What the recent drug recalls really mean

Many of you have probably heard about the recent drug recalls of a variety of blood pressure medications. While there are a lot of names of medications being thrown around as recalled, this situation centers around one drug in particular, Valsartan. Valsartan is part of a class of blood pressure medications known as angiotensin receptor blockers, or ARBs. The drug was originally recalled months ago due to trace findings of an impurity within the tablets. This impurity is N-nitrosodiethylamine (NDEA), which has possible carcinogenic (cancer causing) properties. This means that miniscule amounts of what may or may not be a cancer causing agent had contaminated the tablets. This also means that the drug Valsartan itself is not a cancer causing agent.

Only certain manufacturers are involved in this recall, meaning that just because you take a product containing valsartan, does not mean your tablets are affected. Only certain lots, or batches, of the drug from certain manufacturers are involved. These manufacturers include Mylan and Teva pharmaceuticals. The identified lots of Mylan and Teva products containing the contaminated valsartan includes combination products that have other drugs in them. This is why you have seen the names Amlodipine and Hydrochlorothiazide (HCTZ) thrown around in recall news. The products recalled were combination drugs of Valsartan + Amlodipine, Valsartan + HCTZ and Valsartan + HCTZ + Amlodipine. However, Amlodipine and HCTZ as stand alone products ARE NOT included in the recall and do not contain the impurity. If the product you are taking does not contain the drug valsartan it is NOT contaminated and you should continue taking the drug as prescribed.

How do you know if your medication is part of the recall? When a recall is announced ALL pharmacies are notified via a form that lists all of the recalled products that they use to check their stock. Every pharmacy must return this form stating whether they do or do not have the product being recalled. If they DO have the product the pharmacy must print a report of all individuals who have the contaminated drugs and notify them. If you have NOT already been contacted by your pharmacy stating that you are in possession of a recalled drug, your medication is safe and you should continue taking it as prescribed.

If you have been notified that your medication is part of the recall, do not worry. The risk involved with the impurity is nearly negligible. Once you have been notified, there are 2 options you can take. Your pharmacy can issue you a replacement supply of your medication from a different lot or manufacturer that is not contaminated. It is possible that your pharmacy may not have any replacement stock to give you, due to the increased demand and decreased supply of the products. If that is the case, you or your pharmacist can contact your doctor for an alternative medication to replace the one you have been taking. The ARB class of medication contains other drugs that work the same as valsartan, including losartan, irbesartan and olmesartan. These drugs should be equally as effective for you at controlling your blood pressure. These products also come in combination forms like valsartan, in the event that you are taking the combination product.

If you are unsure if your medication is involved in the recall, contact your pharmacy as soon as possible to inquire. Do NOT stop taking your medication until you are told that your medication is part of the recall. The risk involved with stopping your medication is greater than the risk involved with taking the contaminated product. Your Four Corners pharmacist or pharmacy student is always available to answer any question you may have about the recalled drugs and exactly what that means for your medication.



The 411 on the Flu

We hear about it everywhere; a relative has it, your doctor and pharmacist want you to get vaccinated against it, tv commercials mention it, but what exactly is the flu? The flu, or influenza, is a viral infection (like the common cold we mentioned in the last blog post) caused by haemophilus influenza virus A or B. The virus attacks your upper and lower respiratory tracts, including your nose, mouth, throat and chest areas. These are also the areas from which is spreads. The virus is spread through contact with the respiratory secretions of an infected person. This means coming into contact with something an infected person has coughed on, sneezed on, eaten off of or drank out of. Flu symptoms include coughing, sneezing, runny nose, chest and sinus congestion, headache, fatigue, body aches and a high fever. These symptoms are likely to begin 1 – 4 days after coming into contact with the virus.

