Rosacea is a common problem and the redness and flushing that goes along with it is a bummer for rosacea sufferers. There are two good topical medications for the pimples and acne associated with rosacea: metronidazole and Finacea (azelaic acid) but there hasn’t been much help for the redness. Until now.
Why would you need Mirvaso? Facial redness and erythema is a common rosacea symptom. Before now, not many of the rosacea meds worked well for the redness.
How do you use it? You will apply a pea-size amount once daily as a thin layer across the entire face covering the central forehead, each cheek, nose, and chin
What the heck is it? Topical 0.33% brimonidine gel, Mirvaso, is a vasoconstrictor that has been shown to reduce the redness. Topical brimonidine gel appears to be well-tolerated though rare side effects were flushing, skin burning sensation, and contact dermatitis.
As always, new medications are expensive so look out for discount coupons and ask your doctor about samples.
Mirvaso is likely to cost about $275 to $300 per tube with a discount card or coupon, and may not be covered by many insurance plans. If covered, it is likely to be a Tier 2 or 3 medication, meaning you’ll pay a higher co-pay. For insured patients, the manufacturer does offer a co-pay card that reduces each prescription to $50 if your plan covers it and $80 if it does not. You can find more information here: http://www.mirvaso.com/savings
Topamax (topiramate) is used for the treatment of epilepsy, migraine headaches and weight loss (as half of the new weight loss drug Qsymia). Now, there is a new long-acting Topamax called Trokendi XR.
• Trokendi XR has been approved, for now, only as an anti-epileptic drug indicated for treatment in patients 10 years of age and older with partial onset or primary generalized tonic-clonic seizures.
• It’s available in 25mg, 50mg, 100mg, and 200mg extended-release capsules.
• We don’t know or think it’s any better than Topamax but it may have easier once daily dosing.
Trokendi XR will start from around $180 for 30 capsules of the lowest dose, 25 mg, up to about $650 for 30 capsules of the highest 200 mg dose. Since there is a generic version of topiramate available, many insurance plans will consider Trokendi XR a Tier 2 or 3 medication if it’s covered, meaning you’ll pay a higher co-pay. In contrast, generic topiramate is available from many pharmacies at under or around $20 for 60 tablets, depending on the strength, and will be covered by most insurance plans under the lowest tier or co-pay level.
Each year the flu vaccine covers the strains of the virus that were most prevalent the previous flu season. This information is collected and released by the Centers for Disease Control (CDC), the institute that also sets recommendations for vaccination. Following the recent H1N1 (swine flu) outbreak, each yearly influenza vaccination now covers H1N1 as well.
Which form of the vaccine should I get?
There are several different flu shots available to choose from, based on your personal and medical needs.
Trivalent (three component) flu shot:
This is the “standard” flu shot that provides coverage against three strains (H1N1, H3N2 and an influenza B strain) of the flu. It is provided as an intra-muscular injection and is recommended for all patients above the age of six months. Common brand names for this type of shot include Fluvirin, Fluzone, and Afluria. Some of these formulations are also available as “preservative free” options.
Quadrivalent (four component) flu shot:
This is the first year this type of flu shot will be available! The quadrivalent form covers two strains of influenza A and both strains of influenza B. This vaccine provides expanded coverage against the virus, and will likely replace the standard flu shot in the coming years. Common brand names for the quadrivalent shot include Fluarix Quadrivalent and Flulaval Quadrivalent.
Live nasal mist:
FluMist Quadrivalent is the flu vaccine available as a nasal spray. This version is squirted into the nasal passages, and is indicated for persons aged two to forty-nine. This form covers against the four strains of the virus. Since the vaccine is live (it had components of the active virus in it) it should be avoided if you are considered high risk (immunosuppressed, asthmatic, diabetic or pregnant).
The FluZone High-Dose vaccine is indicated if you are above the age of 65. The higher dose is intended to protect the elderly from complications that can occur from an infection, as they are more likely to have a severe infection and possibly need hospitalization.
The FluZone Intradermal flu shot is an option if large needles make you nervous. The intradermal shot contains several micro needles that provider a shallow injection under the skin, rather than into the muscle. FluZone Intradermal is a trivalent (three component) formulation.
Recombinant Flu Vaccine:
Finally an option for the estimated 1% of adults that are allergic to eggs! For the first time a recombinant vaccine has been developed (cultured in caterpillar cells) that is safe to use if you have an egg allergy. FluBlok is a trivalent vaccine that is indicated for use in patients between the ages of 18 and 49.
