The GoodRx Prescription Savings Blog

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

Tamiflu Prescriptions Reveal Shocking Flu Trend

by Tori Marsh on January 18, 2018 at 4:20 pm

A recent report published by the Centers for Disease Control and Prevention (CDC) confirmed what we already knew: this year’s flu is bad. Since October, widespread influenza activity has been reported in 49 states, resulting in 20 pediatric deaths and more than 6,000 influenza-related hospitalizations thus far. These rates surpass last year’s total numbers – and it’s only January.

One more way to see how bad the flu is this season: prescriptions for Tamiflu (oseltamivir), the most popular antiviral medication for treating the flu, are way up. According to a GoodRx analysis based on a significant sample of US pharmacy fills, Tamiflu fills are 640% above this time last year.  

What’s more, it’s only January. As you can see below, fills for Tamiflu peaked in February of last year, indicating that the flu was the most widespread during that time. It’s possible that there is still more to come this year.

This is a stunning illustration of how bad the flu is – and how much worse it may still get.

Why Tamiflu?

If taken within the first 28 hours of getting the flu, Tamiflu can work to block the actions of influenza in your body, and shorten the duration of the virus. You can also take Tamiflu for up to six weeks to prevent you from getting the flu. Not surprisingly, Tamiflu is prescribed more often between the months of October and March, during flu season. Despite the surge of prescriptions, there are some doubts about whether Tamiflu is even effective for treatment or prevention – more on that below.

A shortage in Tamiflu

The high volume of Tamiflu prescriptions at this point in the season has resulted in a shortage of the medication. While the FDA has not yet confirmed this shortage, doctors and pharmacists in both urban and rural areas are reporting difficulty in accessing Tamiflu for their patients.

Those unable to access Tamiflu this year do have other options. Besides Tamiflu, there are two other influenza medications: Relenza and Rapivab. Both are considered just as effective as Tamiflu and may be easier to access this year. For more information on these medications, see our post here.   

Over the counter medications can also help ease symptoms. Read here for more details on over the counter flu medications.

Is it effective?

Tamiflu is sometimes treated as a cure for all cases of the flu, but recent studies call this reputation into question. According to a study-of-studies, or meta-analysis, performed by Cochrane Research of 46 studies involving more than 24,000 people, Tamiflu may provide a much smaller benefit than expected. At best, the analysis found that Tamiflu may only help patients recover one day faster, and may not reduce the number of flu-related complications, like pneumonia. Additionally, it may only reduce the risk of getting sick by 55%. At over $50 per prescription for generic oseltamivir, for some, the benefits may not outweigh the cost.  

While these findings don’t negate the use of Tamiflu, they may indicate that it is less protective than we had previously thought.

Tamiflu side effects

There has been recent concern about Tamiflu’s side effects, especially in younger children. Recently, a 6-year-old girl reportedly attempted to jump out of her bedroom window during a hallucination while taking Tamiflu.  The FDA has warned of similar side effects previously, noting that:

“Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Tamiflu of may happen in people when the flu is not treated. These serious side effects are not common but may result in accidental injury to the patient. People who take Tamiflu should be watched for sins of unusual behavior and a healthcare provider should be contacted right away if the patient shows any unusual behavior while taking Tamiflu.”

More common side effects include nausea, vomiting, headache, and pain. Be sure to speak with your doctor if you or a loved one experience any of these side effects for a prolonged period of time.

Why is the flu so bad this year?

This year’s flu is different from past year’s. The reason? Around 80% of flu cases this year involved H3N2, a strain of the influenza A virus that is more dangerous and results in more complications. H3N2 is generally also harder to prevent with the flu vaccine, and this seems to be true this year. Experts say that this year’s flu vaccine may be only 10% effective.

How can you protect yourself?

  • You can still get your flu vaccine. Even though the flu shot may only 10% effective against this year’s flu, you may still want to consider getting it. Even if you get sick, a flu vaccine can also help ease the severity and duration of the virus.
  • Visit your doctor immediately. When true flu symptoms hit, go to the doctor. The sooner you visit, the sooner you can get your prescription for an antiviral medication.
  • Wash your hands. This may go without saying, but washing your hands is your best weapon against the flu virus.
  • Exercising may help. While heavy exercise may predispose you to the flu, a moderate amount may be protective.

FDA Updates Safety Communication for Opioid Cough Medicines

by The GoodRx Pharmacist on January 18, 2018 at 3:38 pm

On January 11th, the FDA issued a drug safety communication for certain prescription cough and cold medications that contain codeine or hydrocodone.

Many prescription medications are to blame for our current opioid epidemic, especially in our adolescents and teens. Therefore, limiting the prescribing of unnecessary medications to children under 18 years of age is particularly important.

What is the significance of this safety communication?

The significance of this safety communication is that the benefit of a prescription cough and cold medications containing codeine or hydrocodone no longer outweigh the serious risks associated with their use. Especially in children less than 18 years of age.

