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

Flumist Nasal Spray Pulled from Pharmacies

by Roni Shye on June 30, 2016 at 1:21 pm

In the middle of summer, flu season may seem far off. Believe it or not though, most pharmacies will start to receive their shipments of flu vaccines beginning in August, only a couple of months from now.

This year that shipment will be missing one of its key players: Flumist nasal spray. The nasal spray option has been pulled from pharmacies, and will not be available for the 2016 – 2017 flu season.

Why will Flumist no longer be available?

The ACIP voted against using Flumist for the 2016 – 2017 flu season based on data from 2013 to 2016 that showed Flumist to be less effective compared to the flu shot.

Last flu season, Flumist was shown to be only 3% effective, compared to the flu shot which was shown to be 63% effective. This data also showed that Flumist had no protective benefit in children ages 2 through 17.

How effective are most flu vaccines?

Flu vaccine effectiveness varies from flu season to flu season but are typically 50 to 60% effective.

Who determined that Flumist will not be used this flu season?

Recently the CDC’s panel of experts known as the Advisory Committee on Immunization Practices (ACIP) voted that Flumist should not be used for the 2016 – 2017 flu season. Find out more on the decision here.

Is this the final recommendation?

No. The final annual recommendation from the ACIP will be published in the late summer or early fall 2016.

Is Flumist still going to be made at all?

Yes. The manufacturer of Flumist, AztraZeneca, has data about its effectiveness that conflicts with the CDC’s findings. Their data shows that Flumist was 46 – 58% effective overall during the 2015-2016 flu season.

Flumist will likely continue to be distributed and used as planned in other countries, but this may change as the annual recommendations are released for those countries.

Are any other nasal spray flu vaccines available?

No. Flumist was the only flu vaccine available as a nasal spray.

Are there any alternative options for the flu shot?

The only choice at this time is the actual shot. If you or your child have an aversion to needles, you may be able to ask your doctor about the intradermal shot. Fluzone Intradermal uses a much smaller needle and is injected into the skin rather than the muscle.

Is High Cholesterol Actually Bad for You?

by Dr. Sharon Orrange on June 29, 2016 at 10:50 am

High cholesterol may be much ado about nothing, especially in older folks. A recent meta-analysis published in BMJ Open raises a strong argument that lowering LDL cholesterol in older people doesn’t help at all.

Where does this leave us? Are we over-treating millions of folks with cholesterol lowering drugs, “statins” like Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin)? Let’s take a look.

After reviewing 19 studies with over 68,000 people here are 6 things we know:

  1. Previous research has shown a weak association between total cholesterol and death in folks over the age of 60. Most people in this current study were 65 – 85 years of age.
  2. Many of you take cholesterol lowering drugs because some studies have shown you can lower your risk of death from stroke and heart disease by lowering LDL (“bad”) cholesterol with statin medications. Turns out, that is seen most often in younger people.
  3. This new widespread review showed no association between LDL cholesterol and mortality among people older than 60 years. So even high “bad” cholesterol was not found to increase risk of stroke and heart disease in people older than 60.
  4. Our way of thinking about cholesterol may need to change. Because atherosclerosis (plaque buildup in your arteries) starts mainly in middle-aged people and becomes more pronounced with increasing age, there should be an even greater risk of heart attack over time—if untreated high cholesterol was a factor. Why is high cholesterol a risk factor for heart attack and stroke in the young and middle-aged, but not in elderly people? We don’t really know.
  5. What does this mean for the use of statins in older people? They are likely over prescribed. Most statin trials have shown little effect on cardiovascular disease and mortality, with best results showing a 2% reduction in mortality.
  6. This review will again ignite the debate about the cause of atherosclerosis and heart disease and whether the benefits from statin treatment have been exaggerated.

Confused? Where are we now on the use of statins to lower cholesterol if we aren’t even sure lowering LDL cholesterol in folks over 60 years of age helps? For now, those of you between the age of 40 and 65 should check out a risk calculator to see where you stand.

If your 10 year risk is higher than 7.5% according to the calculator, you should talk to your doctor about the risks and benefits of statins.

What do we know for sure? If you score above the 7.5 percent largely because you smoke or have high blood pressure, the best thing you can do is quit smoking or control your blood pressure. That may be enough to get you below the cutoff, so you don’t need to start on statin therapy. Lifestyle changes also help reduce risk so diet and exercise changes are a no brainer.

Dr O.

New Combo Drug Jentadueto XR Approved for Diabetes

by Roni Shye on June 23, 2016 at 12:04 pm

Jentadueto XR (metformin/linagliptin) is the newest once-daily combination drug approved by the FDA to treat type 2 diabetes.

Combination drugs can also be a convenient way to join together two drugs that work differently to treat a particular health condition, and extended release versions like Jentadueto XR mean you only need to take your prescription once per day. In addition, many medications are combined because they work better together than either medication alone.

Do your own research though—while combinations can be easier to take, they can also be pricier than taking the active ingredients as separate medications.

What is Jentadueto XR?
Jentadueto XR is an extended-release once-daily combination of metformin and the active ingredient in Tradjenta, linagliptin.

What are the advantages to using Jentadueto XR?

Convenience, for one. One pill, once per day, for two medications is much simpler than scheduling multiple doses for more than one prescription.

The all-in-one dose form also means you’re more likely to take your medication as prescribed—which means you’re more likely to keep your diabetes under control.

What are the disadvantages?

Potentially, cost. Jentadueto XR hasn’t hit pharmacies yet, but the immediate release version, Jentadueto, costs about $375 per month using a discount.

