By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
The Public Health Agency of Canada released a tiny little 128 page report on July 19 called “Life with Arthritis in Canada”. While I was manning my post at the Winnipegosis Clinic Pharmacy last week, I had a flip through it, and it contained some surprising things.
Manitoba has an average amount of arthritis according to the report. For people 15 and over, Manitoba had 156,349 people with arthritis in 2007-08. That works out to 15.2 people with arthritis for every 100 people in Manitoba. In 2001 survey of disabilities in Canada, in the top ten causes of disability, arthritis was the most frequently reported cause of disability among women and second most frequently mentioned condition among men. Arthritis costs the Canadian economy $6.4 billion per year in health care expenses and lost work days. Arthritis accounts for 6% of all hospitalizations in Canada.
What is arthritis? Arthritis literally means “inflammation of the joint”. As the Arthritis Society points out arthritis encompasses over 100 conditions ranging from tennis elbow, and gout on the mild end to severe crippling forms of rheumatoid arthritis and arthritis related disease like systemic lupus erythematosus. We are going to talk about the two most common types: osteoarthritis and rheumatoid arthritis. Osteoarthritis (OA) is a complicated disease, but on its simplest level it is when the cartilage in a joint wears out and bone rubs on bone. Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints.
So if the joint wears out in osteoarthritis, what is a normal joint like? In a normal joint, a tough, smooth, elastic-like material called cartilage lets the two ends of the bones in the joint slide by each other with almost no friction. As cartilage wears down, bits can break off and go into the soft tissue around the joint and cause pain. The new thing I learned as I was researching this article is that cartilage doesn’t have any nerve endings, so it doesn’t feel any pain. The pain from OA is from the cords that connect muscle to bone (tendons), bone to bone (ligaments) and the muscles which are forced to work in ways they weren’t designed to because of the cartilage break down. When the cartilage breaks down so much that bone rubs on bone, the bone can thicken and form spurs.
What symptoms might I have if I had osteoarthritis? Pain, stiffness and swelling around a joint that lasts longer than 2 weeks. Unlike rheumatoid arthritis, morning pain and stiffness usually lasts less than 30 minutes. Although there can be swelling around the joint in OA, it is usually less than that expected in rheumatoid arthritis. The joints usually affected are the hips, knees and spine. Finger and thumbs joints may also be affected.
Rheumatoid arthritis (RA) is an autoimmune disease condition in which the body’s own immune system attacks the lining of the joints. The first symptom a patient might notice is pain in the hand or foot joints but can also affect other joints. Unlike osteoarthritis, in rheumatoid arthritis morning stiffness usually lasts longer than 30 minutes. The pain of RA can be in 3 or more joints at the same time. (Often osteoarthritis effects only one joint like a knee.) The pain from RA can last all night long. The pain from RA can be symmetrical on both sides of the body. That means, for example, both your wrist are sore. Other symptoms a person might experience include fatigue, dry eyes, dry mouth, fever and/or chills. RA can cause the immune system to attack other internal organs like the eyes, lungs and heart.
Treatment for both types of arthritis often starts with non-steroidal anti-inflammatory drugs or NSAIDS like ibuprofen, diclofenac or naproxen. These medications can work well for the pain, and inflammation but have side effects like stomach upset, risk of ulcers, and risk of increasing blood pressure. In osteoarthritis sometimes synovial fluid replacements can be injected directly into the joint and help lubricate it. It can be effective. It is used most often on knees and it is expensive. In rheumatoid arthritis the body’s own immune system is attacking the joints. The most common medication to calm the immune attack in mild RA is hydroxychloroquine and is generally well tolerated. For moderate RA, methotrexate once a week is very common and seems to work very well. Depending on the DMARD, these drugs can take 6 weeks to 6 months to work.
As our population ages, more disability will be caused by arthritis. Hopefully new and better treatments will keep pace.
For more information visit www.arthritis.ca
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 30, 2010
Friday, July 23, 2010
Asthma and Other Diseases
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“I’m the King of the World!” That may be the most famous line yelled from the front of a ship. However the real story about the discovery of the Titanic was fascinating too. Dr. Robert Ballard had a long time interest in the Titanic and had developed some equipment and the underwater robot Argo that could look for it. The US Navy had no interest in the Titanic, but it wanted to find two of its submarines that had sank. So they struck a deal. Ballard would look for the two subs, and could use the money left over to find the Titanic. When Ballard found the subs, he found that each had a long trail of debris that led to the sub. The debris trail was relatively easy to find, and he could follow it to the sub. Ballard used this technique to follow the debris trail and find the Titanic on September 1, 1985. Are diseases like asthma a debris trail to other conditions?