See the FDA Drug Safety Communication for a list of cough and cold medicines that contain codeine or hydrocodone.

Are there alternatives for those under 18 years of age?

Yes.  Most coughs from the common cold will actually go away on their own and do not require treatment. However, if treatment is required, several over-the-counter medications that contain dextromethorphan can be used for symptom management.  

There are also other non-opioid prescription medications that may be used if your doctor feels as though treatment is necessary.

What is being done to warn people about these serious side effects?

The FDA is requiring safety labeling changes for all prescription cough and cold medications that contain codeine or hydrocodone.  

The FDA is also requiring the addition of safety information about the risks of misuse, abuse, addiction, overdose, death, and slowed or difficult breathing to the boxed warning the strictest warning given to a medication by the FDA.    


Why Taking Your Medications for These Common “Silent” Diseases is Important

by The GoodRx Pharmacist on January 16, 2018 at 1:52 pm

If you’ve ever been afraid to show up at your doctor’s office because you’ve been “bad” then this post is for YOU!  You may think your doctor is “pushing medications on you” especially if you aren’t experiencing any symptoms of the condition they are treating you for. However, their reasoning is not without sound medical and professional judgment. 

One of the many reasons you might receive a lecture about the importance of taking your medications is due to the progressive nature of many diseases if not properly treated. The following are common disease states that are often “silent” and can be deadly if not properly managed.   

Diabetes

Diabetes is a disease that occurs when your blood sugar is too high. Blood sugar is your main source of energy and comes from the food you eat. There are several different types of diabetes, with the most common being type 1 and type 2 diabetes.

Signs and symptoms of uncontrolled high blood sugar can oftentimes be overlooked, as you may not be able to tell. Some signs that are associated with low blood sugar include increased thirst and urination, blurry vision, lethargy, and frequent headaches.

Some people will stop taking their medication or take them inconsistently due to not “feeling” any different whether they take them or not.  This is a more common occurrence with type 2 diabetics but has happened in type 1 diabetics who forgo their insulin.

Diabetes is one of many diseases that is often referred to as a “silent killer” as it can lead to amputations, vision loss, heart attack, stroke, sexual dysfunction, bladder problems, and kidney disease if poorly controlled.

Patients with diabetes may control their diabetes with injectable medications like Humalog, Novolog, Humulin, Lantus, and Tresiba, or oral medications like metformin, glipizide, glimepiride, and invokana

High blood pressure

High blood pressure occurs when the force of your blood pushing against the walls of your blood vessels is consistently too high and can damage or weaken your blood vessels. However, it can’t physically be felt, as there are no obvious symptoms indicating something is wrong. You will need to visit your doctor to determine if you have high blood pressure.

Also referred to as a ‘silent killer,’ consequences of poorly controlled high blood pressure may include heart attack, stroke, vision loss, heart or kidney failure, and sexual dysfunction.

Patients may take oral medications like lisinopril (Zestril, Prinivil), losartan, hydrochlorothiazide, amlodipine, and metoprolol to control their high blood pressure.

High cholesterol

Cholesterol is a substance your body needs to build cells. However, there is bad cholesterol (LDL, and triglycerides) and good cholesterol (HDL).

Too much of the bad kind and not enough of the good kind increases the chances that cholesterol will begin to build up in the inner walls of arteries.  Over time, this buildup can narrow or completely block the arteries leading to a variety of serious, life-threatening problems.

You can’t physically feel if you have high cholesterol and usually don’t know unless something bad happens or through routine blood work called a lipid panel. If not treated properly, high cholesterol can lead to heart attack, stroke, and chest pain. 

People with high cholesterol will typically take oral medications like atorvastatin, simvastatin, pravastatin, fenofibrate, and zetia.

Osteoporosis

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall, or, in serious cases, from sneezing or minor bumps. Osteoporosis affects both men and women, and as our bodies age the likelihood of developing osteoporosis increases.

Breaking a bone is often one of the first indications that you may have osteoporosis. People with osteoporosis most often break bones in the hip, spine, and wrist. You may also notice that you are getting shorter, or your upper back is beginning to curve forward. These symptoms may also indicate that you may have osteoporosis.

Consequences of untreated osteoporosis include one fracture, broken bones, pain, and limited mobility.

Osteoporosis treatments may include medications like fosamax, boniva, actonel, prolia, and reclast.


New Recommendations for All Type 2 Diabetics

by Dr. Sharon Orrange on January 15, 2018 at 4:26 pm

Just recently, the American Diabetes Association updated their guidelines to include the recommendation that certain Type 2 Diabetics add to their regimen one of two medications shown to lower the risk of death from stroke and heart disease. Here is the update:   

If you are a type 2 diabetic with established heart disease, aka atherosclerotic cardiovascular disease, and your target blood sugars aren’t being met with metformin and diet/exercise add Victoza injections 0r Jardiance.

