According to the Centers for Disease Control and Prevention, 1 in 13 Americans has asthma. On the other hand, the COPD National Action Plan released by the National Institutes of Health in 2017 reported that there were around 16 million Americans suffering from COPD, with millions more undiagnosed cases.

Treatment for Reversible Obstructive Airway Diseases

Reversible obstructive airway diseases are incurable. However, they can be effectively managed with medications and lifestyle changes. Effective management of these diseases means finding the minimum treatment that controls airflow obstruction and other symptoms, prevents severe attacks, and helps patients resume a normal life.[2] In most cases, this requires using a bronchodilator and/or anti-inflammatory medication.

Since these lung diseases often cause bronchospasm (tightening of the airways that reduce the airflow by at least 15%), leading to shortness of breath, the treatment plan devised for a patient often involves both rescue and long-acting drugs. As evident from the names, rescue drugs provide instant relief from bronchospasms, whereas long-acting ones help manage symptoms and limit or slow down the progression of the disease, in the long run.

While there are many different drugs available for reversible obstructive airway diseases, beta 2-agonists, when administered via inhaled route, provide the best results[3].

Ventolin HFA – A Short-Acting Beta 2-Agonist

Ventolin HFA, one of the brand names for albuterol sulfate (also called salbutamol), is a selective beta-adrenergic bronchodilator that only activates the beta-2 receptors on the muscles that surround the airways. The activation of these receptors causes the muscles to relax, which in turn dilates the airways and provides relief from dyspnea (the medical term for shortness of breath)[4].

Ventolin HFA is also a short-acting drug, which means it starts working within minutes after inhalation.

What is Ventolin HFA Used for?

Ventolin HFA inhalation aerosol is used to treat or prevent bronchospasm associated with reversible obstructive airway diseases.

The drug is also indicated to prevent exercise-induced bronchospasm.

Is There an Age Limit for Using Ventolin HFA?

Yes! Ventolin HFA cannot be used in pediatric patients under 4 years of age.

How is Ventolin HFA Supplied?

Ventolin HFA comes in the form of an inhalation aerosol that delivers a metered dosage of salbutamol i.e. 180 mcg, in each actuation.

The inhaler is available in two sizes, with 60 and 200 actuations.

Recommended Dosage of Ventolin HFA

Just like most other medicines, the right dosage of Ventolin HFA may vary across patients depending on the severity of the disease, overall health, and the body’s response to the drug. Therefore, it is highly recommended to consult your doctor to determine the right dosage for yourself and stick to that for as long as prescribed.

In most cases, however, the treatment with Ventolin HFA is initiated with the following dosages:

For Bronchospasm

2 inhalations of Ventolin HFA to be taken after every 4 to 6 hours is the standard prescribed dosage to get relief during acute episodes of bronchospasm and to prevent symptoms associated with them. In some patients, however, a lower dosage of 1 inhalation repeated every 4 hours may provide sufficient control. This is why it is recommended that you consult a doctor for determining the right dosage for yourself.

For Exercise-Induced Bronchospasm

People suffering from this type of bronchospasm are generally recommended to take 2 inhalations of Ventolin HFA about 15 to 30 minutes before exercising.

Important Information Regarding Ventolin Use

Here are some important things that you need to know and follow while using Ventolin HFA aerosol spray:

• Make sure to prime the Ventolin HFA inhaler before the first use, after it has been dropped, and when it has not been used for more than 2 weeks. This is to ensure that the right amount of the drug is delivered in each actuation.
• To prevent any difference in dosage due to potential blockage, it is recommended to wash the actuator, at least once a week, with warm water. Make sure to let it air-dry completely before putting it back on the canister or using the inhaler.
• Discard the inhaler when the counter on it reads 000, even if there is some amount of the drug left in the canister and it continues to operate, or after 12 months of opening it, whichever comes first.
• Do not expose your Ventolin inhaler to temperatures above 120 degrees Fahrenheit as it may cause it to burst.
• Always store your inhaler with the mouthpiece down and shake it well before every spray.
• For best results, make sure the inhaler is at room temperature before use.
• Take about a minute’s gap between the two inhalations of Ventolin and shake the inhaler well before each actuation.

What to Tell Your Doctor before Using Ventolin?

It is common knowledge that you shouldn’t use Ventolin HFA if you are allergic to any of the ingredients present in the drug or to albuterol sulfate, in general. However, there are a few more things that need to be considered to determine the safety of the drug for each patient. Therefore, make sure to tell your doctor about all other health conditions you may be suffering from and all the medicines you take, whether they are prescription, non-prescription, herbal, or dietary supplements.

In particular, make sure your doctor knows if you have any of the following:

• High blood pressure
• A disorder of thyroid glands
• Diabetes
• Low blood potassium level
• Heart disease
• seizures

Notify Your Doctor about Pregnancy

Tell your doctor if you are pregnant or planning to get pregnant.

Although the research regarding the effects of Ventolin HFA (or albuterol sulfate) on the fetus is inadequate to make generalized conclusions, various congenital problems have been reported in the babies of the women treated with the drug. These mainly include limb defects and cleft palate. However, researchers and healthcare practitioners have not yet established a clear relationship between the use of albuterol sulfate and birth defects, mainly due to the lack of a consistent pattern in them.

Nursing mothers should also consult their doctor about the safety and effects of Ventolin HFA for the baby.

Potential Drug Interactions of Ventolin

Here are some of the drugs that may alter the effects of albuterol sulfate, so make sure to tell your doctor if you are using any of them:

• Any other bronchodilator or asthma/COPD medicines
• Diuretics, commonly known as water pills
• Digoxin, a medicine used to treat atrial fibrillation and prevent heart failure.
• Monoamine Oxidase Inhibitors (MAOIS), such as isocarboxazid, phenelzine, linezolid rasagiline, tranylcypromine, selegiline, and methylene blue injection.
• Beta blockers, such as carvedilol, atenolol, metoprolol, labetalol, sotalol,and
• Tricyclic antidepressants, such as amitriptyline, doxepin, desipramine, imipramine, and nortriptyline.

Potential Side Effects of Ventolin HFA

Some patients may experience a few negative effects with Ventolin use. Common side effects of Ventolin HFA include:

• Headache
• Dizziness
• Upset stomach
• Sore throat
• Cough
• Stuffy or runny nose
• Sinus pain
• Back pain, muscle pain, and/or body aches
• Feeling nervous or shaky
• Infections of the upper respiratory tract

Serious Side Effects of Ventolin

Get emergency medical help if you experience any of the following conditions while using this bronchodilator:

• Severe headache
• Pounding in your ears or neck
• Chest pain or fluttering in the chest
• Fast or pounding heartbeat
• High blood pressure
• Burning or pain while urinating
• Breathing issues, such as wheezing and/or choking, or their worsening after using the drug. This is called paradoxical bronchospasm and is more likely to be experienced by the new users. Stop using Ventolin immediately, if this happens to you and consult a doctor right away.
• Low blood potassium level – symptoms include constipation, increased thirst and/or urination, muscle weakness, tingling, numbness, limp feelings, leg cramps, irregular heartbeat.
• High blood sugar level – signs include dry mouth, increased thirst and urination, fruity breath odor.
• Serious allergic reactions – symptoms include hives, rash, severe breathing problems, swelling of tongue, mouth, and face.

Prescription Assistance for Ventolin HFA

Although Ventolin HFA inhaler isn’t much expensive, GSK offers assistance to people who are uninsured or have Medicare part D and need help paying for their bronchodilator.

In order to be eligible for the GSK Patient Assistance Program, you have to meet the following criteria:

Conditions for Uninsured Patients

• Live in a US state, Puerto Rico or District of Columbia.
• Do not receive any assistance on prescription drugs through any type of insurance, co-pay, or assistance program.
• Not eligible for or have been denied Puerto Rico’s Government Health Plan Mi Salud.
• Meet the income requirements set out by the company.

Conditions for Patients with Medicare Part D

• Live in a US state, Puerto Rico or District of Columbia.
• Have Medicare Part D Prescription Drug Plan and have already spent at least $600 on prescription medicines, within the ongoing calendar year, through that plan.
• Not eligible for or have been denied Puerto Rico’s Government Health Plan Mi Salud.
• Meet the income requirements set out by the company.

Here’s the maximum income requirement set out by GSK in order to be eligible for its patient assistance programs:

Do not qualify for any of these programs?

Don’t worry!

Many pharmacies also offer drug savings programs for uninsured and underinsured patients. Here are a couple of them:

• Walgreen Prescription Savings Club – the membership for this program costs just $20 a year for individuals and $35 a year for families. By becoming a part of this savings club, you’ll get special discounts on thousands of prescription medicines, along with many other benefits.
• Kroger RX Savings Club – the membership for this savings program costs a little more than the one offered by Walgreens, but it allows you to save up to 85% on prescription drugs. It costs $36 a year for individuals and $72 a year for families with up to 6 members.

[1] https://www.ajmc.com/journals/supplement/2004/2004-07-vol10-n5suppl/jul04-1829ps127-s128

[2] https://www.ncbi.nlm.nih.gov/pubmed/1974671

[3] https://www.ncbi.nlm.nih.gov/pubmed/1974671

[4] https://www.medicinenet.com/script/main/art.asp?articlekey=24664

An important thing to note here is that Tadalafil is also available with other brand names, such as Adcirca that is used to treat pulmonary arterial hypertension and improve exercise tolerance. Do not confuse with any other brand names and do not use any other form of Tadalafil for this purpose.

Limitation of Use

If using Cialis along with a finasteride medicine for BPH treatment, do not use them for more than 26 weeks as the incremental benefit of Cialis after that is not known.

Do not use Cialis for any purpose if you are taking Adcirca for the treatment of pulmonary arterial hypertension or any other form of Tadalafil, for any purpose. Consult your doctor, if you think you need Cialis.

Cialis is not approved for use by young boys under 18 years of age.

Available Dosage Forms and Strengths of Cialis

Cialis comes in almond-shaped tablets in the following dosage strengths:

• 5 mg (the tablets have C 2 ½ debossed on them)
• 5 mg (the tablets have C 5 debossed on them)
• 10 mg (the tablets have C 10 debossed on them)
• 20 mg (the tablets have C 20 debossed on them)

Recommended Dosage for Cialis

For Erectile Dysfunction – As Needed

When used as needed, the general recommended dose of Cialis is 10 mg, to be taken before sexual activity.

Depending on the results and the person’s tolerability, the dose may be reduced to 5 mg or increased to 20 mg. However, the maximum dosing frequency should be kept limited to once a day, unless otherwise advised by your doctor.

For Erectile Dysfunction – Once Daily

When used regularly, the recommended initial dose of Cialis is 2.5 mg once a day. For best results, the medicine should be taken at almost the same time every day and the timing of dosage should be determined with regard to thatof sexual activity.

Depending on the efficacy of the drug and the person’s tolerability, the daily dose may be increased to 5 mg.

For Benign Prostatic Hyperplasia

For treating the signs and symptoms of an enlarged prostate, a 5 mg tablet of Cialis to be taken once a day, at the same time, is prescribed by doctors.

