A New Era for Diabetes and Weight Loss Drugs

A New Era for Diabetes and Weight Loss Drugs

For patients seeking new solutions to managing type 2 diabetes and obesity, the introduction of a class of drugs called GLP-1 receptor agonists (RA) has simultaneously inspired hope and excitement along with misuse and confusion. We developed the following Q&A to go beyond the headlines and explore how Ozempic and similar drugs work, who may benefit most from them, and why they may ultimately represent a true breakthrough in the way these chronic conditions are classified, considered and treated.

What defines type 2 diabetes?

More than 37 million Americans have type 2 diabetes, a chronic disease that affects the ability of the body to regulate glucose (blood sugar) levels. This leads to an increase of glucose over
time which significantly increases the risk for complications to vital organs such as the heart, kidneys, eyes and nerves. Diagnosis is made when testing shows: fasting glucose of 126 mg/dl or higher; or non-fasting glucose of 200 mg/dl or higher; or A1C (average of glucose over the past 3 months) of 6.5% or higher.

How was type 2 diabetes previously treated?

Approved by the FDA in 1994, Metformin is well established as the first line therapy for management of type 2 diabetes if lifestyle changes (low-carbohydrate diet, weight loss and exercise activity) are not enough to bring blood sugar levels down near the normal range. Metformin works by decreasing the amount of blood sugar produced by the liver in a fasting state, decreasing the absorption of food through the intestines, and restoring the body’s response to insulin.

What is different about the GLP-1 RA drugs?

Among the major benefits this class of drugs brings to patients with type 2 diabetes is
lowering their risk for heart disease and stroke, and providing a significant boost to weight loss, in addition to helping reduce glucose levels to a near-normal range. As a result of the positive outcome reported in trials, the American Diabetes Association changed its longstanding guidelines for first-line treatment of type 2 diabetes to include recommendations for GLP-1 RA drugs in patients at high risk for cardiovascular disease or with risk factors such as high blood pressure, high cholesterol, or chronic kidney disease.

How do GLP-1 RA drugs work?

Known as incretin mimetics, this class of drugs mimics the effect of a hormone, glucagon- like peptide-1, or GLP-1, which is normally produced naturally to stimulate the release of insulin secretion after eating a meal. Receptors to GLP-1 are found in the pancreas, the brain and elsewhere in the body. The drug enhances these receptors, which help the pancreas release more insulin and help reduce blood sugar levels without raising the risk for hypoglycemia (too- low blood sugar levels). By limiting the amount of sugar the liver releases into the bloodstream in a fasting state, and slowing down how long food stays in the stomach, the drug promotes a feeling of satiety, leading people to be satisfied with eating smaller portions. In addition, some patients have reported a marked decrease in cravings for carbohydrate-rich and fatty foods.

What are GLP-1 RA drugs intended to treat – diabetes, obesity, or both?

Under certain names, GLP-1 RA drugs are FDA-approved only for treatment of type 2 diabetes while offering added benefits of weight loss and cardiovascular protection; under other names, the drugs are indicated only for weight loss, but not for treatment of diabetes. While the ingredients can be identical, the difference is in dosage amounts and whether the trials focused on the drug’s impact on blood sugar or weight changes. For example, semaglutide, a GLP-1 drug, is approved to treat diabetes under the name Ozempic; a higher-dose version of semaglutide, Wegovy, is only FDA approved for weight loss. The same is true for liragutide, approved for type 2 diabetes as Victoza, and for weight loss as Saxenda.

Are there side effects?

Most side effects for these types on drugs are gastrointestinal, including nausea, diarrhea or constipation, abdominal pain.

How effective are GLP-1 RA drugs like Saxenda and Wegovy for weight loss?

