The GoodRx Prescription Savings Blog

If you’ve ever had prescription eye drops, you know that those tiny bottles can cost a pretty penny, and can be challenging to apply in the eyes. Eye drops can be used for many reasons like allergies, infections, inflammation, dryness or vision disorders.

Here are seven tips to help you get the very last squeeze out of your eye drops.

Don’t waste your drops.

Eye drops can be expensive, so it’s important to make sure you’re wasting as little as possible. If you have trouble applying eye drops, an eye drop guide may help. The AutoDrop Guide, the Magic Touch, and the Simply Touch are three popular guides that can help you easily apply your drops.

Make sure you know if your eye drops require any special instructions.

It’s important that eye drops are sterile when placing them into your eye. Therefore, it’s essential that you abide by any special instructions like:

• Storage requirements. Some drops, like Xalatan (latanoprost), should be stored in the refrigerator if unopened. However, once the bottle has been opened you can store the bottle at room temperature for 6 weeks.
• Expiration limitations. Some eye drops require that you throw it away after 14 days.
• Special directions. Some eye drops need to be mixed or require that you wait a certain amount of time before applying another drop of a different medication. Make sure you read the special instructions before using your eye drops.

Ask your doctor for samples.

The old saying “ask and you shall receive” can apply to prescription eye drops. Some doctors may be able to supply you with a sample bottle of an expensive prescription eye drop, and all you have to do is ask! Many doctor’s offices have a closet full of sample medications from pharmaceutical reps they can give out to you free of charge.

Some eye drops are now available over the counter.

The beauty of OTC medications is the convenience and ability to select a medication for your specific symptoms. Although a visit to your doctor’s office is typically not required, it is always recommended to check with your doctor or pharmacist before beginning to peruse the OTC aisles.

Make sure your eye drops don’t interact with anything else.

Regardless if you take a medication by mouth, apply it on your skin, inhale it into your lungs, or drop it into your eye it will still be absorbed into your blood stream and distributed throughout your body. Eye drops do have a more local effect meaning that they treat the problem you may be having in your eye; however, the medication can still get into your blood stream. This makes it important to disclose any other medications you may be taking to your doctor or pharmacist

Do the math.

Insurance companies won’t allow you to fill your medication if they think it’s too soon, based on the calculation the pharmacy provides them with. This means that it might be helpful to know the number of drops your bottle contains.

The most common conversion is 20 drops per 1 ml; however, some insurance companies may calculate it differently by using 15 drops per 1 ml or even lower at 12 drops per 1 ml. This means that a standard 1 ml bottle will contain 100 drops of medicine.

This calculation can give you an idea of how soon you can refill your medication.

Eye drops can be used in other places.

That’s right, eye drops are multi-purpose – they can be used in places other than just the eyes. Some eye drops are extremely versatile and can be used in places such as in the ears, on the tongue, or onto the nails.

Keep in mind that you shouldn’t use your eye drops in other places unless instructed by your doctor.

Believe it or not, medications are recalled on a daily basis and due to numerous reasons.  Medication recalls can range from minor to life-threatening incidents if not immediately and appropriately taken care of.

One of the most recent recalls, occurring on July 27th, involves two very different medications cyclobenzaprine & amantadine. 

What are these drugs prescribed for?

Cyclobenzaprine is a muscle relaxer, while amantadine can be used for Parkinson’s disease, viral-based conditions, and treating the side effects of other medications.

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, Apace Packaging LLC has voluntarily recalled 1 lot of cyclobenzaprine and 1 lot of amantadine, with the knowledge of the FDA, due to mislabeling.Why

Why where cyclobenzaprine and amantadine recalled?

A small number of cartons containing cyclobenzaprine 5 mg tablets may potentially be mislabeled as amantadine 100 mg capsules. The blister pack inside the carton is correctly labeled as cyclobenzaprine 5 mg, though.

Taking the wrong medication may potentially cause severe adverse effects like dangerous drug interactions, sudden worsening of your disease, allergic reaction or death.

Which products were recalled?

In this recall, only 1 lot of both cyclobenzaprine and amantadine were affected.  

The recall will affect the following:

• Drug: Cyclobenzaprine 5 mg tablets (50 unit dose) and amantadine 100 mg capsules (50 unit dose)
• Manufacturer: AvKare, Inc
• Packager: Apace Packaging, LLC
• Lots:
  • Cyclobenzaprine 5 mg tablet – Lot 16710 (Expiration date: 7/2018)
  • Amantadine 100 mg capsule – Lot 16710 (Expiration date: 7/2018)
• National Drug Code (NDC)
  • Cyclobenzaprine 5 mg tablet: 50268-0190-15
  • Amantadine 100 mg capsule: 50268-0069-15

What has Apace Packaging LLC done to alert those who may be affected?

