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

The Drug Everybody Wants to Know About: Suboxone

by Dr. Sharon Orrange on July 30, 2012 at 12:32 pm

There is a news story once a week about Suboxone. A pill to treat your addiction to pills? Is that madness? Is it different than methadone? There has been a lot of press about Suboxone, so here are the basic facts about this drug.

1. Suboxone is used in the United States for the treatment of opioid addiction. Examples of opioids you know are morphine, heroin, Dilaudid, Demerol and fentanyl.

2. Suboxone is a combination of buprenorphine (the opioid-like part) and naloxone (the anti-opioid part).

3. Suboxone is available as a film or sublingual (under your tongue) tablet.

4. The naloxone part of Suboxone is not really absorbed under the tongue but is placed in this medication to discourage intravenous use/abuse. If you were to try and inject Suboxone it would put you immediately in to withdrawal.

5. Suboxone is believed to have fewer withdrawal symptoms and less potential for death (by respiratory suppression) in overdose than methadone. The overall “sobriety” rate for Suboxone at six months was 54 percent.

6. In the United States, physicians have to get a special qualification to prescribe Suboxone for detox from opioids. Detox regimens range from one day of Suboxone dosing to as long as seven weeks.

7. A study comparing Suboxone with methadone maintenance found that those taking Suboxone had significantly lower rates of illicit opioid use.

8. In the United States, Suboxone is the first drug that can be prescribed in a clinician’s office for opioid detoxification and maintenance. Methadone treatment has required a visit to a methadone clinic, while Suboxone can be prescribed as part of an office visit with a doctor.

9. Suboxone is more expensive than methadone. Though the patent for Suboxone film runs out in August 2013 we don’t yet know if a generic is going to be made.

10. Studies suggest that Suboxone is safe and effective for both mother and newborn and the incidence and severity of neonatal withdrawal and length of hospital stay was lower among newborns of Suboxone treated mothers than those treated with methadone.

Is it crazy to treat addiction to pills with another pill?

Dr O.

Suboxone film and sublingual tablets cost around $125 to $250 for a 30-day course, depending on the form and strength. Both the film and sublingual forms are considered Tier 2 or 3 medications if covered by insurance, though the film is more likely to fall under a lower copay. There is a manufacturer discount available for the film only that will reduce out-of-pocket costs by $50, allowing insured patients to pay as little as $0 per month and cash-paying patients to receive a $50 discount; click here to go to the sign-up page.


Which is Better, Lantus or Levemir? Duel of the New Long-Acting Insulins

by Dr. Sharon Orrange on July 26, 2012 at 3:13 pm

Diabetes care has gotten better. Two new long acting insulins are taking over NPH insulin. They are more expensive, and many of you ask: which is better, Lantus or Levemir insulin?

Here is the story of the new long-acting insulins. For adult onset (Type II) diabetics who have been on maximum doses of diabetes pills yet need better blood sugar control, your doctor may turn to insulin. When insulin is combined with oral agents, a basal (long-acting) insulin used at night is a reasonable first choice.

In the past, intermediate-acting NPH insulin was used at bedtime to supplement pills for diabetes. Now, longer acting insulins, such as insulin glargine (Lantus) and insulin detemir (Levemir) are more tempting options, though you will pay more for them.

Why do we like Lantus and Levemir over NPH insulin? There is less risk for low blood sugars and they are effective in reducing Hgb AIC values. The lower risk for low blood sugars is because there is no “peak” in effect but rather a constant delivery. This is important.

Which one is better Lantus or Levemir? You decide.

First, your insurance plan will usually cover one or the other but not both. You might base your decision on which one is cheaper for you.

Twice daily dosing of Levemir (insulin detemir) is often required whereas once daily dosing is usually all that is needed for Lantus (insulin glargine). If you are someone who has had problems with low sugars on NPH insulin at bedtime, switching to a nighttime dose of Lantus (insulin glargine) may be your best bet.

Dr O.

A package of 5 pens will run around $230 for both Lantus and Levemir. When they are covered by insurance, both insulin options vary between tiers 2 or 3; it’s best to check your individual plan for coverage and pricing.


News in the Prevention of HIV

by Dr. Sharon Orrange on July 23, 2012 at 10:54 am

Update 5/29/2014: On May 14, 2014, the US Public Health Service released the first HIV pre-exposure prophylaxis (PrEP) guidelines, developed by the CDC and other agencies. The guidelines mention the first study referenced below, which showed that Truvada reduced risk overall by 44% in the population studied. However, in even better news, among men with detectable levels of medicine in their blood, the risk was actually reduced by as much as 92%. For more information about the guidelines and other clinical trials, please see the CDC page here.

There is good news and bad news here. Good news is that the FDA has approved a pill we can give to HIV negative folks who engage in high-risk behavior to decrease their risk of HIV infection. Bad news is that HIV Infection is on the rise and prevention and safe sex haven’t been enough to slow this rise.