Trials to date have shown excellent results, with patients able to lose between 5 to 20% of their total body weight. However, these drugs are not meant for people wanting to lose 10 or 15 pounds. They are indicated for those who are obese, as measured by a body mass index (BMI) of 30 or higher; or for people with a BMI of 27 or greater with at least one weight-related coexisting condition such as high blood pressure, elevated cholesterol levels. It’s important to note that obesity is a chronic disease, and these drugs may be needed as a long-term treatment to help lose pounds and maintain weight loss, along with lifestyle changes that include a healthy diet and 150 minutes a week of moderate-intensity aerobic and muscle-strengthening activities.

How do SGLT2 inhibitors fit into the mix of drugs for diabetes?

This is a newer class of drugs that lowers blood sugar levels by preventing the kidneys from reabsorbing glucose back into the bloodstream but instead releasing it through urine. Originally intended only for lowering blood sugar, later research data showed the drugs offered significant benefits for type 2 diabetes patients with coexisting conditions. Now some SGLT2 drugs- Invokana (canaglifozin), Farxiga (dapaglifozin), and Jardiance (empagliflozin) – have also been approved for use by non-diabetic patients with a history of chronic kidney disease or congestive heart failure.

Are other drugs in the wings?

Mounjaro, a GLP-1 RA drug that also promotes a second gut hormone (glucose-dependent
insulinotropic polypeptide, or GIP) is currently approved for treatment of type 2 diabetes, and on a fast track approval by the FDA to be used as a weight loss medication.

How will I know which drug is right for me?

This is a decision best made on an individual basis with your physician, who will consider factors such as your overall health status, drug intolerances, risk factors for developing diabetes-related complications, benefits versus possible harm from side effects, and preferred formulation (oral or injection).

Drugs with Benefits: A Guide to GLP-1 RA Therapies

NOTE: Non-GLP-1 RA drugs used for weight loss are not listed here… Please consult with your healthcare provider regarding your best option.

Brand Name Active Ingredient Dosage/Form Approved For Also Beneficial For
Ozempic Semaglutide Weekly injection Type 2 diabetes Weight loss; decreased risk of stroke and heart attack
Wegovy Semaglutide Weekly injection Weight Loss n/a, studies not conducted
Rybelsus Semaglutide Daily pill Type 2 diabetes Weight loss, cardiovascular safety
Trulicity Dulaglutide Weekly injection Type 2 diabetes Weight loss; decreased risk of stroke and heart attack
Victoza Liraglutide Daily injection Type 2 diabetes Weight loss; decreased risk of stroke and heart attack
Saxenda Liraglutide Daily injection Type 2 diabetes n/a, studies not conducted
Soliqua Insulin glargine & lixisenatide Daily injection Type 2 diabetes Weight loss
Byetta Exenatide Twice daily injection Type 2 diabetes Weight loss
Bydureon BC Exenatide Weekly injection Type 2 diabetes Weight loss
Mounjaro (GLP-1 RA/GIP) Tirzepatide Weekly injection Type 2 diabetes Weight loss

Sources: GoodRx, American Diabetes Association

Joint Assets: An Osteoarthritis Update

Joint Assets: An Osteoarthritis Update

The aching, swollen, stiff joints associated with osteoarthritis (OA) have long been considered a “wear and tear” condition, associated with aging. It was thought that cartilage, the smooth connective tissue on the end of bones that cushion the joints, simply breaks down over a lifetime of walking, exercising and moving. New research shows that it is a disease of the entire joint that also causes bony changes of the joints, deterioration of tendons and ligaments and inflammation of the synovium (lining of the joint). While more prevalent in people over 50, OA can show up in younger patients, especially those who’ve experienced a joint injury such as a torn ACL or meniscus. The promising news is that according to the Arthritis Foundation, “OA is not an inevitable aging disease” and the Cleveland Clinic notes: “Age is a contributing factor, although not all older adults develop osteoarthritis and for those who do, not all develop associated pain.”

