Medrol Dosepak

Medrol (methylprednisolone) is a glucocorticoid similar to prednisone.  Available in 2mg, 4mg, 8mg, 16mg, and 32mg tablets, this steroid can be used to treat bursitis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, and a variety of other conditions.

A fast-taper methylprednisolone dosepak contains 4mg pills conveniently arranged for easy dosing:  6 pills the first day, 5 pills the second day, and so on, decreasing one pill per day.

medrol pack

At my pharmacy, the cash price for these twenty-one pills is $33 ($1.57 per pill); the cost is obviously in the packaging. The cash price for a bottle of seventy 5mg prednisone pills is only $10 (14 cents per pill).  4mg Medrol equals approximately 5mg prednisone, so this is a fair comparison.

Of course, buying a bottle of pills would require you to be able to count to six so you get the right number of pills the first day. It would also require keeping track of which day you’re on. That’s easier said than done, because any condition that would call for that dose of steroid probably puts clear-thinking on hold.  Nonetheless, a simple piece of paper kept on the kitchen counter with the pill bottle would suffice.  Another option would be to put a portion of the money saved toward a pill box (if you don’t already own one).  If you don’t want a bunch of prednisone left for future tapers, you’d still save money buying prednisone instead of Medrol, and just throw the unused medicine in the trash.

Cost is not the only drawback I find.  It amazes me that something marketed for people who might be having difficulty using their hands is so incredibly difficult to open.  Be aware that if you use this medicine, you might need assistance getting at your pills.

If your doctor ever recommends a Medrol dosepak for a quick steroid taper, it might be worth discussing a more economical and easy to use medicine.

Tamiflu

Did you know that Tamiflu isn’t just used to treat confirmed influenza?  If you’ve been exposed, Tamiflu can be taken to prevent the flu (or at least minimize symptoms) after you’ve been exposed.

016As a person on multiple immunosuppressant drugs, flu season is not my favorite time of year.  I get my influenza vaccine hoping to stay healthy, but the shot is only about 60% effective, and the world is full of people who don’t understand how irresponsible it is to contribute to the spread of preventable disease.  $35 to greatly reduce my chances of dying from the influenza seems like a bargain.

A few days ago I was exposed to what was a few hours later confirmed to be influenza A.  This, I determined, was a situation worthy of skipping both my biologic and mtx.  My doctor determined that it was also worthy of a round of tamiflu.  With known exposure, tamiflu can be used to prevent the flu — or at the very least, make the case less severe than it would otherwise have been.  I had not known that Tamiflu could be used prophylactically.

If you are exposed to a confirmed case of the flu, there’s no need to spend any time worrying about whether or not you’ll get sick.  Talk to your doctor.

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How Flu Spreads
Tamiflu

New Oral RA Med

Yesterday, the FDA approved Pfizer’s XELJANZ (tofacitinib) for treatment of RA when methotrexate has failed to work adequately.  This oral medicine is in a new class of drugs:  Janus kinase (JAK) inhibitor.

Another JAK, ruxolitinib, was approved last year for the treatment of myelofibrosis.  Other JAK inhibitors are being tested as treatments for psoriasis, RA, and some cancers.  I have to admit that reading about JAKs made my eyes glaze over; all I retained was “just another kinase” having to do with cytokine receptors and “named after the two-faced Roman god Janus.”   Perhaps Andrew will write something comprehensible for us laymen (hint).  Until then, I know which reading material I’ll select next time insomnia strikes.

Tofacitinab comes with the black-box warning that RA patients are all too familiar with:  elevated liver enzymes, lower blood counts, high cholesterol, and increased risk of infection, tuberculosis, lymphoma, and cancers.  Post-marketing studies were ordered, so time will tell how effective this medication is, and whether there are other side effects to watch for.  Those who have run the gauntlet of every available medicine but found no relief now have a new treatment option.

See Medscape’s article here, and the FDA’s approval letter here.