It’s that time of year: everyone around you is sneezing and blowing their nose thanks to the fresh grass and beautiful flowers that are beginning to bloom. Spring is a beautiful time, but it can turn ugly for those who are prone to seasonal allergies. Good news for this year though—there are several recently approved medications that can help stop your allergy symptoms before they even have a chance to occur!
What strengths do Ragwitek and Grastek come in?
Ragwitek is available in 12 Amb a 1-Unit (Amb a 1-U) immediate-release sublingual tablets. Grastek is available in 2800 Bioequivalent Allergy Unit (BAU) immediate-release sublingual tablets.
YES. The first dose of BOTH medications MUST be administered at your doctor’s office to make sure you do not experience an adverse reaction.
After taking your first dose, you must remain at the doctor’s office for an additional 30 minutes. For future doses, you may fill your prescription and take it at home.
Both are taken once-daily and placed under the tongue (also known as sublingually) for 1 minute to fully dissolve.
They should NOT to be taken with food or drink while you have the tablet in your mouth, or for 5 minutes after it has dissolved.
Wash your hands after taking the tablet.
When receiving either of these medications make sure that your doctor also gives you a prescription for an epinephrine auto-injector such as EpiPen, EpiPen Jr, or Auvi-Q. The epinephrine autoinjector is to be used if you have allergic reaction ingesting the Ragwitek or Grastek.
The most common side effects of Ragwitek and Grastek include: itchy ears, itchy tongue or other oral itching, tongue or mouth swelling, throat irritation. For Ragwitek only, you may experience oral tingling, tickling, or prickling.
Finally, some additional information about Grastek:
Grastek can also be taken daily for a total of 3 years to build up a cumulative effect for a fourth year in which you would not need to take Grastek.
Need more info?
If you have heart failure, you’ll live longer if you have a spouse around. That’s what we learned from a study presented at the annual meetings of the American College of Cardiology. Marital status plays an underappreciated role in heart failure prognosis.
Having a life partner was associated with a 12% reduction in mortality or hospitalization. Authors of this study were looking at folks with moderate to severe heart failure and whether marital status, education level, or economic status made a difference in life expectancy.
Turns out 61% of the people with heart failure had a life partner, and those with a partner had a 12% lower risk of death or hospitalization. Income and education level did not have a significant impact. Interesting.
Let’s guess at why we think this is. Management of heart failure is complicated, and fatigue is a common complaint. Having someone at home to make sure (nag) that you are taking your medications appropriately is important, as is the fact that your life partner can come with you to doctors visits and be a second set of ears. Life partners, by helping you negotiate your medications and doctor visits, are good for your heart.
Tanzeum (albiglutide) has just been approved by the FDA for the treatment of type 2 diabetes. It is intended to be used in combination with diet and exercise to help improve your blood sugar.
What strengths and dosage form will Tanzeum be available in?
Tanzeum is available in 30 mg and 50 mg single-dose pens. It will be sold in a carton of 1 or 4 pen(s) and the package also contains 29-gauge 5-mm thinwall needle(s) for injection.
What is the recommended dosage?
The recommended dosage of Tanzeum is 30 mg once weekly. However, this may be increased to 50 mg once weekly if needed.
When will Tanzeum be available?
According to the manufacturer the anticipated availability date for Tanzeum will be in the third quarter of 2014, so you should see it in pharmacies by the end of this year.
Does Tanzeum need to be injected with meals?
No—Tanzeum can be injected at any time of day, regardless of when you eat.
Can this medication be used in patients with type 1 diabetes?
No. This medication is only indicated for the treatment of type 2 diabetes.
Are there any precautions associated with Tanzeum?
Yes. Tanzeum has a boxed warning regarding the possible risk of thyroid tumors as well as thyroid cancer.
Are there any contraindications to Tanzeum (anyone who should not use it)?
Yes. Tanzeum should not be used in patients with a personal or family history of medullary thyroid carcinoma or in patients with multiple endocrine neoplasia syndrome type 2 (both are types of thyroid cancer).
What are the most common side effects of Tanzeum?
The most common side effects include: diarrhea, nausea, injection site reactions, back pain, cough, and cold or flu symptoms.
Can I use Tanzeum with other diabetes medications?
Yes. Tanzeum can be used with your other diabetes medications, including insulin.
Are there other similar treatment options for type 2 diabetes?
GLP-1 medications help increase the release of insulin from your body in the presence of elevated blood sugar levels. These medications also delay gastric emptying which means that they help you feel full longer.
Does the manufacturer have any assistance programs?
Yes. GlaxoSmithKline has a program, GSK for You, for those who qualify and do not currently have prescription insurance coverage.
Where can you find more information on Tanzeum?
I get asked this question a lot. In most cases, people’s guesses are over-estimates of what doctors make. With the Affordable Care Act and other changes coming our way, many doctors across the country feel their income will decrease. How much do doctors make anyway? Which specialists make the most money? Do they like their jobs?