How is this different from the common cold? The symptoms you experience with both are similar, however, these symptoms will be much more severe if you have the flu. If you have a cold, you should not have body aches or a high fever, those symptoms are more likely to occur with the flu. You will feel more weak and tired with the flu than a common cold, so much so that you may not feel like you can get out of bed or go about your daily life. When your cold symptoms become so severe that you feel the need to call out of work, or can’t get out of bed, you should see your primary care provider.

Like the common cold, antibiotics are ineffective at treating the flu. However, unlike the common cold, there is an antiviral medication that your doctor can prescribe to help fight the virus. This medication is called oseltamivir, better known as Tamiflu. This medication works by preventing the replication of the virus in your body, eventually causing it to die off. Depending on how it is prescribed, it can be used to reduce getting the flu, if exposed to a known case or to shorten the duration and severity of the flu if you have an active case. In both cases, it needs to be taken within 48 hours of first signs of symptoms.  Possible side effects of Tamiflu include, nausea, vomiting and headache.

The best and only way to prevent the flu is to get vaccinated against it. Why do we do this every year? Influenza is a smart virus that changes every year in order to evade the vaccine given the previous year. The vaccine produced each year is effective against the strains of the virus that scientists think are most likely to infect people each year. This means the vaccine is not 100% effective against the flu because we cannot exactly predict how that pesky virus will change, but we can come pretty close!

If you are thinking that you don’t need that vaccine because never get sick or you can tough it out if you do, think about those whose immune systems are weaker than yours and are more susceptible to consequences if they do get the flu! These people include children, people over 65 years old and people with weakened immune systems due to medications or disease states. I bet you know someone that falls into one of those categories! Those people have a harder time fighting the flu, which could lead to pneumonia. Pneumonia is an even bigger beast to tackle, and can result in hospitalizations and death in severe cases. So if you don’t get vaccinated for yourself, get vaccinated for those you care about!

The flu vaccine is covered with a $0 copay under most insurances, so it’s of no cost to you! Flu vaccinations do not require an appointment at our pharmacy, but the best time for us is between 8 AM and 10 AM any day of the week. If you have any questions at all about the flu itself or the flu vaccine your Four Corners pharmacist or pharmacy student would be happy to answer them!

Everything You Need to Know about Cough and Cold

The common cold, sometimes also described as a sinus infection, is a viral infection. This means it is caused by a virus, NOT a bacteria, as the word “infection” might indicate. The main difference between the two being that a bacteria is a living cell, while a virus is not. A virus instead inserts itself into your already existing cells, making you sick. The virus will continue to make you feel sick until the cells it has inhabited dies. Unfortunately, this means a virus needs to run its course, which can range from a few days up to 3 weeks in extreme cases.

As discussed above, the virus causing your common cold cannot be killed. This means that antibiotics DO NOT have any effect on the common cold. Yes, you read that right. Antibiotics kill bacterial cells, however, they do not have that same effect on the cells inhabited by a virus. You can, however, treat the bothersome symptoms you may experience. Symptoms of the common cold can range from mild to so severe that they inhibit your day-to-day life. These symptoms may include, a runny nose, cough, chest congestion, sinus pressure, headache and body aches. Below we will discuss each symptom and how to alleviate it.

