Category: Medicine

These posts provide information about different types of medicine. However, we highly suggest you contact your doctor before deciding to take medicine.

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Understanding the Difference Between Compounding & Pharmaceutical Manufacturing

In the pharmacy, both compounding and pharmaceutical manufacturing touch every aspect of everything we do each day. Both processes focus on the creation and delivery of drugs to treat illnesses; without them, many modern medications wouldn’t be available or would only be available in limited formats. Patients with serious illnesses or complex health cases would essentially be left out in the cold or forced to use sub-par solutions.

But, what’s the difference between pharmaceutical compounding and pharmaceutical manufacturing? Here, we explore the similarities and differences between them.

 

Are They the Same?

Despite the fact that both compounding and pharmaceutical manufacturing share many similarities, the two processes are not the same. In fact, they share more differences they do similarities. Those differences can cause a significant amount of confusion for patients who are trying to find the best and safest medication with the fewest side effects.

Most pharmacists agree that both transparency and patient participation are vital aspects of healthcare. They believe patients should understand how their medication is made, where it comes from, how it benefits them, and what risks they may be taking when they use it. Understanding the difference between compounding and pharmaceutical manufacturing is an important part of that process. Because of this, we created this primer for patients to help you better understand.

 

Base Definitions

Before we get into the nuances and subtle differences between these two important facets of pharmacology, we have to understand their innate properties. We’ll start by defining exactly what compounding and pharmaceutical manufacturing are – the basics.

Compounding

Compounding is the process a compounding pharmacy uses to create custom medications from base ingredients for patients. Rather than simply counting out pills or providing the patient with a pre-mixed formula, the pharmacist starts with base drugs and combines or prepares them to best fit the patient’s needs. Because the compounding pharmacist works with base ingredients, he or she can adjust the dose by infinitesimally small ratios, rather than selecting the closest commercially available option.

Pharmaceutical Manufacturing

Pharmaceutical manufacturing is the process used to formulate and create commercially-available drugs. Unlike compounding, manufacturing creates drugs in pre-set formulas or doses on an industrial scale. Often, pharmaceutical manufacturing companies generate millions of doses or formulas per year. The large scale benefits society by providing quick and easy access to pre-formulated medications, but leaves little room for customization when patients have special needs.

 

 

The History

Before the creation of the Food and Drug Administration (FDA), and certainly before the industrial revolution, compounding was the only method used to create patient medications. Often referred to as an apothecary, historical “pharmacists” would assess patients and take recommendations from physicians. They then return to the apothecary laboratory to hand-create each formula to the patient’s needs. This often included growing herbs or plants, crushing or extracting drugs, and combining base ingredients to produce various formulas. Many of the substances and drugs used came directly from herbs and plants.

Although it may seem logical to assume an apothecary worker was an “apothecist,” most apothecary workers were actually practicing physicians themselves. If you were a patient who was sick or in need of medication, and you did not have a physician, you visited the apothecary. He would very often assess, diagnose, and prescribe medications all at once.

Today’s focus on compounding is a resurgence of respect for the ancient apothecary in many ways. This growing trend recognizes the broad wealth of knowledge pharmacists have on healthcare and pharmacological treatment methods.

 

Legal Differences

Pharmaceutical manufacturing and compounding also differ greatly legally. Compounding pharmacies and manufacturing companies are each held to their own individual set of guidelines. Often, compounding pharmacies have more legal freedom.

Both compounding pharmacies and pharmaceutical manufacturing companies must adhere to oversight from governing bodies. However, pharmaceutical manufacturing companies are overseen by the Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA); compounding pharmacies fall under the oversight of state pharmacy licensing boards instead. This difference is laid out under section 503A of the FDCA.

In “plain English,” this means that the substances, doses, and formulas compounding pharmacies use are technically not FDA-approved. However, this is more of an issue of practicality rather than unreliability. The FDA tends to approve drugs in very specific formats or doses; compounding pharmacies change these formats to better suit the patient’s needs.

The fact that many compounding pharmacies lack FDA approval does not mean that they are inherently unreliable or untrustworthy. Without exemptions from FDA approval, which can often take five to 10 years for a single commercially available drug, compounding pharmacies would be virtually unable to address custom medication needs. Exemptions allow compounders to quickly create safe and reliable solutions for patients with allergies, drug sensitivities, and delicate health conditions.

 

 

Are Compounded Medications Safe?

When people first hear that compounded medications are not FDA-approved, they often grow concerned about the safety of these custom medications. As mentioned above, registered and licensed compounding pharmacies do have oversight from state pharmacy licensing boards. These regulations ensure that the compounding pharmacy is working with safe substances using reliable methods and empirical evidence for every medication they create. Provided that you work with a licensed pharmacy, your medications should be safe and reliable.

