Aspirin may be one of the most popular drugs on the American market.  Its multiple uses, dependable effectiveness, and low cost have made it a popular go-to drug for over a century.
Here are some noteworthy tidbits about aspirin.
Aspirin was invented in 1899 by people at Bayer, a German drug manufacturing company.  It also goes by the name acetylsalicylic acid.  It is similar to a compound that comes from the willow plant.  For many a century prior to that time, people had been using this compound from willow bark to treat pain, inflammation, and fever.  Some findings suggest even Hippocrates, the Greek scientist, around the year 400 B.C., would grind up the willow bark and dissolve it in a liquid and give it as an oral medicine for fever.  At the turn of the century the scientists at Bayer were out to create a more effective version of what was in the plant, and the result was aspirin.
For the next 50 to 60 years, aspirin was viewed as a highly sought-after drug for pain and fever in the United States and in much of the rest of the world.  As an example, when a flu pandemic hit around 1918, aspirin was popular for lowering the fever brought on by the illness.   Its popularity declined somewhat after 1957, when Tylenol, otherwise known as acetaminophen, was discovered.  In 1962 ibuprofen came into use, albeit as a prescription-only product in the U.S. for its first 22 years of existence, and this contributed to aspirin’s moderate decline in popularity. 
Why did aspirin decline?  In spite of its efficacy, there were a few safety concerns.  The big one was effects on the stomach, especially stomach bleeding.  With Tylenol and ibuprofen, this was not as serious of a concern.   For some patients, the risk of stomach bleeding is so high that aspirin is not a good idea for them.  Some other patients do not get stomach bleeding but still may have gastrointestinal side effects, such as a generalized upset stomach, heartburn, or nausea.    For those who get stomach bleeding, in extreme cases it can be life-threatening.  Internal bleeding in other parts of the body is also possible. 
Research that began in the 1960’s more closely examined the internal bleeding phenomenon associated with aspirin.  It was discovered that aspirin inhibits the body’s natural clotting process, where the body’s immune system stops wounds and bleeding.  Individuals with high cholesterol experience blood clotting because the immune system’s clotting process is naturally triggered when in contact with plaques in the blood vessels that cholesterol comprises.  The research showed that aspirin inhibits the formation of thromboxane, a protein the body makes to carry out the blood-clotting process.  Without thromboxane, clotting is not as likely to occur.  In the case of a “clogged artery” caused by cholesterol-rich plaques, this more likely will prevent having blood flow blocked to an organ.  Thus using aspirin may decrease the risk of stroke, where blood flow to the brain is blocked, or a heart attack, where blood flow to the heart muscle is blocked.
By 1990, then, experts were recommending aspirin for people at risk for a heart attack, stroke, and/or other medical conditions involving blood-clotting. They suggested taking one 81-mg aspirin once a day to prevent these serious medical problems.  For a time it was seen as a simple, low-cost method.
However, more recently experts have changed the recommendation.  Some patients who were taking aspirin to prevent heart attacks and strokes had never experienced either of these events, but rather had signs that one might be possible, such as high cholesterol, high blood pressure, or heart arrhythmias.  This prevention is called primary prevention.  Others patients taking aspirin had already experienced a heart attack and/or a stroke, and had survived the event but were trying to avoid a repeat.  Taking aspirin to avoid the second event is referred to as secondary prevention.  Experts now do not recommend using aspirin for primary prevention, but they continue to recommend it for secondary prevention.  In other words, if you have never had a heart attack or a stroke, do not rely upon aspirin to keep those things from happening.  However, if you HAVE experienced one of these cardiovascular events, aspirin is still viewed as more acceptable therapy.
Whether you take aspirin for fever, pain, or for cardiovascular disease, there are several things to remember.  Take it with or immediately after eating.  Do not take aspirin on an empty stomach.  When taken with food, stomach bleeding and other gastrointestinal side effects are much less likely to occur.  For cardiovascular events, always take the 81 mg version of aspirin once a day unless your physician says otherwise.  Some aspirin products contain 325 mg per tablet, but this is four times the recommended dose for prevention of heart attacks and strokes.  Save the 325 mg tablets for treatment of pain and/or fever.  Another way to decrease gastrointestinal side effects is to use what is called “buffered” aspirin.  (Such as in the product Bufferin)  This version has a protective coating in the tablet that protects the lining of the stomach from the effects of the aspirin itself.
By the way, if you are wondering what is best for primary prevention of cardiovascular events, lifestyle changes are the best place to start.  Modifying the diet, getting adequate exercise, and smoking cessation are sometimes adequate.  For some patients prescription medicines to lower cholesterol and/or blood pressure are needed even after implementing lifestyle changes.
Always check with your doctor if you are contemplating using aspirin for cardiovascular issues. Sometimes there are exceptions to the rules of thumb and your doctor can discuss with you what may be best for you.
I hope you found this information about aspirin helpful.  Thank you for reading.

