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It’s easy to save at Fred’s. Just look up a prescription on on GoodRx to quickly see prices, discounts, savings tips and information about Fred’s pharmacy locations. Then, print, email or text a coupon for your prescription, and present it to the pharmacist to save.
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For women having trouble getting pregnant, the decision to try in-vitro fertilization (IVF) is a big deal. It requires 4 to 6 weeks of almost daily office visits, monitoring, and medication – and after everything’s said and done, the average cost of one IVF cycle is $23,000. Those who can afford it or whose insurance will cover it will often go through 2-3 IVF cycles to increase their chances of successful pregnancy.
Each year, about 1.5% of births in the U.S. are conceived through IVF. Fertility treatment is often recommended even after conception to help support and protect pregnancies. But now, progesterone in oil, an injectable medication that does just that, is facing a shortage.
Since the shortage began relatively recently in August, either the drug makers have not yet reported it to the FDA or the FDA has not yet updated their drug shortages database to reflect it. It is expected to be resolved late December at the earliest, which could affect many newly pregnant women in their first trimester.
What is progesterone in oil and why is it used?
Not to be confused with the two types of shots you have to take during the IVF cycle, progesterone in oil is only used after successful implantation through IVF. Progesterone in oil is an intramuscular injection, meaning you take the shot in the butt cheek. It helps thicken the uterine lining to secure the embryo and allow it to develop properly. A daily dose of 50mL is typically administered for the first 6-12 weeks (or first trimester) of pregnancy, but the dosage and length of treatment may be adjusted depending on how your body reacts to the initial doses.
While progesterone for fertility treatment is available in other forms, like oral capsules (generic progesterone, $23.76) and lozenges (not available retail), or vaginal suppositories (Endometrin, $235.34) and gel (Crinone, $422.50), many physicians consider the injection the first line therapy for women with infertility issues, either on its own or in conjunction with other forms. It’s also the cheapest option at $27.39 through GoodRx.
(In case you’re wondering, the other two shots are typically injected under the skin in the abdomen and thigh. Injections of gonadotropin hormones are taken throughout the IVF cycle to stimulate ovulation, while the human chorionic gonadotropin (hCG) injection is only needed 34-37 hours before the retrieval of the egg. The hCG hormone brings the egg to final maturation and assists in its release from the ovaries.)
What exactly is in shortage and why?
Surprisingly, the progesterone itself is not in short supply. Since the hormone comes as a powder that’s insoluble in water, it needs to be mixed with an oil to make it injectable. And it’s the oil that’s become hard to get – specifically sesame oil, which is the standard used by drug companies to produce the progesterone injection. Pharmaceutical grade sesame oil is considered different from food grade sesame oil (the stuff you find in grocery stores) because only certain production facilities following stricter FDA regulations are approved for drug production.
Since progesterone in oil is not officially reported as being in shortage, there is no way to know why there are limited supplies of sesame oil. But for any drug shortage, there are many factors to consider. Sometimes there’s a lack of raw material or a compliance issue during production. Or maybe the drug isn’t profitable enough for the drug company to prioritize manufacturing. The important thing is that the shortage is temporary, or that there are at least comparable alternatives for patients who rely on the treatment.
What if you need progesterone in oil – now?
Luckily, sesame oil isn’t the only oil used to make the progesterone injection. While leading drug manufacturers like Teva, West Ward, and Fresenius Kabi combine progesterone with sesame oil, some specialty or compounding pharmacies create made-to-order progesterone injections with ethyl oleate or olive oil (this is often done when a patient is allergic or has unwanted side effects with sesame oil). The key difference between the vehicles is the thickness of the oil – thicker oil requires a thicker needle, which may be more painful to use. Olive oil is the thickest of the three, while ethyl oleate is the thinnest.
One compounding pharmacy, MDR Fertility Pharmacy, has boosted their production of both progesterone in olive oil and progesterone in ethyl oleate during this shortage to help women in need of the progesterone injection. Robert Makhani, PharmD, MDR Executive Vice President, says MDR and other licensed sterile compounding pharmacies are working hard to ensure every patient who calls in can secure at least 2-3 vials of progesterone in oil (one vial lasts about 8-10 days). While Dr. Makhani is confident the shortage will end in January at the latest, he says MDR will fulfill orders well into the future, as needed.
Progesterone in sesame oil, brand name Progesterone Injection USP, will most likely be out of stock at your local retail pharmacy, like Walmart or CVS. It’s best to call and check to make sure it’s is available for pickup, even if it’s listed on the GoodRx page. If it’s not and you need it soon, call your fertility clinic to see if they work with any compounding pharmacies, or call MDR directly and mention “GoodRx” for competitive pricing.