  • Jardiance, a pill taken once daily, is indicated in type 2 diabetes patients with established heart disease who aren’t well controlled despite metformin and lifestyle changes. Jardiance received an indication for improving survival in adults with type 2 diabetes and heart disease by the FDA in December 2016 and was the first medication to do so.
  • Victoza injection once daily received the FDA indication for “prevention of cardiovascular events as well as death” in August 2017. By how much? Victoza has been shown to reduce the risk of death, heart attack or stroke in diabetics by 13% compared with placebo.

Which one should you choose? Victoza, or? Well, Jardiance is a pill and not a shot. Just sayin’. Victoza injections of 1.2 or 1.8 mg do help for weight loss, and in fact, the 3 mg injection dosage of liraglutide, Saxenda, is FDA approved for weight loss.

What’s the downside? Cost. Both Victoza and Jardiance are expensive and often require prior authorization forms to be filled out by your doctor (I know because I do them every day). With these new ADA recommendations, the hope is both will be covered without requiring such a fight.

Anyone on these already?

Dr O.


10 Things That Don’t Age Well

by Dr. Sharon Orrange on January 8, 2018 at 3:19 pm

With increasing life expectancy comes an increase in age-related complaints. Understandably folks want to know: is this normal with aging? This list is not meant to be depressing or hopeless, but instead, shed light on some of the areas of our body that, frankly, don’t age well.

The eyes

“Can I get a light with that menu?” Presbyopia will hit you after the age of 40, and in fact, studies show it becomes most noticeable at 43 ½.  What you may find more difficult is focusing on objects up close—that’s presbyopia.

Why does it happen? These are normal age-related eye changes that occur due to hardening of the lens inside your eye. In the beginning, you may be able to compensate by holding your reading material farther away or holding a light to it. Eventually, you will need reading glasses, multifocal contact lenses, or multifocal eyeglasses.

The ears

Age-related hearing loss, presbycusis, is the slow loss of hearing that occurs as people get older.

Why does it happen? Tiny hairs inside your ear help you hear. When these hairs are damaged or die, hearing loss occurs. Half of folks 75 and older have some degree of age-related hearing loss. High-frequency hearing goes first so women’s voices become harder to hear than men’s voices (how convenient).

Memory, specifically visual short-term memory

While this may differ widely among people, a hallmark of aging is a decline in visual short-term memory.

What does that mean? Visual short-term memory is the ability to maintain a visual representation in mind after the sensory input (object) has been removed. This matters for memory and thinking because deficits in visual short-term memory have been proposed to cause problems in higher-order (more complicated) cognitive tasks.  

The big joints: knees and hips

Osteoarthritis (OA) of the hip and knee is a leading cause of suffering and disability. Age is the primary risk factor for OA or “wear and tear” arthritis.

Why does this happen? The cells that make cartilage decline in quality and number as you age, so the older joint has a lower reserve to deal with impact. While there is no way to completely prevent osteoarthritis, some people who have knee and hip arthritis won’t have any symptoms. Oh, and there is also the option of knee and hip replacement.

Skin

The purple bruises that fade to brown over several months and occur most commonly on the back of your hands, that’s aging.

Why does this happen? Age-related thinning of the skin, atrophy of subcutaneous tissue, and weakened capillaries cause bruising in older people. This bruising is commonly seen on the back of the hands, forearms, and shins without any known trauma.

The valve at the end of your esophagus

“Why can’t I eat spicy food now that I’m older?” Reflux disease (GERD) is more common as we get older and causes heartburn with spicy foods.

Why does this happen? Lower pressures in the valve at the lower end of the esophagus occur which is designed to keep acid in the stomach, this allows acid to reflux, or flow backward.

The Achilles: the largest tendon in the body

Aging alone increases the chance of injury to the Achilles tendon leading to Achilles tendonitis. Pain in the tendon, heel pain and stiffness are common complaints from patients.  

Why does this happen? The Achilles tendon doesn’t age well due to stiffness, lack of blood supply, and the combination of forces placed on it. Luckily you can get rid of Achilles tendonitis with ice, rest, and nonsteroidal anti-inflammatory drugs but physical therapy, orthotics, and surgery may be necessary for total relief.

The neck

Wrinkles on the neck show your age, no matter how many creams you put on it.

Why does this happen? The neck contains thinner skin, more sensitive to sun damage and other factors that wrinkle the skin. The muscles and skin tissue supporting the neck area are weaker than that of the face so neck skin is more vulnerable to gravity over time.

The pelvic floor

Ladies, do your Kegels. The pelvic floor is the hammock of muscles and ligaments that support the bladder, uterus, vagina, and rectum which starts to fail as we get older. Symptoms include urinary incontinence and prolapse (sagging) of the bladder or uterus. Twenty seven percent of women ages 40 to 59 and 37 percent of women ages 60 to 79 will experience pelvic floor dysfunction.

The whites, or “off whites” of your eyes

The color of the sclera, the white part of your eye, changes with age from bluish (in babies) to yellowish.

Why? This is because of accumulation of fat in the scleral tissue.

Dr. O


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