  • Symptom: a runny nose/post-nasal drip
    • What to use: An antihistamine like cetirizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra)
    • Why it works: These drugs block the histamine receptors that are causing your sinuses to leak fluid resulting in dry sinuses
    • Hint: These products are also used for seasonal allergies
  • Symptom: Productive cough (phlegm in your throat after you cough)
    • What to use: guaifenesin (Mucinex)
    • Why it works: guaifenesin helps your body break up the mucus stuck in your chest and sinuses
    • Hint: You will cough more for a short period of time while your body works out all of that newly broken up mucus
  • Symptom: Dry cough
    • What to use: Dextromethorphan (Delsym)
    • Why it works: Dextromethorphan prevents coughing by suppressing your cough reflex
  • Symptom: Chest and sinus congestion
    • What to use: pseudoephedrine (Sudafed)
    • Why it works: pseudoephedrine reduces swelling in your chest and sinuses by shrinking the blood vessels in this area, causing the pressure to be relieved
    • Hint: This is behind the counter and requires a valid driver’s license for purchase
    • Hint: Consult with your pharmacist (or pharmacy student!) before purchasing if you take any medications for heart disease – they can recommend an alternative product called phenylephrine that works in the same way!
  • Symptom: Headache/body aches
    • What to use: Acetaminophen (Tylenol)
    • Why it works: acetaminophen is NOT an anti-inflammatory pain reliever, like ibuprofen or naproxen, meaning it provides pain relief without the extra property that can cause kidney and intestinal damage if used to often
  • To boost your immune system and help fight the cold
    • What to use: Zinc lozenges (Cold-Eeze)
    • Why it works: Zinc may prevent the virus from multiplying in your system, as well as prevent it from lodging itself in the mucous membranes of your throat and nose
    • Hint: Take every 2-3 hours starting within 24 hours after you begin feeling cold symptoms

In addition to these over-the-counter remedies, FLUIDS and REST are key to kicking a cold. This helps your body grow and shed those infected cells!

Not sick yet, but trying to prevent it? There are a few very easy things you can do to help prevent yourself from catching the common cold this season. Those same fluids and rest that you’re stocking up on when you’re sick, are just as important at preventing you from getting sick! Make sure you’re drinking lots of water and getting at least 7 hours of sleep each night. WASH YOUR HANDS! Do this at every opportunity you get, including after you go to the bathroom, after using the signature pad at the pharmacy or grocery store, and before and after eating. Echinacea has also been proven to be effective at preventing the common cold by increasing your body’s immune response to both viruses and bacteria, and may be worth taking daily during cold season.

If you have any questions about how to prevent or treat your cold symptoms, or about what products are best for you, feel free to ask your Four Corners pharmacist or pharmacy student! We are happy to answer any questions you may have!

Tips to avoid a photosensitivity reaction

Article written by Nick Demenagas

When you pick up your prescription from the Pharmacy, you might hear a Pharmacist say: “This drug might cause increased sensitivity to the sun.” But what does this mean? Certain medications (seen below) can cause your skin to be more sensitive to the sun’s UV rays. This means that even a little exposure could end up becoming a severe burn. The following drugs can lead to photosensitivity:

    • Amiodarone
    • Fluoroquinolones (ciprofloxacin, levofloxacin)
    • Furosemide
    • Retinoids (Accutane)
    • Antimalarial (quinine)
    • Some chemotherapy
    • Sulfonamides
    • Sulfonylureas (glyburide, glipizide, glimpiride)
    • Tetracyclines (doxycycline, minocycline)
    • Thiazides (Hydrochlorothiazide- a water pill, and other thiazide-like diuretics)

A photosensitivity reaction to a medication can lead to an itchy, red rash on the skin, hives or blisters. The symptoms can start within 2-3 hours of being exposed to the sun and go away within 24 hours. You can use NSAIDs for pain, steroid creams for inflammation and antihistamines for itching from the burn.

Screen shot 2018-07-01 at 8.36.45 PM

The best way to prevent photosensitivity is to avoid the sun. This can be done by staying in the shade from 10 am to 3 pm, by wearing protective clothing and sunscreen. Some important tips about sunscreen. First, you want to choose a sunscreen that is broad spectrum. This means it protects against UVA and UVB light. Having this dual protection means that the sunscreen is helping to prevent sunburn, skin cancer and early aging. When choosing the SPF of your sunscreen, it is important to know that the SPF, or sun protection factor, indicates how long you can stay in the sun without being burned, compared to no sunscreen. For example, SPF 6 allows you to stay in the sun 6 times longer without being burned than not having sunscreen. The higher the SPF, the more protection. SPF 15 will block 93% of UVB rays and SPF 30 will block 97%. The maximum SPF is 50, because anything higher has no added benefit.

