Shingles (Herpes zoster) is viral illness that can occur later in life if you have had chicken pox (Varicella). It is a common illness in the elderly, and can cause significant discomfort. People with weakened immune systems are also more likely to get shingles.
Shingles occurs when the chicken pox virus reactivates in the body, leading to a blistering rash, nerve pain, and other nerve-related symptoms. When the infection is active, you can’t give anyone else shingles, but you can spread chicken pox to anyone who hasn’t already had it (this is unusual in adults). Shingles can result in chronic symptoms of severe nerve pain, spreading to the eyes or brain, and other complications. One of the most common complications is the development of post herpetic neuralgia (PHN), which is a chronic form of deep nerve pain that occurs in one out of every five affected people.
How do you treat shingles?
Shingles will generally go away on its own. However, treatment will shorten the duration of the outbreak, and reduce your chances of developing post herpetic neuralgia. Treatment involves a short course of antiviral medication during active infection (acyclovir (Zovirax) or valacyclovir (Valtrex) are most common, and relatively inexpensive generics).
What about the vaccine?
The Zostavax vaccine is recommended if you are above the age of 60 or if you’re at high risk. It should only be given if you don’t have an active infection. You’ll only need to get one shot as a subcutaneous injection.
The vaccine is not a guaranteed cure, meaning that you can still get shingles if you’ve had the vaccination. However, it does substantially lower your risk of getting shingles, and it decreases the severity of nerve pain and complications.
The vaccine is not recommended if you are allergic to any of its components, if you are pregnant, or if you have a weakened immune system. Side effects include localized pain, redness, itching, or bruising. Zostavax is a live vaccine (meaning it contains a weakened version of the virus), so talk to your healthcare provider if you will be in direct contact with pregnant women, newborns, or anyone with a weak immune system.
Where can you get vaccinated?
In most states, you can find the Zostavax vaccine at your pharmacy and have it administered by your pharmacist, with no need for a doctor’s office visit. It is covered under most Medicare plans, and may be covered by your regular insurance; otherwise you can pay cash or use a discount card at your pharmacy.
Always talk to your pharmacist or health care provider if you have any questions.
Till next week,
The GoodRx Pharmacist
After a long debate and following the most recent court order in April 2013, the FDA has announced that Plan B One-Step will be made available over the counter with no age restrictions. This means that all women of reproductive age will be able to purchase Plan B One-Step without a prescription, and without needing to show ID or proof of age. Previously, over-the-counter sales of Plan B One-Step were going to be restricted to ages 15 and older.
For now, the restrictions are only being lifted for the brand-name, single-pill Plan B One-Step. Over-the-counter sales of other two-pill emergency contraceptives and generics will still be restricted to ages 17 and older. It was the court’s opinion that all emergency contraceptive pills should be made available without age restrictions, however, the FDA is only allowing the single-pill Plan B at the moment, making the argument that it is easier and less confusing to use.
It will still take some time for the over-the-counter version to appear in pharmacies; although the restrictions have been lifted, the manufacturer had apply to the FDA to sell Plan B One-Step with no age limits, and the medication must be repackaged for over-the-counter sales.
Some unrestricted generics may eventually become available over the counter, but it’s possible that the manufacturers of Plan B One-Step may get exclusive rights for a period of time. Plan B One-Step typically costs $40 – $50.
For more information, check out the FDA announcement here.
Many new combination Retin-A + antibiotic (either clindamycin or benzoyl peroxide) gels exist. They do kick butt against acne but there are a confusing number of gels to chose from. If you and your doctor have decided to use a Retin-A + antibiotic gel combination to fight your acne then it would help to know which one works best, at the most reasonable cost.
Topical retinoids cause drying, and the itchy, red, dry skin is the main reason people discontinue them. Well, which one causes the least amount of drying? We may be closer to knowing.
Ziana is a gel mixture of clindamycin and tretinoin (generic Retin-A) that was recently compared to Epiduo in a study, and it was found to be less irritating. Epiduo is a popular acne combination of benzoyl peroxide and adapalene (another retinoid).
What was reassuring was that both were pretty well tolerated—nevertheless Ziana does seem to be less irritating than Epiduo. The Epiduo group had more stinging, burning, and itching than the Ziana group. The great news is that both work, and there was no difference between the two topical agents in terms of reduction of acne lesion counts.
