Tag Archives: Prescription Drugs

Dr. C's Journal, Medicine, Rx

Dr. C’s Journal: Expired Medications – What To Do

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Not too long ago, US government required pharmaceutical manufacturers to place an expiration date on their medications. The drug manufacturers embraced this requirement, since it added to their bottom line.

There are three cogent questions that should be asked:

  1. Can outdated medications cause direct harm?
  2. Do medications become ineffective after their expiration date?
  3. How do you dispose of unwanted medication?

Most sites mention only two medications that can become dangerous as they age, tetracycline, and diclofenac. Neither finding is for certain, but its best not to take these medication‘s if outdated.

Everything degrades with time, and medications are no exception. Those that are compressed into tablets and kept in the dark and dry tend retain potency longer than those in liquid form. Certain medications, such as nitroglycerin and epinephrine are quite prone to oxidation; epiPen, In ready-to-inject needles, in particular should be fresh; Biologics in general should be current. Drugs that are exposed to water, warm or humid conditions, or that are crumbly or have an odor should obviously be discarded. Liquid medication’s of all types, such as eyedrops, should be carefully stored and within their expiration date. One of my eye medications, latanoprost, requires refrigeration, a sure sign of instability.

That being said, the US Army found that 90% of 100 medication‘s were still effective 5 to 20 years after their expiration date. Another study found that some retain their efficacy even after 10 to 40 years.

Another factor to consider is the danger of the disease that is being treated. If you have such things as heart disease, or a severe infection, You should exert greater care.

If you plan to get rid of medication, look around for an organization willing to accept them; Developing countries are looking for such medication.

Avoid flushing medication down the toilet, since it may enter the environment and  be harmful to the ecosystem. Ideally it should be packaged in a container that is difficult to get into, so that children and other individuals may not have access; almost all medications are dangerous if taken in large amounts.

A lot of information is available on the Internet, with a variable amount of suggested precautions, depending upon the site.

I am a physician, and have taken many outdated medications In a pinch, but if I plan taking them for an extended time I usually get a new prescription.

—Dr. C.

Medicine, Rx, Videos

Insights: The Lucrative Business Of Diabetes (2022)

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In our modern consumer society, Type 2 diabetes has become a widespread disease. Companies are developing drugs that are increasingly expensive, but not necessarily more effective. Health authorities are powerless. Diabetes is spreading rapidly, all over the world.

The disease destroys lives and puts a strain on public budgets. The UN is calling on governments to take action. Diabetes is proof that modern societies are incapable of adequately treating chronic disease. It affects around 430 million people worldwide, with two main metabolic disorders falling under the name diabetes.

Type 1 is an autoimmune disease that must be treated with lifelong doses of insulin, while type 2 can develop when a person’s diet is too high in fat and sugar and they do not engage in enough physical activity. With turnover of $46 billion, diabetes is a massive and extremely lucrative market. Constantly promised miracle cures have not led to satisfactory treatment, with patients either taking too many drugs or no longer being able to afford them.

It’s a desperate situation, and the only ones benefiting seem to be pharmaceutical companies. A medical focus on blood glucose levels has led to an overreliance on medication, sometimes without due concern for dangerous side effects. Patients become trapped in a cycle of treatment, which in many cases still does not halt the disease’s progression. This can lead to amputations, blindness and heart attacks.

And yet there are alternatives that could flatten the curve of the type 2 diabetes epidemic, while reducing health care spending. Improved diet can be a preventative measure, and a strict adherence to diet can also bring about remission in the case of Type 2 diabetes. But these solutions require effort, as well as a complete rethinking of chronic disease management. Filmed on three continents, this documentary features industry whistleblowers, patients, researchers and medical professionals. It also confronts pharmaceutical companies about their responsibility for the situation.

Medicine, Prevention, Research, Rx

Covid-19: Review Of Latest Treatments & Medicines

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Medicine, Men's Health, Opinion, Rx, Women's Health

DR. C’S MEDICINE CABINET: ‘CELEBREX’ (NSAID)

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NSAIDs are a  common pain medication. Younger people with no underlying diseases take them all the time for headaches, sprained ankles, and other injuries.

I have an underlying stomach problem that makes me want to minimize the gastrointestinal side effects when I need an NSAID medication, and for that reason I have 100 mg Celebrex, or celecoxib in my medicine cabinet.

I am fortunate not to have much severe pain, although I do have osteoarthritis in my hand, and infrequent abdominal pain from a small bowel surgery.

Celebrex is my magic bullet whenever I have pain from diverse causes such as in my legs; I do have a very active exercise program of an hour a day in the morning and a half an hour in the evening.

The Cox 2 inhibitor‘s were initially touted as being able to avoid the stomach problems caused by the non-selective  NSAIDs. Unfortunately, several of them, such as vioxx, were associated with more heart attacks, a 45% increase, and they were removed from the market . Celebrex was a survivor from this group, but it still tends to cause an increase in blood pressure.

Whenever you take any medication, it’s always a trade-off;  relief from the problem at hand, traded for the inevitable side effects. There is no powerful medication that has only the desired activity, and  most people are better off with a healthy lifestyle than taking medication.

Another advantage with medication avoidance is that when you take the medication, it tends to work a whole lot better. At least I have found that to be true, and celecoxib is my magic pain medication, which has salvaged countless nights of sleep.

—Dr. C.