The dose of Cialis remains the same even when it is used along with a finasteride medicine, for BPH treatment that, on average, continues for 26 weeks.

For Both Erectile Dysfunction and BPH

When Cialis is used for treating both the conditions at the same time, the general recommended dose is 5 mg to be taken once daily at the same time.  In this case, however, the dosage doesn’t have to be scheduled according to the timing of sexual activity.

Important

Do not break Cialis tablets or split the dosage; take the whole tablet in one dose.

What to Tell Your Doctor before Taking Cialis?

Just like with all other medications, it is important to determine the safety of Cialis for every individual by taking into consideration his overall health. Therefore, it is highly important to tell your doctor if you have or have had any other health condition, particularly about the following ones:

• Heart rhythm problems
• Angina
• Stroke
• Heart attack
• Heart disease
• Hypertension or hypotension
• Pulmonary hypertension
• Kidney or liver disease
• Sudden loss of vision or retinitis pigmentosa; a rare genetic eye disorder that causes a gradual loss of vision
• Any blood cell disorder, such as leukemia, multiple myeloma, or anemia
• Any bleeding disorder
• Pulmonary veno-occlusive disease; a condition that causes narrowing of the veins that carry blood from the lungs to the heart
• Stomach ulcer
• Any health issue that makes it risky or unsafe to get involved in sexual activity

Note

A small number of cases of sudden loss of vision have been reported among people using tadalafil medications. However, most of those people were either already suffering from some eye problems or had health conditions that put their eye health at risk, such as diabetes, high blood cholesterol, and coronary artery disease. It isn’t yet clear if the loss of vision was due to those health issues or because of tadalafil medicine. Therefore, it is important to discuss the safety of Cialis with your doctor before starting to take the medicine.

Possible Drug Interactions of Cialis

The following medications may alter the effects of or counteract with Cialis and hence, are not to be used with it. Tell your doctor if you are using any of these medications or have recently stopped taking them before starting Cialis:

• Nitrates; generally used for treating chest pain and heart issues. Some examples of nitrate medicines include isosorbide mononitrate, isosorbide dinitrate, nitroglycerin, and recreational drugs, like nitrite poppers and amyl nitrate.
• Riociguat; used for treating pulmonary arterial hypertension, or any other medicine for the disease
• CYP3A4 inhibitors, such as ritonavir and ketoconazole.
• Alpha blockers
• Antifungal and/or antibiotic medicines
• Seizure medicines
• Any medication to treat high blood pressure
• Medicines for treating prostate disorder
• Any other medication for erectile dysfunction
• Antacids
• Rifampin and other medicines of the same formula (CYP3A4 inducers)

Potential Side Effects of Cialis

Here are some common side effects that you can expect to experience with Cialis use:

• Nausea
• Headache
• Dyspepsia
• Heart burn
• Belching
• Sour stomach
• Upset stomach
• Stomach discomfort and/or pain
• Stuffy nose
• Cough
• Infections of the upper respiratory tract
• Myalgia
• Flushes of warmth and/or redness
• Tingly feeling
• Back pain
• Muscle pain
• Pain in arms or legs

Serious Side Effects of Cialis

Stop taking the medicine and get emergency medical help if you experience any of the following effects while using it as they could potentially be life-threatening:

• Severe nausea
• Chest pain
• Dizziness during sex

While it may not be as serious as life threatening, take medical help immediately if you experience an allergic reaction with the drug. Signs of an allergic reaction to Cialis include:

• Difficulty in breathing
• Swelling of throat, tongue, lips, and face
• Hives

Some other serious adverse reactions of Cialis that call for discontinuation of the medicine and reaching out for professional help include:

• Ringing in ears
• Sudden loss of hearing
• Feeling lightheaded or like you are going to faint
• Changes in vision
• Sudden loss of vision
• Symptoms of heart attack, such as nausea, excessive sweating, pressure or pain in the chest, chest pain that spreads to the shoulder or jaw

Less Common Side Effects of Cialis

The occurrence of these adverse effects is not much common, but some people may experience them. Look out for them and consult your doctor if they persist or get severe:

• Dryness, itchiness, or burning sensation in the eyes
• Redness, swelling, or pain in the eye or eyelid
• Excessive discharge from the eyes
• Nose bleeding
• Burning feeling in the stomach and/or chest
• Numbness
• Prickling, itching, tingling, and/or burning sensation on the body or feeling as if something is crawling on your body
• Congestion
• Dry mouth
• Sore throat
• Difficulty in swallowing
• Swollen joints
• Sleeplessness or unusual drowsiness/ feeling excessively sleepy
• Reduced sensitivity to touch
• Neck pain
• Pain in the upper abdomen
• Muscle stuffiness
• Loss of strength and/or lack of energy

What Precautionary Measures You Should Take While Taking Cialis?

• Do not drink alcohol while you are on this medicine as it can cause some negative effects
• Do not consume grapefruit, grapefruit juice, or any grapefruit product while taking Cialis (or any tadalafil medicine) as they may counteract and cause adverse effects.

Each individual should also be assessed by a healthcare professional for the underlying causes of erectile dysfunction and/or BPH. It is also important that each person should be checked for cardiovascular health.

This is because sexual activity may increase the risk of cardiac issues in some people whose cardiac health is already affected. Cialis should not be given to such cardiac patients. Also, it is advisable for patients to get immediate medical help if they notice any unusual cardiac symptoms after taking the medicine or during sexual activity.

Prescription Assistance for Cialis

Cialis is a very expensive drug; a pack of 30 5 mg tablets cost around $150 without insurance or assistance. The high price naturally makes if inaccessible for a large number of people.

In view of the fact that millions of people in the United States are uninsured or underinsured and do not even have access to any kind of medical assistance, the drug’s manufacturing company Eli Lilly offers prescription assistance for it. With the Patient Assistant Program run by the Lilly Cares Foundation, eligible patients can get the company’s medications, including Cialis, for free.

Here is the eligibility criteria to qualify for the Lilly Cares program:

• You have to be a legal, permanent resident of the United States or Puerto Rico
• You have been prescribed a Lilly medication by your doctor
• You don’t have insurance, your insurance doesn’t cover the medicine you are prescribed (in this case, Cialis), or you have Medicare Part D and have already spent at least $1,100 on your prescription medicines within the ongoing calendar year.
• You are not enrolled in Medicaid, or any Veterans Benefits or Low Income Subsidy programs.
• Your annual household income is under the annual income limit

If you qualify for the patient assistance program, you will get up a year’s supply or the amount prescribed by your doctor, for free. Applying for the program is easy; you just have to fill out the online application form. For any help, you can call 1-800-545-6962.

If you don’t qualify for Lilly Cares’ Patient Assistance Program and are looking for an alternative, check out the Prescription Hope. It is a nationally recognized prescription assistance program that provides over 1500 prescription medications (Cialis is included in them) at the fixed price of $50 per month.

Spiriva, a long-acting bronchodilator, is the brand-name for tiotropium bromide, which is used as part of maintenance treatment for chronic obstructive pulmonary disease (COPD) and asthma.

Asthma and COPD are not only the most widespread chronic respiratory diseases, but they are also among the top 20 causes of global disability. However, it is quite difficult to accurately measure the prevalence, burden and mortality rates of both the diseases because they are often misclassified due to a lack of consensus on their case definitions.[1]

Another factor that makes differentiating between the two diseases difficult is that they produce similar effects. Both asthma and COPD can cause:

• Chest tightness
• Shortness of breath
• Coughing
• Wheezing

However, there are also some signs and effects that can help differentiate between the two respiratory diseases.

How to Differentiate Between Asthma and COPD

Here are a few factors that can help differentiate between the two diseases of the respiratory system:

• Asthma is not specific to any age group, whereas COPD generally occurs in people over 40 years of age; there can be some exceptions though.
• In asthma, patients usually experience periods of exacerbation followed by periods of normal breathing, whereas patients of COPD do not experience periods of relief; their breathing does not generally return to normal.
• Chronic cough is more common among COPD patients.
• COPD causes more mucus and phlegm production than asthma.
• Lips and/or fingernail beds of COPD patients often turn blue, a condition known as cyanosis.

Treatment of Asthma and COPD

Asthma and COPD, the chronic diseases of the respiratory tract, are not curable, in the very sense of the term. However, they are eminently controllable due to medical advancements.

A treatment and management plan for asthma and COPD generally involves using a combination of bronchodilators (short and long acting) along with making certain lifestyle changes, such as stopping smoking. Sometimes, patients are recommended to take vaccinations for preventing lower respiratory tract infections.

[1] https://www.pulmonologyadvisor.com/home/topics/asthma/asthma-and-copd-updates-on-prevalence-disability-and-mortality/

How Spiriva Helps With Asthma and COPD

Spiriva is a long-acting bronchodilator that belongs to the class of drugs called anticholinergics; a broad category of medicines that block the action of acetylcholine.

Acetylcholine is a neurotransmitter that controls the contraction of muscles and pain responses and is responsible for the regulation of endocrine functions and REM (rapid eye movement) sleep. Blocking of this neurotransmitter affects various body functions by inhibiting involuntary muscle movements in different parts of the body, such as the urinary tract, gastrointestinal tract, and the lungs.

Since anticholinergic medicines can have wide-ranging effects, they are used to treat several health conditions. Only a qualified healthcare practitioner can determine the right type, dosage, and the duration of use of anticholinergic medicine for asthma and/or COPD patients.

In patients of asthma and COPD, Spiriva helps to prevent or reduce the risk of bronchospasm by causing the muscles surrounding the airways to relax. As a result, the airflow to the lungs increases, enabling the patients to breathe easily.

Is Spiriva a Rescue Medicine?

No, Spiriva is not a rescue medicine and should not be used the treatment of acute bronchospasm during flare-ups.

Availability

Spiriva is available in the following two different forms:

1. Spiriva Respimat, an inhalation spray that is available in two dosage strengths. An actuation of Spiriva Respimat delivers 1.25 mcg or 2.5 mcg of tiotropium.
2. Spiriva HandiHaler, which is an inhalation powder that comes in the form of capsules and is used with a HandiHaler device.

The active ingredient in both forms of Spiriva is tiotropium bromide, an anticholinergic agent.

 Important

The Spiriva Respimat inhalation spray should not be used for children under 6 years of age. Spiriva HandiHaler capsules are not meant to be taken by mouth – they should only be used in the HandiHaler device.

Storage Considerations

Store both Spiriva inhaler and capsules at room temperature away from heat and moisture. Do not store the capsules in a HandiHaler device.

Do not freeze the Spiriva inhaler and discard it after 3 months of first use or when the inhaler gets locked (happens after 60 puffs i.e. 30 doses), whichever comes first.

Recommended Dosage of Spiriva

While it may vary across patients, here are the most generally prescribed dosages of Spiriva:

Spiriva Respimat

Asthma patients are generally prescribed 2 inhalations of 1.25 mcg/ actuation Spiriva Respimat, once daily.

On the other hand, the general recommended dosage for people suffering from COPD is 2 inhalations of 2.5mcg/ actuation Spiriva Respimat, once daily.

Spiriva HandiHaler

Two inhalations of Spiriva powder to be taken with the HandiHaler device, once a day, is the recommended dosage for both asthma and COPD patients.

