My current drugs

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My current drugs

Postby GennysMom2 » Thu Oct 20, 2011 12:26 pm

Drug Name Strength Amount Frequency COST
Liothyronine 25 mcg 2 am VA free
Synthyroid .075 mg 1 am $3/3 month supply
Flonase 50 mcg/spray 2 am $9/3 month supply
Aggrenox 25-200 mg 1 bid $9/3 months
Diovan HCT 160-12.5 mg bid $9/3 months
Pristiq 100 mg 1 qd $22/3 months
Aggrenox 25-200 mg 1 bid $22/3 months
Amlodipine 5 mg 1 qd $3/3 months
Asacol 400 mg 2 tid $9/3 months
Bupropion XL 150 mg 1 bid VA free
Clonazepam .5 mg 2 q/nite VA Free
Gabapentin 300 mg 3 tid VA Free
Lipitor 20 mg 1 q/nite $9/3 month
Metformin 500 mg 2 tid $3/ 3 months
Mirtazapine 30 mg 1.5 q/nite VA Free
Toprol XL 100 mg 1 q/nite $4/3 months
SUPPLEMENTS
Calcium Citrate + D 630mg/500 iu bid
Magnesium 400 mg bid
Omega 3 Fish Oil 1200 mg qd
Centrum Silver qd
B-100 Complex qd
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Re: My current drugs

Postby dlcnurse » Sun Oct 23, 2011 3:06 am

Thank you for posting. In reviewing your list of medications, you are getting some of your meds from the VA for free. These include Liothyronine, Bupropion, Clonazepam, and Gabapentin. I cannot beat that cost. The medications that you are purchasing are Synthyroid, flonase, Aggrenox, Diovan, Pristiq, Amlodipine, Asacol, Lipitor, Metformin, Toprol XL. Your expenses for 3 month supply of medications is approximately $105.00 (Total costs that you listed for your meds, not including your supplements). If the cost you list is per month, please let me know so I can correct your list and see if I can save you any more money. I can list each individual medication and the cost for each medication per pill if you would like but there is not one that is cheaper than what you are already paying.
I would encourage you to discuss with your physcian about alternative medication that may reduce your cost to some extent for example you are taking Liothyronine (T3) and Synthroid (T4) seperately and there is a combination medication such as Thyrolar. Whether it would save you any more money, I can't say. I would be happy to list the costs for the medications that you are taking if you would like. If there is something that I am missing from your list, please repost and I will take another look at it.
For the cost of your supplements that you take, I would need to know the manufacturer in order for me to be more accurate in figuring the cost against other brands.
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Re: My current drugs

Postby jimithy » Fri Nov 11, 2011 11:33 pm

Gennys Mom2,

Sorry I have not been keeping up with posts for a while. Here is my take on your medication list.

You listed 16 medications and 5 supplements. The total is actually higher because some of the medications/supplements are blends with more than one active ingredient. Usually this many drugs and especially the 3 instances of multiple drugs to treat the same problem... are the result of not having a single doctor orchestrating a person's medications. Since specialists do not tend to talk with each other, it is important that at least one competent doctor knows of and approves of all of your prescribed medications.

Drug Interaction checkers look for problems between 2 drugs (see the bottom of this post for Medscape listed interactions in your drug list). Top pharmacists can sometimes spot problems between 3 drugs. Someone taking 21+ biologically active/strong chemicals does not have a chance in hell of knowing what could be interacting with what and ESPECIALLY what the possible effects could be.

You have multiple antidepressants. I don't know of any substantiated research indicating that 2 antidepressants are better than one... much less the 3 you are taking. Most antidepressants try to differentiate themselves by promoting secondary advantages. Buproprion says that it helps you stop smoking. Mirtazapine says that it can help you sleep better. Pristiq is a serotonin norepinephrine reuptake inhibitor that touts fewer side effects versus older SNRIs. Off-label uses of meds are a primary tool drug rep "cheer leaders" use to get doctors to add their drug into a med regime. You are taking 5 psycho-tropic drugs. They are all powerful drugs that affect the entire body. Any doctor who believes he knows how those drugs affect you probably printed his diploma at home.