Still, currently OA is by far the most prevalent form of arthritis, affecting more than 32.5 million Americans, and primarily targeting knees, hips, hands and spine. A variety of factors contribute to the development of OA, including congenital joint deformity, family history, previous joint injury, and years of physically demanding work or contact sports. However, reducing risk is possible with attention to these modifiable factors:

  • Obesity adds stress and pressure to joints. Consider that your knees bear a force equivalent to three to six times your body weight with each step, so a lighter weight relieves the burden considerably – losing one pound takes 3 pounds off the knees.
  • Lifestyle. Being physically active is crucial, as a sedentary lifestyle and obesity are associated with a higher risk of OA. While sports such as football, baseball and soccer may pose a risk because of their impact on joints, most types of regular or moderate exercise can be safely done.

Living with Osteoarthritis

Unfortunately, there is no cure for OA, and managing symptoms such as joint stiffness, tenderness, swelling, and popping or crackling can become increasingly difficult over time. While seeking a pill to alleviate discomfort is a natural reaction, consider trying alternative solutions to help break the cycle of chronic pain.

“The longer the brain processes pain, the more hypersensitive it becomes to pain,” explains Rachel Welbel, MD, a physiatrist who is extensively trained in physical medicine and rehabilitation and sports medicine. “The brain, now constantly on high alert, may respond to non-painful sensations as if they are painful. Poor diets and stress can increase chemicals in the brain that reinforce this response, prolonging the pain cycle.”

Reflecting a more holistic and multi-faceted approach to managing pain, she says: “Opioids are almost never the answer.” Instead, she recommends lifestyle modifications, treatments and medications that help tackle pain in a variety of ways.

Lifestyle Modifications, Treatments and Medications for Osteoarthritis

Weight management. Obesity is not only a leading risk factor for OA, but adds to the pain for those with the condition. Body fat produces proteins called cytokines that cause inflammation, and in the joints, can alter the function of cartilage cells. Shedding even a few pounds can make a difference: losing just 10% of your body weight can cut arthritis pain in half, and losing another 20% can reduce the pain by an additional 25% or more, and may slow or even halt progression of the disease.

Exercise and movement. “Exercise is key to living well with OA,” says Welbel. “While resting aching joints may bring temporary relief, lack of movement ultimately leads to more discomfort. The focus is not on weight loss but on minimizing pain and maximizing strength.” Plan on 150 minutes of light to moderate exercise each week. She recommends working with a physical therapist who can analyze your joint biomechanics and suggest exercises to strengthen muscles and improve range of motion while reducing stiffness and pain. “In addition, exercise is a natural mood elevator,” says Welbel. “Walk, swim, or try mindfulness-based, stress-reducing exercise such as yoga and tai chi.”

Anti-inflammatory diet. Increasing consumption of fruits, vegetables, whole grains, legumes and fish, while reducing consumption of red and processed meats, refined grains, and sugar-containing beverages and foods, may play an important role in reducing pain associated with inflammation from OA, says Welbel. Try incorporating into your diet fatty fish; herbs and spices such as garlic, turmeric and cinnamon; yogurt and other fermented foods; and healthy fats such as avocados, extra virgin olive oil and walnuts.

Supportive devices. A cane or walker can help lighten the load on your joints, decrease pain, and reduce your risk of falling. Intermittent use of a knee brace may be helpful for added stability, especially if walking on uneven surfaces. Foot orthotics such as arch supports and metatarsal pads may reduce foot pain.

Medications. Over-the-counter (OTC) pain relievers like acetaminophen (Tylenol) may help joint pain and stiffness for some. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also used to relieve pain, including OTC medications such as Advil or Aleve, or Celebrex, a prescription medication with a somewhat lower risk of ulcers and upper gastrointestinal bleeding than other NSAIDs. Topical NSAIDS such as Aspercreme and other creams or patches containing ingredients such as capsaicin, menthol or lidocaine can help.

Injections. Corticosteroids injections may provide temporary relief for acute flare-up of OA pain in knees and finger joints, but effectiveness can vary, and you must wait at least 3 to 6 months to repeat an injection in a specific joint if needed. Viscosupplementation involves injection of a gel-like substance containing hyaluronic acid, which acts as a lubricant in the fluid between bony surfaces and is decreased in OA joints. Research results for significant pain reduction or improved function are not yet convincing, but there appear to be a number of patients with mild to moderate knee OA who report symptom relief.

