Cosentyx (secukinumab), a new treatment for moderate to severe plaque psoriasis in adults, was approved by the FDA in January 2015. It is expected to be available within five to twelve weeks.
What is psoriasis?
Psoriasis is a skin condition that causes the skin of an affected person to be red and irritated. The severity of psoriasis is based on how much of the body is covered and how bad it is. Psoriasis may be classified as:
• Mild (less than 3% of the body has psoriasis)
• Moderate (3 – 10% of the body has psoriasis)
• Severe (greater than 10% of the body has psoriasis)
Are there different types of psoriasis?
Yes. There are five different types of psoriasis: plaque (which Cosentyx treats), guttate, inverse, pustular, and erythrodermic.
Plaque psoriasis is the most common form of psoriasis. Plaque psoriasis appears as raised, red patches covered with a silver-white buildup of dead skin or scales on the scalp, knees, elbows, lower back, face, palms of hands, and soles of the feet. These patches of dead skin are often itchy, painful, crack, or bleed.
What are the symptoms of psoriasis?
Some of the most common symptoms of psoriasis include itchy skin, dry skin covered with silver flakes, pink-red colored or raised and thick skin, joint pain, nail changes, and severe dandruff.
Is there anything unique about Cosentyx as a psoriasis treatment?
Yes. Cosentyx is the first of its kind in a new class of medications known as IL-17A antagonists.
IL-17A antagonists work on moderate to severe plaque psoriasis by basically decreasing inflammation and swelling.
For healthcare professional use only, there will also be a single-use vial of 150 mg powder that needs to be mixed.
How is Cosentyx used?
You’ll likely receive the recommended starting dose—two 150 mg injections—once per week for five weeks, followed by a once-monthly maintenance dose. The maintenance dose is also two 150 mg injections, given every four weeks.
Are there side effects?
The most common side effects associated with Cosentyx are diarrhea and upper respiratory infection.
Want more info on Cosentyx?
Take a look at the website here.
Like prescription drugs, there are an enormous variety of over-the-counter (OTC) medications available to treat all kinds of conditions. OTC medications range from vitamin and mineral supplements to emergency contraception and include everything in between.
Also just like prescription drugs, OTC medications can be misused, abused, and even interfere with one another.
Although OTC medications don’t require a consult with your healthcare provider before use, it’s still important to understand what you are taking. If you have any questions, be sure to check with with your doctor or pharmacist.
So what are the most important things to keep in mind when it comes to OTC meds?
1. OTC medications can interact with your prescriptions.
When asked by your healthcare provider, it is important to provide an accurate and complete list of all the medications you take—including all over-the-counter medications, even vitamins, minerals, herbals, aspirin, or any other product you may be taking.
Having an accurate and up-to-date medication list (including OTC products) can be a valuable tool in many circumstances. For example, when it comes to determining whether your medications may be interfering with one another, finding the cause if you are experiencing unwanted side effects, or if you need to be admitted to the hospital.
Always keep a complete list of ALL medications and disclose this information to your various healthcare providers. If you are interested in compiling a list of your current medications you can use this template from the American Society of Health-System Pharmacists.
2. OTC vitamins and minerals may not undergo the same testing as prescription medications.
OTC vitamins and minerals, unlike prescription drugs, do not usually have clinical trials conducted to determine their safety or efficacy. This lack of clinical data can sometimes lead to unforeseen situations such as drug interactions or dose inconsistencies.
For more information on herbs, supplements, and vitamins check out this database from the Mayo Clinic.
3. A lot of the medications now available over-the-counter were once prescription only.
You may have noticed that several medications now in your grocery store or pharmacy’s aisles used to require a prescription.
It is important to keep in mind that before the status of these medications can be changed from prescription-only to over-the-counter, the FDA requires that they are evaluated for both safety and efficacy.