Medications, when broken down to their base ingredients, are all virtually identical from a chemical perspective. Compounding pharmacies often source their base ingredients from the same pharmaceutical manufacturing companies that make commercial drugs. The only difference is that the compounding pharmacy processes or combines them in-house, rather than simply receiving a pill, injection, topical, or  pre-combined formula in a box or bottle.

It is important to note that compounded medications are only as safe as traditional medications when used correctly for the right conditions. Like any other form of pharmacological treatment, not every medicine is right for every patient. Having a working relationship with your pharmacist and taking an active part in your health is the best way to ensure you find a safe and reliable treatment.

 

Do I Need a Prescription for Compounded Medications?

Compounding pharmacists have extensive freedom, but they cannot simply give a compounded medication without evidence of need. Legal and ethical regulations prevent pharmacists from simply handing out drugs unless they can confirm this need, but that doesn’t necessarily mean you always need a prescription. In some cases, a physician’s prescription is needed; in others, the pharmacist’s “prescription” of a treatment may be enough.

For example, if someone walks in off the street and requests a compounded opiate pain medication, they would still require a prescription because opiates are a controlled substance. Unlike other compounding solutions, controlled substances do fall under DEA and FDA regulations and are tightly controlled.

Conversely, if a patient requested bioidentical hormones for a thyroid condition, a prescription may not be needed. However, the pharmacist would need more information about their condition before they can prescribe. The pharmacist can gather information through blood testing, saliva testing, and other hormone monitoring methods to judge the patient’s exact condition. With evidence, he or she can create and “prescribe” bioidentical hormones right from the pharmacy.

Whether or not the medication you need compounded requires a physician’s prescription depends on what the medication contains. The best way to verify is to speak with your pharmacist about your healthcare situation in person. He or she can identify opportunities and work with you to find the very best solution for your

needs.

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Finding the Right Children’s Medicine for Your Child

It’s 3 a.m. You wake up to the sound of your child crying – and coughing. Oh dear; it’s a dreaded winter cold. You have options: give your child medicine or try to ride it out. You opt for the medicine, but when you head to the medicine cabinet, you aren’t sure which is the best children’s medicine to give.

She’s feverish and coughing, but she isn’t congested. She’s nauseous, but she isn’t throwing up. You stare blankly at a shelf full of Children’s Benadryl, Acetaminophen, Triaminic Cough & Cold, Dramamine, Motrin, and a few adult medications.

Eventually, you end up closing the door and placing an after-hours call to your pediatrician, who advises you (after asking a few questions) to try the Triaminic. He also suggests turning on a humidifier beside her bed. You do both, and the cough quiets down.

Ah, rest.

 

Too Many Options?

This scenario isn’t unusual; in fact, it plays out in American households every night of the year. Parents often struggle to identify the best medication for every situation, and unfortunately, it just isn’t always possible to place a call to the doctor. It doesn’t always happen at night, either; sometimes it’s as simple as feeling confused at the pharmacy.

While asking your pharmacist or doctor is always best, there are ways to make the process of choosing children’s medicine easier. Start with this easy step-by-step guide.

 

Finding the Best Children’s Medicine Based on Symptoms

If your child is already sick, begin by quickly assessing his or her symptoms. If old enough, ask your little one how they feel. Check for issues like:

  • Coughing
  • Sneezing
  • Fever
  • Nausea
  • Headache
  • Vomiting
  • Abdominal pain
  • Muscle pain
  • Wheezing
  • Diarrhea
  • Any other symptoms

Ideally, you will match this list of symptoms to the children’s medicine that is best-suited to your child’s needs. However, you never want to give a medication for any need if it will be unsafe to do so.

We also want to make a small note of caution: before giving any children’s medicine, judge the severity of your child’s symptoms. If a symptom is particularly severe, it’s better to call the doctor or pharmacist than not. Specifically, fevers over 103 F (39.4 C) merit an immediate call to the doctor, unless your child is under three months old. In that case, call the doctor at the first sign of any fever. Other problematic symptoms include breathing difficulties, bluish lips or fingers, tremors, convulsions, and clear signs of intense pain.

 

Consider Contraindications

Some medications contraindicate others, meaning the two children’s medicine options cannot be taken together because the combination causes harm. This “harm” may be mild, like itching, or very serious, like liver failure or stroke.

To make the situation even more complicated, not every contraindication will produce negative symptoms for every patient. Sometimes, patients will tolerate the doses fine a few times and then suddenly experience side effects. That’s why you should take care to rule out contraindications every time, no matter how innocuous they may seem.

The most common contraindication is by far accidentally giving the same children’s medicine twice. This commonly occurs when parents give two combination medications that contain the same drug – for example, cold medicines.

The best way to avoid this is to read and compare labels for all drugs the child is taking beforehand. Remember that dose and daily maximums are for the total amount of a substance, not per medication!