You are taking multiple meds that affect blood pressure. Most people do not respect the primary bodily functions that are affected by various blood pressure medications. When you combine those meds it is possible to create problems in other areas of the body. When other drugs are involved it gets even more complex. For example... 2 of your antidepressants affect the primary neurotransmitter, Serotonin. A common method of controlling blood pressure is vasodilation (relaxing smooth muscle tissue of the blood vessels). You are taking the bowel anti-inflammatory med Asacol. Since modifying Serotonin mechanisms affect two areas of the body the most... the brain and the intestines... AND the correct functioning of the bowels is determined a great bit by the proper action of the smooth muscle tissue there. Your mix of complex drugs are churned with Hydrochloric acid to create a brew in your stomach. That chemical plant's effects cannot be predicted but it would be stretch credulity that your digestive system has not been affected.

You are taking Gabapentin. The manufacturer was fined $400 million dollars several years ago for promoting its use for pain since it was only created and approved for treating a rare type of epilepsy (After that, the med was approved for people who have after effects from shingles). There are no substantiated studies showing this med is good for anything else. (If you like to use anecdotal evidence then let me talk to you about a great deal for the Brooklyn Bridge).

You are taking Metformin. GREAT!! The NIH has solid studies that it is the safest and most effective med for Type II Diabetes. It also does a lot to maintain healthy kidneys which is important for any diabetic. BTW Since you are diabetic... if you talk with your doctor about your multiple high blood pressure meds... you may want to bring up using an ACE-inhibitor such as Lisinopril instead. They tend to be quite effective, they have a long safety record, and they also do a lot to protect the health of your kidneys from damage from diabetes.

My mother-in-law fell into a clinical depression. Various meds were prescribed. Her condition worsened and she became agoraphobic. More meds were prescribed. She got worse and worse. Many med changes were made and inevitably the result was an increase in the number of types of meds. After 10 years she could barely stand and became hefty enough that 3 of us could barely get her off the floor when she fell. Finally she was hospitalized for her physical symptoms. The doctor was aghast at the number of meds she was taking. She left the hospital with half the meds. It was as if she awoke from a 10 year dream. She had no problem leaving the house and her depression was reduced. Her physical problems were even more greatly reduced.

Yes, that is anecdotal evidence. I am sensitive to it because I lost 7 years of my life due to overzealous medicating. It also stings because my Grandmother died of the euphemistic "Adverse Drug Event".

Here is what our gov's Center for Disease Control says about "Adverse Drug Events" (ADEs)
Adverse drug events are a large public health problem.
Adverse drug events cause over 700,000 emergency department visits each year. Nearly 120,000 patients each year need to be hospitalized for further treatment after emergency visits for adverse drug events. As more and more people take more medicines, the risk of adverse events may increase.

As people age, they typically take more medicines. Older adults (65 years or older) are twice as likely as others to come to emergency departments for adverse drug events (over 177,000 emergency visits each year) and nearly seven times more likely to be hospitalized after an emergency visit.
http://www.cdc.gov/MedicationSafety/Adult_AdverseDrugEvents.html

A report from the Institute of Medicine of the National Academies says:
Medication errors encompass all mistakes involving prescription drugs, over-the-counter products, vitamins, minerals, or herbal supplements. Errors are common at every stage, from prescription and administration of a drug to monitoring of the patient's response, the committee found. It estimated that on average, there is at least one medication error per hospital patient per day, although error rates vary widely across facilities. Not all errors lead to injury or death, but the number of preventable injuries that do occur -- the committee estimated at least 1.5 million each year -- is sobering, the report says.

Studies indicate that 400,000 preventable drug-related injuries occur each year in hospitals. Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics. The committee noted that these are likely underestimates.

There is insufficient data to determine accurately all the costs associated with medication errors. The conservative estimate of 400,000 preventable drug-related injuries in hospitals will result in at least $3.5 billion in extra medical costs this year, the committee calculated. A study of outpatient clinics found that medication-related injuries there resulted in roughly $887 million in extra medical costs in 2000 -- and the study looked only at injuries experienced by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11623

Notice that the population that takes more types of meds is much more likely to go to the hospital because of them.