Important: Do not take more than two inhalations and one dose in 24 hours.

Things to Consider Before Taking Spiriva

To ensure the safety of this anticholinergic drug, make sure to tell your doctor if you have or have ever had any of the following health conditions:

• Kidney disease
• Enlarged prostate
• Urination problems
• Narrow-angle glaucoma
• Milk allergy

While the effects of tiotropium bromide on the fetus are not known, uncontrolled asthma pregnancy can cause certain complications during pregnancy, such as extremely high blood pressure that can be dangerous for both the mother and the baby. It can also result in premature birth and low birth weight. Hence, it is highly important that women suffering from asthma or COPD tell their doctor if they are or planning to get pregnant.

The use of Spiriva may also not be safe while breastfeeding, so it is highly important to tell your doctor if you are a nursing mother or plan to breastfeed and discuss the potential risks.

Possible Side Effects of Spiriva

Just like all other medications, Spiriva can also cause some negative effects. Some common side effects of Spiriva include:

• Dry mouth
• Upset stomach
• Painful urination
• Symptoms of cold, such as sore throat, sinus pain, and runny or stuffy nose
• Blurred vision
• Nausea
• Sweating
• Pain in jaw, arms, or back
• Irregular or fast heartbeat
• Discomfort, tightness, heaviness, or pain in the chest

Serious Side Effects of Spiriva

Consult your doctor immediately if you experience any of the following effects with Spiriva:

• Blurred vision with redness or eye pain and/or seeing halos around lights
• White patches or sores on the mouth, tongue, and/or lips
• Breathing problems, like wheezing and choking, after using Spiriva
• Burning or pain while urinating
• Reduced or no urination

While many of the negative effects of Spiriva do not need medical attention and they go away as your body adjusts to the medicine, some may need dosage adjustments or change of medicine. Consult your doctor if any of the following side effects do not go away after a few days of beginning the treatment with Spiriva or become severe with time:

• Cloudy or bloody urine
• Bladder pain
• Frequent urge for urination
• Difficult or painful urination
• Chest pain
• Aches or pain in the body
• Belching; gas and bloating, and/or indigestion
• Dyspepsia
• Severe cough
• Congestion
• Dryness in the mouth and/or throat
• Chills
• Discomfort or pain in the stomach
• Heartburn
• Sneezing
• Hoarseness or loss of voice
• Tenderness or pain around cheekbones and eyes
• Tenderness or swelling of glands in the neck
• Fever

Spiriva Drug Interactions

Although it is recommended that you tell your doctor about all the medicines that you are taking whether they are prescription, non-prescription, herbal, or dietary supplements, before starting your treatment with Spiriva, make sure your doctor knows if you are taking medicines for any of the following health conditions, in particular:

• Anxiety or depression
• Mood disorders
• Mental illnesses
• Parkinson’s disease
• Stomach problems, such as irritable bowel syndrome
• Motion sickness
• Overactive bladder
• Allergy or cold

Also, tell your doctor if you are already taking any medicine for asthma or COPD. Spiriva should not be co-administered with any other anticholinergic drug as it may worsen the negative effects.

Warnings and Precautions

Stop taking Spiriva at once and consult your doctor if the drug causes immediate hypersensitivity reactions, such as itching, rash, bronchospasm, hives, angioedema, or anaphylaxis (a severe allergic reaction that could be fatal).

The medicine should also be discontinued if it causes paradoxical bronchospasm i.e. worsening of symptoms, such as wheezing and difficulty in breathing.

Spiriva should be used with caution in patients having the following health issues as it may worsen them:

• Urinary retention
• Narrow-angle glaucoma
• Renal impairment

Prescription Assistance for Spiriva

Spiriva is an expensive drug – the average cost of a pack of 5 Spiriva capsules is around $97, whereas the cost of Spiriva inhaler is around $457. The high cost of the medicine has made it inaccessible to a large number of patients.

In view of the problems faced by many patients in getting access to Spiriva because of their poor financial conditions, Boehringer Ingelheim (the company that manufactures the drug) has incorporated it into its Patient Assistance Program.

The BI Cares Patient Assistance Program is a charitable program run by the Boehringer Ingelheim Cares Foundation – a private non-profit organization that is dedicated to improving the health and lives of patients by making Boehringer Ingelheim medicines accessible for them.

Under the BI Cares Patient Assistance Program, many Boehringer Ingelheim medicines are provided free of cost to the eligible uninsured or underinsured US citizens.

Click here to check the eligibility criteria and to fill out the application form or call 1-800-556-8317, Monday to Friday from 8:30 am to 6 pm Eastern time, for further assistance.

Boehringer Ingelheim also runs several other social welfare programs, such as skill-based volunteering, product donation program and financial contributions program, to help patients across the world, strengthen communities, and to promote the culture of helping each other. Visit the company’s website to learn more about the various support programs it runs.

In addition to its widespread prevalence, the fact that diabetes is a leading cause of disability and death makes it a critical health problem.

Apart from causing millions of people to suffer from health issues, like kidney failure, stroke, heart attacks, lower limp amputation, and blindness, diabetes also causes millions of deaths every year. The incurable disease was the direct cause of around 1.6 million deaths in 2016, according to the World Health Organization fact sheet.[2]

Is It Possible To Reduce The Global Burden Of Diabetes?

Although diabetes is not curable, it can be prevented and successfully managed by maintaining a healthy lifestyle. The treatment of the disease often also involves using blood glucose lowering medicines, along with physical activity, healthy diet, and certain lifestyle changes, such as quitting the use of tobacco.

The medications used to improve glycemic control among people with diabetes mellitus falls into two major categories:

• Oral medications
• Insulin injections

Levemir belongs to the second category of diabetes medications.

Levemir – A Type of Manufactured Insulin for Treating Diabetes

Levemir is a solution of insulin detemir, which is a long-acting manufactured insulin used to maintain healthy blood sugar levels in people with diabetes.

For those who do not know, a long-acting insulin works slowly and its effects last for long as compared to a rapid or fast-acting insulin. After going into the body, insulin detemir takes a few hours to start affecting the blood glucose level, but once it does, it continues to work for up to 16-24 hours. Throughout its duration of action, it continues to provide small amounts of background insulin, similar to the natural process of insulin release in the body, to keep the blood sugar levels stable overnight or between meals.

Also known as basal insulin, it is often a part of the comprehensive diabetes treatment and is used alongside a rapid-acting or bolus insulin.

Limitations of Use

Levemir is not meant to be used for pediatric type 1 diabetes patients under 2 years of age and for the treatment of diabetic ketoacidosis.

It should also not be used for the treatment/ management of type 2 diabetes in children of any age.

How Is Levemir Supplied?

The colorless, injectable solution of Levemir is available in 100 unit / ml strength in the following forms:

• 10 ml vial
• 3 ml Levemir FlexTouch; prefilled pen.

Dosage and Administration

The right dosage of Levemir, or any other type of insulin, has to be individually assessed for every patient as it requires considering a variety of factors, such as a person’s daily insulin requirements, other insulin medications they are using, their body’s response to Levemir, and their overall health.

However, for people with type 1 diabetes, treatment with Levemir usually starts with one-third of a person’s total insulin requirements for a day. The remainder of the insulin requirement is fulfilled with a fast-acting insulin.

On the other hand, patients of type 2 diabetes whose blood sugar levels are inadequately controlled with oral medications and/or GLP-1 receptor agonists are generally prescribed to administer 10 units of Levemir once daily, in the evening. For patients on oral medications, the dosage may be divided into two; to be administered in mornings and evenings.

Important Dosing Instructions for Levemir

Here are some important things that you need to remember while being treated with Levemir:

• When administered once daily, insulin detemir should either be taken with dinner or at bedtime.
• When prescribed to use twice daily, schedule the doses 12 hours apart.
• Monitor your blood glucose levels regularly to make sure they stay within the healthy range and to prevent the risks of hypoglycemia. Do not change your dose or their timings without consulting with your doctor.

How is Levemir Used?

Levemir is administered via subcutaneous injection in the upper arm, thighs, or abdominal wall.

Instructions for Safe Administration of Levemir

Here are some of the most important factors that you need to follow in order to avoid any adverse effects with the use of insulin detemir:

• As with all other types of insulins, rotate the injection site with every injection, when you are administering Levemir within the same region. This is critical to diminish the risk of lipodystrophy – a common issue faced by diabetic patients that causes selective loss of adipose tissues.
• If you are also using a GLP-1 receptor agonist with Levemir, make sure you administer them separately; never mix both the solutions. Also, make sure to never inject them right next to each other; they can be used within the same body area though.
• Always inspect the insulin solution visually before use for any discoloration or presence of particulate matter and do not use if it is not colorless and clear.
• Never mix or dilute Levemir with any other insulin.
• Never share your Levemir pen with anyone, even if the needle has been changed.
• Levemir should never be used intramuscularly or intravenously as it can significantly increase the risk of severe hypoglycemia.

Potential Side Effects of Levemir

While Levemir is an effective drug for regulating the blood glucose levels, it may cause some people to experience a few adverse effects.

Apart from the risk of hypoglycemia that every diabetic patient faces, here are some negative effects that are comparatively more common than others:

• Mild skin rash
• Itching
• Thickening or hollowing of the skin at the injection sites
• Redness, irritation, and/or pain at the injection sites
• Swelling of the hands and/or feet
• Stomach pain

Serious Side Effects of Levemir

Just like any other medicine, Levemir may not suit some people. So, be careful when you start the treatment with this insulin and get medical help immediately if you experience any of the following signs of allergy to the drug:

• Skin rash along with itchiness, all over the body
• Rapid heartbeat
• Trouble breathing
• Swelling of the throat or tongue
• Feeling like you are going to faint

Some other serious side effects that may occur with Levemir use include:

• Hypokalemia; low blood potassium level – signs include constipation, increased thirst, increased urination, muscle weakness, leg cramps, limp feeling, numbness, tingling, fluttering in the chest, irregular heartbeat.
• Fluid retention in the body – signs include shortness of breath, swelling in the hands and/or feet, weight gain for no other apparent reason.

Some adverse effects of Levemir insulin detemir found in clinical trials are:

• Infections of the upper respiratory tract
• Headache
• Sore throat
• Back pain
• Flu-like symptoms
• Abdominal pain
• Gastroenteritis, commonly known as stomach flu or infectious diarrhea
• Bronchitis

What to Tell Your Doctor before Using Levemir

While it is common knowledge that you should not use Levemir, or any anti-diabetic medication per se, if you are allergic to it or experiencing hypoglycemia, tell your doctor about any other health condition that you may be suffering from. This is important to determine the safety of insulin detemir for you. In particular, tell your doctor if you are or have ever suffered from:

• Kidney disease
• Liver disease
• Hypokalemia (low blood potassium levels)
• Diabetic ketoacidosis

Hyperglycemia may complicate pregnancies and as a result, increase the background risk of adverse effects, such as birth defects, loss of pregnancy, etc. Therefore, all female diabetic patients should inform their doctor if they are or intend to become pregnant.