When it comes to health care, quite often the answer lies in a medication or combination of medications.
However, there are some healthy concepts that do not involve medication.
I have come up with four things I think are worth mentioning.
1. Water
2. Exercise
3. Laughter
4. Sleep

There are others, but I will not discuss those, at least not right now.
If you experience adequate amounts of each of these four things, you will probably stay in better health. In this blog we will take a look at water. We’ll look at the other three in future installments.

Consuming an adequate amount of water is vital. It benefits the body in many ways.
1. Water flushes out toxins in the human body which, in large enough quantities, could be harmful. On a related note, consumption of adequate amounts of water can prevent what are called urinary stones. Urinary stones are mineral deposits that can accumulate in the excretory system, especially the kidneys. If these stones materialize, they can be a source of tremendous pain. However, if you drink enough water, you probably will not have to worry about this painful scenario.

2. Water promotes weight loss. Water has no calories, so if you consume water instead of consuming drinks that have calories, you are more likely to lose weight. Some research has found that people who consume water 30 minutes or so before a meal are less likely to overeat at that meal because they feel satiated. (Full) One study found that people who consumed 500 ml of water 30 minutes before meals lost 44% more weight over 12 weeks, compared with people who did not have water before a meal.

3. Water also makes it easier to go to the bathroom. (Defecate) Thus it may help in the prevention and relief of constipation and hemorrhoids. If you do not get enough water, the body pulls more water from the food in the digestive system. As a result, stools forming in the intestines become harder. Hard stools are more difficult to defecate. At this point, constipation and hemorrhoids are more likely to occur. Hard stools can rub up against the tissues of the rectum and anus, even causing bleeding.

4. Water lubricates joints, so joint and muscle pain is less likely. Joints in the human body consist in part of synovial fluid. This fluid is a cushion between the bones on either side of the joint. The more water you drink, the more synovial fluid you will have, and the more cushioning there will be in the joints. Better cushioning means it is less likely you will have to deal with joint pain. On the other hand, inadequate water will lead to less synovial fluid in the joints, and then it is more likely the bones will rub against each other. This rubbing, which is seen with arthritis, can be quite painful and debilitating.

5. Water helps the brain. The more water you drink, the easier it is to concentrate and think effectively. It may even help your mood.

6. If you have certain illnesses, such as a cold, drinking water can help. In the case of the common cold, drinking more water loosens phlegm in the throat and other areas of the respiratory system, making it easier to breathe and decreasing the likelihood of nasal congestion.

In many of these scenarios, water is transporting ions, nutrients, and other materials throughout the body. Movement of such particles is necessary for the body to function properly and at its best. Without the presence of water, such movement is not going to occur as much as it should. Both physical and mental body function will suffer.

Those are just some of the benefits of adequate water consumption. It is definitely one of the things we must have to stay alive.

How much water, then, should we consume? That is up for debate. Many sources recommend eight 8-oz glasses. (That’s 64 ounces or about two liters.) Another source recommends taking your weight in pounds and multiplying by 0.67. (Two-thirds) The resulting number is the number of ounces of water you should consume in a day. An example: A 180-pound person should try to get 120 ounces of water per day. Furthermore, if you exercise, you need to increase your water intake to make up for water loss caused by perspiration.

Does water from food or other beverages count? That is also debatable. I would say yes. This is part of why it is so good to have plenty of fruits and vegetables in the diet: They contain a relatively high percentage of water. Many solid foods do have some water in them. One caution, though: If what you are consuming has high amounts of caffeine or alcohol, you may actually lose water. Caffeine and alcohol are diuretics, which means they accelerate the rate at which water is excreted from the body through the kidneys. To avoid water loss, you have to drink more water to make up for the diuretic effect.