I had a hard time finding out about how many people die from ADEs annually in the U.S. I am an excellent researcher but this quite important stat is curiously missing. I asked another researcher and she also could not find any legit statistic. I kind of like the US General Accounting Office's report to Congress.
ADVERSE DRUG EVENTS
The Magnitude of Health Risk Is Uncertain Because of Limited Incidence Data

... We provided a draft of this report to the Commissioner of FDA and five outside experts, including physicians, pharmacists, and epidemiologists who are actively involved in analyzing ADEs. FDA responded that the report accurately describes the current status of adverse event reporting. The agency also provided technical comments that we incorporated as appropriate. The outside experts generally found that our characterization of currently available information on ADEs is accurate and thorough. However, several of them expressed concern that our critical assessment of existing studies might create the misperception that there is little evidence that ADEs pose a substantial health risk to patients. We revised sections of the report and its title to make clear that while the magnitude of the health risk is uncertain its existence is not.
http://www.gao.gov/archive/2000/he00021.pdf

An "Adverse Drug Reaction" is one type of an "Adverse Drug Event". Most people believe human error causes most ADEs. Actually the best estimates are that about 80% of ADEs are not caused by human error but are actually "Adverse Drug Reactions". So the 28 drug interactions listed below that are due to human error are not what should worry you. The "Adverse Drug Reactions" from that chemical plant in your stomach is much more likely to get you.

Thank you for posting,

jimithy

Drug interactions listed by Medscape (http://reference.medscape.com/drug-interactionchecker). 1 Serious, 17 Significant, & 9 Minor. Remember that this is the tip of the iceberg. This is a check of any two of your medications. There is no known method to predict the interactions of 4 or more drugs. Think back to Organic Chemistry Class... take several chemicals and mix them with HCl (stomach acid)... you won't have any idea what the resulting compounds are EXCEPT you definitely know the result will not be the chemicals you started with.)

28 Interactions Found

Serious - Use Alternative

niacin + atorvastatin
niacin, atorvastatin. Either increases toxcity of the other by pharmacodynamic synergism. Serious - Use Alternative. Increased risk of rhabdomyolysis (>1 g/day niacin).

Significant - Monitor Closely
bupropion + metoprolol
bupropion will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Significant - Monitor Closely.

mesalamine + aspirin
mesalamine, aspirin. Either increases toxcity of the other by pharmacodynamic synergism. Significant - Monitor Closely. Additive nephrotoxicity.

metoprolol + valsartan
metoprolol, valsartan. Mechanism: pharmacodynamic synergism. Significant - Monitor Closely. Risk of fetal compromise if given during pregnancy.

calcium citrate + metoprolol
calcium citrate decreases effects of metoprolol by unspecified interaction mechanism. Significant - Monitor Closely.

aspirin + metoprolol
aspirin decreases effects of metoprolol by pharmacodynamic antagonism. Significant - Monitor Closely. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

calcium citrate + amlodipine
calcium citrate decreases effects of amlodipine by pharmacodynamic antagonism. Significant - Monitor Closely.

calcium citrate + levothyroxine
calcium citrate decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Significant - Monitor Closely. Separate by 2 hours.

valsartan + aspirin
valsartan, aspirin. Either increases toxcity of the other by Other (see comment). Significant - Monitor Closely. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

fish oil + aspirin
fish oil, aspirin. Other (see comment). Significant - Monitor Closely. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

fish oil + dipyridamole
fish oil, dipyridamole. Other (see comment). Significant - Monitor Closely. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

metoprolol + amlodipine
metoprolol and amlodipine both increase anti-hypertensive channel blocking. Significant - Monitor Closely.

aspirin + valsartan
aspirin decreases effects of valsartan by pharmacodynamic antagonism. Significant - Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

valsartan + metoprolol
valsartan and metoprolol both increase serum potassium. Significant - Monitor Closely.

valsartan + aspirin
valsartan and aspirin both increase serum potassium. Significant - Monitor Closely.

metoprolol + aspirin
metoprolol and aspirin both increase serum potassium. Significant - Monitor Closely.

clonazepam + mirtazapine
clonazepam and mirtazapine both increase sedation. Significant - Monitor Closely.

