With our new “Ask Your Walgreen’s Pharmacist” feature, your medication questions can be answered. Email your questions to - pharmacist@50plusstlouis.com or you can mail them to: 

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What you Should Know About Generic Drugs

By Amanda Covey, Pharm.D.

The Food and Drug Administration (FDA) cites that 7 out of 10 prescriptions dispensed in the United States are filled with generic drugs.  But do you really know what a generic drug is?

Let’s begin with the origin of a generic drug.  A generic drug starts as a brand name drug.  A brand name drug is the first version of the medication that a drug company develops.  The drug company spends a great deal of money and time on research and development of the new drug to make sure the drug is safe and effective for human use.  The drug company then presents their research to the FDA for approval of the new drug.  At this time, the FDA grants a patent for the drug, but the drug is not yet released to the public.  After thorough evaluation by the FDA, the drug will then be approved and released onto the market.  Patents on drugs last 20 years from the date they are issued, meaning that the company that developed the new drug is the only company that can manufacture and sell the drug for the length of the patent.  This is the reason that not all brand name drugs have generics available.  A good example is a class of drugs that lower cholesterol called “statins.”   Lipitor® is a well-known brand name “statin” that does not yet have a generic because of its original patent protection.   

Once the patent expires, other drug companies can apply to the FDA to make and sell a drug in its generic version.  The active ingredient (what actually does the work to treat your condition) must be exactly the same as what was in the brand name drug.  This is called bioequivalence:  when a drug has the same action and effect in the body, along with the same strength, potency, and manufacturing standards as the brand name drug.  Therefore, generic drugs are exactly the same as brand name drugs in the way they work in the body, with a narrow margin of variance that is allowed.  However, the inactive ingredients (starches, fillers, dyes) do not have to be the same.  In fact, the generic drug is not allowed to look the same as the brand name drug—they must be a different shape or color or have a different inscription, and the name must be different from any other drugs on the market.  This is all closely regulated by the FDA.   
      
Continuing with our previous example of “statins,” Zocor® is a brand name “statin” that does have a generic—it is called simvastatin.  Simvastatin is made by several different companies, but all versions are bioequivalent to the brand name Zocor®.  They all have the same actions in the body and have the same manufacturing standards, even though they look different.  
   
Generic drugs are usually less expensive than brand name drugs.  This is not because they are inferior, but because the company making the generic drug did not spend the money on research to develop the drug initially.  This means they can sell it for a lower price.  The brand name drug company has to bear the cost of years of developing the drug, which in some cases can take decades of work. 

When doctors write a prescription, they have the option to sign that a generic drug can be dispensed, or that they prefer a brand name drug only.  The pharmacy must fill the prescription in accordance with what the prescriber indicates if the prescriber signs the order “dispense as written.”  It is common for prescribers to sign a prescription to permit generic substitution.  Pharmacies often dispense generic drugs, as long as the prescriber has indicated that it is allowed, and insurance companies generally prefer that generic drugs be dispensed to help keep costs as low as possible.

For additional facts about generics, please feel free to ask your Walgreens pharmacist or consult the FDA website at www.fda.gov.
 

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Sun Safety: Lower Your Risk for Skin Cancer

Ask the Pharmacist: Types of Drug Interactions

Ask the Pharmacist: National Kidney Month

By Amanda Covey, Pharm.D.

A familiar proverb regarding the month of March is that it comes “in like a lion, out like a lamb.”  Kidney disease, however, in contrast to the month hosting its awareness, often has an unnoticeable onset.  With March being National Kidney Month, there is perhaps no better time to discuss healthy kidney function, factors that may place individuals at risk for kidney disease, simple tests that can assess kidney health, and the impact kidney function may have on managing medications.

Healthy kidneys are responsible for filtering the blood supply to remove waste products, surplus fluids, and medications, eliminating these products by producing urine.  As reported by the National Kidney Foundation, the kidneys have other important jobs, too, including making a type of vitamin D that contributes to bone health, circulating hormones that control blood pressure, and regulating the creation of red blood cells.  After realizing the essential roles assumed by the kidneys, the negative health impacts of chronic kidney disease seem more understandable:  bone disorders, anemia, poor nutritional status, and swelling. 