So pour yourself a glass of water. Repeat throughout the day. Do it for good health.
I hope you found this helpful. Thank you for reading.
– The Helpful Pharmacist

Have you gotten a flu shot yet?
If yes, splendid! You will probably not have to worry about getting the flu this coming flu season.
If no, why haven’t you?
When it comes to preventing influenza, the research consistently points to getting a flu shot to prevent the illness from infecting you. Health care professionals are very much in unison on this one: Get a flu shot.
In the 2017-2018 flu season, more than 170 American children died due to influenza according to CDC. Adult death numbers are more difficult to ascertain but it is estimated in the tens of thousands. Hospitalizations due to the flu can vary widely in number, but the number of Americans hospitalized is in the hundreds of thousands every year.
Influenza leads to many cases of children staying home from school and adults not coming to work when they are otherwise supposed to. Especially in the case of adults, this translates to something called lost productivity. When there is lost productivity, due to employees calling out sick, it can hurt the employer’s profits and their ability to carry out their mission statement.
Getting a flu shot can prevent much of these unwanted scenarios. For example, one study done within the past year showed that getting a flu shot reduced the chances of being hospitalized due to flu by 82 percent. The vaccines available have prevented illness 40 to 60 percent of the time. While that may not look as good as 100 percent or even 80 percent, it is, in my opinion, still worth getting immunized.
With any flu vaccine, the principle is as follows: The vaccine is made up of particles that are an inactivated (or “killed”) form of the virus. The human body’s immune system responds to the particles as if they were an actual infection, even though inactivated flu virus particles are harmless. This response produces proteins in the body called antibodies that can fend off an actual influenza infection should one occur after experiencing the vaccine. Once a person is at this point, they are much less likely to get sick because their immune system is prepared.
The flu vaccine comes in several different forms. Most of them are injectable, and they are administered into a muscle in the patient’s upper arm. There is another version that is inhaled through the nose. This is called Flumist. This version might be right for a patient who does not like getting shots, or is afraid of needles. However, Flumist is not always the right choice. Only individuals ages 2 to 49 years old should receive it. It is not recommended for individuals 50 years of age or older, nor is recommended for people of any age with chronic medical conditions such as asthma or diabetes. Why? The vaccine consists of flu virus particles that are not inactivated or “killed.” Instead they are “weakened.” Thus there is a bit of a chance that a patient age 50-plus or people with certain medical conditions could get sick if receiving this version. Pregnant patients should avoid it, also.
The injectable flu vaccines come in several types. The original injectable version, which goes by several names (Fluvirin etc) is a trivalent vaccine that can be used by most individuals. A trivalent vaccine is any vaccine that will protect against three strains of the flu virus. Quadrivalent forms of the flu vaccine, which protect against four strains of influenza, including the three strains that trivalents are for, have become more popular in recent years.
Some versions of the flu shot are more concentrated. (Fluzone, etc) They are usually reserved for individuals over the age of 65. What’s the idea here? As we get older, our immune systems naturally slow down as part of the aging process. A slowed immune system, though, may need a higher concentration of flu vaccine than what was produced in the original flu vaccine. A more concentrated version makes up for a slowed human immune system.
A pregnant individual should get a flu shot that is preservative-free. Why? Most versions of the vaccine have a preservative called thimerosal. Some data suggests that thimerosal may adversely affect the development of an unborn child. Although the data is not the most reliable, pregnant women are encouraged to ask for a preservative-free version of the vaccine. If, for no other reason, do it for peace of mind.
And by the way, being pregnant is all the more reason to get a flu shot! Not only will it protect you, the pregnant mother, but the vaccine will also protect your unborn child. The alternative—getting the flu while pregnant—can lead to serious pregnancy complications. It is so much easier and safer to get a flu shot. The preservative-free version is best.
So if the flu shot is such a good idea, why do some people not want to get it? Here are five things patients might mention:
1. “Won’t it make me sick?” No. The virus that makes up the vaccine is inactivated, unless it is the nasal spray, so it cannot make you sick. Viruses only make you sick if they are functioning and able to have an effect on the immune system. Inactivated viruses, including influenza, cannot do that.
2. “I’m not feeling well, so a flu shot might not be a good idea right now.” You are right, IF you have a fever over 100 degrees F, or if you are experiencing nausea and/or vomiting, or if you are in serious pain. However, if you are not dealing with any of these, vaccine-induced illness is less likely. Minor illness, such as low grade fever, a mild head cold, a stuffy and/or runny nose, or a sore throat are not necessarily reasons for postponing getting a flu shot. Talk with your immunizer, pharmacist, or doctor if you are unsure.
3 “I’ve never had the flu. Why do I need the vaccine?” The specific version—or strain—of the flu that appears each flu season changes from year to year. The vaccine manufacturers modify the vaccines in turn in order to counter what strains will be expected. The strain that you resisted last year may be totally different from what will be present this time around, and this version could find a way to make you sick. Get immunized.
4. “I’m allegic to eggs and they use egg protein to make the vaccine. Won’t I have an allergic reaction?” The most recent research says no. For several years people with egg allergies were told to avoid most versions of the flu vaccine, but now it has been determined that this is not a concern. However, Flucelvax is a version of the vaccine that is not made using eggs, so it can be given for peace of mind.
5. “Is the flu vaccine expensive?” Not nearly as expensive as seeking medical attention because you got the flu! Without insurance, a flu shot is usually less than $60 and some versions are less than $40. Can you get an appointment with your doctor for less than $60, with no help from your insurance or other third party? Highly, highly unlikely. Furthermore, if you get the flu and go see a doctor, a drug to treat influenza might be prescribed. A prescription-only drug called oseltamivir (Tamiflu) is very good at treating influenza and speeding up the recovery process. However, without insurance or any other discount a five-day course is well over $100. Most patients who need this drug have to take it for at least five days.
This is why insurance companies usually pay for a flu shot. If you go to a doctor or pharmacy to get the flu shot, and you have valid health insurance, it’s almost 100% likely the insurance will pay for the shot. You may not owe the immunizer a dime. Insurance would much rather cover your flu shot than the more expensive visit to the doctor and the five-day course of oseltamivir.
Are there cases where the flu vaccine will not work? Although rare, the answer is yes. However, the odds of it not working are so low that I would recommend getting immunized anyway. Why does it sometimes not work? There are several possible reasons.
1. You may have been exposed to the flu before getting immunized. Certain individuals get exposed to the flu without knowing it, then get a flu shot, then get symptoms several days later. The vaccine takes 18 days to gain a full effect, so any virus exposure prior to that may make you sick.
2. The strains of flu present in your community may be different from the strains of flu the vaccine was made for. The CDC and the manufacturers of the flu vaccines make every effort to predict what strains of the flu will be present in a given flu season, but it is tricky to predict. Mismatches occur, although they are infrequent enough that getting the flu shot is still recommended.
If you do get the flu, there are several things you can do. First of all, REST. Do not go to school or work. Do not go anywhere else unless it is an emergency or your purpose for venturing out is to get medical care. Otherwise, stay home. Drink plenty of fluids. Sometimes illness can lead to dehydration, especially if you have nausea, vomiting, and/or diarrhea. If you have any digestive system symptoms, limit what types of food you eat. Apple juice, toast, crackers, chicken broth, beef broth, bananas, and rice are some foods that most people can consume. They are relatively mild on the digestive system. Talk to your doctor if your symptoms last more than three days or if you have a fever of 103 F or more.
In any case, I hope you are able to stay well this flu season. Please get a flu shot.
I hope this blog has been helpful. Thank you for reading.