In addition, if a sunscreen says it is water-resistant, that means it is effective for 40 minutes in water and for 80 minutes while sweating. So even water-resistant sunscreens need to be re-applied after some time. In conclusion, to avoid being sunburned you should use a liberal amount of SPF 30 or more for times where you are going to be exposed to the sun.

As always, if you have any questions feel free to reach out to your neighborhood Pharmacist at Four Corners Pharmacy and check out our sunscreen stock in the pharmacy!


Photosensitivity. Micromedex. In: Care Notes [database on the Internet]. Greenwood Village (CO): Truven Health Analytics; 2018 [cited 2018 Jun 15]. Available from: www.micromedexsolutions.com. Subscription required to view.


Hester SA. Shedding Light on New Rules for Sunscreens. Pharmacist’s Letter. 2016 July. Available from www.pharmacistsletter.com. Subscription required to view.

What if the Over the Counter Medications Aren’t Enough to Treat My Symptoms?

In the past couple weeks, we have discussed seasonal allergies and Over the Counter medications that you can take to treat them. But, what if these aren’t enough to treat your symptoms?

Well, there is a bit of good news for you, because there are still more options. There are inhalers, nasal sprays and prescription medications that you can ask your doctor about, depending on your symptoms.

If you are experiencing a lot of nasal congestion and runny nose, you can ask your Four Corners pharmacist about pseudoephedrine, a decongestant. It comes alone and in combination with the second generation antihistamines that we talked about last week. It is dosed 60 mg every 4 to 6 hours or 120 mg twice per day for the extended release 12-hour formulation. The maximum amount you can take in one day is 240 mg. If you have high blood pressure or other cardiac conditions, you’ll want to talk to your doctor before taking this.

Another OTC medication that you can buy for your nasal congestion is Flonase, or generically fluticasone. Fluticasone is an intranasal steroid. This is a nasal spray that you can use 2 sprays daily in each nostril to alleviate your congestion. Before using this, you’ll want to blow your nose to clear out your sinuses. Also, make sure you wipe the tip of the nasal spray after each use. It may take up to a week of using this to see maximal benefits.

A more short-term nasal spray is Afrin, or oxymetazoline. This will work in a different way than Flonase to relieve your nasal congestion. However, you cannot use this for more than 3 days in a row. Doing so will lead to something caused rebound congestion, which means the spray will cause congestion, instead of helping it. These are just two of the nasal options that are available.  For more information, feel free to stop in and ask your Pharmacist for help!

If you are having trouble breathing, there are a couple options that you will have to get a prescription from your doctor for. The first is Singulair, or montelukast. This is usually dosed 10 mg in the evening. It works to open your airways, by making the muscles relax. The most common adverse effect of this medication is headache. This is a medication that you should take daily during the allergy season.

Other medications you can use are Ventolin or Proair, which are both albuterol inhalers. These are rescue inhalers that you should only use when it is hard to breathe, or you can’t stop coughing. This medication works in a different way to relax the airway muscles.  Both are prescription only medications that you will need to talk to your doctor before getting a prescription. They are also commonly used for treating Asthma.

As always, if you have any questions, please feel free to call or stop in and ask your neighborhood Pharmacist at Four Corners Pharmacy!


Seidman MD, Gurgel RK and Lin SY. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology- Head and Neck Surgery. 2015; 152(1S): S1-S43.

Micromedex. In: In Depth Answers [database on the Internet]. Greenwood Village (CO): Truven Health Analytics; 2018 [cited 2018 Jun 7]. Available from: http://www.micromedexsolutions.com. Subscription required to view.

Finding the right medication is key to getting through allergy season

In last week’s blog we talked about how to determine if you have seasonal allergies, also known as allergic rhinitis. This week we are going to talk about some oral Over the Counter (OTC) medications you can use to treat your allergies.

