Tag Archives: medication

FDA Investigating Misuse, Abuse of Gabapentinoids

FDA Investigating Misuse, Abuse of Gabapentinoids – by Joyce Frieden, News Editor, MedPage Today – February 15, 2018

Gabapentinoids such as pregabalin (Lyrica) as well as the original agent gabapentin (Neurontin) are approved to treat a variety of conditions, including post-herpetic neuralgia, fibromyalgia, and neuropathic pain associated with diabetes, and

“some literature suggests that clinicians may be prescribing these drugs off-label … as alternatives to opioids, outside approved indications,” Gottlieb said.

Desperate times call for desperate measures.  Continue reading

Study Shows How Aspirin Fights Inflammation

Study Shows How Aspirin Fights Inflammation – National Pain Report

A daily low-dose aspirin has long been recommended by doctors for its cardiovascular benefits.

But only now are researchers getting a better understanding of how aspirin reduces the inflammation that can lead to heart disease and other chronic health conditions.

So, doctors were recommending something even though they didn’t know its mechanism of action. I always thought it worked because it thinned the blood.    Continue reading

How To Save Money on Your Rx Drugs

Are You Paying Too Much for Your Drugs? – Aug 2018 – by 

Health care in America is expensive. One of the biggest costs? Your medications.

A recent study from researchers at the University of Southern California highlighted part of this expensive problem. Based on their analysis, 23% of customers overpaid for their prescriptions. Nobody will tell you you’re overpaying, not the pharmacist — who might not be allowed — and certainly not your insurance company.

If you’re one of the nearly 50 percent of Americans who’s taken at least one prescription drug in the last 30 days, it probably won’t surprise you that 16.7 percent of healthcare spending in 2015 was on drugs alone. That’s a total cost of about $457 billion annually, and the prices aren’t going down any time soon.

Here’s how you might be able to save money on your drug costs, even if you’re covered by insurance.

Work With Your Doctor (and Pharmacist!)

Sometimes when clinicians prescribe medication, they have choices about the specific brand or generic they give you that can make or break your budget, depending on the cost.

If your doctor wants to prescribe something that isn’t covered, ask if there’s a similar medication or generic version that is covered.

If you need a medication that is more expensive or not on the formulary list, your insurance company may require you try step therapy before approving your drug of choice.

And buyer beware. Sometimes pharmaceutical companies offer doctors financial incentives to prescribe particular drugs. This may not be in your best medical or financial interest.

If you need help sorting through your option, try asking your local pharmacist. They know just as much, if not more, about drugs as your doctor.

But they know nothing of me, and it’s my personal biochemistry and medical history that usually determines the effectiveness of any particular medication – and the pharmacist has no access to any of that.

Choosing a Generic Medication

n the U.S., drug companies can patent new drugs for 20 years, which means patients prescribed those meds are stuck paying brand prices. This system is partly why your drug costs are so high in the first place.

Once that time period ends, other companies can make a generic version that sells for much less. One of the best ways to save money is to switch to the generic version of a medication.

While there’s been some debate in the media about whether or not generics are as good as the brand, most concerns are unfounded.

I have my doubts about the quality control of generic medications and the equality of different generics.

My experience has been that sometimes when my pharmacy gets their generics from a different vendor, that generic will affect me differently than the previous one I used or the brand name medication.

Generic drugs are regulated by the Food and Drug Administration and must have the same active ingredients as the brand version.

However, one critical difference is that:

The non-active ingredients in a generic don’t need to be the same.

These non-active fillers determine how much and how fast your body can metabolize the medication, so they are a critical component of how the drug works in our individual bodies.

Medication Therapy Management Programs

If you’re on Medicare, you might have heard of a medication therapy management (MTM) program.

An MTM helps you review the medications you use if you have more than one chronic condition. With a pharmacist and/or your doctor, you’ll check to make sure the drugs you’re taking work effectively.

doctors prescribe new drugs each time symptoms occur. Eventually, it’s hard to tell what you’re taking and why. An MTM evaluation can help consolidate prescriptions so they’re more effective and cost-efficient.

Manufacturer Assistance

If you can’t afford your prescription, you can try reaching out to the drug company directly. Drug manufacturers often offer some version of a prescription assistance program for those can’t afford their medications

Drug company Pfizer, the manufacturer of drugs such as Lyrica, has a RxPathways patient assistance program.

After searching for the medications you take and answering a few personal questions, including your monthly income, you’ll find out if you’re eligible for discount meds.