When you take an antibiotic for an infection or for certain other conditions, a probiotic becomes a good idea.
What is a probiotic? It is a product that contains billions of bacteria, packed into a single tablet, capsule, chewable tablet, or one of several other dosage forms.
Why use probiotics? Some people might cringe at the idea of consuming something with bacteria in it. However, some bacteria are actually beneficial to the health of the human body. In fact, some of these “good” bacteria are essential. Without them, illness and even death are a possibility. This is because some of these good bacteria digest food and protect the body against other microbes that can be harmful.
Some of these bacteria naturally reside in the human body’s digestive system, particularly in the large intestine. One of the most common of these species goes by the scientific name Lactobacillus acidophilus. Others include Lactobacillus bulgaricus, Streptococcus thermophilus, and the yeast Saccharomyces florentinus.
Probiotics can be used to treat several medical conditions. The use I hear about the most is for the treatment of antibiotic-associated diarrhea. When people take antibiotics, one of the most common side effects is diarrhea. Diarrhea occurs because the good bacteria that normally reside in the human digestive system are destroyed by the antibiotic. Without the good bacteria, other microorganisms may increase in number in the digestive system. The result can be fluid imbalances and illness, as well as inadequate digestion of food. All these things can lead to diarrhea. Diarrhea is more serious than one might think. In extreme cases it can lead to dehydration. Serious enough dehydration is life-threatening. Thus, treating it is wise, and preventing it is perhaps even wiser.
There are a variety of probiotics available, and most are non-prescription. One of the products is Saccharomyces boulardii. (Florastor, etc) It is one of the most effective if you are dealing with antibiotic-induced diarrhea. Studies have shown that this actually replenishes the good bacteria that were lost due to the presence of an antibiotic.
It is recommended that you 2 capsules twice a day starting no more than 3 days after starting the antibiotic, and continue taking it for 3 days after you are finished with the antibiotic.
Some other probiotics contain a good bacteria called Lactobacillus GG. (Culturelle, etc) This can help with antibiotic-induced diarrhea but it is more often promoted for overall good digestive system health, independent of whether or not you have antibiotic-induced diarrhea. Usually adults take 1 capsule (10 billion bacteria per capsule) per day.
Probiotics may be very useful for one other reason: Prevention of a Clostridium Difficile, of “C Diff” infection. C Diff can lead to serious diarrhea, fever, inflammation of the large intestine, dehydration, If not treated, this can become life-threatening. It can occur if good bacteria are wiped out by an antibiotic. Use of probiotics, then, can make a C Diff infection less likely.
Probiotics can be used by patients of all ages. Some versions can be used by infants. If you see a probiotic in a a powder form or dissolvable tablet, this is the version for infants and children. If you are a parent with a child on antibiotics, it is recommended that you ask your child’s pediatrician if a probiotic would be a good idea for your child. Quite often the answer is yes but not always.
Probiotics have several other uses, but usually they are either for antibiotic-induced diarrhea or overall digestive system health. Leave a comment if you want me to talk about other uses in more detail.
Hopefully this blog has been helpful. If you need antibiotics, consider using a probiotic, also. It just might prevent additional health problems, especially diarrhea, from flaring up.

