The latest updates on prescription drugs and ways to save from the GoodRx medical team

Generic Tikosyn for Arrhythmia Now In Pharmacies

by The GoodRx Pharmacist on July 21, 2016 at 5:25 pm

Generic Tikosyn (dofetilide) has been approved by the FDA for some types of abnormal heartbeat: atrial fibrillation and atrial flutter—and is in pharmacies now.

Atrial fibrillation and atrial flutter are two common types of abnormal heartbeat that are often treated with the same medications, as many people experience both together. Atrial fibrillation is an irregular, often rapid heart rate that commonly causes poor blood flow. Atrial flutter is similar to atrial fibrillation but it causes the heart to beat in a fast, regular rhythm.

How is dofetilide be available?

Like brand name Tikosyn, dofetilide is available as a capsule in 125 mcg, 250 mcg, and 500 mcg strengths.

What are the side effects of dofetilide?

The most common side effects associated with dofetilide capsules include headache, chest pain, and dizziness.

What if I want to keep taking brand name Tikosyn?

If you would like to continue on brand Tikosyn, make sure your doctor handwrites BRAND MEDICALLY NECESSARY on your next prescription. This means the pharmacy is not permitted to substitute and give you the generic product.

Otherwise, you can still request that your pharmacist fills the brand medication for you—just make sure to ask before your prescription is filled.

Keep in mind that because the generic is now available your insurance company may not be willing to cover the cost of the brand medication. You may want to call your prescription insurance company to find out the potential cost (or if it’s covered at all) before wasting a trip to the pharmacy.

Are there any other ways to save if I keep taking the brand?

The manufacturer of Tikosyn has a Patient Savings Card for those who are eligible.

Eligible patients will get their Tikosyn for as little as $4 a month. The offer is not available for patients eligible for Medicare, Medicaid, or any other federal or state healthcare programs.

Differin for Acne Now Approved Without a Prescription

by The GoodRx Pharmacist on July 20, 2016 at 2:30 pm

Differin (adapalene) 0.1% gel for acne is the latest prescription medication to make the jump over the counter, with approval from the FDA in July 2016.

There are many prescription and over the counter (OTC) options out there to treat acne, but most of the OTC products have one of two active ingredients: benzoyl peroxide or salicylic acid.

Differin has been a popular prescription treatment, and you’ll now be able to find it on the shelves of your local pharmacy without a visit to your doctor.

Who can use Differin?

Differin Gel 0.1% is for use by patients 12 years of age and older.

Is there anything unique about the OTC approval of Differin Gel 0.1%?

Yes. The approval of Differin Gel 0.1% for sale without a prescription marks the first new FDA-approved product to be introduced to the OTC acne category in over 30 years.

It’s also the first and only OTC acne product containing a full prescription-strength retinoid (a strong acne fighter).

Are there any other strengths of prescription Differin?

Yes. Differin gel is also available in a 0.3% strength. Differin 0.3% still requires a prescription and is not available OTC.

Are there any other dosage forms of prescription Differin?

Yes. Differin (and generic adapalene) is also available with a prescription in the following dosage forms and strengths:

  • 0.1% cream
  • 0.1% lotion
  • 0.3% gel

What is an advantage of using OTC Differin Gel?

Convenience, first and foremost. Because Differin gel 0.1% will available without a prescription you will no longer be required to see your doctor to get refill.

The second advantage is that you get the same prescription strength as the original Differin—this isn’t a different medication with the same active ingredient.

What is a disadvantage of using OTC Differin Gel?

Cost. Because generic Differin (adapalene) is available by prescription it can be billed to your prescription insurance. Your co-pay will typically be lower than the cash price of OTC Differin.

And, because Differin is the only OTC product of its kind, the manufacturer may be able to set the price higher than other OTC acne treatments.

What other options are available OTC for acne?

The big OTC options include any of the various benzoyl peroxide and salicylic acid acne products.

There are also a bunch of “natural” products that can be used for acne, including tea tree oil, witch hazel, green tea extract, masks and exfoliants, and more.

Want more information?

Check out the news release from the FDA here.

When Do I Need Pneumonia Vaccines?

by Dr. Sharon Orrange on July 19, 2016 at 1:37 pm

Strep pneumonia also known as pneumococcal pneumonia is a major cause of bacterial pneumonia in adults. There are 90 different strains (serotypes) of strep pneumonia, and even if you’ve had one type, you are only immune to that one type again.

Because your immune response is specific to that type, you still need a vaccine to help you out. Two in fact. Two vaccines that cover 23 different serotypes (aka strains) of pneumococcal pneumonia.

There are two vaccines for pneumonia:

Pneumovax 23 was introduced in 1983 and covers 23 strains of pneumonia.

Prevnar 13 which is not new, but it is a new recommendation for adults. This vaccine gets a better immune response though it only covers 13 types.

I’m 65 or older—should I get the pneumonia vaccines?

