-What are they?
Trulicity (Dulaglutide)-Bydureon (Exenatide)-Ozempic/Rybelsus (Semaglutide)-Victoza/Saxenda/Wegovy (Liraglutide) are Glucagon Like Peptide (GLP-1) Agonists are drugs used to help patients with diabetes to lower their blood sugar. Mounjaro (Tirzepatide) is a GLP-1 and Glucose-Dependent Insuilinotropic Polypeptide Agonist (GIP) also used to help treat patients with diabetes. They are injected daily or weekly subcutaneously. Rybelsus is taken orally.
Liraglutide and Dulaglutide have received an indicated use by the FDA for use in weight loss. This is because trials from patients taking these medications have shown weight loss in patients taking them. It is common for drug companies to rebrand a drug for use for another condition. This was the same with Viagra for erectile dysfunction after the drug trials for pulmonary hypertension.
-Why are people talking about them?
Many celebrities have been talking about using these medications (specifically Ozempic and Mounjaro) for weight loss. Typically these medications are not covered for weight loss by most insurance companies. They typically cost $1000 or more per month for cash paying patients. The increase in use for weight loss has created a shortage in the market, making it hard to find the medication. Many insurances are requiring a diagnosis code and/or previous use of metformin before covering them.
-What about compounding?
Compounding is the making of a specific drug for a patient. A commercially available drug can not be compounded unless there is a medical necessity (ie allergy to inactive ingredient, dye, etc). We can use commercially available products (like tablets to make a liquid) or raw powder to make the dosage form needed. This is for very specific cases and should not be used for the general public since the level testing and procedures are not the same as FDA inspected facilities. There is a higher risk taking a compounded medication.
-Can compounding pharmacies buy these raw powders?
These medications are protected under drug patents for the time being. No company selling Active Pharmaceutical Ingredients (API) for compounding can sell it. This means we can not buy these drugs for compounding. The major companies that sell these chemicals are PCCA, Medicare, and Fagron (they do not sell these powders). Some smaller companies are selling research grade ingredients or different salts of the drugs. Theses sodium salts are not listed in the FDA organge book and cannot be used legally in compounding (in my opinion).
-I’ve seen compounding pharmacies advertising these compounds!
These compounding pharmacies may be buying the powder from peptide companies. These peptide companies specifically say these products are for research purposes only. It is not intended for animal or human use. The quality controls are not the same as they would be for buying APIs. They may be adding things like Vitamin B-12 or BPC-157 to them so that it is not identical to the commercial product. BPC-157 does not have safety or efficacy studies performed and was recently banned by the Wold Anti-Doping Agency. Combining B-12, BPC-157, or other ingredients may interact with the drug. Unless several tests are performed to verify stability and efficacy, there is no way to know if it lowers the efficacy of the medication.
-What are the risks of using these compounded products?
The main issue is going to be safety. These products are produced in a licensed FDA facility. The quality controls for manufacturing are not regulated by their FDA. The purity standards are not the same as they are for human use. There are no FDA approved facilities making these medications in powder form (as far as I know). BPC-157 has no safety studies performed on the risk of adverse events or long term use. I doubt patients are made aware if this information. Efficacy could be lower if combined with other chemicals. Providers prescribing these medications and pharmacies making them can be held liable if a patient is injured.
-How can you find out if your medication is safe?
Ask your pharmacy for a Certificate of Analysis (CoA) of the chemicals they are using. Anytime we buy API, we get a CoA that we have for reference. It shows when/who/how the chemical was tested and the quality level. It also says where it came from. This will tell you where the pharmacy got the chemical. If the company does not sell APIs to pharmacies, it is not legal in most states to be used in compounding. Missouri law specifically says the APIs must be bought from distributors licensed in Missouri. I would wager the CoA for these chemicals would specifically say for research purposes only. Even if the CoA is valid, it may be for a chemical that is not FDA approved (like semaglutide sodium salt).
