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

Hyperglycemia vs Hypoglycemia: What’s the Difference?

by The GoodRx Pharmacist on June 30, 2017 at 2:24 pm

If you have diabetes, you’re likely well aware of the issues that can come with blood sugar levels that are too high—or too low. Hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) may sound similar, but they can have very different consequences.

Using too much or too little insulin can affect your blood sugar levels, but even if you aren’t diabetic, you should know that side effects of other medications, not eating enough (or eating too much), or even exercising more than usual can all affect your blood sugar. The scary part? Some people don’t have many symptoms, and may not be able to tell that their blood sugar is too high or too low without a glucose meter check.

So what’s the difference, and how can you avoid hyper- and hypoglycemia?

Hypoglycemia (Low Blood Sugar)

Low blood sugar can be caused by not eating enough food or a delayed meal, an unusual amount of exercise, and drinking alcohol without eating food. If you use insulin, you know that your blood sugar levels can go too low if you use too much of your medication.

Symptoms of hypoglycemia include sweatiness, shaking, dizziness, confusion, a fast heartbeat, hunger, feeling weak or tired, feeling nervous or upset, or headache.

Will I notice if my blood sugar is low?

Maybe. You may experience some of the symptoms mentioned above like feeling sweaty, shaky, or dizzy; a fast heartbeat; or feeling hungry. However, some people don’t feel anything at all.

Hypoglycemia unawareness is the term for not being able to tell if your blood sugar is low, and it can be very dangerous.

How can I know if my blood sugar is low if I don’t notice any symptoms?

You’ll need to use a blood glucose meter, which can determine the amount of sugar in your blood using a small drop of blood typically from your finger tip, although some meters allow you to test from sites other than your fingertip.

How can I treat low blood sugar?

A quick sugar source containing at least 15 grams of carbohydrates is effective—this is known as the rule of 15. Some examples include:

  • 4 glucose tablets
  • ½ cup of juice or milk
  • ½ cup of regular (non-diet) soda pop
  • 1 cup of milk
  • 1 tablespoon of sugar or honey
  • 5 – 7 candies you can chew quickly (like jelly beans or gum drops)

How can I make sure my blood sugar doesn’t get too low?

It’s important to make sure you eat a meal or snack containing protein—this will help keep low blood sugar from coming back.

What risks are associated with low blood sugar?

Severe low blood sugar is an emergency is usually requires help from someone else.

Hyperglycemia (High Blood Sugar)

High blood sugar can be caused by certain medications, stress, having a cold or other infection, and eating certain foods. If you use insulin, you know that not using enough, or using damaged or out of date insulin can also let your blood sugar levels get too high.

Early symptoms of high blood sugar include frequent urination, increased thirst, blurred vision, headache, and tiredness.

Later and more serious symptoms include fruity or alcoholic smelling breath, dry mouth, confusion, weakness, stomach pains, general aches, shortness of breath. You may have a loss of appetite and nausea and vomiting. If you are measuring your glucose and ketone levels, you would see large amounts of sugar in the blood and ketones in the urine.

Will I notice if I have high blood sugar?

The symptoms of high blood sugar may be easier to spot. If you’re thirstier than usual, frequently urinating, and tired, you may want to check your blood sugar, or see your doctor.

How can I keep my blood sugar low?

Healthy diet, exercise, and lowering stress levels can all help keep your blood sugar levels low. If you have a fasting blood sugar level high enough to be considered diabetes, your doctor may also prescribe medications like metformin or insulin to help control your blood sugar levels.

What risks are associated with high blood sugar?

Severe high blood sugar can result in diabetic ketoacidosis or DKA. DKA occurs when there isn’t enough insulin in the body, and while it can mean you haven’t used enough insulin, it can also be triggered by infection or other illnesses.

This condition is where you’ll see the more severe symptoms, including thirst, frequent urination, nausea, abdominal pain, weakness, fruity-scented breath, and confusion.

If you think you may be experiencing DKA, contact your doctor immediately.


FDA Approves Parsabiv for Secondary Hyperparathyroidism

by The GoodRx Pharmacist on June 28, 2017 at 3:31 pm

In February, manufacturer Amgen announced that the FDA approved Parsabiv (etelcalcetide) for secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on hemodialysis.

Secondary hyperparathyroidism is a condition that lowers calcium levels, causing your parathyroid glands to overproduce the parathyroid hormone. This can cause cardiovascular, neurological and immune system complications. Secondary hyperparathyroidism is especially seen in patients with CKD, but can also be caused by severe vitamin D or calcium deficiency.

What is chronic kidney disease (CKD)?

Chronic kidney disease is a condition characterized by the gradual loss of kidney function over time. It can be caused by diabetes, high blood pressure, inflammation of the kidneys, kidney infections, or urine backup into the kidneys.