Contraindications like these don’t always mean your child can’t use a medication at all; in many cases, pharmacy pediatric compounding can make a med safe to use again. This includes dosage format changes or the removal of a problem substance to create a new formula.

Your compounding pharmacist can also change the delivery method of your children’s medicine to make it easier for your child to take. They can also add or remove ingredients based on necessity or personal preference as well.

Ask your pharmacist if you have questions!

 

Consider Pre-Existing Health Concerns

Sometimes contraindications happen because of medical conditions, rather than combining medications. A parent may inadvertently give an allergen or may give a medication that produces serious negative harm due to a medical condition (e.g., giving a child with ulcers NSAIDs).

If your child has a serious medical condition, like liver, heart, kidney, or gastrointestinal disease, speak with your pharmacist before choosing a medication. Some children’s medicine, like Children’s Motrin, can exacerbate their symptoms or even cause serious harm. Others require a dosage adjustment for safe use.

Also note that simply being too young for OTC medication is a concern. Children under the age of one year are often more sensitive to medications, and thus, their age may contraindicate medication use. It’s safer to have your doctor prescribe a specific dose than to try to guess on your own.

Lastly, if your child takes any daily medications (be they for physical or mental health issues) you should not give over-the-counter medications period without consulting a pharmacist. While many drugs can safely be combined or used together, determining which cannot is too complicated for the average layperson. This isn’t meant as an insult – most pharmacists have access to contraindication bibles to help guide their decisions.

 

Plan for the Future

If your child isn’t sick, you can still plan for the future by stocking your medicine cabinet with medicines that will help. Use the same symptom list and stock up on standard solutions recommended by your pharmacist. Be sure to tell your pharmacist if your child is taking any regular medications or if he or she has any specific medical conditions as these can impact which medications your child can take.

It’s a good idea to have at least three days of children’s medicine for mild illnesses available in your medicine cabinet at all times. The most common three are Benadryl, Tylenol, and Motrin (diphenhydramine, acetaminophen, and ibuprofen respectively).

Don’t forget that just because you have medicine on-hand, doesn’t mean you should necessarily use it every time for every symptom. Children with the flu who are vomiting, for example, should generally be allowed to vomit provided that they can keep down fluids and stay hydrated. This is also true for children with diarrhea and little ones who are coughing productively. Coughing, vomiting, and diarrhea are the body’s way of ridding itself of germs, so they do serve a purpose. Medications are best given when the goal is to simply get a bit of rest or bring symptoms down to a tolerable level.

The best advice we can give you about choosing children’s medicine is also the simplest: talk to your pharmacist. Medication and treatment can be an incredibly complicated, patient-specific task, but you and your pharmacist ultimately have the same goal: to help your child be well again. He or she can review your child’s history and conditions to find the safest, most effective option.

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How Your Pharmacist Can Help You Manage Anxiety

Whether you have generalized anxiety or a specific fear, you know how debilitating the symptoms are without proper care. While your doctor should always serve as your first point of contact for diagnosing and treating anxiety, your pharmacist also plays a role in helping you find ways to manage anxiety symptoms. Although any pharmacy can dispense your anxiety medication, you should know that a compounding pharmacist goes the extra mile for tailoring your treatment plan to fit your needs. As you develop strategies to manage anxiety, consider these benefits of visiting a compounding pharmacist who has additional insight into ways to manage anxiety and its related symptoms.

 

Manage Hormone-Related Anxiety

Hormonal fluctuations are a common cause of anxiety that occurs later in life, and menopause brings mood swings and other emotional changes that all add up to increased stress. When your hormones are out of balance, it is important to know that there is not always a one-size-fits-all replacement available. This is why many commercially prepared hormone replacement therapies are ineffective at helping to ease your symptoms. However, your compounding pharmacist can give you an individualized bio-identical hormone replacement treatment that is carefully formulated to be the exact dosage to fit your unique needs.

Commercially prepared medications may not work on every individual. There may be side effects that hinder one’s daily life, or maybe the only delivery method available is not right for you. By utilizing a compounding pharmacy for individualized hormone-related anxiety medicine, you can successfully manage anxiety.

 

Choose An Acceptable Delivery Method

Anxiety produces many symptoms that interfere with you being able to take your medication or treat another ailment. For example, needle anxiety is enough to keep people from going to the dentist, and the fear of swallowing pills stops people from taking everything from vitamins to their arthritis medication. This is why it is important to be honest with your pharmacist. Once they know about your fears, they can compound a medication to fit your preferred delivery method so that you don’t skip needed treatments due to discomfort. This is also helpful when your anxiety symptoms such as nausea make swallowing a pill difficult. Being able to rub a pain medication onto your skin or use a nasal spray make staying on track with your health more manageable.

