According to the FDA, there is new information that quinolone antibiotics may cause very serious side effects when used to treat sinusitis, bronchitis, and urinary tract infections.
What kind of serious side effects can occur if a quinolone antibiotic is used to treat these conditions?
Heads up—this is a serious new warning. These side effects can be disabling, and potentially permanent. Potential adverse effects include:
- Tendon pain
- Joint pain
- Muscle pain
- “Pins and needles” or a tingling or pricking sensation
What are the new FDA recommendations?
The FDA is advising that the use of these antibiotics be restricted, and recommending using an alternative medication if possible.
What are some examples of quinolone antibiotics?
The warning affects systemic forms of quinolone antibiotics (that you take by mouth, or that are injected). It does not apply to topical forms at this time. Some examples of systemic quinolone antibiotics include:
- ciprofloxacin (Cipro)
- ciprofloxacin ER (Cipro XR)
- levofloxacin (Levaquin)
- moxifloxacin (Avelox)
- gemifloxacin (Factive)
- ofloxacin (generic tablet only)
Is this the first safety communication for quinolone antibiotics?
What should I do if I experience any of the side effects listed?
If you experience any of the side effects mentioned above while taking a quinolone antibiotic, contact your health care provider immediately.
Metformin (Glucophage) is first line therapy for diabetes which carries the benefit of helping with weight loss. It’s cheap, does not result in risky low blood sugars (hypoglycemia), has a cheap generic—oh AND it may help you live longer. In a previous blog I told you about the exciting early evidence that metformin may help prevent aging.
Well, a recent loosening of restrictions from the FDA means that 40% or 50% of patients with type 2 diabetes who have mild-moderate chronic kidney disease (CKD) will now be eligible to take metformin.
- Labeling of metformin and metformin-containing drugs (Janumet, Metaglip, Glucovance) will be changed to show that they are safe to use for people with mild to moderate renal (kidney) impairment. This is great because many diabetics have kidney disease and this opens up metformin use for you.
- Instead of your doctor measuring just a creatinine blood test for your kidney function, your doctor can do tests to estimate your GFR (glomerular filtration rate) which takes into account your age, gender, race and/or weight. Just so you know, this is easily done with a GFR calculator where you enter blood creatinine (Cr) and other factors and get the GFR number back.
- Now, before starting metformin, your doctor will estimate your GFR instead of your creatinine. The restrictions now: If you have a GFR lower than 30 mL/min, which is severe kidney disease (stage 4 or higher), you should still not use metformin. It’s also not recommended that you start metformin if you have stage 3 chronic kidney disease (GFR 30-45).
- Your doctor should do a GFR check once a year if you are taking metformin.
- One other change: before, everyone taking metformin had to stop taking it prior to imaging studies like a CT scan. Now, it’s only recommended you stop taking metformin before certain imaging procedures if your GFR is between 30 and 60 mL/min—or if you have a history of liver disease, alcoholism, or heart failure. If you do need to stop taking it for a CT scan or other imaging, you can restart 48 hours after the procedure as long as your kidney function is stable.
There are many medications on the market that have very similar names, which can sometimes be confusing for you, your pharmacist, and your doctor.
One example is Brintellix (an anti-depressant) and Brilinta (a blood thinner). Especially since they treat such different conditions, confusing these two prescriptions can cause big problems—and could even be life-threatening.
To lower the risk of mixing these two up, and to decrease prescribing and dispensing mistakes, the FDA just approved a name change for Brintellix. If you’re currently taking Brintellix, here’s what you need to know:
What is the new brand name for Brintellix?
Brintellix will now be known as Trintellix.
When will Trintellix be available?
Trintellix is expected to replace Brintellix in pharmacies by June 2016.
Will I still be able to get my medication during the name change transition?
Yes. During the transition your doctor can still prescribe Brintellix for you, and your pharmacy will still have it in stock.
Is anything other than the name changing?
No. Trintellix will be the same exact medication and continue to look exactly the same.
What sparked the name change?