Cardiovascular disorders can be another complication of chronic kidney disease.  In fact, according to Dr. Leslie Spry via the National Kidney Foundation Kidney Disease FAQs Fact Sheet, patients with chronic kidney disease are more likely to die from an adverse cardiovascular event than kidney failure.  Unfortunately, despite the seriousness of these complications, early kidney disease often has no symptoms.  As explained by the National Kidney Disease Education Program (NKDEP), this means that you may not feel as though anything is wrong until the disease has significantly progressed. 

Since early kidney disease is not associated with noticeable symptoms, it is critical to identify risk factors for kidney disease and learn about the simple blood and urine tests that can tell doctors how well the kidneys are working.  The two most common causes of chronic kidney disease are diabetes and high blood pressure.  These health conditions may cause damage to the blood vessels of the kidneys, negatively impacting the ability of the kidneys to perform their normal functions.  Heart disease and a family history of kidney failure are among the other risk factors for developing chronic kidney disease.  The National Kidney Foundation recommends that individuals with risk factors undergo testing to detect kidney disease.

A blood test can help determine how much blood the kidneys filter per minute, a measurement called the glomerular filtration rate (GFR) by healthcare professionals.  Comparing a GFR test to the normal range may indicate whether kidney disease is present, as well as the severity of disease.  Urine tests can identify the presence of proteins that are usually too large to be filtered into the urine.  The NKDEP emphasizes the importance of this test, as you can’t see protein in the urine or feel it passing.  If you have risk factors for chronic kidney disease, speak with your doctor about how often to have your kidney health checked.  While kidney disease can’t typically be reversed or “cured,” it is possible to slow the progression of kidney disease and take steps to protect your kidneys.

Kidney function also has important implications in medication management, as there are medicines available that may help reduce the amount of protein in the urine and slow the progress of disease.  Your doctor may prescribe a type of medication called an ACE-inhibitor or ARB to help protect your kidneys and avert further kidney damage.  Following medication regimens to help control blood pressure and diabetes is another important aspect of treating kidney disease.  In addition, because the kidneys filter drugs from the blood, having kidney disease may require an adjustment in the dose of certain medications to ensure that toxicity does not occur.  It is also necessary to consider the safety of over-the-counter medicines and herbal supplements if you have chronic kidney disease.  For example, certain nonprescription pain medicines, called NSAIDs, may be harmful to the kidneys. An example of one such NSAID is ibuprofen.  Finally, the National Kidney Foundation cautions against the use of herbal supplements by patients with chronic kidney disease, in part because the safety of herbs is often not studied in such patients.

For more information, visit the National Kidney Foundation website at www.kidney.org or the NKDEP website at www.nkdep.nih.gov.  Alternatively, you may call 1-866-KIDNEY or contact your local Walgreens pharmacist for advice.

Ask the Pharmacist: Disposal of Expired or Unwanted Medication

By Amanda Covey, Pharm.D.

While the cold temperatures are a potent reminder that spring-cleaning remains a few months in the offing, it is never too early to address the common concern of how to properly dispose of old or unneeded drugs collecting dust in the medicine cabinet.  The primary issue to consider when discarding medication is whether it is appropriate to flush the medicine down the toilet or utilize an alternate method of disposal.  Luckily, federal guidelines addressing this topic, updated in October 2009 and accessible online at www.WhiteHouseDrugPolicy.gov, and recent articles released by the Food and Drug Administration (FDA) are available to provide guidance on safely disposing of prescription drugs.  First, medications recommended for flushing will be reviewed, and then other manners of drug disposal will be discussed.

While most drugs may be discarded in the household trash after combining the medication with an unpleasant additive, as will be described later, certain medications may be particularly harmful if obtained and used by someone other than the intended recipient of the prescription order.  To prevent children, pets, and other unintended individuals from dangerously receiving a dose of such medicines, the FDA recommends that these medicines be flushed down the toilet.  Such medications may be disposed of by following the instructions in the prescribing information accompanying the order.  If the prescribing information is not available or does not mention a safe disposal method, a list of these medicines can be found on the FDA website, accessible at www.fda.gov.  Entering the term “flushing medicines” in the website search field will return the article “Disposal by Flushing of Certain Unused Medicines:  What You Should Know.”  This article includes a list of the medication name and active ingredient for medicines recommended for flushing.  Potent painkillers, such as morphine, oxycodone, hydromorphone, methadone and other related medicines, are among the drugs listed.  The list also includes medicines available as patches to be applied to the skin, such as fentanyl and methylphenidate, the active ingredients in Duragesic® patches and Daytrana® patches, respectively. 

