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!

Natroba (spinosad) is a new prescription topical treatment for head lice.   Natroba seems to work better then the OTC Nix (and other OTC permethrin).  Natroba works similarly to Nix, however Nix only kills living lice.  This means you need to wait for the nits (eggs) to hatch then re-apply and kill them too (gross, I know!)  Well, Natroba is thought to kill the nits too -so there is a better chance that there will be no need to reapply!

What’s the hitch?  Well, Nix is OTC and cost ~$15; Natroba is by prescription and cost ~$200!  So, best bet is to use the OTC Nix (or generic) options unless there is resistance in your area (your physician should know) or Nix treatment has failed after 2-3 treatments.

Current available topical treatments for head lice: 

• OTC permethrin (Nix or generic) 
• OTC pyrethrins (Licide or genereic)
• Prescription malathion (Ovide)
• Prescription benzyl alcohol (Ulesfia)
• Prescription spinosad (Natroba). 

If nothing seems to help -ask your physician about prescription oral ivermectin (Stromectol).

What about home remedies?  Cetaphil, Vaseline, mayo, olive oil, tea tree oil, Listerine, shaving hair, vinegar, etc…none have been proven to work and some can be harmful!

What do you swear by to treat head lice?  We would love to hear your input -please leave a comment

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!

Dificid (fidaxomicin) is approved to treat C.diff only.  Typically, it is taken twice daily for 10 days.  It works as well as oral vancomycin.  There was one study that showed that patients treated with Dificid had a slightly lower risk of recurrent infection then those treated with oral vancomycin. 

Here is the kicker…

option 1: oral metronidazole 500mg three times a day for 10-14 days -COST: ~$4 to $8

option 2: oral vancomycin capsules four times a day for 14 days -COST: $1,800

option 3: using the injectable vancomycin but taking it orally four times a day for 14 days-COST: $40

and the new one -option 4: Dificid 200mg twice daily for 10 days -COST: ~$2,800 – ouch!

Which one looks best to you?! 

Just a note here, if you are having trouble with recurrent C.diff  that has already been treated with metronidazole and vancomycin then Dificid is definitely an option.  However, a large part of recurrent C.diff infections are caused by a specific strain -BI/NAP1/027 .  For this strain, Dificid has NOT been proven to work better then oral vancomycin and recurrent rates are the same.

Keep these points in mind when you discuss your options with your physician.  If you need some hints on the best way for your physician to write a script for injectable vanco taken orally -please see the article Oral Vancomycin.

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!

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!

Did you go to the pharmacy to pick-up your Kapidex only to find out that you were getting a drug with a different name?  If so, check this video out:

There you have it…Kapidex underwent a name change -it is now Dexilant!  No worries, nothing else about the drug has changed.

Share your thoughts, give us your opinions, visit us often, and definitely leave a comment below…we’d love to hear from you!  You can also find me at Cate@getpharmacyadvice.com if you have a specific question.

If you could check out our video course on how to save money on your prescription medications and then provide us with some feedback, we’d be forever grateful!  Get it for free by clicking here.

Here is a quick, quick video comparing generic sumatriptan and the new Sumavel DosePro

As always, we would love to hear from you so please leave a comment!

Would you like to learn how to save some money?  Be cool and watch our FREE video course on How to Save Money on Your Prescription Drugs.