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

Move Over Voltaren Gel: Herbal Remedy Traumeel Is Just as Effective in Ankle Sprains

by Dr. Sharon Orrange on August 30, 2012 at 12:17 pm

A topical ointment or gel is always more appealing than a pill for musculoskeletal pain. You can target the area, and you don’t have to deal with as many side effects. With the recent shortage of Voltaren gel, the widely-used prescription topical anti-inflammatory, this study comes at the perfect time.

The homeopathic ointment Traumeel out-performed Voltaren gel on ankle sprains. Ankle sprain is the most common ligament injury caused by sports and other physical activity and here is what we found out: Traumeel proved equal to Voltaren gel (diclofenac gel 1%) in achieving pain reduction and improved joint function in patients with acute ankle sprain.

Physically active patients aged 18 – 40 with an ankle sprain received treatment with either 2 grams of Traumeel ointment, Traumeel gel, or Voltaren gel (diclofenac) 1% applied three times daily for 2 weeks. The Traumeel group had more reduction in pain than the diclofenac group. At 6 weeks of follow-up, all participants reported total pain relief and normal functioning. The median time to normal activity was 19 days for both the Traumeel ointment group and Voltaren gel.

So what is this Traumeel? Traumeel is an over-the-counter homeopathic remedy containing a mix of 12 medicinal herbs, including arnica, calendula, hypericum, chamomile, witch hazel, belladonna, and monkshood, as well as two minerals.

It is available over the counter in the US and more than 60 other countries. Voltaren gel is a prescription medication that is approved for treating osteoarthritic joints that has been hard to find in pharmacies due to shortages. Turns out, Traumeel may be a better bet anyway.

Dr O.

Voltaren Gel is available only with a prescription, and does not have a generic equivalent. If covered by insurance, it will likely be a Tier 2 or Tier 3 medication, meaning a moderate to high copay. A 100g tube of Voltaren may cost as low as $40 – $45 for cash-paying patients, and there is a manufacturer discount available; more information can be found here:
Traumeel ointment or gel is available for as low as $10 – $25 per tube, and can be found in local stores and online.

Your Loved One Has Alzheimer’s Disease – Now What?

by Dr. Sharon Orrange on August 20, 2012 at 4:13 pm

When your friend or family member is diagnosed with Alzheimer’s disease your second thought, after the despair sets in, will be to wonder what treatment options are available. The answer is that while there are options available for treatment, they just don’t work very well.

Here is what we know:

Aricept (donepezil) has been around the longest and is available in a tablet and an oral dissolvable tablet (ODT) for mild, moderate, or severe dementia. Donepezil attempts to help Alzheimer patients by increasing the amount of acetylcholine floating around at the receptor. Donepezil is generally well tolerated but has well-described side effects of nausea, diarrhea, and insomnia, among others.

Namenda (memantine) then came along for the treatment of Alzheimer’s disease. Namenda is available both as an immediate release and extended release tablet (Namenda XR) and it’s expensive. Side effects include dizziness, confusion, headache, hallucinations, and diarrhea, and I’ve seen all of those in my patients.

Before you spend the money or risk the side effects of these dementia medications, how well do they work?

A recent study looked at the treatment of moderate to severe Alzheimer disease and asked that same question: which medications work, is there a noticeable difference, and is one better than two together?

Patients already taking donepezil (Aricept) were divided in to four groups:

1. No therapy (donepezil was discontinued)

2. Donepezil alone

3. Donepezil (Aricept) plus memantine (Namenda)

4. Namenda alone

After one year, average scores on two dementia assessments (the Mini Mental Status Examination and the Bristol Activities of Daily Living) showed slight benefit for patients receiving donepezil or memantine therapy compared to those not receiving treatment. Ok, so that sounds promising. Well, not really. In general, the differences in scores did not meet the thresholds considered to be clinically important. What this means is that you wouldn’t notice a difference in your loved one on or off medications. What about both medications together? No benefits were noted for the combination of memantine and donepezil over donepezil alone.

I know this sounds discouraging, and it is. When there are no other options it is worth taking a leap of faith, but watch closely to make sure the downsides (cost, side effects) don’t outweigh the upsides for your loved one.


Dr. O.

What over the counter medications can I take when I’m pregnant?

by Dr. Sharon Orrange on August 16, 2012 at 2:23 pm

In my primary care practice, many of my female patients worry about taking over the counter medications when they are trying to conceive, afraid they may take something bad before knowing they are pregnant.

So it is important to know: what over-the-counter (OTC) medicines can you take while you are pregnant, or trying to get pregnant?

First, what are the common things you will need OTC meds for?

– Fever

– Cough and cold

– Allergies

– Skin rashes or hives

– Diarrhea or constipation

– Heartburn

Now, there are some grey areas where doctors aren’t sure if a medication is safe or not because that medicine hasn’t been studied well enough in pregnant women. It also may depend on how far along the pregnancy is. Most birth defects happen in the first few months of pregnancy. If you take an OTC medicine during that time, you can increase the chance that the medicine will harm your baby. Having said that, here we go:

1. What is the best pain reliever during pregnancy?
Use acetaminophen (brand name: Tylenol) to treat pain. Check with your doctor before taking any other pain medicines especially aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve). These are NSAIDS which may cause harm especially in the last 3 months of pregnancy. Taking a lot of NSAIDs in the last 3 months of pregnancy could harm your baby or cause problems during labor.

