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

FDA Recalls Lomotil For Diarrhea

by The GoodRx Pharmacist on December 8, 2017 at 5:28 pm

On November 16th, 2017, Manufacturer Greenstone LLC issued a voluntary recall of Lomotil (diphenoxylate/atropine), used to treat diarrhea. 

This is a class II recall, the most common type of recall, which means that there is a situation where the use of the recalled medication may cause temporary or medically reversible adverse health consequences, but 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 recall their medication, or the Food and Drug Administration (FDA) can request or require that a manufacturer recalls a particular medication. In this case, the manufacturer has voluntarily recalled diphenoxylate/atropine.

Why were these products recalled?

Greenstone LLC has issued a recall due to possible sub-potent and super-potent tablets. In other words, some tablets may contain too much medication (super potent) or not enough medication (sub-potent).

Taking a diphenoxylate/atropine tablet that contains too much medication can cause life-threatening toxicity, coma, problems breathing, lethargy, skin flushing, and drowsiness. On the other hand, taking a diphenoxylate/atropine tablet that doesn’t contain enough medication can worsen diarrhea.   

Have there been any adverse events reported to the FDA from patients?

No. At this time, the FDA has not received any reports of adverse events associated with this recall.

Which products were recalled?

According to the FDA’s announcement, the affected products were distributed nationwide to wholesalers and retailers in the United States from November 2016 to June 2017.

This recall will affect the following:

  • Drug: Diphenoxylate/atropine 2.5 mg/0.025 mg tablets
  • Manufacturer: Greenstone, LLC
  • Bottle Size: 100-count (NDC 59762-1061-01), 1000 count (NDC 59762-1061-02)
  • Lots 
    • 100-count bottles: R83962, R93347, R93348, R93349, R93350, R93351, R93352, S57831, S57832, S57834
    • 1000-count bottles: R93356, R93357, R93358, R97310

FDA Approves New Device to Help With Opioid Withdrawal

by The GoodRx Pharmacist on December 7, 2017 at 2:46 pm

The opioid epidemic in the United States has become a serious public health problem, causing many pharmaceutical companies to focus their efforts on creating new and innovative treatment options.

The newest device aimed at increasing treatment options for opioid addiction was just approved by the FDA. The NSS-2 Bridge device is an electric stimulation device that can provide relief from opioid withdrawal symptoms.

How does the NSS-2 Bridge device work?

The Nss-2 Bridge works by emitting electrical pulses to the brain, which may provide relief from opioid withdrawal symptoms. The device works best if placed behind the ear, and can be worn up to 5 days during the initial physical withdrawal phase.

The device will help ease symptoms of withdrawal like sweating, upset stomach, agitation, problems sleeping, and joint pain within 30-60 minutes.

Is there anyone who should not use this device?

Yes.  The device should not be used in patients who have hemophilia, psoriasis, or a cardiac pacemaker.

Is the device waterproof?

No.  The device is considered water-resistant and can be worn while a patient washes their hair; however, it has been recommended that holding a dry washcloth or a small plastic cup over the ear while showering will be enough to protect the device.

For more information, visit the Innovative Health Solutions website.


Generic Viagra Now Available: Here’s How to Get It

by Thomas Goetz on December 7, 2017 at 2:44 pm

As of Monday, Dec. 11, 2017, two generic versions of Viagra (sildenafil) will be available in pharmacies: one by generic manufacturer Teva, and the other by the original manufacturer, Pfizer. Prices for generic sildenafil should be about half what they are for the brand version, according to the AP.

Current prices for Viagra are around $70, which would put the generic versions between $30 and $35. That’s before any additional discounts – check back at GoodRx to see what additional discounts might be available.

Pfizer announced plans to release its own generic version days before Teva’s version arrives on the shelves (Teva has planned a generic version since 2013). This will allow Pfizer – which sold more than $1 billion of Viagra in the US in 2016 – to keep some of that cashflow coming in. Other generic versions are expected to arrive in pharmacies in the summer of 2018, which should drive prices even lower.

