High blood pressure is a key risk factor for stroke and heart disease, but it is easy to treat! If you have tried lifestyle changes and your blood pressures is still greater than 140/90, your doctor may discuss starting a medication to lower your pressure. If this is the case, it might be difficult to decide on which blood pressure medication is best for you. However, it turns out this question has been well studied, and the answer partly depends on your age and race.
Here is what you need to know if you are starting a medication for high blood pressure.
Younger people with high blood pressure (20-50 year olds):
- Start here. ACE Inhibitors, or angiotensin receptor blockers (ARBs), are recommended as first line therapy because they lower blood pressure and the risk of stroke and heart disease. ACE inhibitors are cheap, well tolerated medications that end in -il (for example: lisinopril, enalapril, benazepril). ARBs are very similar to ACE inhibitors but do not carry the dry cough side-effect that ACE inhibitors have. Common ARBs are losartan, irbesartan and valsartan.
- Another option. Beta blockers are a second option for younger patients who can’t take ACE inhibitors or ARBs, as some studies show that they don’t provide the same protection against stroke risk. Commonly used beta blockers include atenolol, metoprolol and carvedilol.
- Final notes. Studies show improved blood pressure in patients taking the above options rather than diuretics (chlorthalidone, hydrochlorothiazide) and calcium channel blockers.
African American patients with high blood pressure have lower levels of renin activity, a hormone that controls blood pressure. For this reason ACE Inhibitors and ARBs are not as effective.
- Start here. Thiazide diuretics (hydrochlorothiazide, chlorthalidone) are suggested as a first line treatment. Chlorthalidone is preferred over hydrochlorothiazide as there is more evidence of improved outcomes and it is more potent and longer acting. Both are safe, effective, well tolerated, and cheap.
- Another option. Calcium channel blockers, namely amlodipine (Norvasc), or the less often prescribed felodipine, are also recommended as first choice to control blood pressure, specifically in African Americans.
People over 60-65 years old:
- Start here. According to many studies, thiazide diuretics (hydrochlorothiazide, chlorthalidone) and calcium channel blockers (amlodipine) are the place to start.
- Another option. ACE inhibitors (lisinopril, benazepril, etc) or ARBs (valsartan, irbesartan, losartan) are also recommended as a good place to start.
- Final notes. Studies have shown that beta blockers should not be used as first line therapy for high blood pressure in patients over the age of 60, as they may be associated with inferior protection against stroke risk.
Folks with REALLY high blood pressure (approximately 160/90 and above):
- Start here. Combination medications (two drugs) as an initial therapy should be considered when the blood pressure is more than 20/10 mmHg above goal. Many combinations exist, so discuss the options with your doctor.
What about patients with heart failure, diabetes, or heart attack?
For people with diabetes, heart failure, and those who have had a heart attack, blood pressure medications are added to lower blood pressure and also improve outcomes. Simply put, beta blockers, ACE inhibitors and ARBs improve outcomes in people after a heart attack and in those with diabetes or heart failure.
For years, GoodRx has been telling Americans to compare prices and shop around.
With the support of millions of Americans, GoodRx has just negotiated even greater savings at a number of pharmacy chains. There’s never been a better time to shop around than now.
Prices at many pharmacies will be changing in February and March—which means big opportunities for you to save even more.
CVS drops prices by as much as 80%
Starting February 1, GoodRx discount prices at CVS will drop by up to 80% for many prescriptions. This is great news—CVS has more than 9,000 pharmacy locations across the US, and CVS is often the most convenient option for many folks.
Expect to see huge savings on popular cholesterol meds like rosuvastatin (Crestor), which will decrease by 80%—from around $200 to under $40 for thirty 10 mg tablets! You should see price decreases on many other prescriptions as well, including duloxetine (Cymbalta)—a 50% drop from around $60 to around $30—and montelukast (Singulair)—dropping nearly 30% from around $70 to $20 for thirty 10 mg tablets.
If you fill your prescriptions elsewhere and there’s a CVS nearby, you may want to take another look. When visiting CVS, be sure to bring a new GoodRx coupon to get the best price.
Big savings at other pharmacies
We’ve negotiated better discounts at a number of other major pharmacies. Many of these new prices will be lower than your insurance co-pay, so it’s always worth checking. Over the next few months, you’ll see new, lower prices rolling out across many major pharmacy chains.
Price increases at Sam’s Club and others
While many pharmacies are dropping prices, they will be increasing at some pharmacy chains. For example, Sam’s Club has just announced that they will no longer honor pharmacy discounts (from anyone, not just GoodRx). If you’ve used GoodRx to fill at Sam’s Club, you may want to consider other options or check out their membership program (we list Sam’s membership prices on GoodRx so you can compare).
It’s never been more important to shop around. But why?
Whether you see your costs at your regular pharmacy go up or down, we always recommend checking GoodRx every time you fill for the latest coupons and discounts. We never want you to be surprised when you pick up your prescription.
To make sure you get the best price, simply print, text, or email yourself a new coupon for your next refill. If you have our mobile app, just ask your pharmacist to enter the new coupon information you’ll find on the app.
Generalized pain, migraines, increased sensitivity to light touch, fatigue, not waking up feeling rested . . . that’s what folks with fibromyalgia are dealing with. For years patients have asked: what really works for fibromyalgia? Primary care doctors and their patients are frustrated there are no quick solutions and options for treatment.
Well, the Annals of Rheumatic Diseases just published a review of what works, and what doesn’t work for the treatment of fibromyalgia. Here goes.