The FDA issued a safety warning in July 2015 on confusion between Brintellix and Brilinta. Since Brintellix was approved in September of 2013 there have been both prescribing and dispensing errors due to mix-ups with Brilinta.
Are there any other recent examples of a medication name change of this caliber?
Yes. Believe it or not, the same manufacturer of Brintellix had this happen in 2010 with their drug formerly known as Kapidex.
Since mixing up medications confusion can be potentially life-threatening, manufacturer Takeda, with the help of the FDA approved the name change from Kapidex to what we know today as Dexilant.
You and your healthcare provider have decided it’s time to wean off your antidepressant and now you wonder: what is the best way to stop? Does taking it slow make more sense than cold turkey? What symptoms might I feel?
First: the “discontinuation syndrome” is worse when you stop your antidepressant abruptly. This may include dizziness, nausea, fatigue, muscle aches, chills, anxiety, and irritability. Dizziness is by far the most common symptom reported. These symptoms are not dangerous and usually lessen over one to two weeks, but they can certainly be uncomfortable.
When you stop taking an antidepressant, it is common practice to taper them (to take a progressively lower dose) over two to four weeks to keep the discontinuation symptoms to a minimum. But the evidence on the effectiveness of slowly tapering doesn’t really give us the best answer for exactly how to wean down. Here’s what we know:
How should I wean off my antidepressant? A study comparing tapering over three days with tapering over two weeks found no difference in discontinuation and depressive symptoms. What was different, however, was that the longer the taper the less likely the recurrence of depression. Other evidence suggests that discontinuation symptoms can be reduced by tapering the dose 25 percent per week. Tapering is unnecessary for patients who have been taking an antidepressant for 4 weeks or less as this is insufficient time to develop a withdrawal reaction.
Why does it happen? There is still debate about the cause of the antidepressant discontinuation syndrome. It can occur after stopping any antidepressant, but it’s more pronounced with antidepressants that are more potent (stronger) and shorter-acting like paroxetine (Paxil) and venlafaxine (Effexor).
Do some antidepressants have worse withdrawal symptoms than others? Yes. The worst withdrawal symptoms tend to happen in the antidepressants with the shortest half-life—again, this would be venlafaxine (Effexor) and paroxetine (Paxil). The mildest symptoms occur with fluoxetine (Prozac), which has a long half-life. Stopping sertraline (Zoloft) causes fewer symptoms than Paxil but more than Prozac. Stopping citalopram (Celexa) generally produces only mild symptoms, less than Paxil.
I’ve had really bad withdrawal symptoms even with weaning down—what can I try? Folks who have difficulty tapering off of paroxetine (Paxil) may benefit from being switched to an equivalent dose of fluoxetine (Prozac) then tapering off of that.
To sum up—four specific guidelines have been proposed for stopping antidepressants:
- Your doctor will reassure you that the discontinuation syndrome will end.
- Your doctor may start you back on the drug and taper at a slower rate for severe cases.
- All drugs (with the possible exception of fluoxetine) should be slowly tapered to reduce the incidence of a discontinuation syndrome.
- You may initially be prescribed or switched to drugs with a longer half-life (like fluoxetine).
Hoping to save a few bucks on your prescription? Trying to avoid a trip to the drugstore? If so, maybe you’ve considered getting your meds through your insurance company’s mail-order pharmacy.
More than one-third of respondents in a 2013 Consumer Reports survey got at least some of their prescriptions through a mail-order pharmacy during the previous year. But while mail order can be a good option for some, it can also be a hassle, and savings aren’t guaranteed.
GoodRx sat down with Consumer Reports Best Buy Drugs to answer five common questions about when mail order makes the most sense—and when you should stick with a walk-in pharmacy.
GoodRx: How do mail order pharmacies work?
Best Buy Drugs: Most mail order programs operate through your insurer’s pharmacy benefit manager, or PBM. These companies often have exclusive rights to provide mail order pharmacy services to members of that plan. If you use other mail order services, you may not receive coverage from your health plan.