Prices shown are average GoodRx discounted prices as of Nov 29, 2017. Local results may vary.
New medications used to treat type 1 and type 2 diabetes are popping up left and right. From 2013-2016 there have been 15 new oral and injectable medications approved for the treatment of diabetes alone.
What’s noteworthy about this class? There’s a possibility that we might see some oral GLP-1 inhibitors soon! This could mean no more painful injections.
But first, what are GLP-1 agonists?
GLP-1 agonists are considered non-insulin injections that help to improve blood sugar control and control weight in patients with type 2 diabetes. Drugs in this class work by slowing the release of food from your stomach, reducing the amount of sugar your liver releases, and controlling the amount of insulin released into your pancreas.
GLP-1 agonists work strategically to control your blood sugar and can help lower your A1C by 0.8% to 2%. The downside? GLP-1 agonists are only available as injectables.
Will we see oral treatments in the foreseeable future?
Possibly! A leader in diabetes care, Novo Nordisk, has been working on an oral GLP-1 formulation that’s comparable to the current injectable formulations.
Before the possibility of an oral GLP-1 agonist, Novo Nordisk will most likely receive approval for their once-weekly injection, semaglutide.
But have no fear, Novo Nordisk has been testing the oral form of semaglutide in patients with type 2 diabetes. There are two current clinical trials that show a lot of promise for oral GLP-1 agonists, PIONEER 2 and PIONEER 8. In both of these trials, oral and injectable forms of semaglutide were related to an average drop in A1C by about 1.9%, and an approximate weight loss of at least 5% for most people.
At this point, the possibility of a once-daily oral GLP-1 agonist may soon become a reality for those with type 2 diabetes. Stay tuned!
For people who need to take insulin, there are a couple of different types—long-acting, short-acting, rapid-acting, intermediate-acting, etc. That’s a lot of options!
One question I see most often is the difference between rapid-acting and long-acting insulins. So, let’s get into it.
What is rapid-acting insulin?
Rapid-acting, or meal-time insulin, is a type of insulin that’s usually taken before, during, or after a meal to lower your blood sugar levels associated with meals.
How long does it take rapid-acting insulin to begin working?
The onset of action varies between rapid-acting insulin products, but can begin working in as little as 5 minutes, or could take as long as 30 minutes, depending on the insulin.
The following are the typical onset of action times for each individual rapid-acting insulin products.
What is long-acting insulin?
Long-acting, or basal insulin, is a type of insulin that gives you a slow steady release of insulin that helps control your blood sugar between meals, and overnight.
How long does long-acting insulin last?
The duration of action varies between long-acting products but should last anywhere between 22-24 hours. The following are the typical duration of action times for each individual long-acting insulin product:
Do I need more than one insulin?
Maybe. It’s up to your doctor to determine the best medication regimen for you.
Some type 2 diabetes patients may only need to use a long-acting insulin to get their blood sugar control on track; whereas others may need a combination of meal-time and long-acting insulin to best control their blood sugar.
If you are using an insulin pump, you will only need to use a rapid or short-acting insulin. The pump is able to give you a slow and steady amount of insulin to cover you all day like a long-acting insulin would do. However, it’s a good idea to have a back-up of long-acting insulin on hand in case your pump should fail.
Is there anything in between rapid-acting and long-acting?
Yes. There are short-acting and intermediate-acting insulins available.
- Short-acting insulins are used like rapid-acting insulin to cover blood sugar elevation from eating.
- Intermediate-acting insulins are similar to long-acting insulins as they are used to cover blood sugar elevations when the rapid-acting or short-acting insulins finish working.
Are there any combination options available for those who don’t want to inject themselves so often?
Yes. Some insulin products combine fast and longer-acting insulins that work together to help manage blood sugar between meals and at night, as well as blood sugar “spikes” that happen when you eat. Here are a few examples of these:
- Humalog 50/50
- Humalog 75/25
- Novolog 70/30
- Humulin 70/30
- Novolin 70/30
- Ryzodeg (FDA approved but not yet available)
Combination insulin products typically only need to be injected twice daily since they are single insulin products that work in 2 ways.
Are there any insulin products that last longer than long-acting insulins?
Does all insulin need to be injected?
No. Currently, there’s 1 rapid-acting insulin product, Afrezza, that’s inhaled through the mouth.
Prescription opioids like oxycodone, hydrocodone, codeine, and morphine have long been considered some of the most helpful drugs for managing acute pain, where the body is immediately reacting to trauma or injury. Each year, over 200 million opioid prescriptions are given out in the United States.