While flushing is the preferred method of disposing of particularly harmful medicines, other medications should not be flushed, as the Environmental Protection Agency reports that pharmaceuticals detected in bodies of water may be harmful to aquatic ecosystems.  According to the October 2009 federal guidelines, the remaining majority of medications can be properly disposed of by pursuing the following steps.  First, remove the medicine from the provided container and place it in a sealable plastic bag or a container with a lid.  It is also advisable to remove personal information from the original labeling by scratching out the information or otherwise rendering it unreadable to protect your privacy and identity.  Next, mix the medicine with an unpalatable substance such as kitty litter, coffee grounds, sawdust, or another undesirable ingredient that would make consuming the medicine less appealing to children, pets, or other individuals. 

The SMARxT Disposal campaign, created by the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Researchers and Manufacturers of America, suggests crushing or dissolving solid dosage forms, such as tablets or capsules, in the sealable plastic bag prior to adding the unpleasant substance to further discourage accidental consumption.  After making the mixture, seal the bag or place a lid on the container and discard the mixture in the household trash.        

Alternatively, you may contact your county governmental offices to inquire about local take-back programs.  Such programs collect unused medicines and other potentially hazardous waste items to coordinate their proper disposal.  For further assistance in determining the most appropriate method of disposal for unused medicine, you may always ask your Walgreens pharmacist.

The following local communities have Take Back Dates upcoming:

Saturday, February 20, 2010 and April 17, 2010, between 9 A.M. and 1 P.M.

Wildwood Police Precinct: (636) 458-9194
Clarkson Valley: (636) 227-8607
Ellisville Police: (636) 227-7777
Ballwin Police: (636) 227-9636
Eureka Police: (636) 938-6600

Ask the Pharmacist: Cold and Flu Medicine:  Tips for Seniors

By Amanda Covey, Pharm.D.
During this time of year, the list of common cold and flu symptoms is all too familiar:  runny nose, cough, sore throat, congestion, fatigue, body aches, and watery eyes.  Perhaps the only list more exhaustive than this is the number of nonprescription medicines, also referred to as over-the-counter (OTC) drugs, available to help alleviate these ailments. 

These medicines come in all different forms, ranging from familiar tablets to hot tea beverages and even vapors.  Accompanied by an array of descriptors, products vary according to the time of day for their recommended use, the severity of symptoms described, and the number of symptoms to be treated.  Given the wide assortment of options that are offered, selecting a medicine that will be both appropriate and safe can be a challenge.  This choice is further complicated by the fact that some nonprescription drugs may interact with your prescription medications or health conditions.  While your Walgreens pharmacist will always be happy to offer OTC drug advice, a few tips to assist in finding a safe and appropriate nonprescription medicine will also be reviewed.  Keep in mind that over-the-counter medicine for the cold and flu can only help relieve symptoms and is not intended to cure the viral infection causing illness or lessen the duration of infection. 

A good first step in selecting an over-the-counter medicine is to make a list of the symptoms you are experiencing.  Since many of the cold and flu medicines available contain more than one drug, it is important to read the Drug Facts label to ensure that all active ingredients are necessary.  This information is listed in the first section of the Drug Facts label under “Active Ingredient(s)” and “Purpose(s)”.  The active ingredient, or drug name, is usually listed along the left side of this section while the corresponding “purpose,” or symptom the drug is used to treat, will be listed to the right of the drug name.  Compare the list of ingredients and purposes on the Drug Facts label with your list of symptoms.  You may notice that you are considering a multi-symptom cold medicine that contains a cough suppressant when you are not currently experiencing a cough, for example.  Avoiding products that contain active ingredients used to treat symptoms that you are not suffering from can prevent you from experiencing side effects from drugs that are not providing any treatment benefit.   

Becoming familiar with the list of active ingredients is also critical if you are taking more than one medication, either prescription or over-the-counter, as taking too much of one active ingredient can be dangerous.  It is important to note that the active ingredient names may be unfamiliar and difficult to recognize without the help of your doctor or pharmacist.  For example, the active ingredient name for Tylenol® is acetaminophen.  Acetaminophen, used for pain relief and reducing fever, is a very common active ingredient in cold and flu medicines.  A medicine that does not have the brand name “Tylenol®” written anywhere on the packaging may still contain the active ingredient acetaminophen. 

