Briviact (brivaracetam) is a newly approved drug meant to be used along with other epilepsy treatments, for a specific type of seizure.
What exactly does Briviact treat?
Epilepsy is a disorder of the brain that causes reoccurring episodes of abnormal brain activity—often referred to as a seizure. Seizures can actually feel and look very different for each person, and fall into two major groups: partial and general.
Briviact is specifically intended to treat partial-onset seizures (not the sterotypical full-body convulsions). Partial seizures are also broken down into a few types, including: motor (affects movement), sensory (affects your senses like smell or taste), autonomic (affects part of your nervous system), or psychic (affects how you think or feel).
Is there anything unique about Briviact?
Briviact is already in pharmacies in the UK and Germany.
How does Briviact work?
It’s actually not exactly known how Briviact works to control seizures—but studies have shown that it has anticonvulsant effects.
The recommended starting dose of Briviact tablets is 50 mg twice daily with or without food, but your long-term dose will be individualized by your doctor, based on how well you tolerate it and how well it works. The amount you take may need to be adjusted up or down if you continue to have seizures or see any negative side effects.
The tablet should be swallowed whole with liquid. Tablet should not be crushed or chewed.
What are the side effects of Briviact?
The most common side effects associated with Briviact are drowsiness/sedation, dizziness, fatigue, nausea, and vomiting.
When will Briviact be available?
Briviact is still under review by the Drug Enforcement Agency (DEA), since it will be considered a controlled substance. Once it’s decided what kind of restrictions Briviact will need, it should be available in pharmacies shortly.
Want more information?
See the press announcement from the manufacturer UCB here.
Diabetes—specifically type 2 or adult onset diabetes—is a growing epidemic in the United States, in part to the increase in obesity over the past 10 years.
However, there are several medications that (with healthy diet and excercise) can help keep your blood sugar under control. Glumetza is the newest option to have a generic version approved, which should mean lower prices and more options for you in the near future.
When will generic Glumetza be in pharmacies?
Generic Glumetza is a tablet, available in 500 mg and 1000 mg strengths.
Do I have more than one generic option for Glumetza?
No. Lupin Pharmaceuticals is currently the only pharmaceutical company allowed to make the generic of Glumetza. They have been granted exclusivity for 6 months or 180 days. After that, you may start to see other companies creating their own generic versions (which should help bring prices down even further).
Are there any similar alternatives to Glumetza?
Since the generic for Glucophage XR has been in pharmacies for quite some time, it may be significantly less expensive, especially if you’re paying out of pocket.
Is there a reason why my doctor might still prescribe me Glumetza instead?
What if I want to keep taking brand-name Glumetza?
If you don’t want to switch to the generic, make sure your doctor writes BRAND MEDICALLY NECESSARY on your next prescription. This means the pharmacy is not permitted to substitute with the generic.
However, keep this in mind: now that the generic is available, your insurance company may not be willing to cover the cost of brand-name Glumetza. I recommend calling your prescription insurance plan to find out your potential cost, and to see if it’s covered at all before wasting a trip to the pharmacy.
Beta blockers save lives after heart attack and improve mortality for heart failure patients. They also work well to control blood pressure. Carvedilol (Coreg was the brand name) has been known as the “heart failure beta blocker”—but now it appears that metoprolol (Lopressor) may share that title.
Many of my patients are asking: which is better? Let’s look at the recent evidence.
What’s the difference between carvedilol and metoprolol?
Carvedilol is known as a “non-selective beta blocker” meaning it blocks all beta receptors throughout the body. Metoprolol is known as a “selective beta blocker” and blocks primarily specific (β1) receptors which affect the heart, and heart rate. Why does this matter? Well you’d think you only want a medication that affects the heart, but carvedilol also inhibits β2 receptors and the effects of norepinephrine (similar to adrenaline) throughout the body. Turns out that’s important for heart failure.
Well, a JAMA (Journal of the American Medical Association) 2014 article looked at mortality rates in heart failure patients and found the effectiveness for prevention of death was similar for carvedilol and metoprolol. However, a very recent VA study found that metoprolol resulted in less frequent hospital admissions for heart failure, and that metoprolol had a slightly lower risk of death than carvedilol. I’d say they are about the same, or evidence tips in favor of metoprolol.
Which is better for survival after a heart attack?
What if I have diabetes?
The evidence is a little gray here. New diabetes diagnoses were more common in heart failure patients taking metoprolol than carvedilol. However, in a more recent study, the risk of diabetes for patients with high blood pressue was similar for carvedilol and other beta blockers like metoprolol. So, try to stick with carvedilol if you have diabetes but it’s not a must.
What about if I have COPD and heart failure?