In the case of Pfizer, if you do meet the income requirements, you can apply to receive free Pfizer-brand drugs at your doctor’s office, home or by using a discount co-pay pharmacy card.

Price Shopping to Get Your Drugs for Less

you can shop around for your medications just like you would any other product.

This means not only checking out a variety of pharmacies or big box and club stores, but also your options available through discount prescription services like ScriptSave WellRx and FamilyWize.

Discount prescription companies negotiate rates directly with drug companies. Often you can get a better rate through one of these services than what you would pay in cash — and sometimes better than your cost with insurance.

You might need to print out a savings card or coupon to present to your pharmacist. Some companies let you order directly online or send medications straight to your house.

Here are six discount prescription services:

Please see the full article for the list and description of each.

How Much Can You Save?

We asked the Mighty community which prescription drugs they have a hard time affording — and more than 500 people shared a variety of costly prescriptions.

Based on the community’s answers, we pulled four common drugs — Abilify, Savella, Remicade and Pristiq — and did a little price shopping.

We compared the average amount you paid, which included brand and generic drugs, with how much you might be able to save (based on calculations in Los Angeles).

Abilify (Aripiprazole)

Abilify is an antipsychotic used to treat conditions such as schizophrenia, bipolar disorder and depression. Brand and generic versions are available. The brand version can cost as much as nearly 95 percent more than the generic version based on these discount prescription services.

Savella (Milnacipran)

Savella is a nerve pain and antidepressant medication often used to treat fibromyalgia. Currently, only the brand version is available.

Remicade (Infliximab)

Remicade is an immunosuppressive drug used to treat conditions such as rheumatoid arthritis, Crohn’s disease and ulcerative colitis. It is only available as the brand version, though two similar medications, Inflectra and Renflexis, have been approved by the FDA.

Pristiq (Desvenlafaxine)

Pristiq is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat depression. Currently available in both brand and generic variations. The generic version costs about 20 to 30 percent of what the brand costs based on these discount prescription services.

Author: Renée Fabian is Associate Editor, News & Lifestyle at The Mighty.

AMA Rejects Time Limits On Opioid Scripts

American Medical Association Rejects Idea of Time Limits On Opioid Scripts – by Bill Meagher – Apr 2018

In the midst of an epidemic of opioid use that caused almost 32,000 deaths last year, the American Medical Association is pushing back against a wave of legislation that sets limits on doctors prescribing the pain med.

Dr. Patrice Harris, the chairwoman of the AMA‘s opioid task force, says her organizations has grave concerns about

  1. limiting a physician’s ability to prescribe medication that a patient might need and that
  2. decisions on how a doctor treats a patient is best left up to them.  Continue reading

FDA Investigating Misuse, Abuse of Gabapentinoids

FDA Investigating Misuse, Abuse of Gabapentinoids – by Joyce Frieden, News Editor, MedPage Today – Feb 2018

Here comes another round of addiction hysteria, this time about medications doctors are prescribing on the slim chance they could help suffering pain patients for whom they are no longer allowed to prescribe opioids.

The FDA is looking at whether gabapentinoids are an addiction threat, FDA Commissioner Scott Gottlieb, MD, said Thursday.

Gabapentinoids such as pregabalin (Lyrica) as well as the original agent gabapentin (Neurontin) are approved to treat a variety of conditions, including

  • post-herpetic neuralgia,
  • fibromyalgia, and
  • neuropathic pain associated with diabetes,

Continue reading

Why a patient paid a $285 copay for a $40 drug

Why a patient paid a $285 copay for a $40 drug | PBS NewsHour – By Megan Thompson – Aug 2018

Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan [prescribed after transient ischemic attack]through Express Scripts, the company that manages pharmacy benefits for Anthem.

The copay for a 90-day supply was $285, which seemed high to Ma.

…during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.

The pharmacist told him it would cost about $40.   Continue reading

Battle Against Opioids = Misery for Pain Patients

Opinion: The Battle Against Opioids Could Mean Misery for Patients in Pain – By Heather Wargo – August 16, 2018

While the United States is distracted by politics, a human rights battle to the virtual death is being played out in Oregon and no mainstream media outlet is covering it.

The ramifications of ending Medicaid coverage of prescribed pain medication for chronic illness except for a very narrowly defined list in Oregon will affect every American whether they realize it or not within the next decade. The effects will be disastrous if it goes the way the bipartisan players desire.