Supplements. Research results are mixed, but we note some of the more well-known supplements with the caution that these are not recommended to be used alone as treatments for OA. Glucosamine and chondroitin sulfate, naturally occurring compounds found in healthy cartilage, may help reduce joint pain and stiffness, and have been available in the U.S. and Europe for several decades. Other supplements such as tart cherry and turmeric may help reduce OA symptoms for some.

Other promising but not yet proven treatments. Platelet-rich plasma (PRP) injections and stem cell therapy have been used to treat pain of mild to moderate knee OA, but evidence of effectiveness is mixed, and these are still considered experimental. Elements of Eastern medicine, including herbs and acupuncture, may help control OA symptoms, but have not yet been confirmed in large clinical studies.

A Generation of Joint Replacements

When diet and exercise modifications, supportive devices, medications and injections no longer sufficiently ease the pain of OA, a hip or knee replacement may be recommended. The number of people opting for this surgery increases each year, now totaling more than 790,000 knee and 450,000 hip replacements annually.

The implants, made of plastic, metal or ceramic, are traditionally kept in place with bone cement, which is gradually being replaced by newer cementless and porous titanium systems to improve bone fixation and durability. Also on the rise is computer-assisted surgery to increase placement accuracy of the prosthetic components, and patient-specific implants using 3D printing technology. The combination of modern materials and advanced surgical techniques have extended the durability of most implants to 20 years, a marked improvement over the previous standard of 10 to 15 years.

Recovery time has also changed for the better. With rehabilitation to regain strength and motion, normal activities can usually be resumed within weeks to months. Most importantly, the majority of patients are highly satisfied with the results, reporting minimal to no pain and significantly improved function and quality of life. However, outcomes can vary and potential complications should be discussed before proceeding.

Additional breakthroughs may be on the horizon: researchers at Duke University start trials this spring of a hydrogel-based cartilage substitute that may prove more durable than natural cartilage…stay tuned!

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.


Bone Up: What Is Osteoporosis?

Bone Up: What Is Osteoporosis?

Except for dedicated thespians, saying “break a leg” is most definitely not a harbinger of good luck. More than 10 million Americans are living with osteoporosis, a condition of low bone mass that results in increased risk of bone fracture, sometimes even from a minor fall or pressure from a big hug. Over 1.5 million osteoporotic fractures occur annually, and 1/3 of women and 1/5 of men over 50 will experience an osteoporotic bone fracture in their lifetime. The good news is that reliable diagnostic testing and treatments are available, which we share below.

Who’s at Risk for Osteoporosis?

Osteoporosis is sometimes referred to as a “silent disease” because it is painless unless a fracture occurs, so people often are unaware they have it until that happens. Post-menopausal women are at highest risk, in part due to the decline in estrogen levels. Estrogen, and to an even greater extent, testosterone, are hormones that help ward off osteoporosis, which is why it is not as common in men. Others at risk include those with autoimmune diseases such as rheumatoid arthritis and celiac disease, those with high parathyroid or thyroid levels and certain other chronic diseases.

Medications including corticosteroids, proton pump inhibitors and certain antidepressants and anti-seizure medications may increase risk of bone thinning. Inherited factors may affect risk, such as race (more common in Caucasians and Asians), body shape and size (smaller/thinner individuals more at risk) and family history of osteoporosis. Physical activity level and diet play a role, placing those who are sedentary and/or have a diet low in calcium at higher risk. Cigarette smoking and higher alcohol intake are also risk factors.

How Osteoporosis is Diagnosed

A bone density measurement test is the best way to diagnose osteoporosis, using the DEXA (dual energy x-ray absorptiometry) scan of hip and spine. The severity of decrease in bone mass is determined by your T-score: Between -1.0 and -2.5 is defined as osteopenia, when bones are weaker than normal, while -2.5 or less indicates osteoporosis.