Apace Packaging LLC has notified its distributors and customers by email and is arranging for return of all recalled product.

Distributors that have any of the product which is being recalled should contact Customer Service at AvKARE, Inc. at 931-292-6222 to arrange for its return.

What do I do if I think I have a recalled package of Eliquis?

If you have questions regarding this recall you can contact Apace Packaging LLC by calling 270-434-2722 Monday-Friday from 8am–4pm Central Standard Time. You should contact your physician or healthcare provider if you have experienced any problems that may be related to taking or using these drug products.

Always inspect your medications, including all parts of the packaging and devices. If you ever notice your medication doesn’t look or smell right, contact the manufacturer or ask your pharmacist for more information. You can also notify the FDA’s MedWatch Reporting Program as they can conduct further necessary investigations.

Combination inhalers prescribed for asthma, smoking lung disease (COPD), or persistent cough after an upper respiratory infection are some of the top selling drugs in the United States. Several steroid + long acting bronchodilator combinations are currently available: the older Advair and Symbicort and the newer Dulera and Breo Ellipta.

While Advair and Symbicort are recommended for treatment of both moderate persistent asthma and COPD, Breo has been introduced with the indication for COPD treatment only. Which combo inhaler you are prescribed is often based on your insurance coverage because while they differ in delivery mechanism, they generally work just as well.

If you have similar insurance coverage for Advair, Symbicort, Dulera, or Breo, you may want to consider the commonly reported side effects:

1. Voice changes. Hoarseness or huskiness are common symptoms, related to the steroid component of the inhaler. Voice changes occur in 5 to 10% of people and are more common with frequent use and with fluticasone (in the Advair) compared to other steroids. Rinsing your mouth by gargling with water will help remove the locally deposited steroid in the mouth (not where you want it, you want it in the lungs). It has been shown that 56% of the dose from your inhaler is deposited in the mouth/throat and a mouth rinse promptly can remove 60% of this residue.
2. Yeast infections of the mouth/thrush. The steroid in your combo inhaler may cause candidiasis (yeast) infection in the mouth as a potential side effect. This will look like white, soft plaques that leave a painful red, eroded, or ulcerated surface. The sides of the tongue, back of throat and inside the cheek are common sites where you may notice tenderness, burning, and pain with swallowing. The antifungal mouthwash Nystatin can be used to treat this.
3. Cavities (dental caries) from dry mouth. Dry mouth and increased thirst is reported with the combination inhalers. The bronchodilator part of the inhaler (beta-2 agonist) is associated with the increased frequency of cavities. Long term use of beta-2 agonists is associated with diminished saliva production and secretion.
4. Pneumonia. This may be the case only with the steroid in Advair (fluticasone) and not with Symbicort (budesonide). The use of Advair has been associated with a higher prevalence of pneumonia in the major long-term studies, but no similar increased risk of pneumonia has been reported in patients with COPD treated with Symbicort. This difference may be explained by the longer retention of fluticasone in the airways.
5. Headache. 7% to 11% of folks using these combination inhalers report headaches.
6. Cough. While we don’t know exactly why this occurs, cough may be a result of throat irritation from the inhaler.
7. Throat pain. Even without thrush, pain and soreness in the throat is reported in 6 to 9% of folks using these combination inhalers.
8. Adrenocortical suppression. Side effects like this are unlikely to occur at prescribed doses of the newer inhalers unless you are using them long term. With long term use of inhaled steroids at high doses you can suppress your own production of certain hormones (cortisol). Abruptly discontinuing your inhaler may lead to serious symptoms like extreme fatigue and low blood pressure.
9. Osteoporosis and bone fractures. Steroids stimulate the process of bone turnover but at doses lower than 800 mcg a day this is unlikely to occur. Long term use of inhaled steroids (half of the contents of your combination inhaler) may lead to brittle bones and increased risk of spine and hip fractures. For reassurance you can look at your inhaler for the dose of steroid it contains: for example Advair 250 mcg/50 mcg contains 250 mcg of the steroid fluticasone.
10. Skin thinning and purpura (purple spots on the skin, most commonly arms). Long term use of the steroid in your combo inhaler leads to loss of subcutaneous fat. Skin bruising and purple spots may happen with long term combination inhaler use.

One last note on weaning off and discontinuing Advair, Symbicort, Dulera or Breo:

An interesting fact—inhaled corticosteroids, particularly fluticasone, are absorbed more (meaning more chance for unwanted systemic side effects) in folks with normal lung function. This is a reminder that you should step down the inhaled steroid dose/combo inhaler once your breathing from asthma or COPD is adequately controlled.

