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

ACE Inhibitors vs ARBs: What’s the Difference?

by The GoodRx Pharmacist on July 31, 2014 at 2:47 pm

ACE Inhibitors and ARBS – these abbreviations may not look all that similar or even have any meaning to you as a patient. However, 1 in 3 adults have high blood pressure and are likely on one of these two types of medication even if they do not know it. Drugs in these classes have the same main indication, hypertension (high blood pressure), but differ in how they work and their side effects.

What is hypertension?

Hypertension, also known as high blood pressure, is when the pressure in the blood vessels known as arteries is elevated. According to the American Heart Association the current normal or standard blood pressure goal is 120/80; blood pressure is usually considered high when over 140/90. You can find more information from the AHA on blood pressure here.

Can I feel high blood pressure like I can feel when I have a cold?

Not really. High blood pressure often has no signs or symptoms which is why many people do not realize their blood pressure is high until they’ve been checked.

You may hear people say that they can feel their blood pressure rising in certain situations or circumstances which may be true, however, high blood pressure is a concern when it remains elevated for a long time.

Are there complications that may arise due to high blood pressure?

Yes. Having uncontrolled high blood pressure may result in life-threatening complications like heart attack, heart disease, stroke, and kidney disease.

What are ACE inhibitors?

ACE inhibitor (or ACEI) stands for angiotensin-converting enzyme inhibitor. Examples include lisinopril (Zestril), benazepril (Lotensin), and enalapril (Vasotec).

ACEIs work by stopping the change of a natural substance in your body called angiotensin I to its evil twin angiotensin II. Angiotensin II is a vasoconstrictor and causes your blood pressure to increase which leads to high blood pressure. Stopping the change results in blood vessel relaxation and a decrease in blood pressure.

What are ARBs?

ARB stands for angiotensin-receptor blocker. Examples include losartan (Cozaar), valsartan (Diovan), and irbesartan (Avapro).

ARBs also affect angiotensin, but they work by blocking angiotensin II from binding to the special area on blood vessels otherwise known as receptors. In the end, this also results in blood vessel relaxation and a decrease in blood pressure.

What is the difference between ACEIs and ARBs?

ACEI and ARBs work on the same pathway to stop high blood pressure, but each type of medication works at different spot in the process.

What is an advantage of using an ACEI compared to an ARB?
Cost. All ACEIs are available as generics, which means a lower cost for you, the patient. Several ACEIs are also available on many well known pharmacy generic prescription savings programs for as little as $4 for 30 tablets—benazepril, lisinoril, and enalapril are common examples.

Although several ARBs are now also available as generics, the cost can still be significantly higher than their ACEI counterparts.

What is an advantage of using an ARB compared to an ACEI?
Side effects. A common disadvantage to using an ACEI is their potential to cause a cough. The cough is a known and nagging side effect of many ACEIs.

Although ACEIs and ARBs work very similarly, ARBs DO NOT cause a cough, and are considered alternatives to ACEIs if you’ve tried them and they did not work for you due to the cough side effect.


The Best Treatment for Melasma: Tri-Luma

by Dr. Sharon Orrange on July 29, 2014 at 10:24 am

Melasma, a disorder of facial hyperpigmentation, is most common in women 20 – 50 years of age. Melasma looks like brown, tan, or blue-gray spots on the face and is caused partly by sun, genetic predisposition, and hormonal changes. Combination therapy with hydroquinone, tretinoin, and fluocinolone acetonide has proven effective, but is generally more expensive than older treatments. What is Tri-Luma and why might it be worth spending the money?

Tri-Luma has proved to be much more effective. Studies have shown that the cost effectiveness is best for Tri-Luma because guess what, it works better. Way better than older treatments.

Tri-luma is a cream that is a mixture of three things: a steroid (fluocinolone acetonide 0.01%) a “bleaching” agent (hydroquinone 4%) and a topical retinoid (tretinoin 0.05%). Several studies comparing Tri-Luma to hydroquinone 4% alone show that Tri-Luma has a 30% better rate of complete clearing. Despite the fact that Tri-Luma has been shown to be the most cost-effective treatment for melasma it’s still not covered by most insurance companies, and it’s expensive. Expensive but worth it.

Dr O.


Byetta vs Bydureon: What’s the Difference?

by The GoodRx Pharmacist on July 28, 2014 at 9:25 am

Byetta (exenatide) and Bydureon (exenatide) for type 2 diabetes can be confusing—they have similar names, and both are injected rather than taken orally. However, there are advantages and disadvantages to each, and they are available in different strengths, and have different directions for use.

What is type 2 diabetes?

Type 2 diabetes, also known as adult onset diabetes, occurs when the body does not use the insulin it makes properly. Symptoms may include frequent urination, increased thirst or hunger, tiredness, slow healing, trouble seeing, and darkened skin in the armpits and neck.

In what forms are Byetta and Bydureon available?
Byetta is available as a prefilled pen that delivers either 5 mcg or 10 mcg of exenatide per dose (each pen contains 60 doses).

Bydureon is is available as a kit containing a vial of exenatide and delivery system. Bydureon kits contain 2 mg per dose, and are only used once.

Do these medications require injections?

Yes. Both Byetta and Bydureon are injectable medications.

What types of medication are Byetta and Bydureon?

