Q. A woman wrote to you recently about not being able to afford her husband’s medications for diabetes. Their choice was food or medicine.
I just wanted to let your readers know that many of the major pharmaceutical companies have programs to help folks who cannot afford their drugs. My mother receives her heart medication Tikosyn and cholesterol-lowering medicine Zetia for free using these programs. All that is needed is usually a form to be filled out by her doctor, and it is renewed each year.
My son receives a rebate on his Remicade infusion that helps with his copay. Such programs make vital medications available to folks who couldn’t afford them otherwise.
A. Patient assistance programs (PAPs) have long been available. The Pharmaceutical Research and Manufacturers of America (PhRMA) is a trade organization of leading brand-name drug companies. It acts as a clearinghouse to facilitate access to free brand-name medicines at pparx.org.
The catch is that one has to pass rather stringent eligibility requirements. People have to be uninsured, not on Medicaid or Medicare Part D, and have a very low income to qualify (Innovations in Pharmacy, Vol. 3, No. 1, 2012). That excludes a large portion of the population.
People who do pass the strict PAP eligibility requirements can benefit, but they will have to recruit their doctors as allies in this effort.
Q. I heard that the Food and Drug Administration issued a stronger warning about cardiac risks associated with NSAID use. Is this correlated with age?
If older persons are at greater risk of heart attack and stroke from NSAIDs, at what age does the danger increase? In persons older than 50? Older than 65?
A. The FDA’s announcement in July 2015 did not specify any age at which the hazard of heart attacks and strokes increases. The agency did say that the risk rises within the first weeks of taking a drug such as ibuprofen (Advil, Motrin IB), naproxen (Aleve), diclofenac (Cataflam, Voltaren) or celecoxib (Celebrex).
It is higher for people who have already had a heart attack or stroke, and for those with risk factors for these conditions.
This leaves people with chronic joint pain in a difficult dilemma. How can they get relief without increasing their chance of a cardiovascular catastrophe?
A number of nondrug approaches to controlling inflammation might be helpful. Some people get relief from herbs such as boswellia or turmeric, while others include foods such as pineapple or tart cherries in their diets.
Q. You have written that the diabetes drug metformin can lead to low vitamin B-12. What dose of this vitamin is appropriate for people on metformin?
A. Research suggests that up to 30 percent of the patients on metformin to treat high blood sugar may develop low vitamin B-12 levels.
In one case, doctors overcame the resultant deficiency by injecting 2 mg/month of cobalamin (European Review of Medical and Pharmacological Sciences, July 2015).
An oral dose of 1 mg/day of cobalamin may be sufficient to overcome deficiency within two weeks. Thereafter, 1 mg/month should maintain adequate levels of vitamin B-12 (BMC Public Health, May 31, 2012).
Whether injected or oral supplements are used, a physician must supervise.