This is important because achieving and maintaining adequate blood glucose control before and during pregnancy can help decrease the chances of adverse events. And since insulin requirements continue to change during the pregnancy and post-partum periods, maintaining healthy glucose levels require regular monitoring and dosage adjustment.

Although it is not known if Levemir passes into human milk, it is recommended that nursing mothers also exercise caution with Levemir. This is because of the fact that a large number of drugs, including the natural human insulin, are known to be excreted into human milk.

Tell your doctor if you are a nursing mother as your Levemir dosage may need to be adjusted.

Possible Drug Interactions of Levemir

Any medicine that somehow affects the process of glucose metabolism and as a result, may increase or decrease the blood-glucose lowering effects of insulin can possibly interact with Levemir. Therefore, it is important that you let your doctor know about all the prescription, non-prescription, herbal, and supplemental medications that you may be using before starting diabetes treatment with insulin detemir.

Apart from beta-blockers, alcohol, lithium slats, and clonidine, the following medications, in particular, are known to potentially alter the effects of Levemir. Inform your doctor if you are using any of them to find out if they are safe to use with Levemir.

Medicines That May Increase the Effects of Levemir

• Oral anti-diabetic medications, rosiglitazone or pioglitazone, in particular. Using some oral diabetes medicines, along with Levemir may increase the risk of heart issues.
• ACE inhibitors
• Monoamine oxidase inhibitors (MAOIs)
• Pramlintide Acetate
• Pentoxifylline
• Propoxyphene
• Fluoxetine
• Fibrates
• Disopyramide
• Salicylates
• Sulfonamide antibiotics

Medications That May Decrease the Effects of Levemir

• Corticosteroids
• Diuretics
• Glucagon
• Niacin
• Danazol
• Thyroid hormones
• Protease inhibitors
• Estrogens
• Progestogens (generally present in oral contraceptives)
• Sympathomimetic agents, such as albuterol, epinephrine, and terbutaline
• Atypical antipsychotic medications, such as clozapine and olanzapine

Prescription Assistance for Levemir

Although Levemir is an effective and widely prescribed insulin, it is beyond the reach of a large number of diabetic patients due to its high cost and restrictions, which make it difficult to obtain the drug even through insurance.

A 30-day supply of this brand of insulin detemir costs over $500 and most insurance providers require patients needing Levemir to complete step therapy or submit a prior authorization form to get coverage for the drug. Both of these factors make Levemir highly inaccessible for many diabetic patients.

But, luckily, there are also a couple of ways to save on your Levemir prescription:

·   Savings Card

With the savings card offered by the drug’s manufacturer Novo Nordisk, eligible insured patients can get their monthly supply of Levemir insulin for as little as $45, for up to 2 years, along with a box of Novo Nordisk needles for free.

Check out the eligibility criteria for Novo Nordisk’s Diabetes Savings Card Program and request your savings card today if you meet the criteria.

You can also find out if you have any other co-pay or coverage options for Levemir on the Novo Care website or by calling at 1-866-310-8517.

·        Patient Assistance Program

For uninsured diabetic patients, Novo Care runs a Patient Assistance Program that provides free diabetes medicines for up to a year, to qualified patients. Visit the Novo Care PAP webpage to learn about the eligibility requirements and application procedure.

With these prescription assistance programs, many people who are otherwise unable to get Levemir insulin can receive their prescription drug at highly affordable rates or for free.

[1]https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

[2]https://www.who.int/news-room/fact-sheets/detail/diabetes

Novolog, the brand name for insulin aspart, is a type of rapid-acting manufactured insulin that is used to prevent mealtime spikes in the blood sugar level among patients of diabetes mellitus. The medicine is generally used as part of a basal-bolus insulin therapy to keep the blood sugar levels within a healthy range.

For those who do not know, basal-bolus insulin therapy is a comprehensive treatment plan that involves using two types of insulin – long-acting (also called basal insulin) and fast/short/rapid-acting (also called bolus insulin) – to closely mimic the natural insulin release mechanism of the body.

The therapy helps maintain stable blood sugar levels during periods of fasting as well as at meal times and is used for patients of type 1 diabetes and people with type 2 diabetes who do not benefit from oral medications and basal insulin alone.

Who Can Use Novolog?

Novolog is suitable for adults with either type 1 or type 2 diabetes. However, it can only be used in children with type 1 diabetes who are at least 2 years of age.

How Quickly Novolog Functions?

Novolog works faster than many other fast-acting varieties of insulin, such as insulin lispro (sold under the brand name of Humalog) – it starts to work within 5 to 10 minutes after entering into your body. The effects of Novolog peak in about 1 hour and last for a total of 2 to 4 hours.

Novolog’s Mechanism of Action

The insulin aspart medication Novolog prevents blood sugar levels from increasing after consumption of food primarily by regulating the process of glucose metabolism.

It binds to the insulin receptors on both fat and muscle cells and facilitates the process of cellular glucose uptake as well as prevents or reduces glucose output from the liver.

In animal testing (on rabbit and mice), Novolog has shown the same glucose-lowering effects as natural human insulin. However, in humans, the effects are found to be more rapid and short-lasting than natural insulin due to the quick absorption rate of the manufactured insulin.

Available Forms and Strengths

Novolog is available in 100 units/ml (U-100) injection solution in the following forms:

• 10 ml vials
• 3 ml Novolog FlexPen
• 3 ml PenFill cartridges, to be used only with the 3 ml PenFill cartridge device
• 3 ml Novolog FelxTouch

Dosage and Administration

Just like most other types of insulin, there is no universal recommended dosage of Novolog. It has to be individualized according to each patient’s metabolic needs, the severity of the disease, other medicines or insulin the patient is using, and the required level of glycemic control. The dosage may also need to be adjusted during the treatment according to the patient’s response to the drug, any changes in the treatment plan that requires starting or stopping any other medicine, and any changes in diet and/or physical activity. Dosage adjustment for Novolog may also be required during acute illness and with any changes in hepatic and/or renal function.

How is Novolog Used?

Novolog can be taken subcutaneously via an injection, insulin pen and insulin pump. When administered via an injection, Novolog can be diluted (with Novolog diluting medium only) or mixed with other types of insulin. However, make sure to ask your doctor about the right way to do it.

Important: Novolog can only be mixed with NPH insulin formulations. When mixing these two types of insulin, make sure to first draw Novolog into the injection and then the NPH insulin and administer it immediately after mixing.

Important Administration Instructions for Novolog

While using Novolog, or any other type of insulin, is quite simple, here are some important instructions that you need to know and follow to avoid any issues or negative effects:

• Always inspect the insulin before using – it has to be colorless and clear. Do not use it if there is any coloration or particulate matter in your Novolog solution.
• When using Novolog through an injection, administer it subcutaneously in the upper arm, thighs, abdominal area, or buttocks, and make sure you eat something within 5 to 10 minutes. Novolog is a fast-acting insulin and will most likely cause hypoglycemia (low blood sugar) if you do not eat after administering it.
• While insulin injections can be administered in the same area, it is highly recommended to change the injection sites within that area. Regularly administering injections at the same site can lead to lipodystrophy; an adipose tissue disorder that causes selective loss of body fat.
• When using Novolog via an insulin pump, administer it into the subcutaneous tissues of the abdominal wall. Again, change the infusion sites to prevent lipodystrophy.
• Follow your doctor’s recommendations and directions when diluting Novolog for subcutaneous injections.
• Never dilute Novolog or mix it with any other insulin when administering it by continuous subcutaneous infusion via an insulin pump.
• Intravenous administration of Novolog should only be done under medical supervision because it requires close monitoring of blood sugar and potassium levels to make sure they don’t get too low.
• Do not change the prescribed dosage of Novolog on your own and consult your doctor if you feel you need dosage adjustment.

Storage Directions for Novolog

Just like with all other types of insulin, it is critical that Novolog should be stored the right way in order to maintain its effectiveness. Here are some important storage directions that you should follow:

General

• Store the unused Novolog insulin vials/injections/pens/cartridges in the refrigerator between 36 to 46 degrees Fahrenheit (2-8 degrees centigrade) to keep them in good condition until their expiry date. Even when unopened, Novolog can only be stored at room temperature, that too at below 86 degrees Fahrenheit (30 degrees centigrade), for 28 days.
• Opened Novolog vials can be stored either at room temperature, below 86 degrees Fahrenheit, or in the refrigerator. However, Novolog cartridges and pens should not be refrigerated, once they are opened; store them at room temperature below 86 degrees Fahrenheit and discard after 28 days.
• Do not store Novolog insulin for later use once it is drawn into a syringe – use it immediately or discard it.
• Store Novolog pens without needles. This ensures accurate dosing by eliminating the risk for leakage as well as helps prevent contamination and the resulting infections.

For Diluted Novolog

Diluted Novolog can be used for up to 28 days if stored at temperatures below 86 degrees Fahrenheit (30 degrees centigrade).

For Insulin Pump

Discard the Novolog insulin in the pump reservoir at least after every 6 days, or even earlier if it gets exposed to temperatures above 98.6 degrees Fahrenheit (37 degrees centigrade). Also, change the infusion set and set the insertion site every 3 days.

For Intravenous Infusion Fluids

Novolog infusion bags prepared for intravenous administration remain stable for 24 hours, at room temperature. They should not be used after that.

Possible Side Effects of Novolog

In addition to providing the desired effects i.e. preventing blood sugar spikes after a meal, Novolog may cause some adverse effects in some patients. Tell your doctor if you experience any negative effects with Novolog use. While some of them are not dangerous and may go away with time, others may need medical attention.

Common Side Effects of Novolog

The following side effects are comparatively more common among diabetic patients using Novolog:

• Hypoglycemia; low blood sugar – signs include excessive sweating or cold sweats, hunger, dizziness, shakiness, headache, nervousness, anxiety, moodiness, irritability.
• Mild skin rash
• Itching
• Excessive hunger
• Weight gain
• Hollowing or thickening of the skin at the injection site(s)
• Blurred vision
• Restless sleep
• Lightheadedness
• Difficulty in concentrating and/or thinking
• Slurred speech
• Tingling in hands and/or feet

Serious Side Effects of Novolog

While their occurrence is rare, get medical help immediately if you experience any of the following severe side effects with Novolog use:

• Low blood potassium level – symptoms include irregular heartbeat, fluttering in the chest, constipation, increased thirst, increased urination, muscle weakness, limp feeling, leg cramps, numbness or tingling in hands and/or feet.
• Heart issues – signs include rapid weight gain without any apparent reason, shortness of breath, swelling.
• An allergic reaction to Novolog – signs include skin rash with itchiness all over the body, increased heart rate, redness and/or swelling at the injection site, trouble breathing, swelling in the throat or tongue, feeling like you are about to faint.
• Difficulty in swallowing and/or breathing.
• Swelling of arms, hands, feet, lower legs, face, throat, and/or tongue.
• Accumulation or redistribution of body fat.

Prescription Assistance for Novolog

Novolog is only available as a branded drug; a generic version of insulin aspart isn’t yet available. Hence, it doesn’t come as a surprise that it is an expensive drug. The average price for a 10 ml supply of Novolog solution is over $300, which makes it unaffordable for a large number of patients.