Strong evidence this works:
- Supervised aerobic exercise training. Walking, hiking, running, spinning, dancing, swimming, kick boxing, etc. Aerobic conditioning and training (preferably one that is supervised by a trainer or physical therapist) has the best results for the treatment of fibromyalgia.
- Sleep hygiene habits. This is the term used to describe good sleep habits. You may think you know these, but take a look at one of the best resources for sleep hygiene tips.
- Cognitive behavioral therapy (CBT). Ask your primary care doctor for a referral or look online at the Psychology Today Therapist Finder to find a therapist near you who takes your insurance.
- Acupuncture. While the studies for acupuncture and fibromyalgia are somewhat mixed, many suggest benefit. Cost is the downside here as many insurance plans don’t cover acupuncture.
- Tai Chi. This form of meditative exercise has been shown to help with fibro aching. If you don’t have access to an occupational or physical therapist adept in this, there are many Tai Chi resources online.
- Meditation. Meditation apps like Headspace, Buddhify, or Calm have made it easier to learn basic meditation techniques and practice these daily on your own.
Evidence is weak—don’t waste much time on these:
- Cymbalta (duloxetine)
- Lyrica (pregabalin)
- Flexeril (cyclobenzaprine)
- Savella (milnacipran)
- Low-dose amitriptyline
- Ultram (tramadol)
Recommendation AGAINST. Doesn’t work, and could be harmful:
- NSAIDs don’t appear to work for fibromyalgia. Non-steroidal anti-inflammatory drugs (NSAIDs) include naproxen (Aleve) and ibuprofen (Motrin, Advil).
- Opioid narcotics. These include hydromorphone, hydrocodone, fentanyl, etc. They don’t work for fibro and could be harmful—and addictive.
- MAO inhibitors. These aren’t really used at all anymore but they include rasagiline (Azilect), selegiline (Eldepryl, Zelapar) and tranylcypromine (Parnate).
How do I know if I have or don’t have Fibromyalgia?
The Fibromyalgia Rapid Screening Tool (FiRST) is a self-administered questionnaire developed by the French Society of Rheumatology. It can quickly detect fibromyalgia with a sensitivity of 90.5% and a specificity of 85.7% in the general population.
FiRST consists of questions covering: fatigue, pain characteristics, non-painful abnormal sensations, sleep problems, and so on. Each question requires only a “yes” or “no” answer, with a “yes” being worth one point and a “no” worth zero points. The highest possible score is 6, with a cutoff of 5 or more associated with the highest sensitivity and specificity for fibromyalgia.
Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2016 Jul 4. [Epub ahead of print]
Recently, the FDA approved two new orphan drugs, Rubraca and Spinraza.
But first, what is an orphan drug?
An Orphan drug is a medication used to treat a rare disease. By definition, a rare disease is one that affects less than 200,000 patients in the United States, according to the Orphan Drug Act or 1983.
Because some diseases are so rare, a lot of pharmaceutical manufacturers are hesitant to develop medications for the small amount of people that are affected. However, the FDA provides financial incentives to pharmaceutical companies willing to research and develop medications for rare disease.
Some rare diseases that are typically treated with orphan drugs include blood disorders, autoimmune disorders, generic disorders, and spinal muscular atrophy.
What is Rubraca indicated for?
Rubraca is for the treatment of patients with a certain type of ovarian cancer. It has been approved for women whose tumors have the BRCA gene mutation.
What is Spinraza indicated for?
Spinraza is the first and only treatment for spinal muscular atrophy in children in adults.
Spina muscular atrophy is a genetic disease that affects the part of the nervous system that controls voluntary muscle movement. Spinal muscular atrophy causes weakness of muscles used for activities like crawling, walking, sitting up, and controlling head movement. In severe cases, the muscles used for breathing and swallowing are affected.
You might be tired of hearing about the EpiPen pricing controversy after the past couple of months. In 2016, it felt like the the life-saving epinephrine auto-injector would never be affordable, as even generic epinephrine was priced around $300.
However, the new year has brought good news for auto-injector patients. As you may have heard, CVS announced last week that they would be offering the an EpiPen alternative for $109.99, and this week we have even more good news. According to the manufacturer Kaleo, an Epipen alternative, Auvi-Q, will be hitting pharmacies on February 14th. And the best part? Kaleo is making Auvi-Q free for many consumers.
What is Auvi-Q?
Just like EpiPen, Auvi-q is an epinephrine auto-injector used to counteract anaphylaxis, however there are some differences. For one, at the size of a credit card, the Auvi-Q is smaller than the EpiPen. The Auvi-Q also has a voice prompt system that guide patients through the epinephrine delivery process. You can read more about Auvi-Q here.
How much will Auvi-Q cost?
Auvi-Q has been listed at $4,500 for two auto-injectors. We know, this isn’t cheap. However, Kaleo has made it their mission to make Auvi-Q affordable and is guaranteeing a cash price of $360. Even better though—there are ways for most consumers to get Auvi-Q for free!
How can I qualify to get Auvi-Q for free?
Kaleo has created the Auvi-Q Affordability Program with the mission to make the auto-injector affordable for everyone. Under this program, there are two ways you can get the auto-injector for free:
- Anyone with insurance, including those with high-deducible plans, will able to get Auvi-Q with no out-of-pocket cost.
- Anyone without insurance can also get Auvi-Q free of charge if your household has an annual income of $100,000 or less.
Too good to be true? We don’t think so. In a recent press release, Kaleo Chief Executive Spencer Williamson mentioned that he is “confident the model provides access and affordability, and that it is a sustainable model.”
It seems like things with the epinephrine auto-injector are finally looking up! Stay tuned, and we will let you know when Auvi-Q is released.