Drug companies have a patent on medications for many years. These peptides can be easily made in labs and sold. Eli Lilly and other manufactures don’t outsource their research into these drugs. There’s no legitimate way it would be available on the market for compounding. There is a strong demand in the market and some doctors/pharmacies are taking advantage of patients. Using these products can be dangerous and should be avoided in my professional judgment. If you have any questions, feel free to call me at the pharmacy. You should be aware of the chemicals you are injecting into your body.
Dr. Tyler Taylor
There are a lot of medications that come in different forms that are known as immediate release (commonly written as IR) or extended release (commonly written as ER or XR). You might see the symbols XR, ER or sometimes IR after the name of your medication. When you see these letters, it is telling you how fast the medication is going to work inside the body. When it comes to IR drugs, it is what the name suggests, they are made to work fast after you take the medication. Most of the time, these drugs will not have the “IR” at the end of their name, as most drugs are made this way. So, think of metformin for high blood sugar. This is the fast form of the drug. What you will see most commonly is ER or XR at the end of a drug name. An example of this is metformin ER. This tells you that your medication is going to start working a little slower than your fast release medication. It also means it will stay in your body for a longer time. The main difference you will see with these 2 different types is how many times you are taking it in the day. Metformin can be taken 2 to 3 times a day compared to metformin ER once a day. The medications still work just as well whether you are taking the IR or ER versions.
There are certain medications that have a Controlled or Scheduled status. This means there are stricter rules around filling and keeping track of these medications. Medications become controlled if drugs are known to have some chance to be addictive and abused.
There are 5 levels, each with increasing strictness on filling and storage rules. Controlled medications are categorized by how likely it is to become mentally and physically dependent on the drug.
Schedule V (C5): medications in this category have the smallest chance to be addictive and abused. Medications in this category include Lyrica (pregabalin) and Robitussin (dextromethorphan)
Schedule IV (C4): these medications have a low chance to be addictive and abused. This category includes Xanax (alprazolam), tramadol, Ambien (zolpidem), and Valium (diazepam).
Schedule III (C3): these medications have a moderate to low chance to be addictive and abused. Includes Tylenol #3, testosterone, and ketamine.
Schedule II (C2): these medications have a high chance to be addictive and abused. Most opioids, including any hydrocodone or oxycodone containing medications, fall under this category.
Schedule I (C1): medications in this category have the highest chance to be addictive and abused. These medications also have no medical use in treating diseases or conditions. LSD, ecstasy, and heroin fall in this category. Despite being legalized in several states, marijuana still falls under this category as well.
Prescriptions for C2 medications must have the following information before a pharmacy can begin filling it:
- Patient’s full name, date of birth, and address.
- Medication’s name, strength, form, quantity, and directions.
- Prescriber’s name, address, DEA number, and (if the prescription is written on paper) signature written in ink on the date the prescription was given.
If any of the above information is missing, the pharmacy will not be able to fill the prescription. The pharmacist cannot add or change any missing or incorrect information. Only a physician can change or add information.
With flu season coming in, it is important that everyone gets their flu vaccine. We all understand that getting the vaccine will prevent us from getting the flu, but how do vaccines work?
First, let’s go over the different types of vaccines. There are 6 different types of vaccines:
- Live-attenuated vaccines: these vaccines contain a small living amount of the germ that actually causes the disease. The amount isn’t enough to get you sick but it is enough for the body to create a defense against it. Vaccines under this type include: MMR (measles, mumps, rubella), smallpox, chickenpox, yellow fever, and rotavirus.
- Inactivated vaccines: similar to live-attenuated except the germs are dead. Inactivated vaccines include flu, polio, rabies, and Hepatitis A.
- Subunit vaccines: instead of containing the whole bacteria or virus, these vaccines contain fragments of the germ. The body will still create a response against them. Subunit vaccines include Hepatitis B, human papillomavirus, and shingles.
- Toxoid vaccines: instead of the whole germ or fragments of the germ, these vaccines contain the toxin, or the harmful product, of the germs. Toxoid vaccines include tetanus and diphtheria.
- Virus-delivered vaccines: these vaccines use a virus to deliver the instructions to create a fragment of the germ. The body will build a defense against the fragment similar to subunit vaccines. Virus-delivered vaccines include the Johnson & Johnson COVID-19 vaccine.