As I write this, we are getting closer to a time of year when prescriptions for antibiotics become more abundant.
Children are back in school. It becomes more likely that germs gets passed from one person to another, as pupils and others are more frequently spending time together in enclosed areas such as classrooms. Before long some of them are not feeling well. There is an increase in stuffy noses, runny noses, body aches, fever, fatigue and some other undesirable symptoms. Quite often these individuals are dealing with the common cold. In turn, some pupils—and maybe adults—are staying home because they feel ill.
Could there be a bacterial infection present? Sometimes, but not always. Thus, antibiotics are sometimes—but not always—a good idea.
Many patients, and many parents of pediatric patients, have spent quite a bit of time at their physician’s office due to illness. Quite often, the outcome of such a visit is the prescribing of an antibiotic. Many patients and health care professionals appreciate the idea that an antibiotic will treat some of these illnesses. Once that occurs, the patient should feel better.
There is one big concern with this trend, though. More and more often, the antibiotics that are prescribed are not working as well as they used to. It is due to something called antibiotic resistance.
Sometimes resistance occurs because an antibiotic was prescribed but was not necessary. One example of this is a case where the patient has been infected by a virus, not a bacterial infection. A key point: Antibiotics will not eradicate, or completely destroy, viruses. The pharmacological properties of an antibiotic are of no benefit. They will not stop the virus from infecting a patient.
Tied to this is a response seen by bacteria when they are present in the human body. If the antibiotics are not used properly, the bacteria that they are supposed to eradicate will actually change until they can withstand the antibiotic’s presence. Bacteria have the ability to change their anatomy and physiology so that the antibiotic is no longer able to kill them. At this point, the bacteria are able to continue infecting the patient. It is as if no antibiotics were prescribed in the first place.
As a result, some illnesses that were less of a concern say, 50 years ago, are now increasing in frequency in the United States and other parts of the world. Some antibiotics that were successful back then are no longer worth prescribing. They will not work.
What can patients do? I have three recommendations.
1. Do not seek out a physician or the antibiotic that physician may prescribe unless certain conditions occur. It becomes more acceptable to seek out that physician if you are experiencing any of the following:
– A fever of over 102 F
– A fever of less than 102 F IF it lasts more than four days
–A cough that lasts more than three weeks
– A sore throat that lasts more than a week
– Other cold symptoms that last more than 10 to 14 days
Quite often what happens is that some of these illnesses get better by themselves. If it is a virus, the body usually will get rid of it without the help of antibiotics or other medications. Now that may take some time, so this calls for patience, but that is how the human body works. It is designed to take the time to do it right, when it comes to responding to most viral infections.
In that specific situation, while waiting for the body to get rid of such infections, the symptoms that occur can be treated with non-prescription products. For example, ibuprofen and/or acetaminophen can often treat a fever, body aches, or a sore throat. Ibuprofen can be used up to four times a day (every six hours) on an as-needed basis. Acetaminophen can be used every 4 to 6 hours, again as needed.
By the way, when we say “as needed,” the implied message is this: If you don’t need it, don’t take it.
2. If you do see a physician, follow his/her instructions as to how to take care of yourself. That physician may tell you NOT to use antibiotics. More often than not, that is wise advice. Instead of antibiotics, sometimes the physician will refer the patient back to non-prescription products and tell the patient to “wait and see.”
3. If you do get a prescription for an antibiotic, take it exactly as prescribed. One of the common causes of bacterial resistance is the misuse of antibiotics even when they are a good idea. Research has found that if you use it longer than necessary, or not as long as is necessary, the bacteria involved find a way to become resistant. For example, some antibiotics should be taken twice a day for ten days. If you do get an antibiotic with that type of schedule, take it for ten days, just like the label says. In many cases where 10 days is the recommended period of time to take the drug, a patient will feel better after less than ten days. Splendid! That is what we are hoping for. However, that does not mean the bacterial infection has been completely eradicated. Some of those bacteria may still be in the body, so its wise to continue taking the antibiotic for the prescribed amount of time to make sure all of the bacteria are eliminated. Research has found that if a patient stops taking the antibiotic prematurely, the bacteria that have not been eliminated are more likely to adapt to the presence of the antibiotic and find a way to resist it. Bacteria, like most other organisms in the biological world, have the ability to adapt to a changing environment.
If right now you are ill, I hope this advice helps. I also hope you feel better soon.