The Bottom line
This year there are several options to choose from when you get the flu shot. The quadrivalent vaccine does provide more protection versus the standard flu shot, but the standard shot is still effective. This is because the fourth strain is generally more common in children and does not account for a large number of cases.
Check with your pharmacy or clinic for availability, as not all locations will carry all the available shots. Your insurance may also only prefer particular types of the vaccine. Prices will also vary for each type, with the newer forms tending to cost more.
For more information check out the CDC website: http://www.cdc.gov/flu/
Now that you know the menu: get your annual flu shot!
Till next week,
The GoodRx Pharmacist
Just when you think you’ve heard it all along comes Xylazine. Xylazine is a medication used to treat spastic colon and abdominal pain in horses so yes, makes sense we’d add it to our illicit drugs right? Here comes trouble.
Users of illicit drugs are now combining xylazine with other drugs of abuse and may be increasing their risk of death.
Xylazine aka ‘horse anesthesia’ has been used over the last couple of years as an additive in heroin and now cocaine. It scares us because Xylazine is being found in a large number of patients who die due to heroin and/or cocaine and if you get into trouble with Xylazine there is no known antidote.
75 cases of folks who died from cocaine and/or heroin overdose were analyzed specifically for Xylazine and 36 of 75 (48%) were positive for Xylazine. Ick.
How much Xylazine is too much? ANY of it is too much. There is no defined safe, toxic or fatal concentration in humans. What’s happening is that heroin and cocaine are ‘cut’ (adulterated) with xylazine, intensifying the intoxication and contributing to more severe drug addiction and dependence.
Flu season is around the corner. Influenza viruses cause the flu, and infection is spread through respiratory routes. Here is what you need to know in preparation.
• Sudden onset (symptoms start and worsen over several hours)
• Persistent fever
• Muscle aches
• Fatigue, general malaise
• Nausea or vomiting
• Chills, shakes, and sweating
The flu is also contagious, with adults capable of spreading the virus up to 7 days following onset of symptoms, and children for up to 10 days.
It is common to confuse flu symptoms with cold symptoms. With the seasonal cold, symptoms generally progress slower, and are accompanied by:
• Stuffy nose
• Sore throat
• Milder cough that takes longer to develop
• Fatigue, weakness and muscle aches can occur but are generally milder
Don’t get the flu this year: Get Vaccinated!
If you haven’t been vaccinated yet, plan to get your annual flu shot at your healthcare provider or pharmacy. Pharmacies can provide this service in most states.
Studies show that the influenza vaccine is proven to decrease outbreaks, decrease severity and prevent spread of the virus. Some recent studies have even suggested a cardiovascular benefit from the flu shot.
The flu season peaks between January to March. However, last year the flu season did start early with cases reported in November and December. This left many institutes underprepared and overwhelmed, and lead to numerous hospitalizations and several deaths.
The best time to get vaccinated is between September and October.
This will give your body time to build up immunity to the virus in time for the peak of the flu season and will cover you if the season starts early. The vaccine will cover you for about 8 to 10 months, but your body takes around 2 to 4 weeks to start developing immunity. You’ll still be susceptible to infection during that time, so it’s important to get your shot early enough.
Who should get vaccinated?
Currently all patients above the age of 6 months are encouraged to receive the vaccination, unless you’ve had a severe reaction to a previous vaccine or if you developed Guillain-Barre Syndrome post-vaccination. If you are acutely ill (currently sick), you should wait for your condition to improve before getting the vaccine.
However, most pharmacies do not provide vaccinations to young children, who should be vaccinated under the guidance of a pediatrician.
If you are considered a high-risk patient then it is especially important to get vaccinated. Patients that are high risk are at an increase risk for having severe infections that may require hospitalization, and include: children (younger than 5), the elderly (older than 65), and people with certain conditions including pregnancy, immunosuppression, asthma, kidney disease, diabetes, and cardiovascular disease.
What else do I need to know?
Check with your insurance company about billing for the vaccination. Some will only cover the service in clinics, pharmacies or specific locations. Most pharmacies that do give the vaccine can bill your insurance for it though. If you need to pay out of pocket, the flu vaccine can range from $30 – $40. Also check with your pharmacy or provider regarding availability, as supply levels can vary and may run out quickly.
Next week’s post will cover the different flu shots available this year and which option may be best for you.
The GoodRx Pharmacist