Ok, now the downsides. This study was funded by the makers of Ziana, just know that. Also, Ziana is expensive . . . really expensive. Veltin is the same combination as Ziana (clindamycin + .025% tretinoin) and it is cheaper. You can also talk to your doctor about using the generic clindamycin 1% gel + tretinoin .025% gel and mixing them, both are generic and that is much much cheaper.
Ziana runs about $320 per 30 g tube, and $600+ for a 60 g tube, even with a coupon. The manufacturer does offer a discounted price of $35 for insured patients and $50 for cash-paying patients, but this is only good for three refills within the first six months—after that you’re on your own. The tier of insurance coverage varies quite a bit depending on the company and plan, but many do consider Ziana a Tier 2 or 3 drug, meaning a moderate to high copay.
Veltin is cheaper by almost half, about $190 per 30 g tube and $350 per 60 g tube.
In contrast, a 30 g tube of clindamycin 1% gel can be found for under $30 at several pharmacies, and is included in some pharmacy membership programs for as low as $12. A 15 g tube of tretinoin .025% gel costs about the same, under $30 at many pharmacies, and a 45 g tube may offer more savings (if your prescription allows) at anywhere from $40 – $60. Both are typically covered under the lowest copay Tier 1 by most insurance plans.
What is Combivent?
Combivent (ipratropium and albuterol) is a combination medication inhaler used in patients with chronic obstructive pulmonary disease (COPD). The two medications open the airways in your lungs to help you breathe better. The medications are the same in the current Combivent Inhalation Aerosol and the new Combivent Respimat inhaler.
What’s the reason for yet another inhaler discontinuation?
The FDA has requested the discontinuation of all inhalers that use inhalation aerosol due to the chlorofluorocarbon (CFC) content. CFCs are used as propellants in aerosols to spray the medicine out of the inhaler. However, CFCs are known to decrease the ozone layer, and therefore the United States and other countries have agreed to discontinue using such items over an agreed time frame.
When will the Combivent Inhalation aerosol be no longer available?
The FDA mandated that the current inhalation aerosol inhalers no longer be sold or made after December 31st, 2013. The manufacturer of Combivent has stated that their inhalation aerosol version will be discontinued by next month, July 2013.
So, how is the Combivent Respimat different . . . ?
The Combivent Respimat contains the same medication as the previous inhalation aerosol. The newly designed inhaler does not contain CFCs, and is a suitable alternative to the Combivent inhalation aerosol. The Combivent Respimat does work a little differently from the old inhaler, so ask your pharmacist to go over it with you or read over the directions carefully.
What should you do if you are currently using Combivent?
If you currently have the Combivent inhalation aerosol, it is still safe to use as long as the product is not expired. After July 2013 though, you will have to switch to the Combivent Respimat. Most pharmacies are already not able to stock the inhalation aerosol anymore, as the manufacturer has already started phasing the product out. However, since the Combivent Respimat is considered an alternative to the older version of Combivent, you will need a new prescription. Ask your pharmacist to request a change in the prescription or speak to your healthcare provider for a new prescription.
Till next week, breathe easy.
The GoodRx Pharmacist
Combivent and Combivent Respimat should be priced about the same, around $250 per inhaler, though Combivent Respimat is slightly more expensive at the moment. Insurance plans should also treat the two inhalers the same; both are considered Tier 2 prescriptions by many plans, meaning you’ll pay a moderate copay.
Manufacturer Zydus is recalling one lot of their warfarin 2 mg tablets. Some tablets from the lot were found to be oversized, meaning they could deliver a higher dose than intended. With warfarin, this could cause problems with excessive bleeding.
The lot being recalled is MM5767, and it expires June 2014. The NDC number (this will appear on your prescription label) for Zydus’s 2 mg warfarin tablet is 6838-2053-10. If your prescription label has a different number or manufacturer, your tablets are not affected by the recall.
In this case, the recall is on the retail level, meaning that pharmacies are working with the manufacturer to stop distribution and return any tablets from the affected lot.
If you’ve received tablets from the recalled lot, make sure all of your tablets are the same size and check with your dispensing pharmacy if you have any concerns. If you believe you’re experiencing any health issues related to taking warfarin from this lot, contact your doctor or healthcare provider.
You can also call Zydus Pharmaceuticals Drug Safety/Medical Affairs at 1-877-993-8779, Option # 2 with any questions or concerns about the recall.
For more information, you can find the full FDA press release here.