The main class of medications used to treat seasonal allergies is called oral second-generation antihistamines. Some examples of these are Zyrtec (cetirizine), Allegra (fexofenadine), Claritin or Alavert (loratadine), and a newly OTC item Xyzal (levocetirizine). All of these second-generation antihistamines are non-drowsy, so they won’t affect your ability to get around during the day.

These will treat your runny/itchy nose, sneezing, watery/itchy eyes and some nasal congestion. If you are experiencing a lot of congestion, some of these drugs come combined with pseudoephedrine, a decongestant. These will treat your more severe nasal congestion.

The brand names of these drugs are Allegra-D, Zyrtec-D and Claritin-D. These drugs are mostly dosed once daily (see chart below) and are rapid acting. For best results, use daily during the allergy season. If you try one drug and it isn’t working for you, you can try another one of these medications, because some people respond differently to each of these.

Check back next week for more info on prescription medications, nasal medications and inhalers to treat some of your more severe allergic symptoms! Thanks for reading and as always, stop in to Four Corners Pharmacy and ask your pharmacist if you have any questions!

Second Generation Antihistamines

Drug Name


(based on age)

Is it available as a Generic drug?

Common Side Effects

Approved Ages

Cetirizine (Zyrtec)

2-5 y/o: 2.5 mg 1-2/day

6-12 y/o: 5-10 mg/day

12-65 y/o: 10 mg/day

66-76 y/o: 5-10 mg/day

≥77 y/o: 5 mg/day


Occasional sedation, mucosal dryness, urinary retention

≥6 months old



2-5 y/o: 1.25 mg/day

6-11 y/o: 2.5 mg/day

≥12 y/o: 2.5-5 mg/day


Occasional sedation, mucosal dryness, urinary retention

≥6 months old



2-11 y/o: 30 mg twice/day

≥12 y/o: 60 mg twice/day

              OR 180 mg/day


Occasional headache

≥2 years old



2-5 y/o: 5 mg/day

≥6 y/o: 10 mg/day


Possible sedation at high doses

≥2 years old


Seidman MD, Gurgel RK and Lin SY. Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology- Head and Neck Surgery. 2015; 152(1S): S1-S43.

Tips to battle seasonal allergies

Article written by Nick Demenagas

Do you have a runny nose, watery eyes, sneeze or cough during the Spring and Summer months? If you said yes to any of those, then you might have seasonal allergies.

Spring seasonal allergies can start as early as February and extend into the summer. Spring and summer allergies are most commonly caused by tree pollen and grass pollen. Inhaling these pollens causes your body to have an allergic reaction and cause symptoms like runny nose, itchy or watery eyes, coughing and sneezing.

Luckily, there are some simple tips to help these symptoms and ways to avoid pollen.

The first way is to know what pollens you are allergic to and avoid them. You can find out what pollens you are allergic to with a simple skin test at your doctor or allergist. Keeping your windows in your home and car closed as well as using air purifiers and air conditioners, are some ways to keep pollen out. If you must have your windows open, wash your sheets frequently to wash away the pollen that comes into your home.

After you have been outside for a while, change your clothes and wash yourself to get rid of any pollen that may still be on your body. If you are doing gardening or other outdoor activities, wear a filter mask to avoid pollen.

Another way to avoid pollen, is to track pollen counts. Meteorologists will usually report daily pollen counts with their forecast. Keep track of those and try to stay indoors when pollen counts are high. Rain usually washes away pollen, however days after heavy rain tend to have increased pollen counts. Pollen levels tend to be the highest in the morning and on windy, warm days.

During allergy season, things other than pollen might “trigger” your allergy symptoms. These can be things like smoke (from campfires, grilling or cigarettes), chlorine and insect bites. Try to avoid these as much as possible.

There are also various OTC medications that you can buy here at Four Corners Pharmacy that will treat your allergy symptoms if these non-pharmacologic approaches aren’t working. Check back for next weeks blog to learn more about these medications.