You can take beta blockers if you have COPD (chronic obstructive pulmonary disease) and heart failure—although a recent study on patients with both found there was no survival benefit in folks taking carvedilol or metoprolol compared to non users. Hmmm.
Can either hurt my kidneys?
If you undergo a coronary angiogram, a contrast dye is used that may lead to kidney damage. One recent study found that carvedilol was better for kidney injury or “contrast induced nephropathy” after an angiogram than metoprolol.
These are both cheap, excellent generic medications with some subtle upsides for each. It’s a win win situation.
Coughing can be uncomfortable, and comes along with some unpleasant side effects like sore throat, chest pain, and exhaustion.
So where do you start to find some relief? First, know that your cough may be productive (a “wet” cough that produces mucus), or non-productive (a “dry” cough). There are many treatments available over-the-counter (OTC) without a prescription that can help both types.
When should I see a doctor instead of looking for an OTC remedy?
This is important. Skip the doctor and head straight to the emergency room if you’re coughing up anything pink or red (this can mean blood), if you’re choking, or if you’re having difficulty breathing or swallowing.
You should give your doctor a call if:
- You’ve had a cough for several weeks
- You’re wheezing
- You have shortness of breath
- You’re coughing up thick greenish-yellow mucus (gross, I know, but it’s something to watch out for)
- You have a fever over 100° F
So, say I just have a stubborn, uncomfortable cough. What are my options?
There are many products out there to help with coughing and its side effects, from simple cough drops to cough syrups, topical ointments, and throat sprays.
What can I do for a productive (“wet”) cough?
Guaifenesin is the active ingredient you’ll want to look for. It’s an expectorant—it helps relieve chest congestion, and thins and loosens the mucus you’re coughing up. You can find guaifenesin in Robitussin and Mucinex, and in some combination products.
No matter what you take or don’t take, it’s important to drink a lot of water, which will also help thin out the mucus of a productive cough.
What can I do for a non-productive (“dry”) cough?
Dextromethorphan is the common active ingredient for a dry cough—it’s a cough suppressant, which offers temporary relief from coughing. Dextromethorphan can be found in Delsym, and many combination products.
When would I use a combination product?
Combination cough medicines usually contain guaifenesin and dextromethorphan, and they can both control your cough and thin and loosen any mucus. Be aware though—some combination products out there also contain acetaminophen (Tylenol) for pain or fever relief, and you’ll want to watch your dose very carefully to make sure you don’t take too much. According to the FDA, the maximum safe dose of acetaminophen for adults is 4000 mg per day.
What about side effects from a cough?
There are also OTC medications that can help with coughing side effects. For chest pain, you can try a topical ointment like Vicks Vaporub, which can also act as a cough suppressant and topical pain reliever. If you have a sore throat, the go-to is probably cough drops, but you can also try chloraseptic spray.
Are there any other options? What about Primatene and Bronkaid?
Yes, both Primatene and Bronkaid tablets can help loosen mucus and thin secretions to make a cough more productive. However, you’ll want to make sure to talk to your doctor, pharmacist, or other healthcare provider before you start taking them.
Why? These tablets contain forms of ephedrine, which can increase blood pressure. This can increase your risk for heart attack or stroke, especially if you already have high blood pressure.
Ephedrine can also interact with a variety of medications (prescription and over-the-counter).
Still have questions about which medication is right for you? Reach out to your doctor or pharmacist.
Nearly 52.5 million people in the US have arthritis, according to an estimate from the CDC (Centers for Disease Control and Prevention).
Rheumatoid arthritis one of the most common types, and a new drug has just been approved to help make treatment easier. A new, extended-release form of Xeljanz (tofacitinib) recently received approval from the FDA to treat moderate to severe rheumatoid arthritis.
What is Xeljanz XR used for?
Xeljanz XR is recommended for adult patients with moderately to severely active rheumatoid arthritis—and who have had a poor response to methotrexate, or can no longer tolerate it. That means you’ll likely have tried methotrexate first, and it didn’t work for you.
Is there anything unique about Xeljanz XR?
Xeljanz XR is the firtst and only once-daily oral Janus kinase (JAK) inhibitor treatment for rheumatoid arthritis.
How does a Janus kinase (JAK) inhibitor work?
A JAK inhibitor works deep inside of your cells disrupting activities occurring in signaling pathways. This is believed to play a role in reducing the inflammation associated with rheumatoid arthritis.
You can use it with or without other medications for rheumatoid arthritis.
What are the side effects of Xeljanz XR?
The most common side effects associated with Xeljanz XR include upper respiratory tract infections (like colds and sinus infections), headache, diarrhea, stuffy or runny nose, and sore throat.
Want more information?
See the press announcement from the manufacturer Pfizer here.