Several medications have made the jump from prescription only to an over-the-counter or OTC status. The past several months have been a particularly busy time for prescription-to-OTC switches, with heartburn med Nexium and steroid nasal spray Flonase as the most recent examples. Some more medications that used to require a prescription from the doctor but can now be puchased over-the counter include:
- Oxytrol transdermal patch
- Zaditor/Alaway eye drops
- Prevacid capsules
- Prilosec tablets
- Pepcid tablets
- Plan B emergency contraceptive tablets
- Allegra tablets
- Zyrtec tablets
- Miralax powder
- Alli capsules
- Abreva cream
- Nasacort nasal spray
4. You can still use your FSA and HSA on OTC products.
If your employer offers either a flexible spending account (FSA) or a healthcare spending account (HSA), you are eligible to use those pre-tax dollars on various healthcare-related items such as OTC medications.
However, there is a catch—in order to use your FSA or HSA on OTC meds you must have a prescription from your doctor. You will need to buy your OTC med at the counter of the pharmacy of your choice, just like a prescription medication.
A few years back you used to be able to grab the item right off of the shelf and check out using your FSA or HSA debit card, but this changed at the end of 2010.
For more information on FSAs or HSAs check out this article from health insurance company Cigna.
5. There are many variations of the same product available over-the-counter.
Exploring the aisles of OTC medications can make your head spin with the amount of choices that exist these days. Many medications are available in a variety of strengths, dosage forms, and combinations, which can lead to confusion if you aren’t exactly sure what you are looking for.
If you’re looking for a calcium plus vitamin D supplement, for example, it sounds like a simple trip to the vitamin aisle. However, once you get there, you’ll find many varieties, strengths, and dosage forms for this one vitamin combination alone.
Consider the following:
- Calcium is available in many salt forms, including (but not limited to) calcium carbonate and calcium citrate.
- Calcium with vitamin D is available in many strengths, including (but not limited to):
- 315 mg/200 unit
- 500 mg/200 unit
- 600 mg/200 unit
- 600 mg/400 unit
- 630 mg/400 unit
- 600 mg/500 unit
- 600 mg/800 unit
- Calcium with vitamin D is available in many dosage forms, including (but not limited to) tablets, capsules, chewable tablets, soft chews, and gummies.
Digoxin has been used for the treatment of atrial fibrillation and heart failure since the 70’s. Brand names of Digoxin include Lanoxin and Digitek and all work by inhibiting the sodium/potassium ATPase pump in heart cells which leads to increased contractility (squeeze).
However, there are better options for treatment and new reasons for concern about digoxin, so here are five reasons to talk to your doctor about a switch:
- The role of digoxin for rate control in patients with atrial fibrillation has been limited due to its relative lack of efficacy—it isn’t as effective compared to other treatments.
- Studies show a possibility of an increase in mortality in patients without heart failure who take digoxin for atrial fibrillation.
- In patients treated with digoxin for atrial fibrillation, there was nearly a 25 percent increase in all-cause mortality.
- New recommendations suggest limiting the use of digoxin for atrial fibrillation to only patients in whom beta blockers and calcium channel blockers have not achieved rate control and who are not considered candidates for other procedures to treat atrial fib (ablation or surgical Maze procedure).
- Beta blockers (metoprolol, atenolol) and/or calcium channel blockers (diltiazem) work better for rate control than digoxin and don’t carry the potential risk of higher mortality.
When an authorized generic is available, it means that the company making the brand name product has either made a deal and given their exact recipe to a company that specializes in authorized generic products, or made the generic product themselves to be distributed by another company.
Will there be any differences between the brand medication and the authorized generic medication?
Yes. You may notice different tablet markings, taste, and label and packaging changes. However, these very small changes will not affect the experience you had with the brand.
How is an authorized generic medication different than a regular generic?
An authorized generic uses the same exact recipe as the original brand medication. Other generic medications use a similar recipe to the original brand medication but they are allowed to make changes to it. Regular generics may have different inactive ingredients, color, shape, and markings.