Osteoporosis Medications

A number of medications are available to treat osteoporosis.

  • Bisphosphonates to slow the breakdown and removal of bone are typically tried first. Fosamax, used most, is a weekly pill often taken for 5 years followed by a “drug holiday.” The IV bisphosphonate Reclast is generally continued for three years.
  • Evista is a daily pill for post-menopausal osteoporosis that protects against bone loss and also reduces the risk of breast cancer in high-risk women.
  • Prolia is injected every 6 months to slow breakdown and removal of bone and help increase bone density. It should not be discontinued once started or must be followed by another medication if stopped.
  • Evenity is injected once a month for a year to increase new bone and reduce breakdown and removal of bone.
  • Forteo and Tymlos are drugs that help build bone for people at high risk of fracture. These are injected daily for two years.

Managing Osteoporosis

Peak bone mass is achieved by age 25-30 years, but at any age, a healthy lifestyle can aid in strengthening bones. Focus on eating a balanced diet rich in vitamin D and calcium (see sidebar), and remember that exposing the body to natural sunlight increases production of vitamin D. Eliminating tobacco use and limiting alcohol is strongly recommended to promote maximum absorption of calcium and vitamin D. Taking fall prevention measures is crucial: consider that 95% of hip fractures are caused by falls.

Aim for 30 minutes of weight-bearing and muscle strengthening exercises on most days:

  • Walk or run on level ground or a treadmill
  • Dance
  • Climb stairs
  • Lift weights without straining your back
  • Sit-to-stand exercises: start with an elevated seat height, and progress to a lower chair as you get stronger
  • Strengthen thighs: stand against a wall and slide down into a slight knee bend, hold for 10 seconds and repeat a few times
  • Tai Chi: combines slow movements, breathing exercises, and meditation

Nourishment Know-How for Bone Health

For optimal bone health, a daily intake of 1200-1500 mg of calcium and 400-800 IU (international units) of Vitamin D is recommended for adults. In many cases, supplementation may be appropriate.

Selected sources with calcium and/or Vitamin D:

  • Dairy products
  • Calcium- and vitamin D-fortified foods and beverages (soy or almond milks, cereals, cheese)
  • Dark green, leafy vegetables
  • Fish such as salmon, trout, mackerel, tuna, sardines
  • Egg yolks
  • Sesame or chia seeds, figs, almonds

Fall Prevention Measures for Those with Osteoporosis Include:

  • Avoid ladders, step-stools and roof work
  • Eliminate tripping hazards like throw rugs, obstacles or cords on the floor
  • Be careful around pets and leashes
  • Use good lighting, night lights, update glasses and eye care to optimize vision
  • Stay fit with regular strengthening and balance exercises
  • Wear non-slip shoes
  • Install handrails and grab bars in the bathroom

Every patient is unique…please check with your healthcare provider to discuss recommendations for prevention and treatment based on your individual health situation.

Sources: Arthritis Foundation, AAOS, Orthoworld, Cleveland Clinic, National Academy of Medicine (formerly Institute of Medicine), UpToDate, US Department of Agriculture, American College of Rheumatology.



Pandemic Inspires and Challenges Medical Innovation

Pandemic Inspires and Challenges Medical Innovation

Pandemic Sparks Promising Future for Clinical Trial Speed and Flexibility

Like wartime medicine, the pandemic inspires and challenges medical innovation.

The silver lining of the pandemic is the reinvigorated sense of urgency breaking down
cumbersome and expensive barriers to the FDA’s phased approval process. While the research- lab-to-patient-arm trials for the highly successful COVID-19 vaccines famously moved the traditional pace to warp speed, other critical and life-altering medicines, devices and therapies also broke through during this period.

To be clear, the current surge of medical innovation through clinical trials in immunology, cardiology, multiple sclerosis, oncology and more, is not the result of a rush-to-market panic. All necessary and appropriate testing protocols to ensure quality are still being achieved, but at a more expedient pace in many cases. This is the good news.