While reading and understanding all components of the Drug Facts label is crucial to ensuring safe and appropriate over-the-counter medication use, another section particularly relevant to treatment of cold and flu symptoms is the “Warnings” section.  This section will list reasons why the medication should not be used or circumstances under which a doctor or pharmacist should be consulted before use.  One example of the relevance of considering this section in the treatment of cold and flu symptoms can be seen when noting the effect of a common ingredient on blood pressure.  Oral decongestants, or active ingredients used to help treat congestion and a stuffy nose, may raise blood pressure.  Therefore, patients with high blood pressure, also known as hypertension, should consult their doctor or pharmacist before selecting a product with an oral decongestant.  Other treatment options, such as nasal decongestant sprays, may be a better option. 

According to the Consumer Healthcare Products Association (CHPA), seniors use more than 30% of the over-the-counter medicines purchased in the United States, which represents the highest OTC use out of all age groups.  The CHPA also reports that seniors use an average of three prescription medicines in a given month.  Considering seniors’ frequent need for over-the-counter medicine, coupled with an underlying use of several prescription medications for multiple health conditions, the need to safely select nonprescription medicine cannot be overemphasized.  Ask your Walgreens pharmacist to assist you in choosing a safe and appropriate medicine for your cold or flu symptoms. 

Ask the Pharmacist: Seniors Prepare for Medicare Part D Open Enrollment

By Amanda Covey, Pharm.D.

Is the vibrant colors fade from the autumn trees and begin appearing in seasonal storefront displays, both the end of the year and the holiday season are approaching.  While twinkle lights may be more reminiscent of the upcoming festivities, they also accompany the timeframe for annual Medicare Part D open enrollment, occurring from November 15th through December 31st. 

This is the time of year when anyone enrolled in a Medicare Part D plan can switch to another plan for the following year.  It is important for Seniors to review their Medicare Part D coverage each year because a majority of plans change their medications costs and coverage from year to year.  A Senior’s medication needs can also change throughout the year.  To best prepare for Medicare Part D plan open enrollment, it is important to understand the main differences between plans and the resources available for plan selection assistance.   Rest assured that while the details that differentiate the various Medicare Part D plans may be complicated, Walgreens pharmacists are able to assist you in selecting the best plan for you based on your medication needs. 
  
There are five main categories used by the official Medicare website (available at www.medicare.gov) that are used to compare available Medicare Part D plans.  The first point for comparison is whether the plan offers additional drug coverage during the coverage gap, commonly referred to as the “donut hole.”  Before the “donut hole” is reached, prescription drug costs are shared by both the member and the drug plan.  After a certain spending limit for covered drugs has been surpassed, a member may reach the coverage gap, a period during which all prescription drug expenses will be paid out-of-pocket. Some Medicare Part D plans may offer no additional coverage during the coverage cap, while other plans may offer some degree of coverage during the gap period.  These plans may be evaluated by whether coverage is provided for formulary generics or brand name medications, or both, and the number of these types of medicines covered.  Note that a drug plan’s formulary is a list of medicines that the plan prefers based on factors such as cost and effectiveness.  Drugs that are listed on a plan’s formulary are often less expensive than similar medications that are not on the formulary.

The next three plan features outlined on the Medicare website that should be assessed when selecting a Medicare Part D plan are the cost of the plan’s monthly premium and annual deductible, as well as the plan’s cost sharing structure.  A monthly premium is a payment that is required at a regular interval for prescription drug coverage.  An annual deductible is the amount of money that a member must first pay before the plan begins to share additional prescription drug costs.  For example, for a member with a $100 deductible, the first $100 of prescription drug costs would be paid for in full by the member, after which the plan would begin to provide coverage for some costs.  The plan’s cost sharing structure will determine what payment a member will contribute to drug costs.  These payments may be in the form of a co-payment (co-pay), which is a flat fee paid by the member per prescription, or coinsurance, which is a fixed percentage of the prescription cost.  Plans with a low deductible that offer additional gap coverage and require low co-payments will likely have a higher monthly premium.  Conversely, plans with a low monthly premium may not offer gap coverage and could have a higher deductible and greater patient cost sharing.  Your Walgreens pharmacist can help you find a plan that best meets your needs. 