More than 60 million men worldwide have used Viagra since it hit the market in 1998. Those are the official numbers from Pfizer; many men are embarrassed to ask their doctors for a prescription, and the Internet has long been awash in dubious offers for the drug without a prescription.

 

This story has been updated to reflect current news. The original story is below.

Pfizer, the manufacturer of erectile dysfunction med Viagra, just reached a settlement with generic manufacturer Teva that will allow Teva to start selling generic Viagra (sildenafil) in December 2017—that’s more than two years earlier than the current patent expiration in April 2020.

This is great for anyone using Viagra, as the cost of generic sildenafil will be lower, but a there are a few things to keep in mind.

The Teva generic will be the only one available for two-plus years, unless there are other settlements or the patent is contested successfully. This means that there won’t be a lot of competition to drive the generic price down once it hits the market.

There is also a chance that because the indication (the reason it’s prescribed) isn’t considered essential by many insurance plans, your odds of getting the generic covered may not be all that much better than the brand.

Some better news though: The patent expiration for Cialis also falls in that 2017 – 2020 window, in May 2018, so other generic options in the same class of drugs may help lower prices as well.

You may also be aware that generic sildenafil is already available, as a generic to pulmonary arterial hypertension drug Revatio. You can check out Dr. O’s article It’s Here! Finally a Viagra You Can Afford for more info.

Overall, don’t expect major changes for a little while longer yet, but they are coming.

In the meantime, you can see Viagra offers and prices here, and Cialis offers and prices hereViagra and Cialis both offer free trials, and Viagra offers a home delivery program.


Xarelto Generic Is Three Years Away: Here’s How to Save While You Wait

by Tori Marsh on December 6, 2017 at 5:22 pm

Xarelto is a commonly prescribed drug that helps prevent blood clots, stroke, and atrial fibrillation (a so-called anticoagulant).

The bad news? It’s really expensive, and Xarelto isn’t expected to be available as a generic for some time. If your doctor thinks Xarelto right for you, how can you make it affordable?

Here’s some information about Xarelto and how you can save.   

How popular is Xarelto?

Xarelto is the third most popular anticoagulant, a class of medications that also includes Coumadin (jantoven, warfarin), Praxada, and Eliquis. Commonly referred to as blood thinners, these drugs help to prevent blood clots that can cause deep vein thrombosis, pulmonary embolism, angina, stroke, and heart attack.

When will generic Xarelto be available?

As of December 2017, there is no generic available for Xarelto. However, it may become available as rivaroxaban in 2021, when the brand name patient expires. While you might have to wait three more years to save with the generic, there are other ways to cut costs on Xarelto.

Are there any cheaper anticoagulants I can try?

While Xarelto doesn’t have a generic, there are a couple of alternatives. Be sure you speak with your doctor to see if these alternatives will work for you.

  • Coumadin (warfarin, jantoven). Coumadin is a popular anticoagulant that has two affordable generic alternatives, warfarin and jantoven, that can cost as little as $4 for a one month supply. Very affordable, but what is the downside? Well, Coumadin can raise your risk of bleeding and bruising, so it requires regular blood tests to ensure its effectiveness.
  • Other anticoagulants. Pradaxa or Eliquis are both still only available in brand form – so they don’t have cheaper generic versions. Still, these alternatives may be more affordable, especially if they are covered by your prescription insurance.
  • For more information on how Xarelto compares to other anticoagulants, check out Iodine’s page on Xarelto alternatives. As always you’ll want to speak with your doctor if you think other medications might work better for you.

Xarelto still works best for me—how can I save?

  • Fill a 90-day supply. This can help shave a little more off of your out-of-pocket costs. Be aware that you will need a new prescription from your doctor, and approval from your insurance to fill for a higher quantity. Check in with your doctor, insurance, and/or pharmacist.
  • Use a Xarelto coupon from GoodRx. GoodRx offers discounts for Xarelto online, which can usually save at least 15% off the full retail price.
  • Split a higher dosage pill. This can help reduce costs, especially if two strengths are priced similarly. You’ll want to check in with your doctor to see if this is a safe option for you.
  • Try to appeal your coverage. If you have insurance, and your plan doesn’t cover Xarelto, ask your doctor about submitting an appeal. Some plans require prior authorizations—meaning you need permission from your insurance plan and a special request from your doctor before you can fill your prescription. If you have insurance, call your provider and ask how to get this process started.