atorvastatin + valsartan
atorvastatin will increase the level or effect of valsartan by Other (see comment). Significant - Monitor Closely. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

Minor
aspirin + mesalamine
aspirin will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor or non-significant interaction.

metformin + cyanocobalamin
metformin decreases levels of cyanocobalamin by unspecified interaction mechanism. Minor or non-significant interaction. It may take several years of metformin therapy to develop vitamin B12 deficiency.

metformin + folic acid
metformin decreases levels of folic acid by unspecified interaction mechanism. Minor or non-significant interaction.

dipyridamole + metoprolol
dipyridamole, metoprolol. Mechanism: pharmacodynamic synergism. Minor or non-significant interaction. Risk of bradycardia.

clonazepam + cyanocobalamin
clonazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction.

gabapentin + cyanocobalamin
gabapentin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction.

aspirin + folic acid
aspirin decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction.

mesalamine + folic acid
mesalamine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction.

aspirin + cyanocobalamin
aspirin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction.

mesalamine + cyanocobalamin
mesalamine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor or non-significant interaction.
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Re: My current drugs

Postby dlcnurse » Fri Nov 18, 2011 12:25 am

Genny's Mom,
Currently I find 2 coupons on http://www.internetdrugcoupons.com that would be a savings for you. These coupons are on your aggrenox, Diovan HCT, and the Pristiq. Once on the site, just type in the name of the medication and it will bring up the coupon that is current. On the Aggrenox alone, you can save $20.00 off your prescription.
Given that there are alot of interactions within your medication list, I would encourage you to utilize this site (I also take alot of medications and I use this site myself) http://www.mediguard.org It is a great site that closely monitors interactions and rates the severity of the interaction. It sends you updates to your email which is great to stay on top of it.
In reviewing your medications, there are some concerns that should be discussed with your physician. Many times medications are used for different purposes and the physicians prescribing them don't take into consideration the other medications you are on. I am assuming that you have some cardiac history by the list of meds that you take i.e. Aggrenox, which is a combination drug of Aspirin and Persantine, which is used most often after a heart attack. Both of the medications in this combo inhibit platlet adhesion in the wall of the arteries. Amlodipine or Norvasc is a calcium channel blocker also used to control chest pain and as a anti-hypertensive. Diovan HCT or Valsartan is a anti-hypertensive with the addition of a water medication (Thiazide). This medication is generally used to control blood pressure. Toprol XL which is a Beta-Blocker is also often used after a heart attack to decrease the cardiac output, contractility, chest pain and heart rate. It is also used as a anti-hypertensive to decrease blood pressure.

Two concerns that indicate that discussing with your doctor might be appropriate. 1) The Mirtazapine is contraindicated in persons with a cardiac history. It isn't to say that it can not be used but certainly calls for close monitoring and possibly switching to a different medication. 2)The Pristiq actually can cause hypertension. If you are taking all of the above medications for lowering your blood pressure, this medicine actually counter-acts what the other medications are being used for.

Also noted are that you are one several medications that can be used for depression. It is often assumed that these are used for depression. That is not necessarily true. 2 of those medications are most generally prescribed for seizure activity. The first is Clonazapam or Klonopin and the second one is the Gabapentin. These two medications are also presribed for depression. My comment is that if these are being used for depression, there are no indications that either of these medications are effective in the treatment for depressive states.
Then you are on 2 medications used for the depression which are the Bupropion XL and the Mirtazapine. My concerns is this: If you are taking the first two for a seizure disorder, I would encourage you to talk with your doctor in regards to the last two. Both the Bupropion XL and the Mirtazapine decrease the seizure threshold and increase the risk of having seizure activity. If they are all 4 used for depression, a discussion with your doctor should happen as like jimithy said, all of them will decrease your abilities to function with any degree of normalacy.

I would encourage you to schedule a appointment with your doctor and at least review your medications and ask their purpose, what were the reasons for prescribing, if there are any concerns that you should be aware of, let your doctor know that you were reviewing all of them and have some concerns yourself and don't be afraid to bring those concerns up. The bottom line is that you are responsible for your own healthcare and you have to be a active participate in your care along with the doctors.I will continue to check to see if I find any other savings for you.
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