The Food and Drug Administration (FDA) has approved a new use for Truvada, the single combination tablet containing emtricitabine and tenofovir, to reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners.

Truvada is meant to take every day and used, in combination with safer sex practices, to reduce the risk of sexually acquired HIV infection in high-risk adults.

People who have an HIV infected partner can take the drug daily to lower their chances of becoming infected with HIV should they be exposed to the virus.

Approval of Truvada doesn’t mean we are giving up on prevention (condoms, etc.) but is designed for use in conjunction with safe sex practices to reduce the risk of uninfected individuals of acquiring HIV.

FDA approval of Truvada was based on these results:

– In a study of 2,500 HIV negative men or transgender women who have sex with men, results showed that Truvada was effective in reducing the risk of HIV infection by 42%.

– In a study of 4,758 heterosexual couples where one partner was HIV-positive and the other was not, results showed that Truvada reduced the risk of becoming infected by 75%.

Thoughts?

Dr O.


GlaxoSmithKline Pays Up, and Outs Dr. Drew at the Same Time

by Dr. Sharon Orrange on July 11, 2012 at 1:00 pm

This story should get under your skin. GlaxoSmithKline (GSK), the drug company that makes Wellbutrin (bupropion), has agreed to pay $3 billion to the federal government. GSK plead guilty to charges of illegally promoting two antidepressants and withholding key safety information about the diabetes drug Avandia.

As part of the settlement, the drug company admitted promoting the drugs Paxil (paroxetine) and Wellbutrin for off-label uses and failing to report safety data about the diabetes medication Avandia. Yuck.

In another twist to this case, Dr. Drew – who hosts Loveline and his own show on CNN – was one of the doctors paid a ridiculous sum to promote Wellbutrin as the antidepressant of choice for young people who want preserved sexual function.

Here are some other sordid details:

GSK sponsored dinner and spa programs to encourage physicians to prescribe the drug for children and adolescents, even though it was not approved for pediatric use.

GSK paid physicians to promote off-label uses of Wellbutrin ranging from weight loss to the treatment of sexual dysfunction.

People should be disturbed by this, recognizing what GSK did along with the doctors who promoted uses of these medications they weren’t approved for. All for money.

Why does this bug me so much? Dr. Drew graduated from residency at USC, where I currently work as faculty. Unlike Dr. Drew, I don’t receive money from drug companies and USC discourages this as a policy. Dr. Drew’s role in talking to his Loveline audience, who are unaware of his paid status, bothers me. Similar to the audience tuning in to him on Headline News every night, he was speaking to people who were relying on his medical authority. Among other things, the general public got to hear Dr. Drew assert that Wellbutrin can make women multiorgasmic, which is not true. In exchange he received $275,000 in two months.

What do you think?

Dr O.


Belviq: The Belle of the Ball, the New Weight Loss Sweetheart

by Dr. Sharon Orrange on July 9, 2012 at 11:10 am

The Food and Drug Administration approved the obesity drug lorcaserin (Belviq) on June 27 despite concerns from physicians and others that it might increase the risk of valve disease.

It may be time to get excited about a new weight loss medication, but let’s get to know it. Previous weight loss medications like Meridia and Fen-phen (fenfluramine + dexfenfluramine) ended up a thing of the past.

Lorcaserin (Belviq) is a serotonin receptor agonist that stimulates the area in your brain to tell you that you are full.

Here is our hesitation. There were higher rates of heart valve problems associated with lorcaserin treatment in trials and this was the same problem with Fen-phen. Fen-phen contributed to pulmonary hypertension and valve disease in all valves of the heart (mitral, aortic, tricuspid) in a small number of people who took it, enough to get it pulled from the market.

Now, the patients treated with Belviq in these studies did have a higher incidence of valve problems seen on cardiac ultrasound but it did not reach statistical significance.

So, how well does Belviq work?

– If you take Belviq for a year you will have an average weight loss of 3% – 3.7%.

– Half of non-diabetic patients lost at least 5% of their body weight.

What were the common side effects reported?

Belviq (lorcaserin) may cause problems with thinking, sleepiness, confusion, and, in higher doses, hallucinations, euphoria, or disassociation.

– It may also cause priapism (an erection that doesn’t go away ouch).

As a primary care doctor I am on your side, the weight loss side, but I have concerns. In the 1990s I trained at UCSD medical center where our specialists were well known for treating pulmonary hypertension from Fen-phen, and it led to awful slow deaths in young women, some I will never forget as long as I live. Rare, yes, but remember weight loss of 5% is only 10 pounds if you weigh 200 pounds and that’s the BEST this drug can do for you. Worth it? I’m just not sure.

Thoughts?

Dr O.

Belviq is approved by the FDA, but not yet available for prescription. It should become available in early 2013.


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