The Best Medication for Insomnia: Ambien, Sonata, or Lunesta?

by Thomas Goetz on December 6, 2017 at 4:37 pm

These days, insomnia is pretty much part of the national condition. Every evening, millions of Americans use a prescription drug to help them get to sleep and stay asleep – usually a generic version of Ambien (sold under the generic name zolpidem), Sonata (zaleplon), or Lunesta (eszopiclone).   

These three medications are all so-called “z-drugs”: Non-benzodiazepines that calm the brain and induce sleep by inducing a sort of hypnotic effect. They’re considered safer to use than the benzodiazepine drugs, which have a higher risk of dependence and overdose.

How effective are these sleep drugs, anyway, and who do they work for best? It’s a straightforward enough question. But answering it isn’t so simple.

One problem is that in clinical trials, sleep medications are usually tested in sleep laboratories. Sleep labs look something like a motel room — there’s a bed and a bedside table, but also a machine that has all sorts of wires connected to it. These wires are hooked up to the study subjects to monitor vital signs as they sleep (or try to sleep). But a sleep lab is a poor proxy for real life. At best the labs are unfamiliar and somewhat uncomfortable; at worst they can heighten the anxiety that can cause insomnia.

And then there’s the problem of sample size: Sleep lab studies are expensive, so many clinical trials include fewer than 1,000 people, and sometimes fewer than 100 people, sleeping in the lab for just one or two nights.

 

Data from the Real World

Our friends at Iodine have collected a lot of data about the real-life experience of real people taking these drugs. Hundreds of people have shared their experiences with Ambien, Lunesta, and Sonata.

People rated these drugs in three respects: 1) how well did they think the drug worked, 2) how much of a hassle – in terms of side effects and other challenges – did the drug create, and 3) what was their overall satisfaction with the drug – a “worth it” score.

So what did people say? For one thing, younger people are less satisfied with sleep medications and find them to be more of a hassle, in terms of side effects – and older people find sleep drugs to work better with fewer side effects.

And then there’s the bottom line: which drug works best. Comparing the “worth it” scores for these three drugs, the Iodine data shows a clear preference for Ambien, in terms of overall satisfaction – the “worth it” score. People taking Ambien (zolpidem) say it’s worth it 67% of the time, while Lunesta (eszopiclone) gets a 55% worth it score, and just 42% of people say Sonata (Zaleplon) is worth it. That leaves a lot of people still unsatisfied with these sleep medications. And that means lots of people are still going to struggle with insomnia, even with medications.

These results are especially interesting compared to published research. A study in Japan that compared eszopiclone (Lunesta) versus zolpidem (Ambien), for instance, found that at doses of 2mg or higher, eszopiclone was comparably effective in helping people fall asleep and more effective in overall sleep efficiency (defined as the percentage of time people stayed asleep). But the effect depended entirely on dose: eszopiclone’s advantage disappeared when it was administered at 1 mg. That’s important because the FDA reduced the recommended dose for eszopiclone from 2 mg to 1 mg, following reports that people on higher doses were less alert in the morning and at a higher risk in activities such as driving a car. This followed an earlier FDA adjustment in the recommended dose for zolpidem in women from 10 mg to 5 mg. (We don’t know the dose for people in our survey).

And here’s where price matters: at GoodRx, prices for zolpidem are around $8 – that’s about half what they are for zaleplon, and 60% cheaper than a prescription for eszopiclone. Considering that people report better satisfaction with zolpidem than the others, it looks like the cheapest drug might also be the one people prefer most. In other words, Ambien (zolpidem) offers the best bang for the buck.

Prices shown are average GoodRx discounted prices as of Dec 6, 2017. Local results may vary.


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