In order to manage anxiety, it’s important to find a delivery method that works for you. The fear of swallowing any medication is very common, especially among those suffering from anxiety. Because of this,

 

Customize Your Medications

Anxiety medications sometimes generate side effects that are intolerable, and commercial preparations tend to come in only so many strengths. A compounding pharmacist has the ability to create a customized medication in a dosage that fits your needs. This allows you to treat your anxiety with a lower dosage than what is commercially available so that you experience fewer side effects. Customizing your medication is also beneficial when you suffer from allergies to common filler ingredients since your pharmacist can simply leave them out of the preparation.

 

Treat Anxiety Naturally

Compounding pharmacists understand that science and nature can combine to give patients even more benefits for handling their anxiety. For example, your pharmacist can blend a B-vitamin complex into your prescription medication so that you can receive natural healing benefits at the same time as your traditional medication works. Your pharmacist can also offer alternative methods for treating your anxiety such as aromatherapy or soothing lotions that help round out the benefits you receive from your compounded medication.

Controlling anxiety always works best when you utilize every resource available. Making your pharmacist a partner in your treatment plan opens up options such as customized dosing and delivery methods that allow you to effectively manage your symptoms and enjoy life again.

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5 Questions to Ask Your Local Pharmacist

Your doctor may not be telling you everything you need to know about your medications. This isn’t necessarily malicious; today’s busy doctors have limited time with patients, and information often gets left behind.

Sometimes, doctors realize that a prescribed drug works for your situation, but they aren’t familiar with the nitty gritty details. That’s not a purposeful failing, but rather due the complex nature of prescription drugs. Each patient has a slightly different body chemistry and health situation, and that can make responses highly individualized.

Your doctor understands the broader scope of your health issues, including how each of your health conditions impact each other and your need for medication. That takes talent, but it isn’t the whole story. Medication interactions and contraindications can be extremely complex, so it’s never a bad idea to double check all of the variables before you begin a new medicine. That’s where your local pharmacist shines.

Prescribing drugs safely requires a high level of knowledge. Doctors and pharmacists alike must heed complicated and nuanced safety guidelines. Though doctors receive extensive training in pharmacology, your pharmacist is truly the “specialist” when it comes to drugs.  This includes use guidelines, side effects, and how each medication interact with other substances.

The very best way to fully understand your medicine is to ask your local pharmacist these five questions before you pick them up.

 

1. What Medication Was I Prescribed?

This question is more important than you may first expect. The same medication can go by multiple names and they’re all somewhat different. Knowing the exact name of your medication will ensure that you’re getting precisely what you need. Here are the name conventions.

The least used, and known, by the average person is the scientific name. Every chemical known to mankind receives a scientific name based on the compound’s physical structure and elemental composition. These names follow a strict set of rules and guidelines. You may wonder why we don’t use these names until you try to say a few of them out loud. The names themselves are tongue-twisters and differ in complexity.

The simplest one-word names are typically around twenty letters long, while some of the more complex substances contain a combination of hyphens, numbers, letters, prefixes and suffixes. Relaying these names to anyone (especially your pharmacist,) requires the utmost precision. The smallest error in pronunciation could amount to you talking about a different drug or combination.

Drug naming convention isn’t exactly straightforward, especially for newer drugs. Researchers basically make up a name on the spot. This applies when there is a generic brand available or when the medication in question is paired with another drug.

It is common practice to combine medications when they synergize with each other. For example, acetaminophen (Tylenol) is a common additive to prescription pain relief medications. Tylenol is harmful in large doses regardless if you’re allergic to it or not. Patients can accidentally take double or triple doses if they aren’t familiar with their medications.

Your local pharmacist can help you get to know what drugs you’re getting and how they interact with your other medications or health issues.

 

2. Can I Take a Generic Version Instead?

The first company to create and identify a drug in their laboratory can patent it. The patent protects the company’s right to distribute and market their new drug for 20 years. They may license the drug out to manufacturers or solely produce it. In either case, they have plenty of time to recoup their initial research investment and make a profit. Any manufacturer can produce the base drug after the initial 20-year patent expires. This means that newer medications won’t have generic versions available.

Older drugs almost always have generic options that are, for all intents and purposes, exactly the same as brand names.

Asking your local pharmacist if you can swap to a generic is wise because generics are often cheaper. They contain the same active ingredient at a lower price. The only substantial differences between generic and name brand drugs are:

  • The format (e.g. capsule or pill)
  • The fillers used in that pill
  • Extra ingredients, like sugar coating on Advil tablets

Generics are overwhelmingly safe. The FDA requires that all generics be virtually identical within a tiny margin of difference, standardizing them to match brand name versions.

3. Does My Medication Come With Special Instructions?

Every medication has different effects and side effects, and these can range from mild drowsiness to severely impacting your diet.