Dr O.

Menopause is the period in a woman’s life when menstruation stops. It typically occurs between 45 and 50 years of age and can increase the risk for medical conditions like heart disease, osteoporosis, urinary incontinence, weight gain, and painful intercourse.

The FDA has approved Intrarosa to treat dyspareunia (painful sexual intercourse), a common symptom of menopause, and it is now available in pharmacies.

What is Intrarosa indicated for?

Intrarosa is a steroid indicated for the treatment of moderate to severe dyspareunia, or painful sexual intercourse. This condition is a symptom of vulvar and vaginal atrophy (VVA), due to menopause. Intrarosa is unique in that it treats dyspareunia without using hormones.

VVA is a chronic condition commonly associated with the loss of estrogen due to menopause. Symptoms of VVA include vaginal dryness, itchiness or burning.

Intrarosa is available as a vaginal insert in the strength of 6.5 mg.

How do I use Intrarosa?

Intrarosa is to be inserted vaginally once daily at bedtime.

What are the common side effects associated with Intrarosa?

Common side effects include vaginal discharge or noticeable changes on a Pap smear.

Are there any treatments similar to Intrarosa?

Yes. Treatments available by prescription to help treat dyspareunia caused by VVA induce Vagifem (yuvafem), Estrace (estradiol), Estring (estradiol) and Premarin (conjugated estrogens).

Over the counter (OTC) medication DHEA (prasterone) is an oral supplement that is sometimes used to treat dyspareunia. However, the FDA has not evaluated it for safety or efficacy.

OTC vaginal lubricants and moisturizers may also help to avoid discomfort during sexual activity, and can usually be found in the feminine care aisle of your grocery store or pharmacy.

For more information on Intrarosa, see the press announcement from the FDA here.

Tinnitus, or ringing in the ears, is a perception of sound in one or both ears in the absence of an external source. It’s often described by patients as buzzing, ringing, or whooshing.

Tinnitus can be a continuous sound or occur intermittently and while there is often no known cause, there are a handful of medications that can contribute. “Ototoxic medications” are those that may damage the inner ear. Toxic damage to the ear from medications can result in symptoms like tinnitus, vertigo, and even deafness. Discontinuing these medications can prevent progression to hearing loss and/or vertigo, though the ringing may not always go away. Here are eleven commonly prescribed medications known to cause tinnitus:

1. Gentamicin and tobramycin are aminoglycoside antibiotics used for the treatment of severe bacterial infections. Gentamicin, used intravenously, is a well known cause of tinnitus and vertigo along with hearing loss.
2. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (Aleve) and ibuprofen (Motrin, Advil) are well known causes of ringing in the ears. Those taking daily aspirin for stroke and heart disease protection should be given a heads up about this possibility—though tinnitus from aspirin usually occurs only at high doses.
3. Loop diuretics including furosemide (Lasix) and bumetanide (Bumex) are commonly prescribed for swelling in the legs, heart failure, and to lower blood pressure. They are known to cause ringing in the ears.
4. Tricyclic antidepressants like amitriptyline and nortriptyline are used for the treatment of depression, chronic pain, and migraine prevention and they may also cause ringing in the ears.
5. Azithromycin (Zithromax or the “Z-pack”) and clarithromycin are antibiotics in a class called macrolides, and they’re prescribed for bacterial infections like community-acquired pneumonia, sinusitis, bronchitis, etc. Both are reported causes of ringing in the ears.
6. ACE inhibitors are medications used to lower blood pressure that may cause ringing in the ears. These end in -il (common examples are lisinopril, enalapril, and ramipril).
7. Amlodipine (Norvasc) and nicardipine (rarely prescribed) are calcium channel blockers. Amlodipine is commonly prescribed for high blood pressure, and reports of tinnitus follow its use.
8. Alprazolam (Xanax), diazepam (Valium) and lorazepam (Ativan) are benzodiazepines used for the treatment of anxiety, which may cause tinnitus.
9. Isotretinoin (Accutane, Claravis, Absorica, and others) is a pill used for severe acne that may lead to tinnitus.
10. The fluoroquinolone antibiotic ciprofloxacin (Cipro) has been reported to cause tinnitus, but, some good news—those reports have not carried over to a similar antibiotic levofloxacin (Levaquin). Cipro is prescribed for bacterial infections like urinary tract infections, acute sinusitis and pneumonia and may lead to tinnitus.
11. Atorvastatin (Lipitor), but not other statins, has been reported to cause tinnitus. Atorvastatin is used to lower cholesterol.

Dr O.