Sometimes people have concerns about the pricing of their prescriptions.
There are a variety of factors leading to this, but one of the big ones has to do with whether you are getting a brand-name drug or a generic drug. There are other factors, of course, but we will save those for another blog.
The U.S. Food and Drug Administration (FDA) defines a generic drug as “A drug product that is comparable to a brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use.” (www.fda.gov) In other words, the generic version of a drug is (supposedly) going to have the exact same effect on the human body as would its brand-name counterpart. Both contain the same active ingredient, and have the same amount of active ingredient per tablet, capsule, ml of liquid, etc. Thus both would treat the same medical condition, have the same likelihood of effectiveness, and the same side effects.
There are differences. The INACTIVE ingredients in a drug—which are sometimes called excipients—may be different. A big one is dyes. For example, a brand name drug that is a white tablet may have a corresponding generic that is a blue tablet. Color of tablets, however, just about never has an impact on the tablet’s therapeutic effect in the human body. There is, then, no rule prohibiting the substitution of one for the other just because it’s a different color or has different inactive ingredients.
Some patients, however, have concerns about getting a generic medication. It is understandable. If it is not the exact same thing, and if it does not look exactly the same, will it fail to treat the medical condition in question equally well? Will it cause harm that the original brand medication did not cause?
Most of the time, the answer is no. A generic usually treats the same medical condition equally well without causing harm or side effects that the brand name drug is not known for. The FDA has put in place strict standards that manufacturers of generic products must follow. These standards ensure that the generic product is therapeutically the same as the corresponding brand-name product. While the brand and generic do not have to LOOK the same, they are expected to ACT the same. One standard is that the generic has to have 80 to 125 percent bioavailablilty of the corresponding brand-name drug. Bioavailability is defined as the percentage of drug consumed that actually reaches the bloodstream once inside the human body and thus is able to have an appreciable effect.
Perhaps the biggest difference between brand and generic medications is the cost. When insurance is asked to pay for patient’s prescription, insurance will usually make the patient pay a lower copay for a generic and a higher copay for a brand-name drug. Why? If the two drugs are therapeutically the same (or 80-125% the same), then why pay more for the brand if you’re not getting more? When a prescription is filled, then, for a brand name drug, often the insurance will still accept the claim (and not reject it), but they will make the patient pay a higher co-pay that includes the difference in cost between the two products. Here’s a hypothetical example: You might have a prescription for a cholesterol medication. Thirty tablets cost $600 without insurance, and thirty generic tablets cost $100. The copay for the generic might be $20. When the prescription is billed to the patient’s insurance, but insurance is told that the patient asked for the brand, they might accept the claim, but if they do they could charge the patient $520. ($20 copay plus $500, the difference in cost between the brand and generic without insurance.) More often than not the increase in copay is not that drastic, but I have seen cases like this in my experience.