If you’ve ever switched from a brand to a generic when it approved, you know that these changes can make a huge difference in some patients—while in others they may not have any effect.
Are the recipes of most generic medications the same from one company to the next?
No. Generic medications can be made by several companies and the recipes can differ. Generic medications must contain the same active ingredient as the brand, but that is where the requirements end.
Can the generic manufacturer of my medication be changed by my pharmacy?
Yes. You may have noticed this if you’ve gone to the pharmacy for a refill and your generic medication looked different than what you received the month before.
If you’re concerned about any differences in your prescription, never hesitate to confirm with the pharmacist that you do have the same medication from a different manufacturer.
If possible, you should try to take the same generic from the same manufacturer each month—however, I know from experience that this is not always feasible.
Why does the pharmacy sell different generic manufacturers of my medication?
Pharmacies may not always be able to provide your prescription from the same generic manufacturer for a few reasons, including:
- Shortages from the manufacturer
- Shortages from the wholesaler
- Manufacturers may decide to quit making the medication
If there is a shortage or discontinuation, the wholesalers where pharmacies order their medications will send the same drug but from a different manufacturer.
Unfortunately, this can lead to confusion for you, the patient. The new generic may not look familiar, or may have different active ingredients.
What are some examples of authorized generics?
- Prasco Laboratories’ colchicine (generic Colcrys)
- Watson/Actavis’s methylphenidate ER (generic Concerta)
- Greenstone’s celecoxib (generic Celebrex)
- Prasco Laboratories’ hydroxychloroquine (generic Plaquenil)
What are some companies that specialize in authorized generics?
- Prasco Laboratories
- Patriot Pharmaceuticals
- Par Pharmaceuticals
Do all brand medications have authorized generics?
No. Not all brand medications have authorized generics. If you have a preference for authorized generics, it is important to research or ask your pharmacist to see if your newly generic brand medication has one available.
For more information and a list of authorized generics from the FDA check here.
What’s the takeaway?
Authorized generics are replicas of their brand-name drugs despite some small cosmetic changes. If you are worried about switching from your brand, using an authorized generic would be the next best option, letting you get the same exact medication at a lower cost.
In the United States, lung cancer is the leading cause of death from cancer. The American Cancer Society estimates that 28% of all deaths from cancer in the U.S. are from lung cancer. The average 5-year lung cancer survival is among the poorest of all cancers (17%) because sadly the majority of patients are diagnosed with advanced disease.
Well, can I be screened for lung cancer? Yes, and as of this month Medicare coverage will be provided for screening for lung cancer with low dose computed tomography (LDCT). This is the first time that Medicare has covered lung cancer screening. Finally, there is an opportunity to reduce deaths from lung cancer in a high-risk group of current and former smokers.
Who should be screened for lung cancer?
You should be screened if:
- You are 55 years to 77 years old and are either a current smoker or have quit smoking within the last 15 years.
- You have at least a 30–pack-year (1 pack per day for 30 years or 2 packs per day for 15 years) smoking history.
- You must also have a written order from a physician for the test.
How do we screen for lung cancer?
- You will get a low-dose radiation chest CT scan (LDCT) which has been shown to substantially reduce the risk of dying from lung cancer.
- Adults who choose to be screened should receive once a year LDCT screening until they reach age 74 years (77 per some guidelines).
- Remember, chest x-ray is not to be used for lung cancer screening.
What are the downsides of LDCT for screening?
- LDCT will not detect all lung cancers or all lung cancers early, and not all patients who have a lung cancer detected by LDCT will avoid death from lung cancer.
- There is a significant chance of a false-positive result, which means you may require additional testing and, in some instances, an invasive biopsy to determine whether or not an abnormality is lung cancer.
- For patients who are at lower risk screening is not recommended. For these lower-risk patients, the harms outweigh the benefits.
If you’ve had an LDCT for screening, let us know how it went.