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

Be Warned: Sexual Enhancement Drugs for Men Sold Over the Internet May Not Be Safe

by Dr. Sharon Orrange on June 27, 2012 at 1:10 pm

Who really buys over the counter sexual enhancement drugs? Many of you do. They are advertised as dietary supplements that promote sexual enhancement and here is what you need to know:

Recent analysis by the FDA (Food and Drug Administration) of four products sold over the internet prompted safety concerns.

Advertised as promoters of sexual enhancement, these products are: VMaxx Rx, Boost-Ultra Sexual Enhancement Formula, Firminite, and X-rock.

Why the concern? Laboratory analysis of these products by the FDA revealed that they contain undeclared ingredients (they have stuff in them that isn’t on the label) or ingredients similar to those used in the prescription drugs Viagra and Cialis.

As you know, there are some people who may have dangerous side effects when taking sildenafil (the substance in Viagra and similar to Cialis). People taking nitrates (nitroglycerin, Isordil,or Imdur) may experience dangerous drops in blood pressure.

If you did have a bad reaction when you used one of these products, report it to the FDA’s MedWatch Adverse Event Reporting Program. You can find more information on reporting to MedWatch by clicking here.

If you want a sexual enhancement drug, get a prescription for Cialis, Levitra or Viagra so at least then you know what you are getting, and there are no potentially dangerous mystery ingredients.

Dr O.

Medicine Cabinet 101

by Dr. Sharon Orrange on June 20, 2012 at 3:45 pm

To avoid the 1 AM trip to the pharmacy you need to be well stocked at home. Headaches, pain, hives, fever, or an itchy rash may be easily remedied with over-the-counter meds. Here are ten things you and your family will face, so be ready:

1. Aches and pains: Toothache, pain from ankle sprain, tension headache

What works? The over the counter non-steroidal anti-inflammatory medications (NSAIDS) include ibuprofen, Advil, Motrin and Aleve. Aleve is available in prescription strength as naproxen.

How can they help? Most aches and pains are best treated with NSAIDS. Acute pain (sprained ankle, tooth ache, headache, ear ache, or knee pain) is best relieved by a pain reliever/anti-inflammatory drug which should be your first choice.

2. Fever

What works? Two medications work well as fever reducers. Acetaminophen (Tylenol) 500 mg tablets and any NSAID like ibuprofen, Advil, Motrin, or Aleve.

How can they help? To lower your temperature you can alternate Tylenol with an NSAID every 4-6 hours because they are two different medications that can work together for your benefit.

3. Cuts and scrapes

What works? Antibiotic ointments work well for cuts and scrapes. Polysporin or Neosporin (both similar topical anti-bacterials) are good to have available. If you can get your hands on prescription Bactroban ointment that’s even better.

How can they help? I’m not a huge fan of cleaning simple wounds with alcohol or hydrogen peroxide because I think you can just wash it with warm water and soap and apply one of the above topical ointments twice a day for a couple of days with a loose band aid.

4. Heartburn or reflux symptoms

What works? Maalox and Mylanta are good for quick relief. The H2 blockers like Zantac, Pepcid and Tagamet are also must-haves as you can take those along with Mylanta or Maalox. The other over the counter heartburn option is the proton pump inhibitor (PPI) omeprazole which is Prilosec OTC .

How can they help? Think of the Maalox as soothing and coating the stomach and the H2 blockers and PPIs following their lead and decreasing the effects of acid on the stomach and esophagus. Prilosec OTC will help, but not immediately.

5. Allergy symptoms: Runny nose and watery eyes

What works? The non-sedating antihistamines are: Claritin (loratadine) and Zyrtec (cetirizine) which come with or without the Sudafed (pseudoephedrine, the “D” part tagged on to the end of the name).

How can they help? Loratadine and Cetirizine will help control your allergy symptoms like runny nose, red watery eyes, and itchy throat. They should not make you tired and can work for most allergy symptoms.

6. Hives or severe allergic reaction

What works? Benadryl (diphenhydramine). Period. Everyone should have Benadryl 25 mg tablets in their medicine cabinet.

How can it help? Benadryl will work for hives and itching from pretty much anything (poison ivy, animal allergies, medication allergies, food allergies). Benadryl’s main side effect is making you very sleepy, and it will.

7. Cough and cold

What works? Let’s face it, the over-the-counter cough medicines don’t work well at all. What will help some of the cold symptoms (stuffy nose, ear congestion, and sinus pain) is a decongestant like Sudafed. Mucinex helps for cough too and if you can get your hands on a prescription dose of Tessalon (benzonatate) capsules, keep them.

How can it help? For a PRODUCTIVE cough where you are bringing up junk an expectorant like Mucinex (guaifenesin) can work well to help you bring up more of that junk from your tight chest.

8. Itchy skin rash

What works? Hydrocortisone cream. A 1% topical hydrocortisone cream is essential for relieving itching and inflammation from many skin lesions. You will see many variations of this cream at a pharmacy with different names, with or without aloe, etc. You just need the 1% hydrocortisone cream.

How can it help? Use it to help you with any skin issue that ITCHES: bug bites, poison ivy or any contact dermatitis (an allergic skin reaction from something that touched you).

