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

The Ten Worst Medications for Your Liver

by Dr. Sharon Orrange on November 30, 2016 at 11:54 am

The liver is the main organ for maintaining the body’s internal environment. Liver failure is always scary because there is currently no way to protect against the absence of liver function. Think about it this way: we can use dialysis to take over for the kidneys or a mechanical ventilator if the lungs fail . . . but there is nothing to compensate for the liver.

Medications are an important cause of liver injury. While there are more than 900 drugs and herbs reported to cause liver injury, ten medications stand out for their potential to cause liver damage. Two thousand cases of liver failure occur each year in the United States and 50% of them are due to medications. Here are ten medications, both over-the-counter and prescription, that are rare-but-known causes of liver damage.

  1. Acetaminophen (Tylenol). Of the liver failure cases attributed to medications, 37% are due to acetaminophen. Acetaminophen works well as a fever reducer and pain reliever—but make sure to keep your use under 2 grams a day, and don’t exceed the recommended dose of 4 grams a day. Many over the counter products contain acetaminophen (Theraflu, Nyquil, Dayquil, etc) and that’s where folks get into trouble. Read the ingredients.
  2. Amoxicillin/clavulanate (Augmentin). Augmentin is an antibiotic used for bronchitis, sinus and throat infections. Liver damage from Augmentin can occur shortly after you start taking it, though signs of liver injury are often detected even after you’ve stopped the medication.
  3. Diclofenac (Voltaren, Cambia). Any NSAID (non steroidal anti-inflammatory drug) can cause liver injury, but it is most common with diclofenac. Liver injury from diclofenac can happen weeks to months after you start taking it. It is very rare, but affects susceptible individuals for reasons we don’t know.
  4. Amiodarone (Cordarone, Pacerone) is a heart medication used to control the rhythm in people with atrial fibrillation. After taking it for weeks to months, liver cell injury has been observed.
  5. Allopurinol (Zyloprim). Taken for the prevention of gout attacks, liver injury from allopurinol may happen within days to weeks of starting it.
  6. Seizure Medications. This whole class of medications is a problem, as several anti-epileptic medications can cause liver damage. Dilantin (phenytoin) can cause liver damage shortly after you start taking it, which is why your liver tests will be monitored. Valproate, carbamazepine, and lamotrigine can also cause liver injury which may declare itself later, after you’ve been taking it for weeks or months.
  7. Isoniazid. If you have a positive TB (tuberculosis) skin test (a “positive PPD test”) you may be prescribed 3 – 6 months of isoniazid (also known as isonicotinylhydrazide or INH) therapy. INH is a well known cause of acute liver injury which occurs weeks to months after you start taking it. This is why you are told not to drink alcohol while taking INH.
  8. Azathioprine (Imuran). Azathioprine is a medication that controls the immune system. It is used in Crohn’s disease and autoimmune hepatitis, among other things. After weeks to months of taking azathioprine, damage to the liver can occur. I’ve seen this happen, keep an eye on the liver while taking this medication.
  9. Methotrexate. Used for many conditions, including rheumatoid arthritis and ectopic pregnancy, liver levels will be monitored while you are taking methotrexate because of the relatively common adverse liver effects.
  10. Risperidone (Risperdal) and quetiapine (Seroquel) are both used as antipsychotics and antidepressants. These medications can cause a blockage of the flow of bile from the liver (drug-induced cholestasis).

Honorable mention. You may wonder about the statin cholesterol medications and abnormal liver function tests. While atorvastatin, simvastatin, lovastatin and pravastatin can frequently affect liver function blood tests, they do not tend to cause significant liver injury. Animal studies reveal that very high doses of statins may cause hepatotoxicity (damage to the liver), but typical doses of the drug are not associated with significant liver injury. Liver cell injury from statins is exceptionally rare in humans.

Dr O.

How to Get Thru the Flu

by The GoodRx Pharmacist on November 29, 2016 at 5:32 pm

If you have ever had the flu, you know just how down and out you can feel. Besides feeling like a zombie, the most common symptoms of the flu include chills, fever, cough, sore throat, muscle or body aches, headache or vomiting and diarrhea.

With flu season peaking as early as December, it’s important to know the common signs and symptoms, and what can be done to decrease your days spent sick and in bed. We have some useful information to help you detect and beat the flu faster!

Is the flu caused by bacteria?

No, the flu is caused by various types of viruses.

Will an antibiotic cure me of the flu?

No, antibiotics are used to get rid of bacteria and do not work on viruses like the flu.

How is the flu virus spread?

The flu virus is spread from person-to-person via respiratory droppings from sneezing, coughing, talking, or touching.

What can be done if you detect the flu early enough?