Most prescription drugs are specialized to treat your particular needs, but no medication is fool-proof. It’s vital that you follow all special instructions to the letter, especially if they come directly from your doctor.

Some patients may need to take meds with one meal a day, while others may need to fast and skip a meal to take their medication on an empty stomach. Still others may need to avoid food interactions.

For example, taking certain medications with grapefruit juice can cause peak blood concentrations to rise dangerously fast. Others, like certain antibiotics, are rendered inert by dairy making treatment ineffective.

Always ask your local pharmacist whether your prescribed medication has side-effects or interactions. They can best advise you how to adapt your lifestyle, diet, or treatment to fit the medicine in question.

 

4. Does My Medication Interact With Other Drugs?

Understanding how your new prescriptions interact with your current medications is one of the most important ways your local pharmacist can help. Drug interactions range from synergistic to disastrous. Negative interaction can be severe enough to warrant a hospital trip, and that’s why most pharmacists cross-check interactions before they disperse medication.

Your local pharmacist can tell you what interactions exist, but only if they know everything you’re taking. Let them know about other over-the-counter drugs, illicit substances, alcohol, and any other substance you ingest on a regular basis. It’s not about judging you for your use; it’s about keeping you safe.

 

5. Are Drugs Advertised on TV the Best Option?

Pharmacies have varying standards for what medications they deem acceptable to carry at their location. Medications go through rigorous testing and they become suitable for consumption when they meet certain standards. Scientists constantly study and document the attributes of pharmaceutical drugs. These attributes include:

  • toxicity levels
  • effectiveness
  • manufacturing cost
  • general safety

Pharmacies compile all available data on medications to form an in-house formulary. The list is under constant revision and changes based on new studies and documented usages of medications, including newer medications.

It’s hit or miss whether the medication you saw on television or a magazine is on your pharmacy’s formulary list, or whether it’s even best for your current treatment plan. Some advertised drugs are effective and safe for individual patients, while others carry too many side effects and harmful interactions.

Understand that just because something is advertised on television, doesn’t mean it’s inherently successful for you. Furthermore, many advertised drugs are new to the market and still under study. If you’re curious about a medication’s suitability, ask your local pharmacist to review your health situation and make a recommendation.

 

Your Local Pharmacist is Here for You

These are just five of many questions that your pharmacist can provide in-depth answers to. If you left your doctor’s office with any of these questions unanswered, don’t hesitate to pick up the phone and call your local pharmacy, or even stop by in person.

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6 Answers to Common Questions About Pet Meds

Responsible pet ownership comes with seeking vet care whenever you believe your companion is sick. Often, vets will prescribe the same medications to treat animal conditions as they prescribe for human conditions. Filling those prescriptions at a human pharmacy rather than at your vet’s office can help you to save money while accessing the same pharmaceutical-grade medications.

Unfortunately, many pet owners question buying pet meds from a pharmacy out of a lack of understanding. They may feel that they won’t have support if they have questions, or they may wonder if the quality of the medication is the same.

The good news is that your pharmacy does sell the exact same pet meds as your vet (just at a cheaper price). The quality is identical, and if you have questions, your pharmacist can likely address them over the phone.

Some of the questions your pharmacist hears about pet meds are more common than others. We’ve listed these questions here for easy access.

 

How Do I Apply Flea and Tick Preventatives?

Because flea and tick preventatives are so common, this is easily one of the most common pet medication questions. The most effective treatments are topical and by prescription only. Grocery and dollar store versions are not safe, and shouldn’t be given to your pet without a vet’s advice.

Most flea and tick preventatives come in a small tube of clear or cloudy fluid. This includes Frontline Plus, Revolution, and Advantage I and II. They begin working immediately after application, and in most cases, will protect your pet for up to 30 days.

How to Use

  1. Begin by reading the package instructions thoroughly. Verify that you have the correct dose for your pet’s size, then pull the lid off of one tube. Most tubes will need the end snipped off or twisted off using the cap to fully open the tube.
  2. Sit your pet down (with help, if needed) and remove his or her collar.
  3. Aim the tip of the tube at the back of the neck where it’s most difficult for your pet to lick or scratch, pushing the hair or fur out of the way.
  4. Gently squeeze the tube until all of the product reaches the skin.
  5. For particularly large dogs, many packages recommend spreading the medication in several spots down the spine. If so, gently squeeze a drop out at the neck, at the shoulders, at three points down the spine, and then at the base of the tail.
  6. You’re done!

 

How Can I Give My Dog or Cat a Pill?

While humans can rationalize the need to take a pill, your pet can’t, and their natural instincts often make them reject the medication because it tastes bad. In the wild, this is a self-protective feature; if it tastes bad, it’s probably bad for them, too.