As always, don’t hesitate to stop in or call us with any questions you may have!




Chapter 95: Allergic Rhinitis. In: Dipiro Jt, et al. Pharmacotherapy, A Pathophysiologic Approach. 10th Edition, 2017. Available free on AccessPharmacy: http://accesspharmacy.mhmedical.com/content.aspx?bookid=689&sectionid=48811483

A Brief Overview of Tips for Using Antibiotic

Article written by Weston Malek, MPH

As the winter weather is finally upon us, we’ve been seeing a steady uptick in the number of antibiotic and cold medicine prescriptions. Each year, there are more than 250 million antibiotics prescribed in the United States, and winter tends to be time when antibiotics are most frequently prescribed.1,2 This means that there are roughly 4 antibiotic prescriptions for every 5 people in the U.S.

Although most people have taken antibiotics at some point and are comfortable with taking them when they are prescribed, those who are taking other medications or are particularly sensitive to medication side effects might have more concerns about adding on an antibiotic. At Four Corners Pharmacy, we do our best to make sure to always counsel patients on new antibiotics. To help with this further, below is a chart to be used as a quick reference outlining the main points and major drug interactions to be aware of for the most common outpatient antibiotics we see.

First, a few things that are common to most oral antibiotics (unless otherwise noted in the chart):

  • Nausea, vomiting, and stomach upset can be common side effects. Taking doses with food may help reduce stomach upset.
  • Diarrhea may also occur later as normal bacteria in the gut are killed off as well. Stay hydrated and let your doctor know if this is severe or lasts longer than a few days after finishing the antibiotic.
  • Some medications are affected by the normal bacteria in the gastrointestinal tract that get killed off by antibiotics. This may cause fluctuations in the way these medications work. Some such are warfarin (Coumadin) and oral contraceptives.
  • For birth control specifically, it is recommended that patients use an additional contraception method while taking an antibiotic due to the potential for reduced effectiveness of oral contraception while taking an antibiotic
  • For liquid suspensions: shake well before each use and refrigerate if necessary

Antibiotic Class

  • Drug (Brand)

Unique Notes

Drug Interactions

Red/Bold = Avoid


  • Amoxicillin (Amoxil)
  • Amoxicillin/Clavulanate (Augmentin)
  • Penicillin V Potassium (Veetids)
  • Clavulanate tends to increase stomach upset over amoxicillin alone
  • Augmentin better absorbed if given with food
  • Methotrexate


  • Cefdinir (Omnicef)
  • Cefixime (Suprax)
  • Cephalexin (Keflex)
  • Only about 10% of people with penicillin allergies will also have cephalosporin allergies
  • Cefdinir only: Wait 2 hours before or after taking food/medications containing aluminum or magnesium (such as some antacids) or iron supplements
  • None significant


  • Azithromycin (Zithromax)
  • Clarithromycin (Biaxin)
  • Wait 2 hours before or after taking food/medications containing aluminum or magnesium (such as some antacids)
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc.
  • Statins, such as Simvastatin and Lovastatin
  • Warfarin


  • Ciprofloxacin (Cipro)
  • Levofloxacin (Levaquin)
  • Moxifloxacin (Avelox)
  • Wait 2 hours before or after taking food/medications with calcium
  • Tell your doctor if you experience tendon pain
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Tizanidine
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc.
  • Simvastatin
  • Theophylline

Clindamycin (Cleocin)

  • Take with a full glass of water
  • Erythromycin

Doxycycline (Oracea)

  • Wait 2 hours before or after taking food/medications with calcium, iron, or zinc
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Take with a full glass of water
  • Methotrexate
  • Penicillins

Metronidazole (Flagyl)