If you can see your doctor within 48 hours of your flu symptoms appearing, your doctor may treat you with an antiviral like Tamiflu or Relenza. These antivirals fight the flu virus in the body which may lessen symptoms and shorten the time that you are sick.

Are there any over-the-counter (OTC) treatments for the flu?

Unfortunately, no. There is nothing you can get over-the-counter to treat the flu. There are, however, some over-the-counter items you can get to help manage the pesky flu symptoms! Here are some drugs that might be helpful for certain symptoms:

  • Fever and body aches can be managed with OTC pain relievers like:
    • Tylenol
    • Motrin
  • Sore throats can be managed with OTC pain relievers, throat sprays, throat drops like:
    • Chloraspeitc spray
    • Demulcent throat lozenges
    • Tylenol
    • Motrin
    • Aleve
  • Coughs can be managed three different ways.
    • A productive cough (with mucus) can be managed with an OTC expectorant like Robitussan or Mucinex.
    • A Dry cough (without mucus) can be managed with Delsym.
    • If you want both, you can also try a combination product with an expectorant and cough suppressant like Muxinex DM or Roitussin DM.
  • Runny noses can be managed with OTC oral histamines or nasal sprays like:
    • Oral antihistamines
      • Benadryl
      • Claritin
      • Zyrtec
      • Allegra
    • Nasal Sprays
      • Flonase Allergy Relief
      • Nasacort Allergy 24HR
      • Saline nasal spray

Recall: Premarin for Menopause Symptoms

by The GoodRx Pharmacist on November 28, 2016 at 3:33 pm

Manufacturer Pfizer Pharmaceuticals has issued a voluntary recall for some brand- name Premarin products. Premarin is a mixture of estrogens used for hormone replacement therapy, and to treat hot flashes and prevent osteoporosis.

This is a class II recall, the most common type of recall, which means that there is a situation where use of the recalled medication may cause temporary or medically reversible health consequences. However, the likelihood of serious adverse effects is small. For more information on the different types of recalls, see our overview here.

Who can recall a drug?

A manufacturer can voluntarily call their medication, or the Food and Drug Administration (FDA) can request or require that a manufacturer recall a particular medication.

In this case, the manufacturer has voluntarily recalled various Premarin products, with the knowledge of the FDA.

Which Premarin Products were affected? 

In this recall, 1 manufacturer, 1 lot and 1 strength were affected.

Drug: Premarin 1.25mg tablets
Manufacturer: Pfizer Pharmaceuticals
Lot: #M35953S
National Drug Code (NDC): 00046-1104-91

If you have any trouble finding the lot and NDC information on your prescription, please check with your pharmacist for more information.

Why has Premarin been recalled?

On November 3rd 2016, Pfizer initiated a recall because of an incorrect expiration date applied to the affected bottle labels. This means that you could be taking expired medication, increasing your risk for experiencing side effects, complications, and decreased efficacy.

Are patients who have taken this medication being notified?

No. This is a class II recall, which means that it isn’t necessary to notify you unless your doctor believes it may have a effect on your health. However, pharmacies with the affected lot in their inventory have been directed to stop distribution and arrange for product return.

If you have concerns that your prescription may be affected, contact your doctor for more information.

Where can I go to lean more information?

At this time, there is little information regarding the Premarin recall.

However, you can visit the Premarin website, or contact Pfizer if you have any further questions.


FDA Approves Xopenex HFA Generic for Asthma

by The GoodRx Pharmacist on November 17, 2016 at 4:52 pm

We have good news for the asthma community! A generic for Xopenex HFA, an inhalation aerosol used to treat bronchospasms, is available in pharmacies now!

The generic, levalbuterol, is a rescue inhaler used to immediately open the airways in your lungs for acute symptoms like shortness of breath, wheezing, or coughing. This is good news for your pocketbook!

What is levalbuterol used for?

Levalbuterol is indicted for the treatment or prevention of bronchospasm in patients 4 years of age or older, with reversible obstructive airway disease.

Levalbuterol is good for people who experience side effects from albuterol sulfate, which is a main ingredient in many alternative inhalers. So, if you experience heart palpitations, rapid heart rate, or shakiness from albuterol sulfate inhalers, levalbuterol may be a good option for you!

What strength(s) and dosage form(s) of levalbuterol will be available?

Levalbuterol will be available as an inhaler in the strength of 45mcg.

What are the most common side effects of levalbuterol?

Just like any medication, there are some side effects:

  • Accidental injury
  • Bronchitis
  • Dizziness
  • Pain
  • Sore throat
  • Runny nose
  • Vomiting
  • Palpitations
  • Chest pain
  • Fast heart rate
  • Tremors
  • Nervousness

Are there any similar inhalers to Xopenex HFA (levalbuterol)?