In The Lab, Medicine, Men's Health, Rx, Videos, Women's Health

COVID-19: MOLNUPIRAVIR – MERCK’S ANTIVIRAL DRUG

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Molnupiravir (MK-4482, EIDD-2801) is an investigational oral antiviral medicine that significantly reduced the risk of hospitalization or death at a planned interim analysis of the Phase 3 MOVe-OUT trial in at risk, non-hospitalized adult patients with mild-to-moderate COVID-19. At the interim analysis, molnupiravir reduced the risk of hospitalization or death by approximately 50%; 7.3% of patients who received molnupiravir were either hospitalized or died through Day 29 following randomization (28/385), compared with 14.1% of placebo-treated patients (53/377); p=0.0012. Through Day 29, no deaths were reported in patients who received molnupiravir, as compared to 8 deaths in patients who received placebo.

In The Lab, Medicine, Research, Rx, Studies

Medicine: Is Metformin A Wonder Drug? (Harvard)

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Physicians, PODCASTS, Resources

PODCAST: ‘THE FUTURE OF DRUG PRICE TRANSPARENCY’

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Interview with Dr. William Feldman on a new federal price-transparency rule and legal challenges to efforts to increase access to pricing information.

William Feldman is a physician and researcher in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal.

Medicine, Men's Health, Rx, Videos, Women's Health

HEALTH: HOW ‘STATINS’ PREVENT HEART ATTACKS AND STROKES’ (CDC VIDEO)

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Statins are a type of medication used to lower the level of bad cholesterol in the blood and reduce build-up in arteries that can cause a heart attack or stroke. This short animated video explains the importance of statins, how they work, and why your doctor may prescribe them.

Medicine, Rx, Studies

PRESCRIPTION DRUGS: ‘WHY THEY REMAIN HIGH-PRICED’

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There may be few issues that unite Americans ahead of the 2020 election as do their concerns about the cost of prescription drugs.

A clear majority — 75% — of respondents to a July survey said the cost of prescription medicines would be among the factors likely to influence their votes this year, according to a report from Gallup and the nonprofit West Health. Gallup reported on results from 1,007 interviews conducted with adults between July 1 and July 24.

1. What are the 2020 presidential candidates saying they will do to lower drug prices?

Both President Donald Trump, a Republican, and former Vice President Joe Biden, a Democrat, have highlighted insulin costs in their discussions of the need to lower drug prices.

In a January interview with the New York Times editorial board, Biden noted the widespread discontent among Americans about sticker shock often experienced at pharmacies. He spoke of a need for the federal government to act to make medicines more affordable.

“This is a place where I find, whether you’re Republican or Democrat, you think you’re getting screwed on drug prices. And you are, in terms of everything from insulin to inhalers and a whole range of other things,” Biden said. “So, again, can I guarantee that it gets done? No, but I can tell you what, if anybody can get it done, I can, and I think there’s a consensus for it.”

2. Why doesn’t Medicare, the biggest U.S. purchaser of drugs, directly negotiate on drug prices?

Congress has taken different approaches in designing the terms under which the two largest federal health programs, Medicaid and Medicare, buy drugs.

Medicaid is a program run by states with federal contributions and oversight. It covers people with low incomes and disabilities. Almost 67 million people were enrolled in Medicaid as of May 2020, including about 29 million children. In 1990 Congress decided that drugmakers who want to have their products covered by Medicaid must give rebates to the government. The initial rebate is equal to 23.1% of the average manufacturer price (AMP) for most drugs, or the AMP minus the best price provided to most other private-sector payers, whichever is greater. An additional rebate kicks in when prices rise faster than general inflation.

3. What’s the deal with rebates and discounts?

There’s widespread frustration among lawmakers and policy analysts about the lack of clarity about the role of middlemen in the supply chain for medicines. Known as pharmacy benefit managers (PBMs), these businesses describe the aim of their business as making drugs more affordable for consumers. Insurers like Cigna and UnitedHealth operate some of the nation’s largest PBMs, as does pharmacy giant CVS Health, which also owns insurer Aetna.

“They will tell you their mission is to lower drug costs,” said Rep. Earl L. “Buddy” Carter, a Georgia Republican, a pharmacist and a critic of PBMs, in a speech on the House floor last year. “My question to you would be: How is that working out?”

4. What is the “distinctly American” phenomenon of specialty drugs?

Kesselheim also has written on what he terms “Specialty Drugs — A Distinctly American Phenomenon.” That’s the title of a 2020 paper in the New England Journal of Medicine Kesselheim authored with Huseyin Naci, an associate professor of health policy at the London School of Economics.

In this Perspective article, Kesselheim and Naci look at how the “specialty” designation morphed from its origin in the 1970s. It then referred to a need for extra steps for preparation and delivery of new injectable and infusion products.

5. How much does it cost to bring a new drug to market anyway? 

The median cost for a medicine developed in recent years was $985 million, according to a study published in JAMA in March 2020, “Estimated Research and Development Investment Needed to Bring a New Medicine to Market, 2009-2018.”

“Rising drug prices have attracted public debate in the United States and abroad on fairness of drug pricing and revenues,” write the study’s authors: Olivier J. Wouters of the London School of Economics; Martin McKee of the London School of Hygiene and Tropical Medicine; and Jeroen Luyten of Leuven Institute for Healthcare Policy, KU Leuven, Belgium. “Central to this debate is the scale of research and development investment by companies that is required to bring new medicines to market.”

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