  • Avoid alcohol  during and for 72 hours after stopping – reaction with alcohol can cause significant nausea, vomiting, and hangover symptoms
  • Alcohol
  • Dronabinol
  • Ziprasidone
  • Dronedarone
  • Drugs that may affect heart rhythm in combination: Citalopram, Donepezil, Ondansetron, antiarrhythmics, etc

Trimethoprim (Bactrim)

  • Contains sulfa – warning for those with sulfa allergy
  • Stay hydrated to avoid kidney stones
  • Use sunscreen while outside to avoid increase risk of sunburn
  • Amiodarone
  • Warfarin
  • Drugs that increase potassium, such as Lisinopril, Losartan, Valsartan, Spironolactone, potassium supplements, etc.

While the actual choice of antibiotic and dosing will vary based on the patient and what’s being treated, a few recommendations are generally always true:

  • Take your antibiotics according to the instructions on the prescription, and never take an antibiotic unless your doctor determines it is necessary. Many colds are caused by viruses, which will not be affected by an antibiotic. Sometimes “watchful waiting” to see if symptoms improve is better than starting a potentially unnecessary antibiotic immediately.
  • Take the full amount of your antibiotic prescription even if you start to feel better sooner (unless otherwise directed by your doctor). The full course is necessary to kill off bacteria, and taking a shorter course can encourage the development of antibiotic resistance.
  • Medications such as cough syrup, decongestants, and pain relievers, on the other hand, only need to be taken when needed to control symptoms.
  • Other techniques may also be used to help you feel better faster, including drinking extra water/fluids, using a humidifier, using lozenges/honey for sore throat and cough, and, of course, getting more rest.

Keep in mind, this is only a general guide, and some people may have additional concerns that require more individual consideration. As always, feel free to ask us at the pharmacy if you have any questions.


  1. Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2014 [Internet]. 2017 [cited 2017 Dec 17] Available from: https://www.cdc.gov/antibiotic-use/community/pdfs/annual-reportsummary_2014.pdf.
  2. Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Taylor TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother. 2014 May;58(5):2763-6.

New guidelines released to manage hypertension treatment

Article written by Weston Malek, MPH

Last year, the American Heart Association (AHA) and American College of Cardiology (ACC) released a joint guideline changing the criteria used to diagnose and treat high blood pressure. As doctors will soon begin to use these new guidelines to manage hypertension treatment, it’s important to consider what this will mean for patients.

High blood pressure, or hypertension, had previously been defined by guidelines as blood pressure ≥ 140/90 mmHg. As such, about 72 million American adults were considered to have hypertension and it is one of the most commonly diagnosed chronic conditions. Under the new guideline criteria, anyone with systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg will now be diagnosed as hypertension. This results in an additional 29 million hypertensive Americans. However, the AHA/ACC statement suggests that only a small percentage – about 4.2 million people – of newly-diagnosed adults will be recommended to use blood pressure-lowering medications that are already suggested to those diagnosed according to the previous guidelines.

The reason only a fraction of those now considered hypotensive will receive medication treatment is because the guidelines distinguish those with blood pressures ranging from 130-139 mmHg systolic blood pressure or 80-89 mmHg diastolic blood pressure as having stage 1 hypertension, and those with higher blood pressures (≥ 140 mmHg systolic blood pressure or ≥ 90 mmHg diastolic blood pressure) to have stage 2 hypertension. In stage 1, the primary recommendation is to address high blood pressure with lifestyle changes, such as following the DASH diet with an emphasis on fruits and vegetables, reducing sodium intake, increasing potassium intake, exercising 90 to 150 minutes per week, and maintaining a healthy body weight. Only those diagnosed with stage 1 hypertension at a heightened risk of developing heart disease or stroke within 10 years are recommended to start on blood pressure-lowering medication in addition to lifestyle changes. Those at higher risk include patients with cardiovascular disease, diabetes, or chronic kidney disease, or those who have a > 10% risk using the AHA’s atherosclerotic cardiovascular disease (ASCVD) risk calculator (available online at: http://static.heart.org/riskcalc/app/index.html#!/baseline-risk).