However, the good news is that this fast-acting insulin is covered by most major health plans, including Medicaid and Medicare.

On the other hand, there are also assistance programs for those who do not have an insurance plan or are underinsured. As part of their Patient Affordability and Access Support Program, called Novocare, Novo Nordisk offers two key financial assistance options for those diabetic patients who do not have inadequate insurance coverage and cannot afford to buy the drug either.

With the Savings Card, eligible patients can get a month’s supply of this insulin for just $25, for up to 2 years.

You may also get this brand of insulin aspart free of cost if you qualify for the company’s Patient Assistance Program (PAP). Click here to check out the eligibility requirements and to know the application procedure.

Do not qualify for any of these support programs?

Don’t worry – get the free discount coupon by Drugs.com and avail up to 80% discount on Novolog at all leading pharmacies, including but not limited to WallMart Pharmacy, CVS Pharmacy, Walgreens, Target, Duane Reade and many more.

What is Insulin and How Does It Work?

For those who do not know, insulin is a natural hormone produced in the body, by the pancreas, after we eat something. It is in the presence of this hormone that the body uses the carbohydrates present in the food for energy and to convert and store the excess in the cells, in form of glucose, for later use.

People whose bodies fail to produce or utilize the insulin (patients of diabetes) often need to take a form of human insulin to lower and maintain their blood glucose levels.

Human or manufactured insulin is available in different types, varying according to their onset and peak time as well as the total duration their effects last for. As classified by the Food and Drug Administration, here are the five types of man-made insulin:

1. Rapid-acting insulin
2. Short-acting insulin

• Intermediate-acting insulin

1. Long-acting insulin
2. Pre-mixed insulin (a combination of rapid or short-acting insulin and long-acting insulin)

While our bodies experience a sugar rush after eating and hence, insulin is needed to prevent the blood glucose level from rising too high, we also need small amounts of the hormone between meals to maintain blood sugar.

This is where the long-acting form of manufactured insulin comes in!

Long-Acting Insulin

As the name suggests, long-acting insulin helps to maintain blood sugar for a considerably longer period than the other types – it can help keep the blood glucose level within a healthy range for up to 24 hours. It also has longer onset and peak times.

Since it continues to work throughout the day, unlike the other types that only help to lower sugar levels after eating, long-acting insulin is also known as background or basal insulin.

The mechanism of action of long-acting insulin is similar to that of the naturally produced hormone. Three different types of long-acting insulin are currently available:

1. Insulin detemir – lasts for 18 to 23 hours
2. Insulin glargine – lasts for up to 24 hours

• Insulin degludec – lasts for up to 42 hours

Lantus – A Product of Insulin Glargine

Lantus is the brand name for insulin glargine injections that (as mentioned earlier) are used to treat hyperglycemia caused by type 1 and type 2 diabetes in adults and by type 1 in pediatric patients.

Since people with type 1 diabetes primarily rely on exogenous insulin supply to maintain their blood glucose level, insulin injections, like Lantus, are generally used as the first line of medications. However, they are not the first choice for the treatment/management of type 2 diabetes. Patients of type 2 diabetes are prescribed with insulin in the later stages when the oral medications lose efficiency or the pancreatic cells get so damaged that they cannot produce the hormone anymore.

Lantus Mechanism of Action

Manufactured by using the recombinant DNA technology, the mechanism of action of this type of long-acting insulin is similar to that of the natural hormone.

It helps to lower and manage blood sugar by regulating the process of glucose metabolism that includes stimulating the uptake of glucose, particularly by fat and skeletal muscles, as well as inhibiting the hepatic production of glucose. The insulin also enhances protein synthesis and inhibits proteolysis and lipolysis; the processes for the breakdown of protein and fats (and other lipids) respectively.

How Protein Levels Are Linked with Blood Sugar?

In the body of a healthy (non-diabetic) person, the higher levels of amino acids (as a result of protein breakdown) signal the pancreas to produce insulin and glucagon. Insulin initiates the uptake of amino acids by the muscle cells, whereas glucagon signals the liver to release stored sugar. As a result, the level of blood sugar remains stable after the consumption of protein.

However, the process is disrupted in people with type 1 diabetes. While the pancreas does not produce insulin, it produces glucagon as soon as the level of amino acids increases in the blood, which then stimulates the release of stored sugar by the blood. When there is no insulin to utilize the sugar, the blood sugar level rises.

The increase in blood sugar would be much lesser with protein consumption than it would be with the use of an equivalent amount of carbohydrates. However, diabetic patients are likely to need additional insulin dosage after consuming a generous portion of protein, such as a large steak.

Limitations of Use

Lantus is not meant to be used for treating type 1 diabetes in children under the age of six and type 2 diabetes in children of any age. It shouldn’t be used for the treatment of diabetic ketoacidosis as well.

Available Dosage Forms and Strengths

The injections of Lantus contain 100 units/ml of insulin glargine and are available as:

• 3 ml SoloStar prefilled pen for single-patient-use.
• 10 ml vial for multiple doses.

Storage

Lantus can be stored for up to 28 days either in the refrigerator or at room temperature. However, just like other types of insulin, it should never be stored in the freezer; discard if it has been frozen.

Also, protect the insulin from direct light and heat.

The unopened pens/vials can be stored in the refrigerator between 36 to 46 degrees Fahrenheit (2-8 degrees centigrade) until the expiration date.

Recommended Dosage of Lantus

The right dosage of Lantus varies across patients because it depends on several factors and may need to be adjusted with certain changes, for example with changes in diet or physical activity, in case of an illness, and/or with changes in hepatic or renal function.

Determining the right dosage for a patient, in the first place, requires considering the type of diabetes, its severity, other health conditions the patient may be suffering from, any other medication a person is taking, health history, and the glycemic control goal.

Initial Dosage

Here is the generally initial recommended dosage of Lantus:

For Type 1 Diabetes

People with type 1 diabetes are generally prescribed to fulfill one-third of their daily insulin requirement with Lantus, in the beginning. The remaining two-third amount of required insulin is taken in the form of a short-acting one, before a meal.

Simply put, people with type 1 diabetes are generally treated with a combination of short-acting and long-acting insulins.

For Type 2 Diabetes

The recommended starting dose of Lantus for patients of type 2 diabetes, who are being treated with insulin for the first time, is 0.2 units per kg or a maximum of up to 10 units per day.

The amount and time of dosage of other anti-diabetic drugs may need to be adjusted with the beginning of treatment with Lantus.

How to Use Lantus?

Lantus should be administered subcutaneously in thigh, abdominal area, or deltoid, once daily. While there is no specific time to take the insulin, it should be taken at the same time every day, once you start it.

Here are some important instructions that you should remember while being treated with Lantus:

• Always inspect the insulin injections before using. The solution should be colorless and clear and should not have any visible particles; do not use Lantus, or any other insulin, if it has a particulate matter or has discolored.
• Rotate the site of injection within the same region every day to reduce the risk of lipodystrophy – a medical condition characterized by the abnormal distribution of fat in the body.
• Administer Lantus at the same time every day.
• Do not mix or dilute Lantus with any other type of insulin or drug.
• Never administer the insulin via an insulin pump or intravenously.

Warnings and Precautions

• Never share your Lantus cartridge or pen with anyone; sharing needles and injections is the leading cause for the spread of lethal diseases, like hepatitis and HIV.
• Do not switch the type of insulin you are using unless prescribed by a doctor, even if both are insulin glargine. This is because not all brands of insulin glargine are equal and may need dosage adjustments while switching from one brand to another. Similarly, always consult your doctor before changing the type, strength, or dosage of insulin.
• Treatment of diabetes generally requires making certain dietary and lifestyle changes along with taking the medications for effective results. Follow all the directions given by your doctor with regards to diet, physical activity, and medication to keep your blood glucose levels under control.
• Do not use Lantus if you have diabetic ketoacidosis or experiencing an episode of hypoglycemia.

Possible Side Effects of Lantus

While Lantus is considered a safe and effective type of insulin for diabetic treatment and hence, is widely used, some people may experience a few negative effects with its usage.

Common Side Effects of Lantus

Here are some of the common side effects associated with Lantus use[1]:

• Hypoglycemia – low blood sugar
• Hollowing and/or thickening of the skin on the injection site(s).
• Mild rash or itching on skin
• Blurred vision
• Anxiety
• Cold sweats
• Chills
• Difficulty in thinking
• Pale and/or cool skin
• Increased heart rate
• Nausea
• Headache
• Restless sleep
• Slurred speech
• Excessive hunger
• Drowsiness
• Weakness or unusual fatigue
• Slurred speech
• Feeling lightheaded or dizzy

Rare Side Effects of Lantus

Immediately seek medical help if you experience any of the following effects with the use of insulin glargine:

• Shortness of breath
• Excessive sweating
• Quick weight gain without any apparent reason
• Swelling of feet and/or hands
• Allergic reaction to the drug – symptoms include redness and/or swelling at the injection site, troubled breathing, skin rash and itchiness all over the body, fast heartbeat, swelling of the throat and/or tongue, having a feeling that may faint.
• Low potassium – signs include constipation, leg cramps, increased urination and/or thirst, irregular heartbeat, muscle weakness, tingling or numbness in the body, fluttering in the chest

Possible Drug Interactions of Lantus

Any medication that affects your blood sugar or alters the effects of insulin can interact with Lantus. Therefore, it is highly important to tell your doctor about all the medicines that you are taken to overrule the possibility of any adverse interaction. In particular, tell your doctor if you are using:

• Any other anti-diabetic medication
• Corticosteroids, such as prednisone
• Birth control pills
• Thyroid medications
• Anti-psychotic medications, such as olanzapine, and clozapine
• Anti-depressants, particularly monoamine oxidase inhibitors (MAOIs) and fluoxetine
• Blood pressure medications, including ACE-inhibitors, clonidine, beta-blockers, and diuretics or water pills
• Pioglitazone or rosiglitazone, sometimes present in combinations with glimepiride or metformin
• Certain antibiotics, including sulfa drugs

Prescription Assistance for Lantus

Eligible patients can benefit from Copay Savings program run by Sanofi Patient Connection. Click here to check the eligibility criteria for the program or here to fill out the application form, if you know that you qualify for it.

In case you need more information or help regarding the process, call 855-984-6302 between 8 am – 8 pm ET, Monday to Friday.

[1] https://www.drugs.com/sfx/lantus-side-effects.html

The medication does not have any effect on the absorption of fat soluble vitamins or triglycerides.

Available Forms and Strengths

White to off-white colored capsule shaped tablets of Zetia are available in 10 mg strength only.

Dosage and Administration of Zetia

Zetia is to be taken orally with or without food once daily. It is recommended to take the medicine at the same time each day.

As discussed above, it is often paired with other medicines for better results. In case, you are prescribed Zetia along with a statin, take both the medicines at the same time. But, if you are prescribed a bile acid sequestrant with it, make sure to take Zetia either at least 2 hours before or 4 hours after the bile acid sequestrant.

What to Do If You Miss a Dose of Zetia?

It is highly recommended to follow the prescribed dosage of Zetia and take it at the same time every day. However, if you miss a dose, take it as soon as you remember.

