Memory loss, dementia, and cardiovascular disease prevention are the main reasons many of you wonder if you should be taking gingko (Gingko biloba).
There was hope for years in gingko. It works to improve blood flow through increased release of nitric oxide, and it works as an anti-inflammatory so it was believed to be neuroprotective.
Well, it doesn’t really do what we’d hoped. The National Center for Complementary and Alternative Medicine funded the Gingko Evaluation of Memory (GEM) study, the largest and longest trial done. The study found no scientific evidence that ginkgo decreases the incidence of dementia or Alzheimer’s disease in elderly adults and sadly, that it was ineffective in slowing cognitive decline. In that same study, ginkgo did not reduce incidence of or mortality from cardiovascular disease.
Gingko may cause side effects and interact with your meds. The main complaints in those taking gingko are GI complaints (nausea) and it can prolong bleeding so anyone having a surgical procedure needs to make their doc aware they are taking this.
Gingko interacts with many medications: alprazolam (Xanax), omeprazole, ritonavir (Norvir), antiepileptics, thiazide diuretics, ibuprofen, risperidone (Risperdal), trazodone and warfarin among others.
I think not.
Recent product recalls from compounding pharmacies have been getting a lot of attention. Here are five things you need to know about compounding and why the recalls have been happening:
1. Compounding pharmacies are pharmacies that are able to make specific drugs for patients. This includes compounding of discontinued or unavailable medications, special formulations (suppositories, liquids, injections) of drugs that might not be sold that way commercially, specialty medications (hormonal treatments, some IV infusions) and other products that are not commercially available. All compounding is done by or under the supervision of a pharmacist, in community and hospital pharmacies.
2. The controversy: Late last year a number of doctor’s offices received spinal injections made by a compounding pharmacy that were contaminated by a fungus. This lead to numerous cases of fungal meningitis in patients that had received the injections, with several deaths reported. The pharmacy in question was closed down and the FDA initiated an investigation. There have been several other voluntary compounding pharmacy recalls in the months following.
3. What does this mean for you? For compounded medications that are used topically (creams, suppositories, ointments) or orally (liquid, capsules) the risk of contamination is generally low. The majority of compounding at your local pharmacy will be of these low risk medications. If you are receiving specialty drugs from a compounding pharmacy though, this may not be the case. The risk of contamination is higher for sterile products such as injections.
4. Check with your pharmacy or health care professional. If you are concerned about a compounded product, contact your pharmacy or your doctor with any questions you may have. Compounding pharmacies are expected to adhere to strict standards for preparing medications. Patients should be able to check on whether equipment, testing and other related procedures are up to date. You can also check the FDA Recalls page for listings of pharmacies and products that are involved in recalls or withdrawals.
5. The latest news: The outbreak of fungal meningitis has since been contained, and all patients that received a contaminated dose were informed and checked. Since then, increased regulation of compounding pharmacies has been proposed. Currently, a bill is being reviewed in the Senate to increase the FDA’s jurisdiction over compounding pharmacies. In addition, the FDA has increased audits and harsher penalties are being imposed on pharmacies that do not meet standards.
The GoodRx Pharmacist
APP Pharmaceuticals has announced a shortage of both forms of their fluphenazine injection, used for the long-term management of conditions such as schizophrenia.
The fluphenazine decanoate 25mg/ml 5 ml vial is currently backordered, with an estimated rerelease in the third quarter of 2013. The fluphenazine hydrochloride 2.5mg/ml 20 ml vial is also backordered, with a new shipment due in late May 2013—although some vials expiring in the next seven months (through 11/30/2013) may be available now.
Fluphenazine is a generic drug without a current brand equivalent. APP Pharmaceuticals’ fluphenazine hydrochloride is the only FDA-approved version, though you may be able to find the more concentrated fluphenazine decanoate vial from another manufacturer. However, the backorder in both cases is due to a shortage of the active ingredient, so other manufacturers could be having the same issue.
If you’re having trouble getting the medication you need, talk to your doctor about other options in the meantime; you may be able to substitue an oral version of fluphenazine or try another injection in the same class of drugs.