- mRNA vaccines: similar to the virus-delivered vaccines except instead of a virus, the instructions are held in a bubble made of fat that will fuse with cells. Again, the body will create a defense against the fragment that is created. mRNA vaccines include the Pfizer and Moderna COVID-19 vaccines.
Even though there are 6 different types, vaccines all end up working similarly. In general, vaccines introduce a small amount of germs into the body. The body’s immune system will recognize that the germs don’t belong inside the body and will get rid of them. Afterwards, the immune system will build up a defense against the germs so next time the body runs into those germs, it will be quicker at recognizing and getting rid of the germs. A quicker response means we won’t get sick as easily. Vaccines are important to get because they will not only prevent you from getting sick but getting them will also protect family and friends from getting sick too.
Over the counter (OTC) medications are the most used drugs in the United States. OTC medications are drugs that can be bought without a doctor’s prescription. They are considered safe for your body. Many vitamins and allergy drugs are over the counter drugs. Common pain medicines like Motrin can be bought over the counter. OTC medications can be found in a local pharmacy. Pharmacists are experts with drugs and how they work. Ask your pharmacist if you have any OTC drug questions.
All over the counter medications have instructions on how to take them. They are considered safe and effective when taken right. Make sure to follow the drug’s directions to stay safe and healthy. Not following directions may lead to unwanted side effects. Stop taking the medicine that caused the side effects and call your doctor. It is important to be honest about the medications you take with your doctor. Your doctor should always know what OTC medicines you take.
Morning sickness is when a pregnant woman feels nauseous and throws up. About 75% of all pregnant women will get morning sickness. The name can be confusing because pregnant women can get sick and throw up at any time of the day. Women usually get morning sickness in the first 4 months of their pregnancy. This is because the body makes a lot more hormones at one time to when she gets pregnant.
There are some prescription medications that can help with morning sickness. What if you don’t want to take medicine? There are other things that you can try to feel better.
- Eat small meals more times during the day
- Stay away from foods that are spicy, fatty, or have a strong smell
- Open the windows when cooking
- Use citrus scents or dryer sheets to help cover up other strong smells
- Eat a small snack in bed and wait 30 minutes before getting up in the morning
- Try acupressure wristbands
- Eat a mint or hard candy when you feel nauseous
- Drink a ginger ale or Sprite to calm your stomach
Talk to your doctor if you still feel sick and want a prescription for a medicine that will help.
There are many different options for COVID-19 virus test. There are diagnostic tests and antibody tests. There is two different diagnostic test. The two are molecular (PCR) and antigen tests.
A diagnostic test tells us if a person has a current infection of COVID-19. Some people have no signs and symptoms of COVID-19. Diagnostic test will help to see if the person needs be isolated.
Molecular Test (PCR)
Molecular testing is also called as PCR test. A healthcare provider will collect sample fluid from your nose, throat, or saliva. Your sample will be sent to a lab to see if it will detect any genetic materials from the COVID-19 virus. The molecular test can take up to three days for results. There is always a chance for false positives and negatives. The molecular test is very accurate so you will not need another test.
Antigen Test (Rapid test)
We call substances that do not belong to the normal human body antigens. The antigen test will find if you have any antigens from the COVID-19 virus. The sample will be collected just like a molecular test. The results can be found within 15 minutes at the location of the testing site. The antigen test is less accurate than the molecular test. Your doctor can ask for a molecular test if the test result comes out negative.
Antibodies are proteins that are created to fight off things that do not belong to our body. The antibody test looks for the antibodies created because of a previous COVID-19 infection. An antibody test cannot be used to diagnose active COVID-19 infection. This is because antibodies can take up to several weeks to be created. A blood sample is commonly collected for the antibody test. It is important to note that the COVID-19 vaccine can cause our body to produce these antibodies.
At St. Louis Hills Pharmacy we offer IGG/IGM fingerstick test and antigen test. You may have any questions about which COVID-19 test is right for you. Please call the pharmacy at 1 (314) 832-2548. Schedule one today!