Yes. If you have not been vaccinated you will get your Prevnar first, followed one year later by your Pneumovax. The two pneumonia vaccines have to be separated by one year. You are then done with pneumonia vaccines, and do not need any sort of booster.

Why do I need both?

Though the Prevnar vaccination, the new recommendation, covers the same strains as the Pneumovax, the immune response seen when you receive both is better.

Why can’t Prevnar 13 and Pneumovax 23 be given together?

Unlike flu shots with pneumonia vaccines, the two pneumonia vaccines cannot be given together. Not because it’s dangerous—but because there is “immunologic interference” making them less effective. The sequence and timing is important. Closer spacing of these vaccines does not induce as good a response. Remember this is only a problem with the two pneumonia vaccines, and not the flu shot.

Do I need both of the pneumonia vaccines if I’m younger than 65?

Yes—if you belong to the following groups listed below. You’ll still get your Prevnar first and your Pneumovax one year later.

  • Cigarette smokers aged 19 and older. This group is often forgotten. People who smoke are at higher risk of pneumococcal pneumonia—get vaccinated.
  • Diabetes mellitus. This is another group that is often forgotten. Every person with diabetes needs their two pneumonia vaccines.
  • Chronic heart disease: congestive heart failure, cardiomyopathies. This does NOT include folks with high blood pressure.
  • Chronic lung disease like asthma, COPD and emphysema.
  • Alcoholics.
  • Chronic liver disease, cirrhosis.
  • Immunocompromised folks. This includes: HIV infection, leukemia, congenital immunodeficiency, Hodgkin’s disease, lymphoma, multiple myeloma, generalized malignancy or on immunosuppressive therapy.
  • Solid organ transplant patients.
  • Chronic kidney failure.
  • The rest. Candidates for cochlear implants, patients who’ve had their spleen removed, people with cerebrospinal leaks (CSF) leaks.

What If I have already received both vaccines before the age of 65?

Then you will get your booster (second doses) at 65 and 66, with one exception. You can not receive a two doses of Prevnar within 5 years of each other.

Dr O.

What Can I Do With Unused Prescriptions?

by The GoodRx Pharmacist on July 14, 2016 at 3:26 pm

In the past we have posted about National Prescription Drug Take Back Days—events throughout the year intended to give you a safe way to get rid of old medications.

The Take Back Days are also a huge help in providing education about prescription drug and opioid abuse.

Many pharmacy chains are leading the fight by installing safe medication disposal kiosks in their stores. They hope to help curb the misuse of medications, and give you a safe and easy way to dispose of unwanted (or unsafe) old prescriptions.

Which pharmacies have begun medication disposal initiatives?

  • Walgreens. As part of a nationwide effort, Walgreens will be installing more than 500 safe medication disposal kiosks in their stores later this year.
  • CVS. In 2013, CVS launched its Medication Disposal for Safer Communities Program. This program distributed drug collection bins to police departments to help their communities safely dispose of unwanted medications and controlled substances that could otherwise be diverted, abused, or contaminate the water supply.
  • Rite-Aid and Safeway. At both chains, you can purchase pre-paid envelopes for unwanted medications.
  • Many independent pharmacies also offer safe disposal programs—check with your local pharmacist for more information.

What drug disposal systems are available?

You may not need to be familiar with the system your pharmacy uses, but know that there are a few different companies out there offering this service:

Can Pain Med Tramadol Cause Low Blood Sugar?

by Dr. Sharon Orrange on July 13, 2016 at 9:43 am

Tramadol (Ultram) is prescribed for pain more than ever, with new recommendations to limit the use of opioid analgesics. Tramadol is a non-opioid that works on the opiate receptors. Unlike other opioids (like hydrocodone and codeine), tramadol doesn’t affect your breathing or heart. It’s a good option for trying to avoid opioids if NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen) aren’t recommended for you.

Why use tramadol instead of an opioid like hydrocodone?

Tramadol works well for pain and is safe—because respiratory depression, cardiovascular side effects, drug abuse and dependence are minor, unlike with opioids.

However, with increasing use of tramadol have come reports of low blood sugar (hypoglycemia) as a side effect. It can be a problem even in people who don’t have diabetes and aren’t taking other medications to control blood sugar.

So does tramadol cause low blood sugar?

Yes. A recent large study found that tramadol use is associated with an increased risk of hospitalization for hypoglycemia.

That risk is highest around the time you first start taking it—mostly within 10 days of starting. In fact, people taking tramadol had more than three times an increased risk of hospitalization for hypoglycemia. This was true for folks with and without diabetes, and taking tramadol at the recommended doses.

Although it’s rare, occurring in only 7 out of 10,000 people, tramadol-induced hypoglycemia is a potentially fatal adverse event.

Why can tramadol cause low blood sugar?

One of the ways tramadol works is by inhibiting serotonin and norepinephrine reuptake. Serotonin pathways are known to have effects on blood sugar regulation. The activation of µ opioid receptors by tramadol (remember, it isn’t an opioid, but works on the same receptors) may also increase the risk of hypoglycemia.

Good to know.

Dr O.

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