Cambia is a powder form of the anti-inflammatory diclofenac. Diclofenac has been available forever as a tablet, which you may know by the brand name Voltaren. It turns out that diclofenac, when taken in the faster acting solution known as Cambia, works very well at the onset of migraine. Very well and fast, within 15 minutes.
How well does Cambia work? Cambia works much better than placebo and even better than diclofenac in tablet form . . . and within 15 minutes. Cambia provides more freedom from pain from migraine as well as relief from nausea, light sensitivity and sound sensitivity. Thirty-three percent of people who took Cambia were able to perform all routine activities at 2 hours post dose and 54.5% were free of disability from migraine at 24 hours.
What is Cambia? It is a powder form of a non-steroidal anti-inflammatory drug (NSAID) similar to naproxen and ibuprofen (Motrin). The diclofenac tablet had been used for acute migraine for years before the release of the powder/solution form.
What are the downsides? As with all NSAIDS, it is advised that people with known heart disease not take Cambia long term and as with the others, Cambia can cause gastrointestinal bleeding. Cambia is also expensive and available only as a brand name.
When used short term for acute migraine it’s a great, safe option that works well.
You should also know that a few pharmaceutical companies have already filed applications for biosimilar drugs, hoping for approval by the FDA and bragging rights to be the first ever biosimilar on the market in the United States.
One generic manufacturer, Sandoz, has received recommendation for approval of their application for their biosimilar, filgrastim. Filgrastim, if approved, would be highly similar to its reference product Neupogen.
What is Neupogen used for?
Neupogen is used in patients who are receiving chemotherapy to help reduce the risk of infection. Chemotherapy can cause a decrease in white blood cells (neutrophils) known as neutropenia which can lead to infection.
Neupogen works to increase the production of white blood cells in the body so that infections can be fought more effectively.
What will be the name of the new biosimilar?
Are biosimilars used in other countries?
Yes. Sandoz has been dispensing this same medication under the name Zarzio for the past 6 years in more than 40 countries.
Biosimilars, although not yet approved in the United States, are widely used across Europe as well as both Australia and Japan. There are currently close to 19 biosimilars on the market in Europe, and 8 in both Australia and Japan.
The first biosimilar in Europe was approved in 2006.
Can we expect to see other pharmaceutical companies filing applications for biosimilars?
Yes. The following medications also have potential biosimilars in the “pipeline”:
Medications certainly aren’t the only thing that will cause hair loss, but they are often overlooked. If you feel like you are losing your hair, one of your first steps is to look at your medication list. You will also pay attention to other well known causes including poor diet (caloric or protein restriction), major illness or surgeries, major psychological stress, significant weight loss, chronic iron deficiency, thyroid disorders, and childbirth.
Don’t have any of those? Well then lets look at which medications are common culprits of hair loss caused by drugs:
- The cholesterol lowering drugs, aka “the Statins”. Only atorvastatin (Lipitor) and simvastatin (Zocor) have reported hair loss as an adverse effect, not the newer statin Crestor (rosuvastatin).
- The anticoagulants (warfarin or Coumadin) are commonly used blood thinners and have been reported to cause hair loss.
- The ACE Inhibitor blood pressure medications captopril and lisinopril are the two in this category that have reported hair loss in > 1% of folks taking them.
- Soriatane (acitretin) is a pill used for the treatment of psoriasis that has a well known adverse effect of hair loss.
- Amiodarone (Cordarone or Pacerone) is used in patients with arrhythmias like atrial fibrillation and has a rare but reported side effect of hair loss.
- The anticonvulsant valproate (Depakote). Depakote is used for seizure disorders, controlling mania in bipolar disorder and for migraine prevention. Valproate does carry reports of hair loss.
- Cimetidine (Tagamet) is an over the counter acid reducer used for ulcers and reflux disease and hair loss has been reported, though infrequently, in people taking it.
- Colchicine is a medication used for the treatment of acute Gout attacks. It does carry a very small risk of hair loss.