There are several medication classes where switching to a generic is not looked upon favorably. One is thyroid medication. A study was done in 1997 to confirm that Synthroid and its corresponding generic – levothyroxine – were bioequivalent. By bioequivalent we mean that one drug would have the same ingredient and effect as would the other. Although the study confirmed that the two drugs were bioequivalent, a number of patients and prescribers began asking for brand Synthroid. To this day some patients still refuse the generic product. It is important to note that when a prescriber writes “Brand necessary” or “Dispense as Written” on a prescription, the pharmacist by law must comply and must not give the generic to the patient.
If you have concerns about the costs of your medication and/or whether or not generic medication is right for you, I would recommend you do three things.
First, talk to your insurance company. Do the best you can to get from them how much they will expect you to pay for your prescription, especially if there is a generic available and you want the brand. You have every right to get the brand name product, but some prescription insurance plans may still want you to pay the difference in price between the brand and generic products.
Second, talk with your doctor or other prescriber. With certain medications, doctors want their patients to get the brand name product. Often this is because they are aware of research or experiences showing that the generic did not work satisfactorily. If you want the generic, you need to make sure your doctor has no objection.
Third, talk with a pharmacist. Pharmacists usually know the differences, if any, between brand and generic products, and how the pricing works.
If you have any questions or comments please feel free to let me know.
Thank you for reading.

Poison Ivy: A common summertime itch

During the summer months, I often encounter many people stopping by the pharmacy with a simple question – What is the best thing to treat poison ivy?

Anyone who spends time outdoors, doing such activities as hiking, yard work, or gardening, runs the risk of encountering poison ivy.

What is poison ivy? Where does it come from? Poison ivy is a type of plant often found in the eastern and southern US. It has leaves that branch out in “threes” from a central stem. The leaves of the plant produce an oil — the fancy name for it is urushiol – that produces a rash with very intense itching when it comes in contact with a person’s skin. Usually the rash shows up a few hours after exposure, although it may take up to 2 weeks after exposure for symptoms to appear.

Poison ivy is related to two other similar plants: poison oak and poison sumac. Because all three plants contain urushiol, the outcome is similar with any of these plants.

The main symptom is very intense itching. Rashes or red lines are also often present. Sometimes blisters may appear, and they can ooze and possibly crust over.

My first recommendation is not to scratch the rash. I realize this is much easier said than done, but scratching the rash can spread the poison ivy chemical to other parts of the skin. Scratching the rash can also lead to the poison ivy chemical getting onto your clothes and causing further spread.

I also suggest washing the affected area with warm, soapy water. If possible, do this while taking a shower. A bath is not as helpful—the oils may disperse, whereas in the shower they are washed down the drain. Exception: If you use colloidal oatmeal in the bath, this may be helpful.

Whatever clothes you were wearing, take them off and launder them. Make sure they are not laundered with other clothes. Also wash any articles that may have come in contact with you or with the plant.

A cool compress may help. If you have a cold pack in the freezer, take it out and, if it’s microwavable, microwave until it is cool (maybe 20 seconds). Then apply to the affected area for five minutes.

Several non-prescription medications are available. Calamine lotion, which contains zinc oxide, seems to be one of the most effective, compared with other non-Rx products. This product—sometimes called an astringent–dissolves oils on the skin, including urushiol. Once dissolved, the oil is less likely to cause symptoms. It is applied every 6 to 8 hours as needed for itching and other symptoms.

Another non-Rx item that may help is hydrocortisone 1% cream. Hydrocortisone can suppress inflammation in the skin. Suppression of inflammation may decrease the discomfort. It is recommended that you apply it four times a day as needed.

Colloidal oatmeal is another non-prescription item that may help. Like hydrocortisone, it can suppress inflammation on the skin, albeit a little bit differently, and as a result possibly provide some relief.

What about antihistamines? They are for itching and rashes, right? Well, yes, but research shows that they do not help all that much with poison ivy. Why? Histamines, which the human body produces in an allergic reaction, do NOT play a significant role in the body’s reaction to poison ivy. Thus antihistamines—which only work on the body’s histamine response—are of little use. One could perhaps use diphenhydramine if the itching is at night and is leading to insomnia, or difficulty sleeping. Diphenhydramine is so likely to make you sleepy that the US Food and Drug Administration began recognizing it as an antihistamine AND a sleep aid. However, it is still not the top choice for poison ivy itself.

There are also several cleansers that have camphor and menthol that are available. Not as much is known about how effective these are. They can provide relief by delivering what feels like a “cooling” effect, but the urushiol may still remain, so the itching may continue when the product wears off. Warm soapy water in the shower may be just as effective or even more so.

If you do try hydrocortisone, colloidal oatmeal, and/or calamine, and are still having symptoms after seven days, see your physician. The main reason for this: Some cases of poison ivy may only respond to prescription products. Most of these products are steroids similar to non-rx 1% hydrocortisone, but are more effective and often work when the hydrocortisone is insufficient.

See your physician immediately (i.e. do not wait 7 days) if the patient is two years old or less, if the swelling and/or itching is severe, if it covers large areas of the body, or if it is on the eyes, ears, nose, mouth, or genital areas.