You can sign up for mail order by sending in your insurer’s mail-order form with your prescription, or having your doctor phone or fax it in. You can usually submit refills online, over the phone, or through a mobile app.
Since it can take up to two weeks to receive your medications through the mail, you may want to ask your doctor for two prescriptions, one to be filled right away at your local pharmacy, and one for your mail-order supply.
Keep in mind that some health plans will require you to switch to mail order after a few fills if you want to receive coverage.
GoodRx: How do I know if mail-order pharmacy is right for me?
BBD: If you’d like your prescriptions delivered to you rather than having to pick them up at the drugstore, mail order may seem like a no-brainer.
Depending on your insurer, discounts can also be significant—particularly when it comes to certain generic medications that you take regularly for chronic conditions like diabetes or high blood pressure. For those meds, you may be able to order a three-month supply of some drugs for a co-payment of just a few dollars, or even $0 in some cases, including free shipping.
But before signing up, you’ll want to make sure you’ll benefit. That means comparing what your insurer’s mail-order pharmacy will charge (including shipping) with your local pharmacy’s prices.
Many insurance companies are now offering 90-day fills at local pharmacies for similar prices to mail order. For example, if Caremark is your PBM, you can purchase 90-day fills at a CVS for the same price as mail order. If Express Scripts or Optum is your PBM, you can purchase 90-day fills at Walgreens. Check with your individual health plan to see where you can get 90-day fills at the best rates.
GoodRx: How is my insurance plan’s mail-order pharmacy different from an online pharmacy?
BBD: It’s easy to confuse mail-order pharmacies and online pharmacies, but the only similarity is that both ship medicines directly to your home. Mail-order pharmacies operate through your health plan, and require that you have one particular kind of insurance, while online pharmacies tend to operate like an online drugstore and may or may not accept your insurance.
In some cases, your health plan will only provide coverage if you use their mail order pharmacy.
GoodRx: When should I stick to my local retail pharmacy?
BBD: If your medications are reasonably priced through your local retail pharmacy, you have a good relationship with your pharmacist, and are happy with your service, there may be no need to change.
Many chain and big-box stores offer generics at deeply discounted prices without insurance. Kmart, Sam’s Club, Walgreens, and Walmart, for example, offer a 90-day supply of dozens of generics for only $10 (though in some cases, there might be annual membership fees.)
Since mail-order programs typically ship a 90-day supply of your meds at a time, mail order may not be feasible for drugs you need immediately or that you take briefly, for example medications you’ve been prescribed post-surgery, or antibiotics for an infection.
Finally, mail order pharmacies have pharmacists on staff ready to assist you and answer questions, but if you prefer a more personal, face-to-face relationship with a pharmacist, stick with a walk-in pharmacy.
GoodRx: What are the downsides to using a mail order pharmacy?
BBD: First and foremost, errors in communication.
For instance, medications may not always arrive on time, which can be dangerous for people who rely on lifesaving drugs. To avoid delays, make sure you set up orders online or over the phone at least two weeks before you’ll run out if you don’t have automatic refills.
The opposite problem can happen too. Mail order pharmacies might auto-renew your prescriptions without confirming you’re still taking a drug or whether your dosage has changed.
Luckily, Medicare Part D drug plans require mail order pharmacies to get the okay from a patient or caregiver before shipping a new prescription or refill.
Also, with any type of delivery service, there’s also the chance your package could be lost, stolen or damaged in the mail. Mail-order programs will try to prevent that by using protective packaging, but in the event that your medications are damaged or lost, call your pharmacy’s 1-800 number immediately for a replacement.
And a final safety note: If you get medications via mail order and other prescriptions you need occasionally at a walk-in pharmacy, be sure to let each pharmacy know about all of the medications you’re taking and update them regularly about any changes, so your pharmacist can alert you to possible drug interactions.
Consumer Reports Best Buy Drugs is a public education project dedicated to helping you talk to your doctor about prescription drugs and helping you find the most effective and safest drugs for the best price.