Yes! Xopenex HFA (levalbuterol) is considered a rescue inhaler, or a short-acting inhaler, and is mainly used to quickly treat an attack. There are a few other rescue inhalers, like:

  • ProAir HFA
  • ProAir RespiClick
  • Proventil HFA
  • Ventolin HFA
  • Combivent Respimat

Unfortunately, none of the inhalers mentioned above have generics, which makes them more expensive for consumers. However, ProAir HFA has an anticipated generic release date of December 2016.

What if I want to continue to use the brand, Xopenex HFA?

First off, if you would like to take brand Xopenex HFA, make sure your doctor handwrites ‘brand medically necessary’ on your prescription. This means that the pharmacy is not permitted to substitute and give you the generic product. If you prefer, you can also speak with your pharmacist and request that they fill the brand over the generic.

Unfortunately though, if you stick with the brand, you will be paying more out of pocket. If you are concerned about the cost, you can always call your pharmacist who will let you know the price ahead of time. This can save you both time and money.

Finally, keep in mind that your insurance company may not be willing to cover the cost of the brand medication, since the generic is now available. Call your prescription insurance company beforehand to ensure that it is covered.

These 15 Medications Can Cause a False Positive on Drug Tests

by Dr. Sharon Orrange on November 15, 2016 at 3:27 pm

We hear “false positive” as a defense from professional athletes all the time when it comes to drug screens—but unexpected  results on drug screens really do happen.

A urine drug screen tests for the presence of certain illegal drugs and prescription medications. You may be more likely to be tested when applying for a job than when playing professional sports, but you could also be affected by a false positive. Here are several common medications—prescription and over-the-counter—that you’ll want to be aware of as potential culprits for a false positive.

  1. Amitriptyline. This is a tricyclic antidepressant used for chronic pain, neuropathy (nerve pain), depression, and migraine prevention. Amitriptyline may lead to a false positive urine test for the hallucinogenic drug LSD (lysergic acid diethylamide).
  2. Bupropion (generic Wellbutrin). Used as an antidepressant, for weight loss, and smoking cessation, bupropion may lead to a positive screen for amphetamine, methamphetamine, and LSD.
  3. Dextromethorphan. Found in Robitussin, Delsym and other over-the-counter cough suppressants. If you’ve taken a medication with dextromethorphan in it, your drug screen may be positive for opiates and PCP (phencyclidine).
  4. Diltiazem (Cardizem) is used for hypertension (high blood pressure) or to slow your heart rate if you have atrial fibrillation. If you’re taking diltiazem your urine drug screen may test as a false positive for LSD.
  5. Diphenhydramine (Benadryl). Many over the counter remedies contain diphenhydramine, an antihistamine also used as a sleep aid, including Tylenol PM and Advil PM. If you’ve taken these, you could test positive for methadone or PCP.
  6. Ibuprofen and naproxen (Advil/Motrin and Aleve). Two very common over the counter anti-inflammatory pain medications. If you’ve taken either of these, your urine screen may test positive for barbiturates, THC (cannabinoid), and PCP.
  7. Metformin (Glucophage). The most commonly prescribed oral medication for diabetes, taking Metformin may result in a positive test for amphetamine or methamphetamine.
  8. Fluoxetine (Prozac) and trazodone. Both are used to treat depression and may result in false positive tests for amphetamine or methamphetamine and LSD.
  9. Pseudoephedrine (Sudafed). Used for sinus and nasal congestion, Sudafed—as many of you already know—may result in a false positive test for amphetamine or methamphetamine.
  10. Labetalol (Trandate) is both an alpha and beta blocker used for blood pressure control. If you’ve taken labetalol you could have a false positive for amphetamine or methamphetamine and LSD.
  11. Methylphenidate (Ritalin). Used for the treatment of ADHD, this Ritalin is a well-known cause of false positive tests for both amphetamine or methamphetamine and LSD.
  12. Doxylamine, found in Unisom and other over the counter sleep aids (similar to diphenhydramine), may cause a false positive on a drug test for methadone, opiates, and PCP.
  13. Sertraline (Zoloft) is an antidepressant and if you’ve taken it, you may test positive for benzodiazepines and LSD.
  14. Tramadol (Ultram) is a non-opioid medication used for pain. Your screen could come up positive for PCP if you’ve taken it recently.
  15. Quetiapine (Seroquel) is an atypical antidepressant/antipsychotic used for bipolar disorder, depression, and schizophrenia. Your drug test may show up positive for methadone if you are taking quetiapine.

Hope this helps.

Dr O.

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