“In times of crisis, we can accelerate the development and review process,” explains Andrew Badley, MD, infectious disease specialist, Mayo Clinic. “Throughout the pandemic, many of these steps were accelerated. No steps were skipped. It was just the amount of effort that went into the development and the review that was increased.”

Of course, there is also some not-so-good news about clinical trials today. During the pandemic, the number of new studies launched dropped by as much as 57 percent, according to Trials Journal, and the overall completion rate of clinical trials decreased between 13 and 23 percent globally. Shifting research priorities (11 percent of studies shifted to pandemic-related trials in 2020) and initial challenges in recruiting and following up with volunteer patients during the global lockdown contributed to this decrease. Often, a clinical trial is tethered to an academic medical center with participants centered in one geographical area, limiting volunteer pools and access.

However, the future speed and flexibility of clinical trial protocols is very promising, reflecting the long-term viability of alterations made to the fabric of patient care and research during the pandemic. Some of the new flexibility that is being assessed and considered for permanent use includes:

  1. Telemedicine. While telemedicine has been available for years, the lockdown most certainly fast-tracked adoption among researchers, regulators, physicians and patients. Clinical trial investigators can now use telemedicine for many patient check-ins, saving time and broadening the geography of volunteer pools. Dr. Ray Dorsey, a neurologist at the University of Rochester, noted in a recent article that his virtual clinical study of
    genetic predisposition to Parkinson’s disease moved forward more quickly amid the pandemic, spurred by a rising number of online enrollments.
  2. Delivery. Like specialty pharmacies and physicians during lockdown, clinical trial investigators are now allowed to deliver trial medicine to volunteers.
  3. Remote Access. Volunteer participants are able to use online platforms for completing consent forms, and they can often visit their local physician for basic assessments. Some
    trials also require less frequent check-ins, which can be important in recruiting volunteer patients. The growing number of smartphone-enabled applications that provide measurement of critical physiologic variables means patients don’t need to continually return to the hospital or clinic for tests during the trial. For instance, an entirely remote study testing vitamin D for treating COVID-19 and preventing transmission is being conducted by Brigham and Women’s Hospital; participants obtain their own blood samples with a finger prick, dot the blood drop onto filter paper supplied to them and mail it back.

The Clinical Trial Explainer

In the United States, the Food and Drug Administration (FDA) directs and approves all prescribed medicines, diets, diagnostics, devices and therapies. Clinical trials are the part of research that determines whether a medical intervention should be moved, or “translated,” from the lab to routine patient care. At each phase along the way, the team must answer different questions about safety, efficacy (whether the intervention works as intended) and whether there might be better options available. The current clinical trial journey to FDA approval, shown below, can take years, a mountain of paperwork and millions of dollars – there is room for improvement.

  • Preclinical phase establishes the pharmacological profile and determines toxicity on at least two animal species.
  • Phase I, a short study of 20 to 80 healthy people to determine safe treatment and dosing.
  • Phase II, a larger-scale study of targeted patients to determine treatment effectiveness and identify side effects; can take months to years to complete.
  • Phase III compares the trial intervention with existing therapies; requires several years of multiple data collection check-ins and comparisons. About 1 in 15 won’t make it past phase III.
  • FDA Review and Approval
  • Phase IV follows patients after therapy approval to ensure the intervention is working and prove the long-term benefits outweigh any risks or side effects.

Antibiotics Awareness is Good for Your Health

Image of Antibiotics

Antibiotics Awareness

Spurred by Alexander Fleming’s serendipitous discovery of penicillin in 1928, antibiotics have rightfully become wonder drugs, often able to change the course of deadly bacterial infections in a matter of days. But in recent years, their unmatched healing power has become overprescribed and over utilized, leading to concerning findings like these: Nearly 23% of antibiotic prescriptions filled in 2016 were unnecessary, and an additional 36% were prescribed for conditions for which an antibiotic is only sometimes recommended, according to a recent study from the Agency for Healthcare Research and Quality. Antibiotics awareness is good for your health

Unintended consequences far from benign

Patients may needlessly experience the drug’s side effects, such as rash, dizziness, nausea, diarrhea or Clostridium difficile infection (C. diff), which can cause severe diarrhea and may be life-threatening. On a larger, global scale, overuse leads to antibiotic-resistant bacteria, a growing danger that occurs when bacteria that have been exposed to an antibiotic mutate, rendering the drug ineffective against them. The Centers for Disease Control estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year in the US, resulting in approximately 23,000 deaths. In fact, Fleming himself predicted the possibility in his 1945 Nobel Prize acceptance speech, saying: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.”

