Medications for Alzheimer’s, Urinary Incontinence, and the Prescribing Cascade

Medications commonly used to treat Alzheimer’s Disease (AD), from a drug class known as the “cholinesterase inhibitors,” also can increase the risk of developing urinary incontinence (referred to as overactive bladder). There are three cholinesterase inhibitors available in the US:

donepezil (Aricept®)
galantamine (Razadyne ®)
rivastigmine (Exelon®)

This adverse drug effect of cholinesterase inhibitors became well-documented after the medications were approved and more widely prescribed. It is important to be aware of and recognize this potential effect because it often leads to the addition of another medication to control the incontinence. Adding a drug to manage the side effects of another drug is referred to as a “prescribing cascade” and is one of the several causes of polypharmacy.

The New Alzheimer’s Drug Aducanumab (Aduhelm®): Noteworthy on Many Levels

The latest buzz in medicine came this week when the Food and Drug Administration (FDA) approved a new medication for the treatment of Alzheimer’s Disease. The monoclonal antibody generically known as aducanumab has the brand name of Aduhelm®. Its approval is noteworthy for several reasons:

It is the first drug approved for treating Alzheimer’s since 2003;
It works in a totally different manner than the existing 2 classes of dementia drugs; and
Its approval is highly controversial for reasons I will highlight below.

Alzheimer’s Disease impacts over 6 million patients and millions of unpaid family caregivers. It is a progressive disease that causes irreversible decline in cognitive and day-to-day physical functioning. It is understandable to be excited about the potential surrounding this new drug therapy. But this drug has a unique situation. Here are the main issues that will help you get a better sense of the value and controversy behind the drug Aduhelm.

Be Aware of Brand Name Extensions: All Zantac is Not the Same

The other night I saw a television advertisement that caught my eye. It was for a heartburn product, “Zantac 360⁰.” It drew my attention because Zantac is the brand name for the generic drug ranitidine, which was withdrawn from the market in April 2020 because of contamination concerns. The easy work-around when ranitidine was withdrawn was to switch to famotidine (brand name Pepcid). Ranitidine and famotidine are in the same drug class of “H2-receptor antagonists.” They are comparable agents and both are available as over-the-counter (OTC) products for treating heartburn. It was an easy substitution.

In late April 2021, however, the manufacturer of Zantac introduced a new product, Zantac 360⁰, to the market The catch is that this new Zantac product contains famotidine, not ranitidine. Adjusting the name from Zantac to Zantac 360⁰ is an example of what is called “brand name extension.” It is a marketing tool commonly used by manufacturers of OTC products to capitalize on consumer familiarity with brand names. Unfortunately, brand name extensions can be misleading to the unassuming consumer.

An Updated Perspective on COVID-19 Vaccines

Since mid-December 2020, we now have three COVID19 vaccines available via emergency use authorizations (EUA): two that use mRNA-based technology by Pfizer-BioNTech and Moderna, and one that uses a virus-based technology by Johnson and Johnson. Still more vaccines are in the pipeline. More information on EUAs is found on the FDA website. Finally, we now are able to see the light at the end of this pandemic tunnel. However, I still hear concerns from people who doubt the benefit vs. risks of the vaccines. Are the vaccines safe, and are they necessary? Yes, and Yes.

Medication Adherence in Older Adults is Not So Simple

Medication adherence, defined as the degree to which a person follows medication instructions, is a challenge for older adults. Indeed, it is estimated that about 50% of older adults are not fully adherent with their medications. The reasons are multifold, however, and not simply a matter of remembering to take a pill. Poor medication adherence among adults age 65 and older results from complex drug regimens plus numerous individual variables.

COVID-19 or Not, Take Care of Yourself and Your Medications

These are unusual times and it’s stressful. In a world with many unknowns and so much that we cannot control, it is important for each of us to take personal responsibility for things we can control. To maximize our health at all times in our lives—not just during this novel coronavirus scare—we must not forget to take care of our bodies, which includes being mindful to take our medications regularly. Other healthy behaviors are integral, too, but beyond the scope of this blog: eat a healthy, balanced diet; drink plenty of water; get sufficient sleep each night; get regular exercise—or any kind of physical activity; don’t smoke; and limit alcohol intake.

Older adults and others considered high-risk because of chronic illnesses or suppressed immune system need to take extra precaution and isolate as much as possible. Face masks are our new friends. With smart medication use on my mind, here are seven tips and reminders that are in your control:

HbL PharmaConsulting as heard on Big 550 KTRS

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Four Rules for Choosing Cough and Cold Products

It is that time of year again, when the common cold—a virus—becomes more common. Hopefully, you wash your hands frequently, cough into your elbow, and drink plenty of fluids to help prevent getting sick. However, for most people, catching a cold will be unavoidable this winter. Many people seek nonprescription drug therapy to reduce the bothersome symptoms of stuffy nose, scratchy throat, runny nose, watery eyes, and cough. Older adults often take other medicines or have underlying medical conditions and thus must be extra careful in choosing the right cough and cold products. Drug interactions and adverse drug effects must be everyone’s first concern. This blog will summarize the good and bad about the different nonprescription cough and cold products and provide tips for how to choose a safe and effective product.

Know Your Medicines: Time to Say Yes

Today is the perfect day to stop and think about the medicines you take every day. What information do you need to know about your medicines to take them safely, take them correctly, and prevent medication errors?

HbL PharmaConsulting promotes “8 Things to Know about Your Medications,” listed below. Many of you already might know this information about each of your medicines. However, if you don’t--or if you know only some of these 8 points--it never is too late to ask additional questions at your next visit to the pharmacy. Pharmacists are medication experts and can help you understand your prescription and nonprescription medicines. The next time you pick up a prescription, whether it is a refill of an old medicine or a brand new medicine for you, when the clerk asks if you have any questions for the pharmacist--say YES!

What Can Your Pharmacist Do for You?

Who should you turn to with questions about your medicines? The answer is your pharmacist. But you may not be familiar with what your pharmacist can do for you. Your doctor and your pharmacist are a powerful team, working to ensure the best selection and management of your prescription and nonprescription medicines.