And here Ms. Wargo has arrived at an near-perfect analogy that makes our plight obvious:   Continue reading

Proton Pump Inhibitors: Nutrient Robbers

Proton Pump Inhibitors: How to Deprescribe These Nutrient Robbers –  JULY 22, 2018 – Anyssa Garza, PharmD, BCMAS

Many medications can cause nutritional deficiencies, and proton pump inhibitors (PPIs) are no different.

1. First is magnesium deficiency.

Several reports have linked long-term PPI use with an increased risk of hypomagnesemia, especially over a year.

Results of studies suggest that PPIs inhibit active transport of magnesium in the intestine.

2. Second is vitamin B12 rated as a moderate depletion. Monitoring of vitamin B12 is recommended, and some people may need a supplement

Because gastric acid is needed to release vitamin B12 from protein for absorption, PPIs can reduce the absorption of protein-bound (dietary) vitamin B12.

Suggested supplementation of vitamin B12 is 25 to 400 μg/day.

Growing Concern

It is common for PPIs to be continued for prolonged periods and, in some cases, indefinitely. But long-term use of PPIs can lead to adverse effects, drug interactions, misuse or overuse, and prescribing cascades

In addition to nutrient depletion, PPIs have been linked to an increased risk of Clostridium difficile and pneumonia infections, kidney damage, and osteoporotic fractures.

Deprescribing

There are several methods for deprescribing PPIs, including

  • stopping (abrupt discontinuation or tapering),
  • stepping down (ceasing taking medication, followed by H2blocker therapy), and
  • reducing (intermittent PPI use, on-demand PPI use, or lowering the dose).

It looks like they assume patients were taking these medications for no reason. Just as with opioid medications, they don’t even consider the outcome of such reductions, when the original symptoms roar back to life.

Regardless of the approach, the overall goal of deprescribing is to avoid adverse effects, improve or maintain quality of life, and reduce inappropriate medicine use.

PPI’s are taken because of chronic and intense heartburn, but these folks are so narrowly focused on taking the drug away, they don’t even think about how else they will treat the uncontrolled and excruciatingly painful symptom for which patients were taking the drug in the first place.

Evidence-based guidelines to help clinicians deprescribe PPIs were published in the Canadian Family Physicianjournal in 2017 [Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline  free full-text PMC article].

These guidelines used a systematic review of deprescribing trials and examined reviews regarding the harm associated with the continued use of PPIs. The development of these guidelines involved a team comprising a family physician, a gastroenterologist, 3 pharmacists, and 5 nonvoting members.5

The guidelines are designed to help clinicians make decisions about how and when to deprescribe PPIs. They are meant to be used in conjunction with treatment guidelines for gastroesophageal reflux disease (GERD) and peptic ulcer disease, and they take into account a patient’s personal situation and are not meant to dictate decision making, the authors noted.

This is how the opioid guidelines should have been handled. We aren’t seeing laws being passed about what doses of PPI’s are legal, doctors aren’t harassed for prescribing “too many”, patients aren’t being accused of only taking them to feed an addiction.

For the PPI deprescribing algorithm, see the Figure.

On-demand PPI use is defined as taking a PPI for a period that is sufficient to achieve symptom resolution.

Upon symptom resolution, the PPI is to be discontinued until the symptoms recur, in which case, the PPI will again be taken daily until symptoms resolve

These recommendations are not for individuals with Barrett esophagus, a history of bleeding GI ulcers, or severe esophagitis (grade C or D, as defined by the Los Angeles Classification for the endoscopic assessment of reflux esophagitis), the authors noted.

…a recently published Cochrane systematic review noted that there are several situations in which continued use of PPIs may be needed and listed those in the algorithm. Furthermore, they recommended seeking advice from a gastroenterologist to assess continuing risk factors for GI disease.

Many of the deprescribing trials included follow-up post deprescribing. Because of this, the investigators recommended establishing a post-deprescribing plan that includes a follow-up after 4 weeks to assess symptom control and after 12 weeks to assess symptoms, the frequency of on-demand use, and other factors, as well as to reassess the need to go back on continuous treatment.

Author: Anyssa Garza, PharmD, BCMAS, received her doctor of pharmacy degree from The University of Texas at Austin. She is the vice president of Content and Patient Education Programs at Digital Pharmacist and an adjunct assistant professor at The University of Texas at Austin College of Pharmacy.

Anticonvulsants in the treatment of low back pain

Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis – July 2018

BACKGROUND: The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence.

We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.   Continue reading