Unfortunately, natural instincts don’t make it any easier for pet parents to give that daily dose of feline thyroid medication or canine antibiotic.

To pill a resistant cat or dog, have a friend sit on the floor with the animal’s back to their chest. If you’re alone, snuggle your pet back into you.

Start with plenty of pets and comfort; make it as stressless as possible before you start.  If your dog or cat is anxious, let her go and try again in a few minutes. Once the animal is comfortable, proceed.

Tilt your pet’s head upward gently. With the pill in one hand and your other hand around the bottom of the jaw, gently pull his mouth open. Quickly place the pill as far back on the tongue as you can, close the jaw, and gently hold the mouth closed for around 30 seconds to a minute. Rub the base of the throat until you feel them swallow.

If your dog or cat struggles with getting the pill down, you can try chasing the pill with a syringe full of water or bone broth. Or, use a pill syringe to gain access to the back of the throat. This is especially helpful for very fearful or aggressive animals.

 

My Pet Won’t Accept Her Medication. What Can I Do?

You’ve tried pilling. You’ve tried hiding the pill in tasty treats. You’ve even tried burying the pill in peanut butter, all to no avail. What can you do to get your resistant pet to take her medication?

First, don’t panic. Pets who resist medications are exceptionally common. Set the medication down, let your pet go, and call in to the vet or pharmacy to get quick help over the phone. Your approach will depend largely on what medication your pet is on and at what dose, but pet parents often find these strategies helpful:

  • Hide the pill in a food with a different flavor (e.g. savory to sweet or vice versa)
  • Change the texture of the food  you hide the pill in (e.g. blend it rather than chopping)
  • Ask your veterinarian or pharmacist if you can crush the pill or mix the liquid in food
  • Ask for a different form of medication via compounding (e.g. a liquid vs. a pill)
  • Request a different medication altogether if all else fails

Some pet meds, like antibiotics and steroids, can be given by injection instead of pill or liquid. If your pet absolutely won’t take them via pill/liquid, getting the medication into them in any way possible is more important than continuing to struggle. Don’t be afraid to ask for changes or assistance!

I Gave My Pet Too Much/Too Little Medication. Help!

Because pets take so little medication compared to humans, it’s exceptionally easy to get the dose wrong at home. This is why many pharmacies and veterinary offices now put liquids in easy-to-use oral syringes rather than sending home the bottle of liquid itself. All you have to do is give the syringe at the right time and you’re done.

If you do accidentally give your pet too much or too little medication, whether it be an accidental double dose or a resistant pet that spits out half of the dose, don’t attempt to correct the dose on your own.

Most pet meds are prescribed in doses that consider minor misjudgements like these. Most pets will be fine, and will suffer little more than nausea or dizziness if anything. However, there are certain medications (like beta blockers, narcotic painkillers, sedatives, and pet insulin) that can cause serious and potentially fatal side effects at the incorrect dose.

To correct a dose issue, stop and telephone the vet or pharmacy immediately for medication-specific advice. If you can’t get through to the vet or pharmacy immediately, you can contact Poison Control for temporary advice at (800) 222-1222.

My Pet is On Multiple Pet Meds. Will They Interact?

Just as human medications can be contraindicated, so, too, can your pet’s medications. Giving the wrong pet meds together can interfere with treatment outcomes or even cause your pet to become extremely sick. If you are prescribed a medication for your pet, be sure to tell your pharmacist everything else your companion is taking; he or she will evaluate both substances for interactions, reducing the risk of negative side effects.

Think your pet is experiencing an interaction right now? Contact your vet or visit the nearest animal emergency hospital right away. Fast intervention is often all that’s required to prevent further harm.

 

My Pet Ate a Topical Medication. Is It Poisonous?

It’s no secret that some pets will eat anything in sight. From dogs digging in the cat’s litterbox to that fresh cake you left sitting on the counter, if it’s available, your companion animal’s curiosity may get the best of her until you tuck it neatly away. This innate desire to taste everything also applies to topical medications like steroids, antihistamines, antifungals, and antibiotics, too.

Most topical medications for pets are formulated to reduce side effects if they’re ingested. Though you should dissuade your pet from licking the application area for a few hours after application, a lick or two isn’t likely to cause any harm along the way.

The risk of side effects rises with the amount your pet ingests, so if your pup eats an entire tube of antibiotic ointment, a visit to the vet may become necessary. Likewise if your cat eats an entire tube of steroid cream. Look for symptoms of gastrointestinal upset like nausea, diarrhea, or drooling. Also watch for convulsions and trembling, especially in felines; this is a symptom of neurotoxicity and must be addressed immediately.

 

Keep Your Pet Healthy!