Unfortunately, the rates of opioid abuse and overdose deaths have skyrocketed in recent years, leading healthcare providers and patients alike to be cautious about the use of opioids. And now it turns out that there is another reason to avoid opioids: they may not be the most effective treatment for acute pain after all.
Do opioids work better than other drugs?
A recent study in the Journal of the American Medical Association throws into question how well opioid drugs actually treat acute pain.
In the study, researchers assigned 416 emergency room patients with moderate-to-severe pain to one of four treatment groups. Three of the treatment groups received a combination of a common opioid painkiller (either oxycodone, hydrocodone, or codeine) plus 300 mg of acetaminophen, a common non-opioid pain medication often sold over the counter as Tylenol. The fourth group received 400 mg of ibuprofen, a non-opioid painkiller, plus 1,000 mg of acetaminophen.
The result? All four groups experienced the same levels of pain relief. While opioid drugs did help to reduce pain, they were no more effective than a combination of non-opioid painkillers.
What are other options for pain treatment?
While opioids are usually given for acute pain, some of the following options also work well for chronic pain, or pain that lasts longer than six months.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen, naproxen, and aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDs). They control pain, lower fevers, and reduce inflammation. NSAIDs are often considered to be the first line of defense for acute pain, especially pain that doesn’t respond to non-drug treatments.
NSAIDs are available over-the-counter with brand names including Advil, Motrin, Aleve, Bayer, and Excedrin. NSAIDs are also available in prescription strength, with common brand names like Celebrex, Naprelan, Anaprox, Voltaren, and Feldene.
One word of caution: long-term use of NSAIDs can lead to stomach distress or bleeding in your gastrointestinal tract, and the FDA warns that non-aspirin NSAIDs may increase the risk of heart disease and stroke.
Acetaminophen is used on its own as a painkiller and is also an active ingredient in many combination medicines for pain and colds. It is a popular over-the-counter option, sold under brand names like Tylenol. Acetaminophen is especially helpful in addressing acute pain for conditions like headache, arthritis, and cancer pain.
Acetaminophen does not cause the gastrointestinal or cardiovascular side effects of NSAIDs, but taking amounts in excess of the recommended dosage may lead to liver damage or even liver failure. Because acetaminophen is present in so many medications, check whether other medications you’re taking contain acetaminophen as well.
A category of antidepressants called tricyclic antidepressants have the most evidence for treating pain, especially nerve pain. Imipramine (Tofranil), nortriptyline (Pamelor), desipramine (Norpramin), and amitryptiline (Elavil) are tricyclic antidepressants. While these drugs can be helpful, they aren’t effective for everyone.
Some evidence shows that two other categories of antidepressants–selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), or serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta)–are also helpful for chronic pain, but more research is needed.
Anti-epileptics can be taken to address chronic nerve pain and chronic pain from conditions like diabetes, shingles, chemotherapy, herniated disks, and fibromyalgia. Research on how well anti-epileptic medications work for pain is unclear. Some people may receive significant benefits while others may not receive any pain relief at all.
Newer anti-epileptic drugs such as gabapentin (Neurontin), and pregabalin (Lyrica) have more evidence of being effective painkillers than older drugs, and they carry fewer side effects. But, some studies have shown that older antiepileptic drugs such as carbamazepine (Tegretol) and phenytoin (Dilantin) can also help for certain pain conditions. However, these older medications cause more side effects.
Corticosteriods, commonly referred to as just steroids, decrease inflammation and reduce the activity of the immune system. They can reduce swelling and pain for conditions like cancer, back injuries, arthritis, joint pain, and nerve pain. Steroids can be helpful for short-term treatment of acute pain and are also used for the management of some chronic pain conditions., Common steroids used for pain relief are dexamethasone (DexPak), prednisone (Deltasone), and prednisolone (Prelone).
Steroids can be taken orally, applied as a cream, injected, or inhaled. Steroids do come with side effects such as weight gain, high blood pressure, and weakened immune system. Taking low doses of steroids for short periods can minimize those side effects. Injecting steroids directly into an area of pain also reduces side effects and promotes targeted treatment of the affected area.
Non-drug treatments like exercise, physical therapy, yoga, acupuncture, cognitive behavioral therapy, biofeedback, chiropractic, and relaxation training can provide pain relief, especially for chronic pain., In fact, organizations as diverse as the American College of Physicians, the U.S. Department of Veterans Affairs, and the Centers for Disease Control and Prevention recommend non-drug treatments as the first course of action for chronic pain. Although side effects for non-drug treatments tend to be minimal, be sure to consult with a healthcare provider before beginning any new treatment activities.