- Hormones, but not all hormones. Hair loss is reported in people taking the androgen testosterone and in people taking progesterone. Progesterone medications like Depo-Provera (medroxyprogesterone) injections or Provera or Prometrium tablets are well described to cause hair loss as an adverse effect.
- Isotretinoin, brand names Absorica or Accutane, is a pill used in the treatment of severe acne and hair loss is a known adverse reaction.
- Ketoconazole is an oral antifungal pill that can cause hair loss.
The TRUEtrack and TRUEtest blood glucose test strip boxes look nearly identical because they are both made by the same company, Nipro Diagnostics, and they can be very difficult to tell apart. The problem is that the TRUEtrack and TRUEtest strips will only work in their respective meters and cannot be interchanged, so you need to know which type your meter takes. Here’s a quick guide:
These test strips are only used with the meter TRUETrack blood glucose meter. This meter is available under the brand name of your favorite retail store such as CVS, Walgreens, or other retail locations (it will be a store brand meter).
TRUEtrack test strips are covered by Medicare and many Medicaid plans, and have a lower average co-pay than other systems for many private insurance plans.
TRUEtrack test strips:
- Are available in 50 and 100 count sizes
- Use a small blood sample of 1 microliter
- Are usually less expensive compared to competitor’s test strips
These test strips are only used with two meters: TRUEresult and TRUE2go. Both of these meters are available under the brand name of your favorite store such as CVS, Walgreens, or other retail locations (also store brand meters).
TRUEtest test strips are covered by most private insurance plans, Medicare Part B, and most Medicaid plans.
- Are available in 50 and 100 count sizes
- Use a smaller blood sample of 0.5 microliters (compared to TRUEtrack test strips)
Pharmacy Prescription Pick-Up Tip:
It is important to make sure you are receiving the correct strips from the pharmacy, especially since these products look very similar to one another.
I suggest double checking that you have been given the correct test strips before leaving the pharmacy counter so that you do not have to make an unnecessary trip back—or discover, when you are about to test your blood sugar, that you have the wrong test strip.
Below are some picture examples of the TRUEtrack and TRUEtest test strip boxes from different pharmacies for a side-by-side comparison of their similar packaging.
TRUEtrack test strips VS TRUEtest test strips
Is drinking coffee bad for me? For a drink as popular as coffee, its physiologic effects are something you should learn about. You will be reassured I’m sure.
Maintaining alertness is a well-known benefit and what most of us rely on caffeine for. But what else? Every day my patients ask me if coffee is bad for their heart. In addition to caffeine coffee contains polyphenols which are dietary antioxidants. Intriguing right?
Coffee and the caffeine in it do not increase your overall risk for coronary heart disease (CHD), nor does it adversely affect heart failure. Studies have actually shown that, in moderation, there may be some benefit for congestive heart failure. What surprises people to hear is that overall, there appears to be a beneficial effect and lower all-cause mortality with caffeine and coffee.
The Brain and Stroke
Doesn’t coffee raise my blood pressure and isn’t that bad? Hypertension (high blood pressure) is not increased by coffee, contrary to what many believe. In fact, there is some evidence that coffee and caffeine show a benefit in reducing stroke.
What about atrial fibrillation?
Association of coffee with arrhythmias has been a major concern though in moderation it is not a significant overall problem. Obviously if you feel worsening arrhythmic symptoms with coffee you should stay away from it.
Wait, it protects me from diabetes?
Yep. Where coffee clearly shines is decreasing the chance you will develop type 2 diabetes mellitus. We aren’t sure why this is but coffee contains an antioxidant, polyphenols, which may contribute to this benefit.
Is all of this really true?
Yes. A New England Journal of Medicine article in 2012 received a ton of attention when they found, in a very large cohort study, that coffee drinkers had lower risk of death due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes and infections. Lower risk.
The bottom line on coffee is there is much to recommend it from an overall cardiovascular standpoint.