The final comparison point reviewed on the Medicare website is a summary rating of the Prescription Drug Plan quality.  This rating is based on data acquired by Medicare regarding the plan’s customer service, member feedback about the plan, member complaints, and drug pricing and safety.  The rating is reported as a number of stars obtained out of five possible stars. 

Fortunately, there are several resources available for assisting seniors in selecting a Medicare Part D plan.  You can call 1-800-Medicare or visit the official Medicare website (www.medicare.gov) to compare drug plans. Available drug plans are listed in table form and compared according to the five factors discussed.  A second alternative is to visit your local Walgreens pharmacy with a list of your current medications.  Our pharmacists are ready to answer your questions and provide you with a FREE plan comparison report to make your decision easy.   Your plan comparison report is also available by visiting Walgreens.com/medicare. 

Ask the Pharmacist: American Diabetes Month

Ask the Pharmacist: What to Know About Shingles

By Amanda Covey, Pharm.D.

A red, painful rash.  Blistering patches of skin.  Crusting lesions.  The possibility of developing long-term nerve pain that may persist for months or even years.  These descriptors all characterize herpes zoster, more commonly known as shingles.  Shingles is an infection caused by the varicella zoster virus, the virus that also causes chickenpox.  According to the Centers for Disease Control and Prevention (CDC), a shingles infection may even lead to pneumonia, loss of vision, hearing problems, or in very rare cases even death.  In order to reduce the chance of getting shingles, it’s helpful to understand factors that place an individual at risk for infection.  In terms of prevention, the only way to truly lower the risk for developing shingles is to become vaccinated against herpes zoster. 

In discussing the risk factors for developing a shingles infection, it’s beneficial to learn why those who’ve had chickenpox in the past may contract shingles.  When an individual has suffered from chickenpox, the varicella zoster virus that caused the infection remains present in the body’s nerves in an inactive state for years.  Reactivation of the virus leads to shingles, a condition characterized by development of a painful, blistering skin rash that typically lasts two to four weeks.  While it’s not known what causes the virus to become reactivated, the CDC reports that about one out of every three Americans will suffer from shingles in their lifetime.  Older individuals are particularly at risk for developing shingles, with approximately half of all shingles infections occurring in individuals that are 60 years of age or older.  Those with a weakened immune system are also at a higher risk of developing a shingles infection. 

To reduce the risk of getting shingles and lower the chance of developing long-term nerve pain, known as postherpetic neuralgia (PHN), following infection, the Advisory Committee on Immunization Practices recommends that all adults age 60 and older receive one dose of the herpes zoster vaccine, or Zostavax.  Individuals who have already suffered from a shingles infection or who have chronic conditions, such as diabetes, kidney disease or lung disease, may also receive the vaccine.  Those who should not receive the vaccine or should seek their physician’s advice include individuals with an allergy to gelatin, neomycin or other vaccine ingredients, pregnant women and those with a weakened immune system.  The vaccine is given as a single dose under the skin.   

The shingles vaccine is available seven days a week at nearly 350 Take Care ClinicSM, located at select Walgreens stores. To find the most convenient location, call 1-866-Take-Care or search online at www.TakeCareHealth.com.  No appointment is necessary; simply sign in at the kiosk, select the vaccine option in the menu and indicate, “shingles vaccine.”  The cost of the shingles vaccine varies depending on insurance coverage.  To determine if your insurance plan covers the shingles vaccine, check with your insurance provider.  A customer service representative should be able to assist you in pricing the vaccine. 

Medicare Part D members may also locate pricing information by calling 1-800-MEDICARE or visiting www.medicare.gov online. Zostavax may prevent a shingles infection in approximately half of the individuals 60 years of age and older that receive the vaccine.  The vaccine may also lessen the pain associated with a shingles infection and reduce the risk of severe, long-term nerve pain, a complication that about one out of five individuals with shingles will develop.  With the most common adverse reaction from the vaccine being soreness at the injection site, a small pinch seems to be a fair exchange for vaccination: the only action known to reduce the risk of developing a painful shingles infection.

Ask the Pharmacist: Seniors Prepare for Flu Season