If it is almost time for your next dose, skip the missed one and take the next dose on time – never take an increased dosage of Zetia to make up for the missed one.

What to Do If You Overdose On Zetia?

While the chances of overdose are extremely rare when you are taking Zetia, seek medical help immediately if you experience any serious adverse effect(s) or call the Poison Control Center at 1-800-222-1222.

How Long Does Zetia Take to Improve Cholesterol Levels?

The medicine can take up to two weeks before your overall and LDL cholesterol levels start to reduce, so do not worry and keep taking the medicine even if you do not experience any improvement in your condition in first few days.

Since cholesterol levels are checked via blood tests, you will need the blood tests frequently to determine the effectiveness of the medicine and to keep your cholesterol levels in check.

Storage

Zetia tablets should ideally be stored between 68 to 77 degrees Fahrenheit; however, excursions are permitted to 59-86 degrees Fahrenheit.

The medicine also needs to be protected from moisture and heat.

Side Effects of Zetia

While Zetia is generally considered safe for most patients, some may experience negative effects while using the drug.

Common Side Effects

Patients administering Zetia can expect to have the following effects while taking the drug:

• Headache
• Runny nose
• Sore throat
• Muscle pain
• Fever

Less Common Side Effects of Zetia

Here is a list of possible side effects of this lipid lowering drug:

• Cough
• Feeling numb
• Fatigue
• Diarrhea
• Dizziness
• Symptoms of cold
• Feeling depressed
• Joint pain
• Pain in arm or leg
• Constipation
• Bleeding from gums
• Bloating
• Dark urine and/or black tarry stool
• Blood in urine and/or stool
• Increased heartbeat
• Indigestion
• Muscle cramps or spasms
• Nausea
• Loss of appetite
• Pain in stomach, back, and/or abdominal area

It is not known if the drug causes any harm to the fetus or if it passes into breast milk, so tell your doctor if you are pregnant, planning to become pregnant, or a nursing mother.

Serious Side Effects of Zetia

Some lipid lowering medications have been known to cause the breakdown of skeletal muscle tissues and kidney failure. Although the chances of these effects are rare with Zetia, it is better to be careful and consult your doctor immediately if you feel unusually tired or experience unexplained muscle weakness, tenderness, and/or pain. See your doctor as soon as possible if these symptoms are accompanied by fever and dark colored urine.

Older adults or people who have poorly controlled hypothyroidism or kidney disease may have higher chances of experiencing these effects.

Inform your doctor immediately if you experience hive-like symptoms i.e. swelling of hands, feet, legs, tongue, lips, and face.

Possible Drug Interactions of Zetia

It is highly important to tell your healthcare provider about all the prescription, non-prescription, herbal, dietary, or recreational drugs that you use before starting to take Zetia. Although Zeita is primarily safe, it may interact with the following medications:

• Anticoagulants, commonly known as blood thinners, such as Jantoven, Coumadin, and Warfarin.
• Gemfibrozil
• Colesevelam
• Cholestyramine
• Cyclosporine
• Colestipol
• Aspirin
• Amlodipine (Norvasc)
• Crestor (rosuvastatin)
• atorvastatin (Lipitor)
• Crestor (rosuvastatin)
• Fish Oil (omega-3 polyunsaturated fatty acids)
• Fenofibrate (Antara, Fenoglide, TriCor, Lipofen, Lofibra, Lipidil EZ, Lipidil Micro, Triglide, Lipidil Supra)
• Furosemide (Lasix, Lo-Aqua, Diaqua-2)
• Gabapentin (Gralise, Neurontin, Gabarone, Fanatrex)
• Hydrochlorothiazide (Aquazide H, Carozide, Ezide, Microzide, Esidrix, , Diaqua, Oretic, HydroDIURIL, Hydro Par, Loqua)
• Ibuprofen
• Lipitor (atorvastatin)
• Levothyroxine
• Tylenol
• Vitamin D3 (cholecalciferol)

Who Should Not Take Zetia?

This lipid lowering medicine should not be taken by people who are:

• Allergic to ezetimibe
• Suffering from a liver and/or kidney disease
• Suffering from a thyroid disorder

Do not take Zetia with a statin cholesterol lowering medicine (such as Crestor, Lipitor, and Zocor) if you are:

• Pregnant
• Nursing mother
• Have an active liver disease

What Should You Avoid While Taking Zetia?

Zetia is only a part of the comprehensive treatment plan for keeping blood cholesterol levels within the healthy range. It has to be paired up with a healthy diet and exercise for better results.

Since diet plays a critical role in determining your health, doctors recommend patients to strictly follow a healthy diet plan and avoid eating foods that have high fat content. Zetia will not be as effective in lowering blood cholesterol if you do not eat healthy (low-fat) diet.

Prescription Assistance for Zetia

Since Zetia is an expensive drug (a bottle of 30 tablets costs around $369) and hence, is out-of-reach for many patients.

If you are also one of those patients who are unable to follow the prescribed treatment plan because of being uninsured, underinsured, and/or poor financial conditions, don’t worry because prescription assistance for Zetia is available.

Merck & Co., the pharmaceutical company that manufactures Zetia, provides the medicine at no cost to patients who are eligible for the Merck Patient Assistance Program, also called Merck Helps.

While the program mainly caters to uninsured or underinsured patients who could not afford the medicines manufactured by Merck without assistance, it may offer assistance to patients experiencing unforeseen medical and/or financial hardships.

Under the Merck Patient Assistance Program, eligible patients can get up to a year’s supply of Zetia free of cost, under a single application. The patients can also re-apply for assistance as many times as they need.

Visit the Merck Helps website to find out the eligibility criteria for the program, to check your eligibility, and to know how you can apply for prescription assistance for Zetia.

Resulting from the body’s inability to use insulin effectively, type 2 diabetes is the most prevalent form of the disease – about 90% to 95% of 30 million Americans who are diagnosed with diabetes have type 2[1]. It is also considered riskier than type 1. This is because its symptoms are less marked, and often unnoticeable, due to which the disease can remain undiagnosed for years after onset. In a large number of cases, type 2 diabetes is often diagnosed when it starts causing complications.

What Causes Type 2 Diabetes?

The exact cause of type 2 diabetes is unknown, but it is believed that a variety of factors contribute to its development. These include genetics, environmental factors, lifestyle, and a person’s overall health and fitness. This means you are more likely to develop diabetes at some point in life if you have a family history of the disease, are overweight, or remain physically inactive.

Symptoms of Type 2 Diabetes

Following are some of the most common symptoms of type 2 diabetes:

• Frequent urination
• Increased thirst and hunger
• Slow healing of wounds and sores
• Fatigue
• Unintentional weight loss
• Frequent infections
• Blurred vision
• Patches of dark skin, particularly on the neck and armpits.

The diagnostic test for diabetes is inexpensive, so make sure to consult a doctor and get yourself tested for the disease if you experience any of these symptoms.

Treatment of Type 2 Diabetes

Diabetes is incurable, but it can be effectively managed with medication and lifestyle changes, most importantly, by staying physically active and eating a healthy diet.

There are several medications available to help patients of type 2 diabetes keep their blood sugar levels in control and Januvia is one of them.

Januvia – Prescription Drug for Type 2 Diabetes

As mentioned above, Januvia is an oral medication that helps to regulate the insulin levels in the body, particularly after eating, in adult patients of type 2 diabetes. However, it is not a first-line medication – Januvia is generally only used when metformin or sulfonylurea fail to provide effective results.

Januvia Mechanism of Action

Sitagliptin, the active ingredient in Januvia, is a dipeptidyl-peptidase-4 inhibitor that helps to control the blood glucose levels after eating.

It blocks the breakdown of the incretin hormones that stimulate pancreas for insulin production after eating. The blocking of their breakdown causes their concentration to increase in the blood, which then will lead to increased production of insulin by the pancreas.

Apart from preventing the breakdown of incretin hormones, sitagliptin also reduces the amount of glucose produced by the liver and the level of glucagon in the blood. Glucagon is a hormone that is responsible for preventing the level of blood glucose from dropping too low.

Limitation of Use

Januvia is not to be used for treating type 1 diabetes or diabetic ketoacidosis. It is also not approved for use among patients younger than 18 years.

Available Dosage Forms and Strengths

Januvia is supplied in the form of oral tablets in 25 mg, 50 mg, and 100 mg strengths.

Dosage of Januvia

While the dosage may vary according to the severity of the disease and other treatments or drugs the patient may be using, a 100 mg tablet of Januvia, once daily, is the prescribed dosage in most cases.

However, patients suffering from moderate to severe renal impairment are given low dosages; 50 mg once a day to patients with moderate renal impairment and 25 mg once daily to those with severe renal impairment.

Since the renal function is a key factor in determining the right dosage, it needs to be assessed both before and during the treatment with Januvia.

How to Take Januvia?

Take the prescribed dose of Januvia orally, with or without food. It is highly important to strictly follow the doctor’s instructions while taking this medicine and do not change the dosage unless prescribed by the doctor. Also, regularly check your blood sugar level to make sure it is within a healthy range.

Januvia is mostly prescribed along with dietary changes and exercise, so make sure you follow the complete treatment plan for better glycemic control.

What to Do If You Overdose on Januvia?

An overdose of Januvia can lead to hypoglycemia i.e. low blood sugar. Seek medical help quickly if you experience extreme weakness, excessive sweating, blurred vision, trouble speaking, severe stomach pain, tremors, and/or seizures.

Things to Consider Before Taking Januvia

Just like with most other medications, a person’s medical history and current health condition need to be considered to determine if Januvia is suitable for them. Therefore, it is important that you tell your doctor everything related to your health. In particular, you should tell your healthcare advisor if you currently have or have ever had any of the following conditions:

• Heart issues
• Kidney disease (also share the treatments you are getting for it, particularly if you are on dialysis)
• Pancreatitis
• Gallstones
• High triglycerides

Also, tell your doctor if you are or have ever been addicted to alcohol, are pregnant or planning to get pregnant, or a nursing mother. Pregnant women may need dosage adjustments during every trimester and nursing mothers need to be assessed for the safety of the medicine.  Pregnant women may also be asked to join the Januvia pregnancy registry.

Talk to your doctor about the safety of the drug and potential effects on the baby if you are pregnant or a nursing mother.

Side Effects of Januvia

Although Januvia is an effective anti-diabetic medicine, it can produce some negative effects, like most other medications. Some of the common side effects of Januvia include:

• Headache
• Low blood sugar
• Stuffy or runny nose
• Sore throat
• Body pain
• Cough
• Ear congestion
• Fever
• Sneezing
• Muscle aches

Most of these effects generally go away on their own, after a few days of starting the treatment with Januvia as your body gets adjusted to the medicine. However, consult your doctor if they become worse or do not disappear after a few days.

Less Common Side Effects of Januvia

Some people may experience the following conditions while taking Januvia:

• Blurred vision
• Cold sweats
• Chills
• Pale, cool skin
• Confusion
• Anxiety or depression
• Fast heartbeat
• Dizziness
• Nausea
• Shakiness
• Seizures
• Loss of consciousness
• Slurred speech
• Extreme weakness or tiredness without any apparent reason

While they are not likely to cause any serious complication, it is recommended to report to your doctor, as soon as possible, if you experience any of them.