2. What can you take for constipation during pregnancy?
To treat constipation, start without OTC meds and add more water and soluble fiber to your diet. Soluble fibers are found in oats, citrus fruits, apples, barley, psyllium, flax seeds and legumes. If you increase fluids and fiber in your diet and still have problems, then you can try a supplement, such as fiber pills (FiberCon is one example) or fiber powders (such as Metamucil). Laxatives can cause intestinal cramping that is hard to distinguish from premature labor which is one of several reasons to be careful here.

3. Can I take herbal products?
I’d also be very careful here and always ask your doctor before you take any herbal product or supplement. Some herbal products can harm an unborn baby.

4. Ugh what about allergies?
You have some good options if you are pregnant and have allergy symptoms. Claritin (loratadine) is safe, as are the saline nasal sprays.

5. Oh that . . . an annoying cough?
OTC cough medicines such as Robitussin or Mucinex can be used for cough in pregnant women. Most experts tell pregnant women to avoid decongestants with active pseudoephedrine or phenylephrine in the ingredients.

6. Last but not least, diarrhea?
Good news here if you are pregnant with diarrhea (cruel) as most OTC options are safe including loperamide (Imodium), Kaopectate II, Maalox and Pepto.

Fight on!

Dr O.

Singulair Going Generic!

by Dr. Sharon Orrange on August 13, 2012 at 4:11 pm

Allergy and asthma sufferers will get relief of their symptoms and from the huge cost!

This month the FDA approved 10 generic versions of Singulair (montelukast) which will soon be available to you. This is a huge deal for people suffering from both asthma and allergies as this medication kills two birds with one stone. Singulair has been popular for that reason, as it works well for both allergies and asthma. What has hurt people is the cost. In just 2011 Singulair made Merck . . . wait for it . . . 5.5 billion dollars. This generic version, montelukast, is a serious game changer for patients’ lives as many folks who simply could not afford Singulair.

Montelukast (the generic Singulair) is in a class of medications called leukotriene receptor antagonists. It works by blocking the action of leukotrienes, substances in the body that cause the symptoms of asthma and hay fever (allergic rhinitis). Though it is not used for acute asthma attacks, the fact that montelukast is used to treat allergies AND treat and prevent the symptoms of asthma makes it extremely attractive.

Other available allergy medications are anti-histamines (Claritin, Allegra, Zyrtec, etc.) and are not indicated to help prevent or treat asthma so when Singulair came along it was amazing for those who could afford it. It is exciting to have montelukast as a cheaper option for our children and adults who suffer from allergies and asthma.

Dr O.

The Travelers Medicine Cabinet: What Meds Should You Bring on Your Trip?

by Dr. Sharon Orrange on August 6, 2012 at 11:49 am

Whether you are travelling to Peru, Tanzania, Indonesia or Puerto Vallarta, among other exotic locations you will likely visit your doctor or travel clinic to see what you need before your trip.

In addition to the necessary vaccines (which you can find on the CDC Travelers’ Health website here are some things you should think about having with you before you leave.

1. Ciprofloxacin, Levaquin (levofloxacin) or Zithromax (azithromycin). Ask your doc for a short course of any of these for a diarrheal illness, urinary tract infection, or sinusitis/bronchitis that may surprise you on your trip.

2. Ambien (zolpidem) to sleep on long plane flights or for when you arrive and want to regulate your sleep pattern. This requires a prescription. You can try melatonin as an over-the-counter option, it just doesn’t work as well.

3. Benadryl or loratadine (generic Claritin) is good for allergy symptoms, food allergies, inflamed beestings, and hives that may pop up out of nowhere. Buy these over the counter.

4. Zofran (ondansetron) pills or dissolvable tablets (ODT) for nausea. Trust me if you get food poisoning or a viral gastroenteritis you will want this. This also requires a prescription.

5. Immodium for diarrhea. If you are having more than 3 episodes in 24 hours you want to have this and you can get it over the counter.

6. Tylenol or ibuprofen for fever, headache, toothache or whatever may ail you.

7. Bactroban (mupirocin) is an antibiotic ointment you’ll want if you step on coral (yipes) or have any infected cut or sore. Unlike Neosporin this is a prescription, but Bactroban will treat the superbug MRSA (methicillin resistant Staph Aureus) and works better.

8. Hydrocortisone 1% cream (Cortaid). Again, an itchy rash, bite, or bump will be less itchy if you use hydrocortisone cream. This is over the counter.

9. Pepcid, Zantac or Prilosec OTC for heartburn and sour stomach. Pick any one of these; Pepcid and Zantac will help you out quicker, and all are available over the counter.

10. Dramamine if you think you will be on a bumpy car ride or boat. A prescription that is smart to ask your doc about if you are going on a cruise is a Transderm Scop (scopolamine) patch which work brilliantly and won’t make you sleepy.

11. Malaria pills if you need them for the area you are travelling (Malarone is the most common). Check the CDC website.

12. Diamox (acetazolamide) for altitude sickness if you will be above 7000 feet, especially if you plan to ascend rapidly.

What did I miss?

Dr O.

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