Your pet deserves the same level of health care and treatment as you do when you’re sick. By making your local pharmacy a valuable part of your veterinary care team, you gain more support than ever in achieving wellness for your companion animal friend. When in doubt, call your vet or pharmacy for more information!

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5 Best Non-Addictive Pain Management Medications

Pain: it’s one of the most common complaints for Americans of all ages today. From tension headaches to more serious disorders like arthritis, dealing with and alleviating pain is often one of the biggest challenges medical professionals face. Overtreating and undertreating are both potentially dangerous; pain is the body’s way of telling us that something is wrong. However, undertreating it can lead to brain fog, issues with concentration, anxiety, depression, and even an inability to focus on and complete everyday tasks. Migraineurs know this affect very well; sometimes it hurts just to look at the screen.

Unfortunately, many of the best pain management medications come with serious side effects like addiction, increased blood pressure, or increased strain on the liver. It’s very difficult to find solutions that balance safety with the need for pain control–but that doesn’t mean it’s completely impossible. These five non-addictive pain management medications are not only safe for the majority of patients, but are remarkably effective at reducing aches and pains, too.

Important: Although the pain management medications listed here are relatively safe, you should always consult your pharmacist or physician before starting a new medication. This is especially true if you suffer from pre-existing health conditions. Always be safe!

 

Anticonvulsants

Anticonvulsants first came to fame for treating epilepsy, but as it turns out, they have an unintended consequence: most also seem to reduce neuropathic pain levels. This class of drugs isn’t addictive, though they can carry certain bothersome side effects. Titrating the dose upward from a very small dose to the average daily dose ameliorates most of these side effects, as does weaning the dose down slowly.

Drugs that fall into the anticonvulsant family include:

  • Lyrica
  • Gabapentin
  • Depakote
  • Lamictal
  • Tegretol

 

How do Anticonvulsants Work?

Anticonvulsants work by impacting both calcium channels and GABA levels in the brain, both of which have a direct impact on pain in the body. By influencing these brain chemicals, they reduce pain signals, causing your brain to interpret them as being less severe than they really are. They are best used in tandem with other pain management medications or treatments.

 

When are Anticonvulsants Indicated?

Anticonvulsants do show efficacy in many conditions, but they aren’t right for every kind of pain. They are most effective for conditions that bring on neuropathic (nerve) pain, including:

  • Herpes viruses
  • Shingles
  • Diabetes-related neuropathic pain
  • Multiple Sclerosis
  • Sciatica
  • Spinal degeneration
  • Fibromyalgia
  • Myalgic Encephalomyelitis
  • Peripheral neuropathy

These pain management medications do require a prescription, and many also necessitate regular blood work, too. Getting the right level is important; too much can cause drowsiness, while too little is ineffective. That said, the vast majority of patients experience few to no side effects if the dose is titrated correctly. See your physician if you have questions about whether they’re right for you.

 

SNRIs and SSRIs

Officially known as “Selective Norepinephrine Reuptake Inhibitors” (SNRIs) or “Selective Serotonin Reuptake Inhibitors,” (SSRIs), these two drug categories are most commonly known as antidepressants. They can significantly improve mood for people with clinical depression, and show marked efficacy in treating chronic pain conditions, too. A few of the most common drugs in this category include:

  • Effexor
  • Cymbalta
  • Zoloft
  • Prozac
  • Celexa

 

How do SNRIs and SSRIs Work?

Each of these drugs influences serotonin and norepinephrine in the brain, both of which impact how and when the body experiences pain signals. Much like anticonvulsants, they can reduce the perceived severity of pain so you can better focus on everyday tasks. They may also reduce the risk of chronic pain-associated depression, too.

 

When are SNRIs and SSRIs Indicated?

As some chronic pain patients experience depression and/or anxiety after extended bouts with pain, some doctors are proactive about treating pain with SNRIs and SSRIs. Others prefer to use it only when the ability to treat pain exceeds over-the-counter options. Both are most commonly used to treat these conditions:

  • Fibromyalgia
  • Multiple Sclerosis
  • Migraines
  • Diabetes-related neuropathic pain
  • Tension headaches
  • Cervicogenic headaches
  • Lower back pain
  • Spinal cord injuries
  • Certain traumatic brain injuries

SNRIs and SSRIs aren’t addictive, but they may not be right for everyone. They are contraindicated in patients with a history of suicidal thoughts and those with bipolar disorder. They also cannot be taken with MAO inhibitors, other serotonin-boosting drugs, or pain drugs like Tramadol that may also have a weak effect on serotonin levels. Your doctor can help you to calculate the best dose for your condition.

 

Tricyclic Antidepressants

Tricyclic antidepressants share the same ability to reduce pain as SNRIs and SSRIs; they change the levels of certain brain chemicals to reduce how your body interprets pain. Unlike the previous two drug classes, tricyclics are older, better studied, and may be better tolerated in certain patient populations. They are also more effective at treating certain pain conditions (like migraines). Tricyclics often cause sleepiness and are most frequently prescribed at bedtime, and may help you to achieve a better sleep at night, too.