For more information, contact APP customer service at: 1-888-386-1300
Recently Pfizer, the manufacturer of Levoxyl, has issued a national recall of all Levoxyl products from retail pharmacies. As of April 2013, pharmacies will no longer have any strengths of Levoxyl available. Here’s what you need to know:
What is Levoxyl?
Levoxyl (levothyroxine) is used to treat low thyroid levels and to prevent certain types of goiters (an enlargement of the thyroid gland). Levoxyl is also available in its generic form, levothyroxine, or as other brands, such as Synthroid, Levothroid, and Unithroid.
With so many options, why does the recall matter?
Thyroid medications have a narrow therapeutic index (NTI), which means that any change in dose or formulation—including from one brand or generic to another—can lead to significant differences in how your body responds. Once you start one, you typically have to continue using the same prescription. Switching between brands should be done under your doctor’s supervision.
Why was the recall initiated?
The manufacturer ordered a voluntary recall after some patients and pharmacists complained about a “plastic-like” smell in some bottles. According to Pfizer’s official statement, the odor came from oxygen-absorbing canisters in the packaging and it was “not likely to cause any adverse health consequences.”
What should you do if you are taking Levoxyl?
If you currently are taking Levoxyl there is no need to discard or discontinue the medication. You should continue taking it as prescribed.
What if you need to fill your Levoxyl prescription?
Since Levoxyl isn’t currently available, you will need to switch to an alternative: the generic levothyroxine or another brand. You can ask your pharmacist to let your doctor know, or contact them directly. You may need a thyroid level test, or may be asked to follow up after changing medications. Any of the alternatives will still continue to act as a replacement for low thyroid levels, but you may also need dose adjustments and further assessment.
Will it cost you more?
Depending on which brand or generic you switch to, you could pay more or less. Copays and prices will be different, especially if you move to generic levothyroxine. The price difference isn’t huge, but the generic is generally less expensive and part of many pharmacies’ generic discount programs. Ask your pharmacist to check what the difference might be for you.
When will it be available again?
Currently there is no date set for the return of Levoxyl to the market. Pfizer anticipates that it may not be available again until 2014.
If you are taking Levoxyl and have more questions do not hesitate to ask your doctor or pharmacist; they can help you find a treatment that will work for you.
The GoodRx Pharmacist
Lifelong treatment with a medication is a tall order for some people—so it isn’t all that surprising that discontinuation rates are high for some of the most popular cholesterol medications, the statin drugs.
Why is this a problem? If you’re on a drug to lower your cholesterol, you will need to keep taking your prescription or your cholesterol will go back up. Statins in particular can help lower cholesterol up to 60%, but their effects will go away a couple of months after you stop taking them.
Despite their benefits, statins are often discontinued. Serious side effects like rhabdomyolysis (breakdown of muscle fibers) and liver test abnormalities are very rare, but many patients know that statins have been reported to cause muscle pain. Because everyone has muscle pain or joint pain from time to time, blaming the medication is a natural tendency.
Unless you’ve had a serious side effect, here are the reasons you should not stop your statin:
- High cholesterol is strongly associated with cardiovascular disease (heart disease) and cardiovascular death.
- Statins (atorvastatin, simvastatin, Crestor) decrease mortality rates in patients with high cholesterol. They will help you live longer.
- Stopping your statin has been linked to increased risk for cardiovascular events (like heart attack) and death in patients with coronary artery disease.
- In a recent 8-year study, more than half of patients stopped their statin believing they were experiencing a side effect. However, when many of them were restarted on the same or on a different statin drug, 90% were fine and still taking it after a year.
- Many statin-related side effects may be mild enough to be tolerable. You and your doctor can decide this, and weigh minor side effects against the benefits of continuing to take the statin.
- Many statin-related side effects are specific to an individual medication, and it may be worth trying to switch to another drug.
- Many reported side effects may not be caused by the medications or may have other causes (muscle pain is a good example).
- Permanently stopping statins could lead to preventable cardiovascular events and deaths.
Take home message: 90% of patients who are re-prescribed a statin after a “statin-related” event end up able to take one in the end.