When we talk about alternative home therapy, herbal supplements can come into mind. These supplements are products that are from plants. It can be from flowers, roots, and leaves. We commonly use herbal supplements to promote general health and cosmetics. You may have heard of Aloe Vera gel that may help with burns, acne, and dry skin. The Aloe Vera pills may help with constipation as well.
It is very important to know the difference between supplements versus prescription drugs. Both herbal supplements and prescription drugs need to be safe. The Food and Drug Administration (FDA) consider herbal supplements as food products. This means herbal supplements do not have the same rules compared to prescription drugs. (See chart below)
|Does it have to be safe?||Yes||Yes|
|Does it have to be effective?||No||Yes|
|Does it need good manufacturing steps?||Yes||Yes|
|Does it need long term studies?||No||Yes|
|Can it claim to cure or treat diseases?||No||Yes|
If you look at any herbal supplement bottle you have at home, it will say an FDA disclaimer. The disclaimer tells us that the FDA has not evaluated the supplement. No herbal supplements can say that they can diagnose, treat, cure or prevent disease.
What good are herbal supplements then?
Saying that herbal supplements do not work at all is not correct either. There are many studies about herbal supplements. The studies support that herbal supplements may have positive effects when used properly. American Diabetes Association has a study posted about how cinnamon can lower sugar levels in diabetic patients. Always be a smart consumer. Do not just believe everything that is on herbal supplements bottles. Make sure to ask your doctor or pharmacist to see which herbal supplement is right for you.
Opioid overdose is a growing issue in the United States. 1 out of 56 deaths in Missouri is because of opioid overdose. Fentanyl, morphine, and hydrocodone are common opioids you may have heard of at your pharmacy. Opioids are pain-slowing medication. The opioids we take will send signals to our brain. This signal keeps us from feeling pain, anxiety, and the “high” feeling.
Opioids can cause serious injuries or death. This is why we have naloxone. It is also known as Narcan. Naloxone is a blocking agent for these opioids. It will block the opioid signals that is going to the brain. This will quickly help the slowed or stopped breathing from opioid overdose to normal breathing. Naloxone is not just for prescription opioids overdose. It can also work with heroin overdose. Everyone must do their part to protect the community.
Naloxone is free through most insurance companies. St. Louis Hills Pharmacy can help you through this process. It is okay if you do not have insurance. There are St. Louis organizations that will help you get free naloxone.
- Missouri Network for Opiate Reform and Recovery: 4022 S. Broadway, St. Louis, MO 63118.
- St. Louis Empowerment Center: 907 Dock Street, St. Louis, MO 63147
Here are some signs and symptoms of opioid overdose
- Small pupils
- No response to name
- Slowed breathing or no breathing
- Cold skin and blue lips
- Making choking or gurgling sound
Always know how to use naloxone. There can be different packaging of naloxone. Ask your local pharmacist how to use naloxone. Do not forget to teach others in your house how to use naloxone. Visit MissouirHopeProject.org for more information about naloxone.
There are three FDA authorized emergency vaccines to fight off the COVID-19 virus today. They are Pfizer-BioNTech (Pfizer), Moderna, and Johnson & Johnson (J&J) vaccines.
If we purely talked numbers against the COVID-19 virus,
- Pfizer vaccine has 95% protection against the COVID-19 virus.
- Moderna vaccine has 94.1% protection against the COVID-19 virus.
- J&J vaccine has 72% protection against the COVID-19 virus.
The percentage shows us that the Pfizer vaccine is the best protection against the COVID-19 virus.
Is this the only consideration I need to have when choosing a vaccine?
It is important to understand the Pfizer and Moderna vaccines need two total shots, but the J&J vaccine does not. The Pfizer vaccine first shot and second shot will need to be 3 weeks apart. The Moderna vaccine will need to be 1 month apart. Make sure to remember you are fully vaccinated 2 weeks after your last dose.
If you have children over the age of twelve, they are only allowed to have the Pfizer vaccine. As the FDA and CDC do more studies on children this may change.
No matter which one you choose, it is important to get one. Continue to socially distance and wash your hand often.
Do you have any questions or want to be vaccinated? Call the pharmacy today!