breaking down the uric acid.  This medicine can seriously lower uric acid levels -the bad side is that it is 10 times more expensive then Uloric (which is 20 times more expensive then allopurinol) …pricey!  AND it has some major side effects, including risk of severe allergic reactions, gouty flares and possibly making heart failure worse.  Some major thought weighing positives and negatives should be done before starting on this med.

There you go -some info on the new meds.  Have some questions or input -LOVE to hear from you!  Please leave a comment or email me at nova@getpharmacyadvice.com

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!

Haha, something I’ve been promising for weeks, but got sidetracked with other topics. 

Please feel free to view the video below!

I know I said you don’t have to wash the nozzle on the eye wash bottle, and I still agree with that statement unless you accidently touch it to a surface of some sort.  You probably should wash the nozzle off at this point because it may be contaminated.

Just saying!

Shoot, almost forgot to give you the link to the article I posted providing info about the eye wash…here’s “Eye Wash to the Rescue.”

Hit me up with your questions at Cate@getpharmacyadvice.com or leave a comment below.

Hit the link here to see how you can save money on your prescription meds!

Night.

Why do we need iron anyhoo?  Besides simply to avoid all the above symptoms.  It helps our body carry oxygen to cells.  Now, imagine you do not have enough iron -that means not enough oxygen.  So it is no wonder low iron can cause fatigue!

What causes iron deficiency?  There are three main reasons that people have iron deficiency -increased need for iron, insufficient intake of iron and decreased absorption.  More specifically…

• Teen years -due to increased need during growth phases
• Menstruation
• Pregnancy/Lactation
• Cancer
• Vegan diet
• Malnutrition
• Gastric bypass
• Vitamin C deficiency
• High gastric pH

Enough reasons for ya?

Where do we get iron in our diet? There is heme iron (from meat) and nonheme iron (from plants).  Our bodies absorb heme iron better…so most of our iron comes from meat.  Other options are dried beans, dark leafy greens, dried fruits and cereal.

Iron is still low…where else can I get iron?  There are supplements available OTC.  Some people need IV iron but typically an oral tablet /liquid will be enough for most people. 

All about iron supplements:  Iron comes as ferrous fumarate, glutamate, lactate, succinate and sulfate- all work about the same.  It is more about how much you need to take.  Iron is dosed as elemental iron.   So, to get 65mg elemental iron -you can take 1 tablet of 325mg ferrous sulfate or 2 tablets of 300mg ferrous gluconate.

Slow release iron (like Feosol) is easier on the belly (iron can cause belly aches).  It is also best to take the iron tablet on an empty stomach with some orange juice or soda -it will help the absorption of the iron.  Milk, cheese, tums (dairy stuff) should be avoided within 2 hours of taking the iron supplement because it will decrease the absorption of the iron.

Side effects: belly ache, nausea, vomiting, constipation, dark-coloured stools.  The liquid version can stain the teeth.

It is good to check with your physician first and see if you actually have low iron levels because iron levels can get too high too and that is a whole other issue!

Are you on an iron supplement -what do you think about all this?  Leave us a comment!

Keep it real and remember, as one of my patients so elegantly said, “Excrement happens!”