9. Diarrhea

What works? Imodium (loperamide) is your best over-the-counter option. Period.

How can it help? Use Immodium to control your diarrhea to less than 3 episodes in 24 hours to avoid dehydration.

10. Nausea

What works? There are many anti-emetics that require a prescription but Dramamine (dimenhydrinate) over-the-counter tablets will work well.

How can it help? Dramamine (also Bonine) can relieve nausea but will make you sleepy. As you know, you can also use them for prevention of motion sickness so they are good to have on hand.

Special needs:

Men: The MUST HAVE for those of you who are sexually active is CONDOMS. For sexually transmitted disease and pregnancy prevention these are your BEST option. Have them on hand.

Women: For yeast infections have an antifungal cream like Monistat (miconazole) on hand. For a urinary tract infection while you wait to see your doctor Pyridium (Azo over the counter) will help relieve the burning with urination.

Dr O.

Finding the Best Prep for Your Colonoscopy

by Dr. Sharon Orrange on June 12, 2012 at 5:02 pm

The main complaint concerning colonoscopy is not the procedure itself but rather the preparation necessary for proper colon cleansing. Patients are placed on a clear liquid diet the day before a colonoscopy, and will be asked to take a solution to clean the colon out. The common complaints from people who endure the prep the day before their colonoscopy include nausea, bloating and vomiting.

It’s important to finish the prep because if you don’t do it well, the procedure is useless as they won’t be able to visualize anything . . . then you have to do it all over again. Scared? You don’t have to be.

The standard used to be that you would drink four liters of polyethylene glycol (PEG). Many folks couldn’t tolerate drinking it leading to vomiting, nausea and incomplete preparation before your colonoscopy.

Several players have come on board to ease the awful prep. So what is the best colonoscopy prep?

1. A 4 Liter solution of polyethylene glycol (PEG) is known as GoLYTELY and was the old standard but now comes in a more condensed version.

2. A reduced volume version of GoLYTELY has become available in a 2 Liter solution (Moviprep or Half-Lytely). This is good because it’s only 2 Liters. Moviprep is commonly used now as the first choice.

3. Fleet Phospho-soda had a promising beginning because it is diluted in several glasses of water or ginger ale and is much less volume to drink. The problem, which is why it’s not often used, is that it is known to be associated with kidney injury.

4. OsmoPrep is a tablet option! But wait – these are sodium phosphate tablets that have also been associated with kidney problems (acute phosphate toxicity) so they carry a black box warning.

5. The new prep being studied is Miralax (polyethylene glycol powder) mixed with 64 ounces of Gatorade. While not FDA approved for this indication, it has been widely used and is an accepted alternative to GoLYTELY in numerous endoscopy centers across the country. Stay tuned on this.

Dr O.

Plavix Now Available as Generic Clopdigrel: Bring on the Savings!

by Dr. Sharon Orrange on June 1, 2012 at 4:33 pm

A staggering 2.5 million Plavix prescriptions are written in the U.S. every month. For those of you forking out the dough for Plavix, the FDA just approved generic versions of the blood-thinning drug, which will now be available to you much cheaper as clopidogrel.

Clopidogrel, the generic Plavix, is used to treat patients who have had a recent heart attack, but that’s not all. Here are a few ways clopidogrel helps us out:

– It is used to stop heart attacks.

– It is used to stop strokes.

– It is used after a heart treatment (angioplasty and stent placement) to protect the arteries.

– It is used to lower the number of heart attacks in people with unstable angina or mild heart attacks.

It does all that? Clopidogrel works because it stops platelets from getting sticky and clumpy.

What’s the downside of clopidogrel? You may bleed more easily on clopidogrel. You need to closely watch other medications and supplements you are taking while on clopidogrel. Ginkgo, vitamin E, garlic, aspirin, ibuprofen and alcohol may increase your risk of bleeding while taking clopidogrel.

Other pearls to know about:

Clopidogrel may not work as well in some people. There is a genetic test that can be done on a simple blood test to see if you are one of these people.

Prilosec (omeprazole) and Nexium (esomeprazole), reduce the effect of clopidogrel, leaving a person at greater risk for heart attack and stroke.

Several drug companies will make clopidogrel 300mg tablets: Dr. Reddy’s Laboratories, Gate Pharmaceuticals, Mylan Pharmaceuticals, and Teva Pharmaceuticals. Apotex Corporation, Aurobindo Pharma, Mylan Pharmaceuticals, Roxane Laboratories, Sun Pharma, Teva Pharmaceuticals, and Torrent Pharmaceuticals will make clopidogrel 75 mg tablets.

Remember, generic drugs approved by FDA are of the same quality and strength as brand-name drugs. The generic manufacturing and packaging sites must pass the same quality standards as those for brand-name drugs.

Dr. O.

Clopidogrel is covered as a Tier 1 medication by most insurance plans, meaning you’ll pay only your lowest co-pay. The 75 mg tablets can also be found for as little as $35 per month. Plavix, in comparison, will now most likely fall under Tier 2 insurance coverage, meaning a moderate co-pay – and one month of 75 mg tablets runs close to $200.

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