With the same active ingredient, exenatide, both Byetta and Bydureon are considered GLP-1 receptor agonists.

GLP-1 receptor agonists work by helping your pancreas release insulin only when needed, and may decrease the amount of food you eat by signaling to your brain when you are full.

See a detailed explanation of how Byetta works here and how Bydureon works here.

Advantages of using Bydureon:

  • Compliance, or how likely you are to take your prescription! Bydureon is a once-weekly injection, where Byetta must be injected twice daily. The once-weekly dose of Bydureon cuts down on the amount of injections and may increase the likelihood that you’ll be willing and able to take it as directed.

Disadvantages of using Bydureon:

  • Side effects. Bydureon has been known to cause a bump at the injection site more often than Byetta.
  • Cost. Although it can potentially be less expensive than Byetta, one month of Bydureon with a discount or coupon may still costs as much as $435 – $488.
  • Ease of use. Bydureon needs to be mixed before injection, while Byetta comes in a ready-to-use prefilled pen. However, this could change later this year—a prefilled Bydureon pen has been approved and should be available later in 2014.

Advantages of using Byetta:

  • Ease of use. Byetta is currently available in a prefilled pen which may be easier to use. At the moment, using Bydureon is more complicated and requires several steps. Watch for a prefilled Bydureon pen to become available later this year.

Disadvantages of using Byetta:

  • Side effects. Byetta has a greater chance of nausea and upset stomach compared to Bydureon. However, nausea should subside after a few weeks of using Byetta.
  • Compliance and frequency. Twice-daily Byetta may not be as convenient, as easy to remember (or as desirable) as once-weekly Bydureon.
  • Cost. One month of Byetta with a discount or coupon may cost around $456 – $474—more than the newer once-weekly Bydureon.

Nexium (Esomeprazole Magnesium) vs Esomeprazole Strontium: What’s the Difference?

by The GoodRx Pharmacist on July 24, 2014 at 9:51 am

With almost identical active ingredient names, these medications can be easy to confuse—but esomeprazole strontium is not a generic equivalent to Nexium. Although both treat GERD (heartburn), they are available in different strengths and have different advantages.

What is GERD?

GERD or gastroesophageal reflux disease is more commonly known as heartburn. Heartburn is a form of indigestion in which your stomach acid comes back up into the esophagus.

What are the dosage forms for these medications?
Nexium (esomeprazole magnesium) is available as a capsule and an oral suspension packet. Esomeprazole strontium is available as a capsule only.

What are the strengths for these medications?
Nexium (esomeprazole magnesium) is available in 20 mg and 40 mg strengths, which esomeprazole strontium is available in a 49.3 mg strength only.

What type of medication are esomeprazole magnesium and strontium?

Both Nexium (esomeprazole magnesium) and esomperazole strontium are considered PPI(s) or Pronton Pump Inhibitor(s).

PPIs work by shutting off the “pumps” in the body responsible for releasing acid in the stomach. They decrease the amount of acid in the stomach and help control the symptoms of acid reflux or GERD.

What are the advantages of using Nexium (esomeprazole magnesium)?

  • Nexium (esomeprazole magnesium) 20 mg capsules are now available over-the-counter and they do NOT require a prescription. Nexium 24HR can be found in your pharmacy or grocery store aisles in the stomach section. Check out our previous article for more information.
  • Nexium’s manufacturer, AztraZeneca, has a savings card program for the prescription version. For those who qualify, you may pay as little as $25 per month for your prescription.
  • Nexium may be going generic soon! The anticipated generic launch date was May 2014, so keep your eyes open for a potential generic product launch in the near future.

What are the advantages of using esomeprazole strontium?

  • Esomeprazole strontium is already available generically. Generic medications provide a potential cost savings to you through a lower cash price or insurance co-pay without needing to use a manufacturer discount.

What Is the Best Treatment for Hepatitis C?

by Dr. Sharon Orrange on July 23, 2014 at 1:25 pm

The Hepatitis C Virus (HCV) can cause both acute and chronic hepatitis. Of the Americans with hepatitis C, 70 – 90 percent have genotype 1 hep C. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, liver (hepatocellular) cancer, and the need for liver transplantation.

Chronic hepatitis C is treatable. Yes, treatable. The goal of treatment is to eradicate the hepatitis C virus RNA, and if you have undetectable HCV RNA 6 months after treatment then we say you have achieved a sustained virologic response (SVR). An SVR is associated with a 99 percent chance of being HCV RNA negative during long-term follow-up and can therefore be considered a cure of the HCV infection. This is awesome news.

So what is the best way to cure your hepatitis C if you are genotype 1? Sovaldi (sofosbuvir) together with Olysio (simeprevir) is the best treatment for genotype 1 chronic hepatitis C infection. Here is the catch. This regimen is not always affordable or available. If you and your doctor can work on getting help from the manufacturer here is why it’s the best.

  1. You don’t have to take interferon. Interferon is hard to tolerate and may cause flu-like symptoms.
  1. You take Sovaldi plus Olysio for 12 weeks and you are done.
  1. In a study of genotype 1 infected patients with either advanced fibrosis or prior non-response to peginterferon and ribavirin, the combination of Olysio (simeprevir) plus Sovaldi (sofosbuvir) resulted in effective cure rates greater than 90 percent.

Worth asking about; there are many assistance programs to help.

Dr O.


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