The medicine may cause an allergic reaction in some cases. Get emergency medical help if you experience any signs of it – swelling in your throat or face, difficulty in breathing, and/or hives.

Some people may also develop a severe skin reaction to Januvia. Signs of the skin reaction include:

• Fever
• Sore throat
• Skin rash that is red or purple and spreads, causing blistering and peeling
• Discomfort or pain in the skin
• Burning in eyes

Serious Side Effects of Januvia

Januvia may cause some serious adverse reactions in some patients. Stop taking the medicine and consult your doctor if you experience:

• Symptoms of heart failure, such as rapid weight gain, swelling or fluid retention in the feet, ankles, or legs, shortness of breath, especially when lying down, and/or unusual tiredness.
• Symptoms of pancreatitis, mainly severe pain in the upper stomach that spreads to the back, with or without vomiting.
• A severe autoimmune reaction causing itching, blistering and breakdown of the skin’s outermost layer.
• Little or no urination
• Joint pain

Possible Drug Interactions of Januvia

Some medications may affect the functioning of Januvia or the blood sugar level, which is why it is highly important to tell your doctor about all the medicines you are taking or have recently stopped taking, including herbal products and dietary supplements, before starting treatment with Januvia. Tell your doctor about the following medications (while they may not cause any serious effects, it is advised to let your doctor know about them):

• Levothyroxine
• Hydrochlorothiazide
• Lisinopril
• Furosemide
• Any other diabetic medicine

Patients using Digoxin, a medicine used to treat heart issues, like atrial fibrillation, needs to be regularly monitored when they are co-administered with Januvia.

Januvia may cause upset stomach, diarrhea, and/or swelling of the legs or hands when used with Avandia (Rosiglitazone); also an anti-diabetic drug.

Important:  It is highly important to strictly follow the dietary instructions and physical activity recommended by the doctor when taking Januvia. This anti-diabetic medicine is only a part of the comprehensive treatment plan and may not provide adequate control over the blood glucose level if other recommended measures are not followed.

Prescription Assistance for Januvia

Januvia (Sitagliptin) is an expensive drug, a month’s supply of 100mg Januvia costs over $400, and hence, is out of reach of a large number of diabetic patients.

However, the manufacturer of the drug – Merck & Co. Inc. – provides the medicine at an extremely low cost under the Merck Patient Assistance Program, also called Merck Helps.

Under the prescription savings program for Januvia, eligible patients can get medicines for as little as $5 for up to 12 prescriptions with up to 90-days supply per prescription. Check out the eligibility criteria for Januvia savings program to see if you can apply for it.

In case you do not qualify for the Merck Helps assistance program for Januvia, you can use the discount card offered by drugs.com to save up to 80% on your prescription medication. You can also talk to your doctor to determine if there are any alternative assistance programs for the drug that you can apply for.

It is expected that Januvia will be available as generic sitagliptin by the end of 2026 – generic medicines are typically available at significantly low costs than their branded versions.

[1] https://www.cdc.gov/diabetes/basics/type2.html

Falling under the category of Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), Cymbalta is an FDA-approved medicine that is believed to affect the levels of two neurotransmitters – serotonin and norepinephrine.

How Cymbalta Works

While scientists aren’t sure about how Cymbalta works, it is believed that it helps with depression, anxiety, and relieves pain by enhancing the effects of noradrenaline and serotonin in the central nervous system.

Noradrenaline also called norepinephrine, is both a hormone and a neurotransmitter and is known to play a role in cognition, thinking, emotions, mood, blood pressure, perception of pain, and flight or fight response.

Commonly known as the ‘Happy Hormone’, serotonin is a neurotransmitter that is mainly responsible for mood regulation. However, it also plays a role in the perception of pain and gastrointestinal functions.

Cymbalta is believed to provide relief from depression and pain in two ways:

1. It blocks the reuptake of noradrenaline and serotonin. Reuptake is a natural process in which neurons take back or reabsorb the neurotransmitters after they have completed their task i.e. transmission of a message.
2. An increase in the levels of pro-inflammatory cytokines in the central nervous system is considered one of the factors that can trigger depression. It is believed that Cymbalta can help with depression by reducing the activity of pro-inflammatory cytokines as well as by increasing the activity of anti-inflammatory cytokines. However, there are no scientific research studies to back this claim.

How Long Does It Take To Get Relief?

The absorption of the drug starts after about 2 hours of consumption, but it can take around 6 hours to provide results. However, you may need to take Cymbalta for several weeks before the clinical effects become visible.

Possible Side Effects of Cymbalta

While Cymbalta is an effective medicine, it should be used carefully because it can cause a number of side effects.

Here are the some of the common side effects that a patient can experience while using the medicine:

• Drowsiness or dizziness
• Nausea
• Insomnia
• Constipation
• Dry mouth
• Skin reactions
• Urinary retention
• Fatigue
• Loss of appetite and weight loss
• Increased sweating
• Increase in blood pressure
• Low blood pressure or hypotension may occur, particularly during the first week of usage. A person may feel light-headed or faint as a result.

Cymbalta may also cause serious negative effects in some people. Immediately consult your doctor if you experience any of the following:

• Pain, swelling, or redness in eye(s) or any change in the vision
• Seizure
• Any problem in liver, such as pain, jaundice, or dark-colored urine
• Severe skin reaction. Its symptoms include swelling of the tongue or face, burning feeling in eyes and on skin, sore throat, fever, skin rashes, and blistering and peeling of skin
• A manic episode characterized by hyperactivity, extreme aggression, severe restlessness, agitation, irritability, and impulsivity

Suicidal Thoughts

While suicidal thoughts are generally associated with major depressive disorders, the use of Cymbalta can make them more prevalent in children and teenagers.[1]

Therefore, doctors usually avoid prescribing Cymbalta to children. But, if it has been prescribed to your child, make sure to regularly monitor his/her condition and immediately consult the doctor if you notice any suicidal inclination, an increase in depressive symptoms, or any unusual behavior.

Serotonin Syndrome

In a few cases, Cymbalta may lead to serotonin syndrome. Serotonin syndrome is a potentially fatal condition caused by excessively high levels of serotonin. The higher levels of the chemical excessively increase the activities of nerve cells and can cause extreme agitation, increased heart beat, heavy sweating, high fever, shivering, muscle stiffness, diarrhea, nausea, loss of coordination, and hallucinations.

Who Should Not Take Cymbalta?

Cymbalta should be avoided by:

• Women who are pregnant. While the adverse effects of Cymbalta on the fetus and infants are not known, some animal studies suggest that it may adversely affect the development. This is why taking Cymbalta is not recommended for pregnant ladies and nursing mothers.
• People who are taking Monoamine Oxidase Inhibitors (MAOIs). MAOIs are also a class of anti-depressant drugs and taking Cymbalta along with them can cause serious side effects that could be fatal. Some common drugs that fall into the category of MAOIs are Nardil, Azilect, Marplan, Furoxone, Zelapar, Emsam, Eldepryl, Parnate, and Linezolid (an anti-biotic). Cymbalta should also be avoided for at least 5 days before and 14 days after the use of MAOIs.

Cymbalta should also be avoided if you are suffering from certain health conditions, both physical and mental. Make sure to tell your doctor if you have:

• A history of drug abuse
• A history of suicidal thoughts
• Bipolar disorder
• Kidney disease
• Liver disease
• Glaucoma
• Heart Disease
• Diabetes
• Any condition that causes seizures, like epilepsy
• A bleeding or clotting disorder

You should also inform your doctor if you are using any of the following medicines as they may interact with Cymbalta and cause problems:

• Diuretics – commonly known as water pills
• Any medicine for arthritis
• John’s Wort
• Amphetamines
• A medication for migraine
• Any medication for treating infections
• A sedative or any medicine that cause sleepiness

The following drugs can reduce the metabolism of Cymbalta in liver. As a result, the levels of Cymbalta in the blood increase, which can then worsen the side effects:

• Anti-arrhythmic drugs, such as Quinidine
• Any other antidepressant or anti-anxiety drug, such a Fluoxetine (Sarafem, Prozac), Fluvoxamine (Luvox), and Paroxetine (Paxeva, Paxil, and Paxil CR).

Cymbalta, when used with the following medicines, can increase the risk of bleeding:

• Warfarin (Coumadin)
• Aspirin
• NSAIDs ( Non-steroidal anti-inflammatory drugs)

When taken with desipramine (Norpramin) Cymbalta can increase the concentration of the drug in blood by reducing its breakdown.

Precautions While Taking Cymbalta

While taking Cymbalta, you should be careful to not:

• Smoke – it can reduce the action of the drug by one-third.
• Drink alcohol – it increases the risk of liver damage.
• Perform any activity that requires an alert and a clear mind, like driving or using machinery.

Availability

Cymbalta is available in form of delayed-release capsules in 20 mg, 30 mg, and 60 mg variations.

Dosage

The right dosage of Cymbalta can vary from person to person. The patient’s age, medical history, and overall health are some of the factors that need to be taken into account to determine the right dosage.

Generally, a 60mg dosage, once a day, is prescribed for treating anxiety. However, depending on the patient’s condition, a doctor may begin with 30 mg and then gradually increase it to 60 mg, after one to two weeks.

Maximum Dosage

In most cases, the maximum per day dosage of Cymbalta is not more than 120 mg.

How Should The Medicine Be Taken?

Cymbalta should be taken orally with water. You can take it with or without food. However, the capsule should never be sprinkled on food or crushed.

What to Do If You Miss a Dose?

If you miss a dose of Cymbalta for any reason, try to take it as soon as possible. But, if it is almost time for the next dose, skip the missed dose and take your regular dosage on its time.

Never take a double dose to make up for the missed one.

What Should You Do In Case Of Overdose?

If you or someone you know has mistakenly overdosed on Cymbalta, immediately call 911 or poison control center at 1-800-222-1222.

Overdose of Cymbalta can cause severe drowsiness or fainting, so avoid driving in the condition and call for help as soon as possible.

Storage

Cymbalta should be stored between 59 to 85 degrees Fahrenheit (15 to 30 degrees centigrade), at room temperature. Make sure to keep it away from direct light, heat, and moisture.

Important Information

If you are using Cymbalta, make sure to stick to the dosage prescribed by the doctor. Also, never stop using the medicine unless directed by your doctor. This is highly important because sudden discontinuation of Cymbalta can cause serious side effects.

Talk to your doctor if you want to stop using the medication for any reason as its dosage needs to be gradually decreased.

Where to Get Cymbalta From

Always buy medicines from a registered pharmacy to ensure that they are original and not expired. A lot of people make the mistake of buying medicines from online pharmacies without confirming their registration, just because they are available at slightly cheaper rates than other places.

Someone selling medicines at lower rates should in fact be a warning sign and you should stay away from such places.

Cannot afford to buy Cymbalta or any other prescription medicine? Find a prescription assistance program in your area!

Prescription Assistance

Sponsored by the manufacturers of prescription drugs or state, Prescription Assistance Programs have been designed to make sure that everyone has access to medicines, regardless of their financial conditions.