I hope you have an enjoyable summer, free of the itch associated with poison ivy.

– The Helpful Pharmacist

Hello, and welcome to my blog here at helpfulrxconsulting.com.

I am a registered pharmacist. I have been practicing in retail and long term care for more than 20 years. It has become clear to me that when some people walk into a pharmacy, they expect fast service. They are sometimes not feeling well, in a lot of pain, in a hurry, or all of the above. Furthermore, they want as much drug and good service as possible and pay as little as possible.

However, something else I have noticed is that when other people walk in to the pharmacy, sometimes the first thing they want to do is talk. They are frustrated, angry, or perhaps frightened about a health condition they are dealing with. They may have unanswered questions or challenges with insurance and other financial issues. Of course, the patients who want to talk still expect something from me, whether it is good advice, fast helpful service, a completed prescription, a good price, or a combination of the above. I believe that if a patient is convinced that the pharmacist is listening to them, they are more likely to accept the details of the overall pharmacy experience that may not be quite to their liking.

Furthermore, I have also watched the pharmacy world change. The forces in play have come together to make it more difficult to give the patients what they want: A completed prescription, done correctly, at (or below) the price they expect, and with all of their questions answered. What is a pharmacist to do? Either cut corners and run the risk of committing errors, or not take the time to get a decent price for the patient, or not take the time to listen to the patient if they need to talk.

I believe that there is a big enough demand for pharmacist-patient discussions that it may suffice as a business in itself. Obviously, the patient still has to acquire their medication from a licensed pharmacy. However, patients still have questions that may not be addressed by what’s printed on the medication label, or even by the leaflet that the pharmacist gives to the patient when they pay for the medication. It is more difficult than it used to be for pharmacists at stores to find the time to talk with patients about their concerns.

There also may be patients who get prescriptions through mail order.  Suppose they have questions about the bottle of pills that is in the mailbox.  Who can they talk to?  Is there someone standing next to the mailbox ready to answer their drug questions?  Probably not.

Here is another observation of mine: People who know me and know that I am a pharmacist have often come to me with questions about their medication therapy when I am off duty. I am pleased to help them and give them answers to their questions. I care about people and want to do something to make their lives better. (That is, improve their quality of life.) These discussions are golden opportunities to do so. With that idea in mind, I started looking into educating patients about their drug therapy, but without the risk of interference from the time-consuming, interruption-prone prescription-filling process.

As of this writing, the cornerstone of this website will be blogs such as this one. One goal of this blog is to provide answers to common questions posed by patients about prescription drugs, non-prescriptions drugs, herbal products, and otherwise healthy living. In each blog entry I will try to explain things as clearly as possible, in order to reduce ambiguity and confusion.

Something else worth discussing is what this website is NOT.

• It is NOT an arena where I can diagnose any illness, disease, or medical condition. Only a licensed prescriber (doctor, dentist, etc) has legal authority to do so.
• It is NOT an arena where I can prescribe. Again, only a prescriber has legal authority there.
• It is NOT an arena where I can dispense medication. Although I am a licensed pharmacist, the design of this website makes it such it is not the right place for this.
• It is NOT a place to come to if you are having a life-threatening emergency.  I cannot stress this enough: If you are having a life-threatening emergency, either call 911 immediately or go to the nearest emergency room.

However, if you have general questions about your medications, I hope you will take advantage of what this website has to offer. I am planning on posting blogs once a week. I encourage you to subscribe to the helpfulrxconsulting mailing list (which I am setting up soon), so you can get notifications via e-mail about new blog entries. I said earlier that I cannot diagnose or prescribe, but I can still address some questions related to prescription medication, and I can also recommend non-prescription products and/or non-drug products that might improve your situation. It just very well may make this part of your life a little easier, may improve your health, or even put less of a pinch on your wallet.

I would certainly like to hear from you. Please leave comments and questions.

Thanks for stopping in.

– The Helpful Pharmacist

Hello and welcome to

Helpful Rx Consulting.

“A source for practical medication information.”

This website’s main purpose is an opportunity for me, the helpful pharmacist, to provide useful information about medication therapy.  I hope to provide practical and relevant medical information in my weekly blogs.  There will also be a chance for viewers to leave comments or questions pertaining to appropriate drug use and healthy living.   I hope you find what I have to offer to be helpful.  Thank you for visiting.

Please click here to read my most recent blog post.  (First weblog coming very soon.)  You can also view the limits/restrictions of this weblog.