The numbers for 2013 have just been released and here are the interesting points from 25,000 physicians across the country working full time.
1. The most . . .
Orthopedic surgeons make the most, at about $413,000 per year, followed by cardiologists who make $351,000 per year. Urology, gastroenterology, radiology, plastic surgery, and anesthesiology follow close behind with salaries of about $340,000 per year. The middle group making about $300,000 per year includes general surgeons, oncology, dermatology and ophthalmology.
2. The least . . .
Family medicine, pediatrics, internal medicine, psychiatrists and rheumatologists are in the bottom of the list making about $170,000 – 190,000 per year.
3. Which doctors make MORE than they did in 2010?
Rheumatologists for some reason make 15% more in the last three years. Many specialties are up about 1 – 3% including all primary care doctors (OB/GYN, internal medicine, pediatrics, family medicine). Psychiatrists, plastic surgeons, general surgeons, and ophthalmology are up more at 6%.
4. Which doctors make LESS than they did in 2010?
Kidney doctors (nephrologists) dropped 8% in salary in the last three years followed by pathologists, radiologists, pulmonary doctors and cardiologists who make 2% less than they did three years ago.
5. Will doctors still take Medicare or Medicaid?
60 – 70% of doctors in this survey across the nation said they would continue to take new Medicare/Medicaid patients.
6. Do you get more time with your patients?
In this years survey half of primary care physicians said they spend 16 minutes or less with their patients, last year that number was 55% so at least there is a trend toward doctors being able to spend more time with their patients. It’s still pretty sad.
7. Paperwork . . .
This year, 35% of physicians spend at least 10 hours per week on paperwork.
8. Would you do it again?
Remember when you look at these salary numbers that after college, you spend 4 years in medical school followed by a 3 – 8 year residency where you are making very little money. Fifty-eight percent of doctors said they would choose medicine as a career if they had to do it all over again. What was really interesting here is that the top earners (plastic surgeons, orthopedic surgeons, anesthesiologists) were less likely to choose it again and internal medicine doctors (my job) were most likely to choose it again with 68% of us saying we’d do it all over again. Yipee.
9. What is the most satisfying part of being a doctor?
The number one answer was “being very good at what I do, finding answers/diagnoses” followed by gratitude/relationships with patients.
10. Are doctors scared health insurance exchanges will decrease their income?
Half of physicians expect no change in their income with the introduction of health insurance exchanges, and 7% expect their income to increase. The rest, 43%, do expect it to decrease.
How is this medication usually used?
Xulane is a topical patch that is to be applied and changed once-weekly for 3 weeks then allowing a patch-free week on week 4. The patch free week will produce a period.
Where can the patch be applied?
The patch can be applied to the stomach, upper outer arm, buttocks, or back.
Can I apply the patch in the same place each week?
NO. The patch must be rotated to a different location than the previous patch.
Important information for applying the patch:
- Apply to clean, dry skin.
- DO NOT apply makeup, cream, lotion, powder, or oil to the skin area that the patch is or will be applied to.
- DO NOT cut or alter the patch.
- Check the patch daily to make sure it is sticking properly.
What to do it if patch is partially or fully detached:
If the patch becomes partially detached press down firmly on the patch with the palm of your hand for 10 seconds, also making sure to run your fingers over the surface of the patch and smooth out any wrinkles.
If the patch becomes fully detached and does not completely re-adhere and stick to skin, you must remove it and apply a replacement patch. The non-sticky patch should NOT be taped or wrapped for it to remain in place.
How do I go about getting a replacement patch?
A replacement patch will require a new prescription from your doctor.
Once you notice that you cannot salvage your current patch, I would recommend placing a call into your doctor’s office and explain the situation at hand. The doctor can then either call, fax, or electronically prescribe a replacement patch to your pharmacy. The replacement patch is a box that contains 1 single patch rather than your monthly box of 3 patches.
It is important to obtain a replacement patch rather than use one of the patches from your current box because you will run out of your weekly patches. This will cause a “refill too soon” issue from your insurance if you try to go to the pharmacy and refill the medication.
A “refill too soon” basically means that your insurance knows how much medication you have received, and exactly when it is time to refill the medication. Because they are aware of these details and do not factor in for mistakes (such as patches falling off) they will not pay for another refill before it is actually due.
Will my insurance cover the replacement patch?
Maybe. Depending on how your individual insurance plan is set-up, there may be an allowance for a replacement patch.
However, I would recommend calling the member service number on the back of your prescription insurance card before going into the pharmacy to find out if it will be covered so that there are no surprises once you get there.
If it is covered, you will be responsible for the co-pay that your insurance sets for you.
If it is not covered, you can always use a discount to help alleviate up to 80% of the cost.
How do I dispose of the used patch?
Because you will be changing your patch once weekly, this process should become second nature after awhile.
The old patch, once removed, should be folded together, placed into a child-resistant container if possible, and discarded into the trash.
The patch should NOT be flushed down the toilet.