How is Parsabiv to be used?

The recommended dose of Parsabiv is 5 mg, by intravenous bolus injection three times a week. Injections should be done at the end of hemodialysis, a treatment that filters waste and removes extra fluid in the kidneys.

Parsabiv will be available as an injection in the strengths of 2.5 mg/0.5 ml, 5 mg/1 ml, and 10 mg/2 ml. Your doctor will determine your specific dose of Parsabiv.

Parsabiv is the first treatment approved in 12 years for secondary hyperparathyroidism. It is also the only medication that mimics calcium and can be given intravenously. Parsabiv was also approved by the European Commission in November of 2016.

What side are effects associated with Parsabiv?

The most common side effects include diarrhea and nausea.

How can I save on Parsabiv?

Manufacturer Amgen has two programs to help patients afford Parsabiv. For commercially insured patients, the Parsabiv Co-Pay card can help you reduce your copay to as little as $5. For more information, see Parsabiv’s website here, or call 1-888-762-6436.

Eligible uninsured patients can receive Parsabiv free for up to one year with Amgen’s Safety Net Foundation Patient Assistance program. For more information visit the Safety Net Foundation’s website here, or call 1-888-762-6436.

You can also learn more about Parsabiv in the press announcement here.


FDA Approves Generic Dexilant for Heartburn

by The GoodRx Pharmacist on June 27, 2017 at 4:01 pm

Heartburn, also known as acid reflux or gastroesophageal reflux disease (GERD), is a digestive disease in which stomach acid of bile irritates the food pipe lining.

These days, many heartburn medications are conveniently available over-the-counter. However, some of these medications still require a prescription from your doctor. Common treatments include medications like Nexium (esomeprazole), Protonix (pantoprazole) and Dexilant—which now has a generic.

On May 16th, 2017, the FDA approved the generic for Dexilant, dexlansoprazole, which can help you save at the pharmacy!

What is Dexilant (dexlansoprazole) indicated for?

Dexilant (dexlansoprazole) capsules are indicated for healing and maintenance of erosive esophagitis, heartburn relief, and treatment of symptomatic gastroesophageal reflux disease (GERD).

Dexlansoprazole will be available as a capsule in a strength of 60 mg. Brand name Dexilant is also available as a 30 mg capsule, but it has not been approved in a generic form yet.

Dexlansoprazole is unique in that it delivers 2 releases of medicine in one capsule. The first release occurs within an hour of taking dexlansoprazole and the second occurs 4 – 5 hours later.

What are the most common side effects of Dexilant (dexlansoprazole)?

The most common side effects associated with dexlansoprazole include diarrhea, nausea, stomach pain, vomiting, common cold and gas. Be sure to speak with your doctor if you experience any of these side effects for a prolonged period of time.

Can I continue to use brand name Dexilant?

If you would like to continue taking brand name Dexilant, make sure your doctor hand writes “brand medically necessary” on your prescription. This means the pharmacy is not permitted to substitute and give you the generic product. If your doctor doesn’t indicate this on your prescription, you can also request it from your pharmacist before having your prescription filled.

Keep in mind that because the generic product is now available, your insurance company may not be willing to cover the cost of the more expensive brand medication. Be sure to check your prescription insurance company to find out if it is covered before taking a trip to the pharmacy.

Does Dexilant have any cost saving programs?

Yes! The manufacturer of Dexilant, Takeda Pharmaceuticals, has an instant savings card available for commercially insured patients. Eligible patients can pay no more than $20 for their dexilant capsule prescription and refills.


These 10 Drugs Could Harm Your Eyes

by Dr. Sharon Orrange on June 25, 2017 at 5:00 am

Your eyes have a combination of a relatively small size with a rich blood supply that makes them extra vulnerable to negative side effects from medications.

These side effects vary—and may involve the lens, retina or cornea. If you’re older, or using a medication at a high dose for a longer period of time, be aware that your risk will be higher.

Here are ten oral medications known to have adverse effects on the eye:

  1. Alendronate (Fosamax) is taken once a week and belongs to a class of medications used for osteoporosis called bisphosphonates. Blurred vision, eye pain, conjunctivitis and even double vision have been reported.
  2. Topiramate (Topamax) is used for the treatment of seizure disorder, migraine headache, and mood disorders. Topiramate is known to cause acute glaucoma (an eye condition that damages the optic nerve) which may present with eye pain, headache and blurred vision. Increased eye pressure, mydriasis (dilated pupil), and other rare eye complications have also been reported. Stop the medication immediately and consult with an eye specialist if you develop these eye symptoms.
  3. Isotretinoin (Accutane, Absorica) is the pill used for acne, and it has many rare but known eye complications. A strange fact is that isotretinoin has been shown to be secreted in tears by the lacrimal gland—which may be why it causes problems. Dry eyes as a result of abnormal meibomian gland function (those glands release oil into tears), blepharoconjunctivitis (inflammation of the eye and eyelid), decreased tolerance for contact lens wear, dry eye, and photophobia (light bothers your eyes) are all known eye side effects of isotretinoin.
  4. Amiodarone (Cordarone) is a medication used to control heart rhythm in people with atrial fibrillation. Ocular (eye) side effects are common and dose-dependent (the higher the dose, the more risk of eye problems). Regular eye exams are recommended for anyone taking amiodarone. Seeing bright lights, haloes around lights, glare, hazy vision, and dry eyes are among the known complications.
  5. Tamsulosin (Flomax) is a medication used primarily for urinary symptoms related to a large prostate (benign prostatic hypertrophy). If you are going to have cataract surgery you must let your surgeon know you are taking tamsulosin. Tamsulosin has been associated with intraoperative floppy iris syndrome (IFIS), a complication that can occur during cataract surgery. Stopping the medication prior to surgery does not prevent or decrease the severity of IFIS. In one study, floppy iris syndrome was reported at cataract surgery in 25 of 58 eyes in those taking tamsulosin—so it is not uncommon.
  6. Sildenafil (Viagra) is sed for erectile dysfunction (ED). Viagra may cause changes in color perception, blurred vision, eye pain, and photophobia. Cialis and Levitra are in the same class of medications as Viagra so may cause the same eye problems. For all three drugs, the side effects are rare, more common at higher doses, and do resolve once the medication is stopped.
  7. Tamoxifen is an anti-estrogen medication used in the treatment of breast and ovarian cancer. It is known to cause eye problems including corneal opacities and loss of visual acuity. It’s recommended that you have an eye exam in the first year of using tamoxifen.
  8. Celecoxib (Celebrex). COX-2 Inhibitors including celecoxib and meloxicam (Mobic) are used for pain and inflammation. They may cause blurred vision and conjunctivitis. Discontinuing these meds will reverse the problem.
  9. Ethambutol and isoniazid are antibiotics prescribed together for the treatment of tuberculosis. Both may cause color vision changes, visual field defects, and an optic neuritis (an inflammation that damages the optic nerve).
  10. Hydroxychloroquine (Plaquenil) is a used for the treatment of malaria as well as rheumatoid arthritis, lupus, and other autoimmune disorders. The eye effects of this medication are numerous—they include corneal deposits and toxicity to the retina. Regular eye exams will be recommended by your doctor while on hydroxychloroquine.

Anyone experience any of these?

Dr O.


Make Sure You Check These 5 Things on Every New Prescription

by The GoodRx Pharmacist on June 23, 2017 at 2:15 pm

Although there are many ways your doctor can get your prescription to the pharmacy (phone in, fax, electronically, etc.), many doctors will still write out a paper prescription. If your doctor hands you a prescription, there are a few important things you should know and/or look for.

1. Is your name correct?

Believe it or not, there are times where patients bring a prescription to the pharmacy with an incorrect first or last name. If this happens to you, the pharmacist will have to call your doctor to ensure that you have the correct prescription, despite the wrong name.

You can prevent this clerical error by always double checking any paper prescription that has been handed to you. This quick check can save you time at the pharmacy!

2. Is it for a pharmacy?

Although most prescriptions are meant for the pharmacy, there are several occasions where I have received a prescription for things other than a medication. Some things your doctor may prescribe to you, that isn’t a medication, include:

  • Prescriptions for blood work, labs, or scans.
  • Prescriptions with instructions for how to care for your condition.
  • Notes for certain over-the-counter medications you might need.
  • Certain medical devices that need to be obtained from a medical supply store. This can include things like canes, walkers, nebulizers or compression stockings.

3. Is it the medication you were expecting?

It’s unfortunate, but many patients I have spoken to at the pharmacy don’t know what their medication is being used for, let alone what is actually being prescribed. It is important to find out what is being prescribed, and what the medication is treating before leaving the doctor’s office. Informed patients are equipped with the knowledge necessary to make important decisions about their own health!

4. Did your doctor sign the prescription?

This is a big one! Pharmacies will not accept a prescription that is not signed by your doctor. A quick glance at your prescription to make sure that your doctor has signed the prescription can save you time at the pharmacy!

5. Is anything missing?

No one expects you, as the patient, to understand or decipher what your doctor wrote on your prescription. However, taking a quick glance could save you time in the long run.

There are a few minor details, if not filled out properly, that could delay you from receiving your prescription. Specifically, be sure that your prescription contains the date, doctor prescribing credentials, quantity, directions, and strength.


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