Through Prescription Assistance Programs, medicines are provided at a low-cost or for free to people who cannot afford to buy them, specifically the ones that are uninsured, underinsured, or ineligible for other government-run medical aid programs.

In view of the fact that over 46 million Americans are living without health insurance (the figure is much higher for people who are underinsured), prescription assistance programs offer great help to people suffering from chronic health conditions, but could not afford treatment due to lack of finances.

While the beginning of such programs can be traced back to 1975, they became widespread after 2000.[2]

Applying for prescription assistance is also very simple and free. Beware of scams – there are some companies that ask you for money in order to make you a part of a prescription assistance program.

To be eligible for most of these programs, you should fulfill the following conditions:

• Be a US citizen or permanent residence
• Demonstrated financial need due to limited income and/or assets
• Limited or no prescription drug coverage from government or any private source

Patient assistance and pharmaceutical assistance are some other names for these types of programs.

Prescription assistance is available for Cymbalta, Visit Rx Assist’s website or click here to see the eligibility criteria to qualify for it and the contact details of the provider.

[1] https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/patient_info/DULOXETINE_2007.pdf

[2] http://www.ncsl.org/research/health/state-pharmaceutical-assistance-programs.aspx

Lyrica (pregabalin) also classifies as an anticonvulsant drug and is used as an add-on medication to treat focal onset seizures in adult epileptic patients.

An important thing to note here is that the medicine only helps to manage these conditions and is not meant to heal them.

Available Dosage Forms and Strengths of Lyrica

Lyrica is available in both capsules and oral solutions forms in the following dosage strengths:

Capsules

Lyrica capsules are available in 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, and 300 mg strengths.

Oral Solution

Lyrica oral solution is available in 20 mg/ml dosage strength.

Recommended Dosage of Lyrica

For Diabetic Peripheral Neuropathy

To get relief from the pain associated with diabetes, patients are initially prescribed to take a maximum of 150 mg per day (50 mg capsules three times a day). However, based on the patient’s tolerability and effectiveness of the drug, the dosage may be increased to 300 mg per day (100 mg capsules, three times a day), within a week.

For Shingles

The recommended initial dosage for postherpetic neuralgia is 150 mg per day (50 mg capsules three times a day or 75 mg capsules twice a day).

It can later be increased up to 300 mg per day and in some cases, up to 600 mg per day too.

For Pain Associated With Spinal Cord Injury

A 75 mg capsule taken twice a day is the recommended starting dosage of Lyrica for patients suffering from pain due to spinal cord injury.

If patients do not experience pain relief, the doctor can increase the dosage to 150 mg capsules twice a day within a week and to 300 mg capsules twice a day after another 2 to 3 weeks.

For Fibromyalgia

For patients suffering from fibromyalgia, the dosage of Lyrica can range from 150 to 450 mg per day.

For Focal Onset Seizures

Depending on a variety of factors, such as the severity of the disease and a patient’s needs and response to the drug, the maximum dosage of Lyrica can range anywhere from 150 to 600 mg per day.

Normally, the initial prescribed dosage of Lyrica is 150 mg per day (50 mg capsules three times a day or 75 mg capsules twice a day). The dosage is later gradually increased according to the patient’s tolerability and response.

Important: Since Lyrica is eliminated from the body primarily through renal excretion, its dosage needs to be adjusted in patients suffering from renal impairment.

Also, it is highly recommended not to exceed the recommended per day dosage, unless suggested by the doctor, to prevent the risks of dose-dependent side effects.

What to Do If You Miss a Dose of Lyrica

Although it suggested that you take the missed dose of Lyrica as soon as you remember, skip it if it is nearly time for the next dose and take the next dose at its time.

Never take a double dose to make up for the missed one.

Administration of Lyrica

Take the medicine as and when prescribed with or without food. However, make sure to take it at the same time every day.

Storage

While Lyrica can tolerate temperatures between 59 to 86 degrees Fahrenheit (15 to 30 degrees Centigrade), it should ideally be stored at 77 degrees Fahrenheit (25 degrees Centigrade).

Side Effects of Lyrica

Clinical studies found that the patients using Lyrica may experience one or more of the following negative effects:

Adverse Reactions of Lyrica Associated With Diabetic Pain

• Back and chest pain
• Edema, particularly in the peripheral vascular system and face
• Asthenia; chronic physical and mental fatigue
• Constipation
• Dry mouth
• Flatulence
• Weight gain
• Hypoglycemia i.e. low blood sugar
• Drowsiness
• Dizziness or vertigo
• Confusion or nervousness
• Tremor
• Euphoria
• Thinking abnormality
• Abnormal or blurry vision
• Dyspnea i.e. shortness of breath

Common Side Effects of Lyrica in Patients Suffering From Shingles

• Headache
• Flu syndrome
• Infection
• Edema
• Increased risk of accidental injury
• Dry mouth
• Vomiting
• Constipation and flatulence
• Weight gain
• Dizziness
• Drowsiness
• Confusion, abnormal thinking, and/or speech disorder
• Eye disorder and/or blurred vision
• Bronchitis
• Urinary incontinence

Patients suffering from this condition may also experience myasthenia gravis with Lyrcia usage. Myasthenia gravis is a rare autoimmune neuromuscular disease that causes weakening of the skeletal muscles.

Negative Effects of Lyrica in Patients of Fibromyalgia

• Headache
• Blurred vision
• Dizziness
• Drowsiness
• Constipation, flatulence, and/or abdominal distension
• Vomiting
• Vertigo
• Fatigue
• Edema
• Chest pain
• Feeling drunk
• Sinusitis
• Fluid retention
• Muscle spasms
• Joint pain
• Increased appetite
• Weight gain
• Back and chest pain
• Lethargy
• Tremor
• Memory impairment
• Difficulty in concentrating
• Confusion or disorientation
• Anxiety or depression
• Pharyngolaryngeal pain

Possible Adverse Reactions of Lyrica When Used for Pain Associated with Spinal Cord Injury

• Nausea, vomiting
• Constipation
• Dry mouth
• Blurred vision
• Cold
• Fatigue
• Edema
• Increased weight
• Vertigo
• Muscle weakness
• Neck and back pain
• Swelling of joints
• Drowsiness or insomnia
• Paresthesia
• Urinary incontinence
• Euphoric mood
• Hypertension or hypotension
• Decubitus ulcer
• Attention disturbance, memory impairment
• Increased levels of Creatine Kinase in the blood

Side Effects of Lyrica in Adult Epileptic Patients

• Increased appetite and weight gain
• Increased risk of accidental injury
• Amnesia; a form of memory loss
• Tremor
• Ataxia; a degenerative disease of the nervous system that causes lack of muscle coordination, which then can cause a number of problems, such as slurred speech, abnormal eye movements, and difficulty in walking and swallowing.

The risk of adverse reaction increases with rapid or abrupt discontinuation of the drug.

Precautions While Taking Lyrica

Despite the fact that Lyrica does not have a high potential for abuse and dependence, patients should be evaluated for a history of drug abuse before prescribing the medicine. In addition to this, they also need to be monitored for any signs of misuse or abuse throughout the intake period. Frequent need for dose escalation due to the development of tolerance and drug-seeking behavior are some common signs of Lyrica abuse.

As mentioned earlier, rapid or abrupt discontinuation of Lyrica can increase the risk of side effects. Hence, the dosage needs to be gradually reduced, at least over the period of one week, before it is completely stopped.

Abrupt discontinuation of the medicine can cause:

• Excessive sweating
• Trouble in sleeping
• Nausea
• Diarrhea
• Increased anxiety
• More frequent seizures (in patients of epilepsy)

Lyrica may also increase the risk of suicidal thoughts and/or behaviors in some patients. So, they need to be monitored for any unusual changes in their behavior or mood, emergence or worsening of depressive symptoms, and any other sign that reflects suicidal thinking and/or behavior.

Do not use alcohol while you are administering Lyrcia as the medicine can increase or intensify the effects of alcohol.

Some animal studies have suggested that the use of pregabalin may cause skin ulcerations. While human clinical studies have not found any increased rate of skin wounds in patients treated with Lyrica, it is highly recommended for diabetic patients to monitor their skin integrity while they are taking this drug.

While there is a lack of research on the effects of Lyrica in pregnant women, animal studies have showed increased risk and incidences of developmental toxicity, such as decreased body weight of the fetus, skeletal deformities, and retarded ossification (ossification is the process of bone formation). Animal studies, conducted on rats and rabbits, have also found the increased occurrence of fetal structural malformations.

Based on both the animal and human studies, it has been estimated that there is about 2%-4% risk of major birth defects and 15%-20% risk of miscarriage in clinically recognized pregnancies.

Healthcare experts advise against breastfeeding while taking Lyrica because small quantities of the drug have been found to be passed into milk.

The effectiveness and safety of Lyrica has not been established for pediatric use.

Patients who are being prescribed with Lyrica should avoid driving as well as getting involved in any potentially dangerous activity, such as working with machines, unless the effects of the medicine become clear. This is highly important because Lyrica can cause some patients to feel sleepy and/or dizzy and performing any of the above mentioned activities while taking the medicine can greatly increase the risk of accidental injuries.

What Should You Tell Your Doctor Before Taking Lyrica?

While it is important to tell your doctor about any and all medical conditions you are suffering from, you should specifically tell the healthcare provider about the following:

• Kidney problems and treatments that you are getting for them, specifically dialysis
• Heart problems
• Low platelet count or bleeding problem
• If you are suffering from or have had a history of severe mood swings, depression and/or suicidal thoughts or behavior.
• If you have had a history of angioedema i.e. swelling of face, throat, neck, mouth, lips, and/or gums.
• If you plan to become a parent
• If you are or plan to breastfeed

Possible Drug Interactions of Lyrica

In addition to all the health conditions, it is highly important to tell your doctor about all the medicines that you are taking whether they are prescription drugs, over-the-counter-medicines, herbal medications or supplements.

While Lyrica undergoes negligible metabolism inside the body and is mainly excreted unchanged in the urine and therefore, the possibility of drug interactions is very minimal, it is better to tell the doctor about all medicines to avoid any harmful effects.

Some of the medicines that may increase the risks of adverse effects when taken with Lyrica are:

• Actos (pioglitazone) or Avandia (rosiglitazone) – medicines taken for diabetes
• Angiotensin Converting Enzyme (ACE) Inhibitors
• Any medication that has a tranquilizing effect
• Anxiety medicines, such as Lorazepam
• Medicines that are used to treat narcotic pain, such as Oxycodone
• Ethanol

Prescription Assistance for Lyrica

Pfizer Inc. and Pfizer Patient Assistance Foundation jointly run a program called Pfizer Rx Pathways to help eligible patients learn about different assistance programs that offer insurance support, co-pay help, and free of cost medicines.

All you have to do is to visit the website of Pfizer Rx Pathways, enter the name of the desired medicine, and answer a few questions to find out the available programs. For example, a Lyrica co-pay savings card is available for patients who are uninsured or underinsured, and cannot even afford to buy the medicine. With the co-pay card, eligible patients can get Lyrica for as little as $4.

You can also check out the eligibility for Pfizer Patient Assistance Program at Rx Assist