Antibiotics: Handle With Care

That’s why the World Health Organization’s annual “Antibiotics: Handle With Care” campaign, launched in 2015, and the United States’ “Be Antibiotics Aware” program, launched the following year, are more important than ever in raising awareness as to why antibiotics aren’t always the answer. Becoming knowledgeable about the difference between bacterial and viral infections, and why an observational (“watch and wait”) approach to antibiotic treatment may be considered for conditions like sinusitis or ear infections, is critical to stemming the tide of overuse.

Below is a look at when antibiotics should be the treatment of choice, when they should be considered only after watching and waiting, or when they are not called for at all. Note that antibiotic drugs effectively kill bacteria but not viruses, which is why they are never recommended for viral infections such as colds or flu. However, not all bacterial infections require the use of antibiotics. As always, check-in with our office regarding what’s best for your individual health.

Common cold/upper respiratory infection No, primarily viral Cough expectorants sometimes combined with decongestants; antihistamines; and cough suppressants
Flu No, primarily viral Antiviral drugs by prescription
Bronchitis/chest cold No, primarily viral; thick, yellow or green mucus does not indicate bacterial infection Cough suppressants/expectorants; decongestants; antihistamines
Sore throat Only if diagnosed with group A streptococcal pharyngitis (the cause of just 5-10% of adult sore throats) Over-the-counter (OTC) pain relievers such as aspirin, ibuprofen and acetaminophen; throat lozenges
Sinusitis Only if severe, or if symptoms persist after

10-14 days. Many studies show no difference in recovery rate with or without antibiotics.

Sinusitis infections are primarily viral; even if diagnosed as bacterial, a watch and wait approach may be recommended.

OTC pain relievers
Pneumonia Yes, if diagnosed as bacterial OTC fever reducers/pain relievers
Middle ear infection For mild cases, watchful waiting or delayed antibiotic prescribing may be recommended Extra fluids; OTC pain relievers
Cystitis, a common bladder infection in females Yes, this infection is usually bacterial Fluids; heating pad on lower abdomen; warm bath
Lyme disease Yes, cause is a bacteria transmitted to humans by a bite from an infected tick; treatment with antibiotics in early stages of disease is most effective and prevents later-stage complications

Sources: Up to Date, CDC

About that penicillin allergy

Most people who believe they’re allergic to penicillin can take it without a problem, either because of the rash, they experienced as part of a virus or because the allergy resolved over time. You may want to get tested by an allergist to be certain, as research shows that patients identified as penicillin-allergic are more likely to receive very powerful antibiotics with greater side effects, and are also at higher risk of developing resistant infections that require longer stays in the hospital. It’s interesting to note that when skin tested, approximately 90% of people will test negative for a penicillin allergy.

Did You Know?

Reactions from antibiotics cause 1 out of 5 medication-related visits to the emergency department.
Source: Centers for Disease Control

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Manage Prescription Drugs Effectively

Manage Prescription Drugs Effectively

Managing Prescription Drugs: From Pickup to Take Back

If you are not taking your prescription medications as directed (or at all), you’re far from alone. Compliance is estimated at just 50% among U.S. patients. Unfortunately, adherence is a direct impact on quality and length of life, and overall healthcare costs, accounting for up to 50% of treatment failures and up to 25% of hospitalizations each year. The reasons for noncompliance vary, from patients not being convinced of the medication’s effectiveness, fear of side effects, the cost of certain medications to difficulty using tools (such as inhalers) or an aversion to injections. What can be done to manage prescription drugs more effectively?