However, if you are already taking Tradjenta and extended-release metformin separately, Jentadueto XR may still be a good option for you—since Tradjenta is still brand-only, the cost is about the same.

How will Jentadueto XR be available?
Jentadueto XR will be a tablet in / and / strengths.

How is Jentadueto XR taken?
Jentadueto XR is taken once daily with food. It should be swallowed whole—don’t split, dissolve, cut, or chew the tablets.

What are the side effects of Jentadueto XR?

The most common side effects associated with Jentadueto XR include stuffy nose, runny nose, sore throat, and diarrhea.

When will Jentadueto XR be available?

At the moment, there isn’t an expected availability date for Jentadueto XR—but watch for it in pharmacies in the upcoming months.

Want more information?

See the press announcement from the manufacturer here.

FDA Safety Alert: Imodium Misuse May Cause Heart Problems

by Roni Shye on June 22, 2016 at 2:13 pm

The FDA has issued a drug safety alert for Imodium (loperamide), a medication used to treat diarrhea.

The FDA warns that taking higher than recommended doses of Imodium can cause serious heart problems and potentially death.

What is Imodium used for?
Imodium is used to control the symptoms of diarrhea.

Why would someone take a higher than recommended dose?

The active ingredient in Imodium, loperamide, is similar to opioids like morphine. Some people have reportedly been misusing and abusing Imodium in an attempt to self-treat opioid withdrawal symptoms or to achieve a feeling of euphoria.

Is Imodium available without a prescription?

Yes. There are both prescription and non-prescription strengths of Imodium.

What type of heart problems could high doses of Imodium cause?

Abnormal heart rhythms, a sudden drop in heart rate and blood pressure, and heart attack can all be caused by high doses of Imodium.

What signs and symptoms should I be concerned about with Imodium?

If you or someone you know takes Imodium and experiences rapid heartbeat, irregular heart rhythm, or fainting, or becomes unresponsive, seek medical attention immediately.

What is the maximum daily dose of Imodium that an adult should take?

For Imodium that you can buy in your pharmacy over-the-counter, the maximum recommended daily dose is 8 mg.

For prescription Imodium, the maximum recommended daily dose is 16 mg.

Is there anything else I should be aware of?

Yes. Imodium can interact with many common over-the-counter and prescription medications, also increasing the risk for potentially serious heart problems.

These other medications could have a negative interaction with Imodium:


What Can I Do About an Embarrassing Itch?

by Dr. Sharon Orrange on June 21, 2016 at 3:33 pm

Itchy butt, pruritus ani, itching around the anus . . . whatever you want to call it, it’s more common than you might think. Many folks try to deal with it on their own without coming to the doctor because, well, it’s embarrassing. So let me walk you through it step by step.

What is pruritus ani? It’s the medical term for itching around the anorectum (this includes outside and inside). Itching around the anus or higher up in the rectal area may bother you the most at night and can really affect quality of life.

How common is it? In one survey of 100 randomly selected individuals (aged 21 to 65), 20 percent had ongoing symptoms. The majority of those folks hadn’t talked to a doctor about it either, so you are not alone.

Why do we get itching around the anal area? Dietary factors and fecal soilage account for the majority of patients with anal pruritus but one fourth of patients have no identifiable cause. Several things can be quickly ruled out with a quick look by you or your primary care doctor: tumors, anal fissures, abscesses or hemorrhoids.

Now “fecal soilage” doesn’t sound good—what does it mean? This does not mean that you aren’t cleaning well enough. In fact some of you clean too well with witch hazel and other astringents which dry the area out, making the itching worse. Stool that is loose or sticky is more likely to cause fecal soilage than formed or bulky stools, and this will worsen the itching.

What foods make itching around the anus worse? The “Cs” of coffee, cola, chocolate, citrus, and calcium (dairy) are potential dietary contributors to itchy butt. Tomatoes and tea also may make itching worse.

Is it just a skin problem? This is where seeing your doctor can help. Skin conditions like psoriasis can also be the cause along with other types of dermatitis. Skin irritation can be worsened by scratching or by the use of additional skin products to relieve the itching, like witch hazel.

What works to ease the itch? Start by avoiding food and beverages known to make the itching worse, and if you are having loose bowel movements or diarrhea try cutting out lactose. If everything else is normal, start with keeping the area dry and clean, but without excessive wiping or use of astringent cleaners (again, like witch hazel).

Here is a stepwise plan you may try before visiting your doctor:

  • After a bowel movement, a bath or using a pre-moistened pad or tissue can be used for wiping.
  • Following bathing, the area around the anus should be dried using a soft towel with a dabbing/patting motion, or with a hair dryer set on cool. Wiping too aggressively is NOT helpful
  • Over the counter options to start with: Calmoseptine is an over the counter ointment that works really well for itchy butt—start with this. Balneol lotion or lotion packets are also a favorite of colorectal surgeons for use after a bowel movement. Zinc oxide (Desitin or Balmex) can be used also as a barrier cream.
  • You can also try talcum powder to help keep the area dry.

Ok, those didn’t work. Now what? See your doctor. An over-the-counter 1% steroid/hydrocortisone cream can be used twice daily to relieve the itching and help healing, but you don’t want to use that for very long.

If the itching is bad at night, take a 25 mg Benadryl (diphenhydramine) to help while you wait for other remedies to kick in.

Last, if the above listed interventions don’t help, your doctor may give you Protopic 0.1% ointment (topical tacrolimus) which has been shown to help.

Allergy (patch) testing is also recommended if it doesn’t get better

Dr. O

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