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

Finally, a Non-Statin Cholesterol Medication That Works: Introducing Juxtapid

by Dr. Sharon Orrange on January 30, 2013 at 2:26 pm

Aside from Zetia there haven’t been any good non-statin options for lowering LDL Cholesterol. Statin drugs like Lipitor (atorvastatin), Zocor (simvastatin) and Crestor work well to lower the “bad” cholesterol, the LDL, and have remained first line therapy for many years. Finally, there may be something new to get excited about. But, it does have some “issues.”

Juxtapid is a new medication approved for lowering cholesterol. For now it is approved for use only in patients with familial hypercholesterolemia already on statin mediations. Those are patients with extreme elevations in LDL cholesterol and high risk of early heart disease. It is unknown whether Juxtapid will eventually receive approval for the treatment of high cholesterol in all adults.

Juxtapid is not a statin, and is the first in a new class of medications called microsomal triglyceride transfer protein (MTP) inhibitors. Expect more from that class.

How do we know it works? When added to statin therapy in patients with familial hypercholesterolemia, Juxtapid significantly reduced LDL by 40 – 50%, which is huge.

Juxtapid has issues, however, that will prevent it from being a game changer for cholesterol. Its side effect profile stinks. Twenty eight percent of patients studied had diarrhea, nausea, vomiting or abdominal pain. Ugh. Juxtapid also caused a bump in liver function blood tests in 34% of treated folks. Based on these results, liver tests have to be obtained before and during treatment. This is the same hassle faced with the statin drugs (Lipitor, Zocor, Crestor, etc.). It works well, but at a cost.

Excited or not?

Dr O.

Juxtapid received FDA approval in December 2012, and will be available early in 2013. If covered by insurance, it is likely to be a Tier 2 or 3 medication, meaning a high copay; Juxtapid will cost more than $20,000 for a 30-day supply, or more than $250,000 per year. There is no patient assistance program available yet.

Due to the required liver tests before and during treatment, prescribers, pharmacies, and patients must enroll in the Juxtapid REMS (Risk Evaluation and Mitigation Strategy) Program, which means that not all doctors and pharmacies will be able to prescribe and dispense Juxtapid.

Ten Things You May Not Know About Tamiflu

by Dr. Sharon Orrange on January 22, 2013 at 1:13 pm

December and January are the high season for flu, and therefore, Tamiflu. Here are some things to know about the pill that may save you from a couple nightmare days.

1. Tamiflu (oseltamivir) has activity against influenza A and B unlike amantadine and rimantadine (Flumadine), which only have activity against influenza A.

2. Tamiflu reduces the time of improvement by 1.3 days (30%) compared to patients receiving placebo.

3. Begin Tamiflu within 48 hours of symptom onset.

4. Tamiflu is not considered a substitute for annual influenza virus vaccination and trust me, it’s not.

5. Tamiflu works by inhibiting the enzyme (viral neuraminidase) which promotes the spread of virus in the respiratory tract.

6. Tamiflu-resistant strains of the virus have shown up during some flu seasons and in some geographic locations. This year, the predominant Influenza A strain making people sick has not shown resistance to Tamiflu. Phew.

7. The most frequent side effect from Tamiflu is nausea and vomiting. In adults, vomiting was reported in 9% of those taking the 75 mg twice daily dose.

8. Tamiflu will not work for colds, or other viral infections.

9. In December of 2012, the US Food and Drug Administration (FDA) approved the use of Tamiflu for the treatment of influenza in infants aged 2 weeks and older.

10. There are no known interactions between Tamiflu and any other medication so it is fine to take along with other meds.

Dr O.

Tamiflu is covered by many insurance plans as a Tier 2 drug, meaning a moderately high copay. A course of the 75 mg twice daily dose (10 capsules) will run about $110 – $120 if you are paying out of pocket.

Migraine Medicine Maxalt to Go Generic!

by Dr. Sharon Orrange on January 10, 2013 at 9:32 am

The triptan medications have been lifesavers for migraine sufferers. Currently, only Imitrex is available as a generic (sumatriptan is the generic name). Well now there are two and this is good for you.

Mylan has received approval from the FDA for generic Maxalt pills and Maxalt-MLT dissolvable tablets. Rizatriptan benzoate tablets and rizatriptan benzoate orally disintegrating tablets (ODT), the generic versions of Maxalt and Maxalt-MLT, are coming your way.

Rizatriptan is used for the acute treatment of migraine with or without aura and has been shown to be more effective than Sumatriptan due to increased central nervous system penetration. When compared to those receiving Imitrex (sumatriptan) 50 mg, more patients receiving rizatriptan 10 mg achieved headache pain relief within 2 hours.

Maxalt (rizatriptan) is a serotonin-agonist and works to treat migraine by binding to the receptors located on blood vessels and sensory nerves inside the head.

Examples of other brand name migraine medications are Relpax, Amerge and Frova but these will cost you more than both rizatriptan and sumatriptan.

Dr. O.

Sumatriptan and both forms of rizatriptan will be considered Tier 1 medications by most insurance plans, meaning you will pay only your lowest copay. Cash prices for both sumatriptan and rizatriptan are still quite high, as much as $150 – $200 for 9 tablets of sumatriptan 50 mg, and upwards of $250 for 9 tablets of rizatriptan 10 mg. However, some online and local pharmacies offer the same quantity of some strengths of sumatriptan for under $20, no coupon or insurance required, so it is worth shopping around in this case.

Move Over Warfarin – No, Really

by Dr. Sharon Orrange on January 4, 2013 at 2:11 pm

Of all the new oral anticoagulants set to take over for Coumadin (warfarin) the new drug Xarelto just scored a trifecta. Remember these newer blood thinners are much more convenient than warfarin because you are spared the weekly blood tests to monitor your INR (coagulation levels).

Xarelto (rivaroxaban) has been approved by the FDA for the treatment of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and to reduce the risk of recurrence of DVT and PE after initial treatment. Xarelto was previously approved to reduce the risk of DVT and PE after knee- or hip-replacement surgery, and to reduce the risk of stroke in persons with atrial fibrillation.

Xarelto received this approval after studies showed it was as effective as enoxaparin (Lovenox) and warfarin for treating DVT and PE. The major adverse effect observed with Xarelto use was bleeding, similar to the other blood thinners.

Unlike other oral anticoagulants available, only Xarelto is a factor Xa inhibitor. Unlike with warfarin, routine blood monitoring is not required for patients receiving Xarelto.

Pradaxa (dabigatran) was the first oral anticoagulant to be approved since warfarin 50 years ago and now there are several new choices including Xarelto. Pradaxa works slightly different than Xarelto and is a direct thrombin inhibitor. They are much more convenient but the cost makes them impossible for some patients.

For those of you on them, is it worth the cost?

Dr O.

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