So, while the change in the number of people diagnosed with high blood pressure according to new guidelines seems alarming, the majority of individuals will not see a significant change in their doctor’s recommendations. Overall, the criteria change represents a need to shift perception about the risk associated with high blood pressure and begin to make dedicated efforts to lower blood pressure earlier.


1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/
AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2017 Nov 13. doi: 10.1016/j.jacc.2017.11.006.

CDC announces Shingrix as preferred vaccine to prevent shingles

Article written by Weston Malek

In our last post, we gave a brief overview of shingles and how Zostavax has been the primary prevention method for the past decade. Now, we’ll discuss the latest development in shingles prevention: the herpes zoster subunit vaccine, Shingrix®.

On October 25, 2017, the Center for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) announced endorsement of a new shingles vaccine, Shingrix, as the preferred vaccine to prevent shingles and shingles-related complications in adults 50 years and older. This marks a shift in current shingles vaccination policy in that Zostavax is no longer recommended as the standard prevention method. Additionally, adults age 50-59 years old who previously were at risk of developing shingles but not eligible for vaccination may now be protected.

Shingrix is a recombinant subunit vaccine given as a 2-dose series. It contains a combination of glycoprotein E, a herpes zoster virus (HZV) surface protein, and AS01B, an adjuvant suspension comprised of a purified soap bark tree extract (referred to as QS-21) and a Salmonella minnesota endotoxin fragment (monophosphoryl lipid A or MPL). This adjuvant mixture augments the immune system’s response to glycoprotein E, improving its ability to recognize and challenge to HZV reactivation before it can cause shingles. As a result, Shingrix was more than 90% effective in preventing shingles occurrence in clinical trials. The most common side effects to Shingrix were typically mild and common to receiving any vaccination: pain/inflammation at the injection site, muscle pain, tiredness, headaches, fever, and upset stomach.

The reason Shingrix has so quickly been adopted as the preferred shingles vaccine is because of how substantially it outperforms Zostavax. While Shingrix is more than 90% effective in preventing shingles rash, Zostavax is only 51% effective. Adequate protection lasts more than 4 years with Shingrix. By comparison, protection rapidly wanes after Zostavax immunization, with only about 20% of people still protected after 4 years. Likewise, Zostavax efficacy rates decrease with age – at the same time as the risk of shingles increases. Shingrix, however, appears to be effective in any age group. Perhaps the most important difference besides improved efficacy is the fact that Shingrix is a non-live, recombinant subunit vaccine while Zostavax is a live attenuated vaccine. While ACIP has not yet made an official statement recommending Shingrix for those who are immunocompromised, a non-live vaccine significantly reduces the concern for complications that prevents those with weakened immune systems from getting Zostavax.

In fact, the advantages of Shingrix are so impressive that ACIP has gone so far as to recommend that adults previous vaccinated with Zostavax should also receive Shringrix. Including these people and adults 50-59 years old who will now be eligible for shingles vaccination, a total of about 62 million Americans are recommended to receive Shingrix. But, for now, those individuals will have to wait: Shingrix is not expected to be available to the public until early 2018. Even then, it may take longer for insurance to begin covering Shringrix – though ACIP anticipates that it will be covered, just as Zostavax is currently.



  1. GlaxoSmithKline. CDC’s Advisory Committee on Immunization Practices recommends Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up [press release] (2017 Oct 25) [cited 2017 Nov 29]. Available from: https://www.gsk.com/en-gb/media/press-releases/cdc-s-advisory-committee-on-immunization-practices-recommends-shingrix-as-the-preferred-vaccine-for-the-prevention-of-shingles-for-adults-aged-50-and-up/
  2. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A, Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation, 2015.
  3. Shingrix [package insert]. Research Triangle Park (NC): GlaxoSmithKline LLC; 2017.