Drugs that fall into the tricyclic family include:

  • Amitriptyline
  • Nortriptyline
  • Norpramin
  • Doxepin
  • Tofranil
  • Protriptyline

Some people seem to naturally respond better to certain analogues, so you may need to try one or two versions before you see results. You should expect full efficacy to take between two and four weeks, though many patients experience a reduction in pain in just a week when taking these pain management medications.

 

How do Tricyclic Antidepressants Work?

Tricyclic antidepressants work by directly increasing the levels of norepinephrine and serotonin, but they also block a chemical known as acetylcholine, too. It’s the latter effect that probably results in better results for people who don’t respond to treatment with SNRIs or SSRIs. Most researchers agree that achieving balance between these three brain chemicals is one of the best ways to reduce pain.

When are Tricyclics Indicated?

Tricyclic antidepressants are remarkably safe and effective, even in sensitive populations like the elderly or liver-compromised. They’re also very easy to scale, so the dose can be reduced or increased in very small increments. However, they can cause confusion or a worsening of symptoms in people with dementia or other neurological disorders. They are most effective for these conditions:

  • Migraines
  • Chronic daily headache
  • Fibromyalgia
  • Multiple Sclerosis
  • Rheumatoid Arthritis
  • AIDS-related neuropathies
  • Diabetes-related neuropathic pain
  • Shingles and/or chickenpox
  • Other nerve pain disorders
  • Osteoarthritis, in tandem with anti-inflammatories

Because tricyclics are an older class of drugs, we know more about them and how they act in certain patient populations. This may make them safer, too. Some doctors provide them solely for the fact that they improve sleep in patients who struggle with painsomnia.

 

Topical Anti-Inflammatories

Just a decade ago, the primary way to take non-steroidal anti-inflammatory drugs (NSAIDs) was via oral ingestion or intramuscular injection. While remarkably effective for conditions like arthritis and soft tissue injury, these drugs can also have very serious side effects on the gastrointestinal tract.

NSAIDs are commonly associated with stomach and duodenal ulcers, and may also cause a condition known as Barrett’s Esophagus–erosion of the esophagus that may increase a patient’s risk for cancer. These risks are significantly lowered to almost negligible amounts if you’re taking them only once in awhile. Take them daily for long periods of time and the risk increases. That’s why researchers came up with topically-applied NSAIDs like Voltaren Emulgel.

Drugs that fall under topical NSAIDs include:

  • Diclofenac
  • Ibuprofen
  • Ketoprofen

These are the only three NSAIDs to be officially approved for topical use in America at this time. By far, the most common brand is Voltaren Emulgel. Voltaren is applied directly to the area in pain and rubbed in deeply. Though relief is temporary, it can be an excellent adjunct to other treatments.

In some areas of the United States, topical NSAIDs may be available over-the-counter. You should still speak with your pharmacist to verify whether they’re safe for you to use.

 

Toradol/Ketoralac

For patients in whom narcotics are contraindicated, yet they are experiencing severe pain, Toradol may be the answer. It is an exceptionally strong NSAID-class drug with a proven ability to reduce pain related injury, post-surgical pain and swelling, and visceral or cancer-related pain, too.

Unfortunately, Toradol’s strength isn’t only in efficacy, but in side effects, too: it can seriously injure the lining of your stomach if the recommended dose is exceeded. Most doctors will not prescribe Toradol more than four days at a time, or for breakthrough pain, for this reason.

 

How does Toradol Work?

Toradol works in the body in a similar way to all other NSAID-class drugs; it blocks the production of inflammation-causing chemicals in the body. Officially, it is a cyclo-oxygenase (COX) inhibitor. In the body, COX plays a role in triggering the body to respond to injury, increasing circulation and swelling in the area to help heal you. That’s desired in minor injuries, but can complicate healing in chronic or long-term conditions.

 

When is Toradol Indicated?

Toradol is rarely used as a first-line treatment for chronic conditions due to its side effect profile. It is most commonly used for presurgical pain, intense breakthrough pain, dental pain, and other forms of acute injury. It may be appropriate for migraines if taken only seldomly. Side effects and risks are reduced when the drug is taken infrequently, so always follow your doctor’s treatment recommendations.

 

The pain management medications listed here are non-addictive and remarkably effective, but that doesn’t make them right for every patient or every condition. The best way to approach unresolved pain is to speak with your pharmacist or physician and get to the root of why it’s occurring. Once you begin to understand the cause of your pain, you can work towards relieving it from all possible avenues, including taking pain management medications. Wellness in the event of chronic or acute pain is possible!

 

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