For most, non-compliance is simply an unintentional consequence of forgetfulness or lack of organization. When faced with the need to keep track of a growing lineup of daily doses – and 77% of older adults manage two or more chronic conditions according to the National Council on Aging – it can become challenging to keep up. Fortunately, many solutions are available, from old school pen and paper to high-tech smartphone apps, that make it easy to reap the benefits of and manage your prescription medications.

Pick up

  • At the pharmacy, check your prescription instructions and make sure you fully understand dosage and timing; if best taken with food; interactions with other drugs, supplements, foods and alcohol; and side effects. If you have questions, ask the pharmacist or call our office.


  • Tried and true, a pill organizer with compartments divided into sections for days of the week is most helpful in managing multiple medications. Keep the original bottles so you can quickly access any dosing and refill information printed on the bottle or packaging.
  • Create a dosing schedule chart to keep next to the pill organizer, with a physical description or visual image of each pill. Use a spreadsheet or word processing program to make a list of all medications, times to take, and a check off space to indicate when taken. A number of pre-formatted charts are available online for download from the American Heart Association, the Food and Drug Administration and others.
  • Online pharmacies are entering the mix, offering delivery of monthly medications sorted by dose.

Smartphone Reminders 

Free smartphone apps can serve multiple functions. A few of the best:

  • Medisafe medication management and pill reminder, highly rated by pharmacists for its comprehensiveness and usability, includes videos for many frequently used medications illustrating use, side effects, contraindications and other information, and emails you a history of your medications and doses in an Excel spreadsheet.
  • Care Zone Health Information Organizer enables you to take pictures of your prescription and over-the-counter (OTC) drugs and supplements, populates with details, and sends reminders to take medications and refill prescriptions.
  • Drugs.com also sends reminders, keeps your medication history, includes an interaction checker for other drugs and foods and provides access to updated information for more than 24,000 prescription and OTC drugs and supplements.
  • Ask your pharmacist about preparing blister packs for daily or weekly medications; timer caps for pill bottles that beep to remind you when to take medications; gadgets that “talk” and relay the information verbally; and stand-alone electronic pill devices enabling easy input of medication name and measures, with an alarm that notifies you when the next dose is needed.

Properly Store your Prescription Drugs

  • Pick a location that is up and away, like a kitchen cabinet (not the bathroom, unless it is well ventilated). Keep medications cool and dry and in a well-lit area to ensure you’ll reach for the right ones.
  • Open the medicine bottle on a flat surface to prevent dropped pills from being lost down a drain or landing on the floor.
  • Make a discard pile of medicines that are discolored, dried out, crumbling, leftover from a previous illness or past their expiration date—particularly biologic products, insulin, refrigerated liquids, eye drops, injectables or specially compounded medications.

Discard with care: Toss, flush or Take Back

Most prescription and OTC medicines can be thrown away in the household trash, with these important procedures:

  • Do not crush tablets or capsules.
  • Mix the medicines with kitty litter or used coffee grounds to prevent thievery or diversion of medicines from the trash. Then, place the mixture in a container such as a sealable plastic bag, and throw away.
  • Remove the label and/or scratch off all personal information when disposing of a prescription vial.
  • Check instructions included with prescription drugs such as narcotic pain relievers e.g. the fentanyl patch and other controlled substances, which must be flushed instead of discarded.

Even more convenient and environmentally sound are programs such as National Prescription Drug Take Back Day, sponsored by the U.S. Drug Enforcement Administration (DEA) in communities nationwide. The next one is scheduled for October 26, 2019: Find a collection site near you at https://takebackday.dea.gov, dispose of your unused or expired drugs safely and easily.

Did You Know?

Approximately 50% of medications for chronic disease are not taken as prescribed.
*Source: Annals of Internal Medicine

11.8 million pounds of prescription drugs collected since Take Back Day began in 2010.
*Source: Drug Enforcement Administration

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