Asthma is usually associated with young, otherwise healthy people. Unlike diabetes which seems to directly or indirectly cause heart disease, kidney disease, blindness, amputation and other conditions, asthma isn’t usually associated with other conditions. During some of my asthma training we were told that there is an asthma, eczema, allergic rhinitis triad. That means people with asthma often also have the skin condition eczema and the runny nose that comes from allergic rhinitis. We aren’t exactly sure why. It may be genetics or environment, but whatever goes wrong with the immune system to cause asthma also seems to be involved with eczema and allergic rhinitis. So I was really interested when I heard there was a study in Ontario that was looking into what other diseases people with asthma get.
The study I read was published by Gershon et al. in the July issue of Thorax. It looked at 4 databases that covered all 12 million people in Ontario in 2005. They found that there were about 1.7 million people in Ontario with asthma or about 13% of the population. Of those people with asthma, they determined about 400,000 had active asthma, and the rest were determined to be less active asthma.
One of the main measures the researchers used to detetmeine how sick the patients were was how often their doctors made a claim to Ontario Health. Over one year for every 100 active asthma patients their doctors made an average of 1616 claims for clinic visits. For non-asthmatics, for every 100 patients their doctors billed Ontario Health an average of 942 times in one year. So the authors estimated that there were an extra 674 claims for the asthmatics.
Another way of looking at is for all the health claims in Ontario 6% of all clinic claims, 8% of all ER visits, and 6% of all hospitalizations were from asthmatics from diseases other than their asthma. That would be like an asthmatic visiting their doctor for depression.
As I said before, these extra co-existing conditions in the asthmatics is interesting because we usually think of asthmatics as being young and otherwise healthy. For example of all the identified active asthmatics in the 2005 Ontario study, the average age of an active asthmatic was 31 years old. However this group had more than twice as many claims for non-asthma respiratory diseases, almost twice as many psychiatric conditions like depression and anxiety and more musculoskeletal claims than the non-asthmatic control group.
Now for the chicken and egg part. Does having asthma make you more likely to get a psychiatric condition like depression? We don’t know. Does treating asthma with inhaled steroids make you more likely to get a musculoskeletal condition like osteoporosis? We don’t know. Do some of these other conditions make it more likely to get asthma? We don’t know. We need more studies.
If you look in the sky, it can be very hard to see a tiny jet plane. But if you follow the contrails or smoke from the plane, you can more easily find it. Dr. Ballard used the debris trail to find the Titanic. Is asthma like a debris trail we can use to find more diseases in a person? We don’t know yet, but it will be interesting to follow the trail.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“I’m the King of the World!” That may be the most famous line yelled from the front of a ship. However the real story about the discovery of the Titanic was fascinating too. Dr. Robert Ballard had a long time interest in the Titanic and had developed some equipment and the underwater robot Argo that could look for it. The US Navy had no interest in the Titanic, but it wanted to find two of its submarines that had sank. So they struck a deal. Ballard would look for the two subs, and could use the money left over to find the Titanic. When Ballard found the subs, he found that each had a long trail of debris that led to the sub. The debris trail was relatively easy to find, and he could follow it to the sub. Ballard used this technique to follow the debris trail and find the Titanic on September 1, 1985. Are diseases like asthma a debris trail to other conditions?
Asthma is usually associated with young, otherwise healthy people. Unlike diabetes which seems to directly or indirectly cause heart disease, kidney disease, blindness, amputation and other conditions, asthma isn’t usually associated with other conditions. During some of my asthma training we were told that there is an asthma, eczema, allergic rhinitis triad. That means people with asthma often also have the skin condition eczema and the runny nose that comes from allergic rhinitis. We aren’t exactly sure why. It may be genetics or environment, but whatever goes wrong with the immune system to cause asthma also seems to be involved with eczema and allergic rhinitis. So I was really interested when I heard there was a study in Ontario that was looking into what other diseases people with asthma get.
The study I read was published by Gershon et al. in the July issue of Thorax. It looked at 4 databases that covered all 12 million people in Ontario in 2005. They found that there were about 1.7 million people in Ontario with asthma or about 13% of the population. Of those people with asthma, they determined about 400,000 had active asthma, and the rest were determined to be less active asthma.
One of the main measures the researchers used to detetmeine how sick the patients were was how often their doctors made a claim to Ontario Health. Over one year for every 100 active asthma patients their doctors made an average of 1616 claims for clinic visits. For non-asthmatics, for every 100 patients their doctors billed Ontario Health an average of 942 times in one year. So the authors estimated that there were an extra 674 claims for the asthmatics.
Another way of looking at is for all the health claims in Ontario 6% of all clinic claims, 8% of all ER visits, and 6% of all hospitalizations were from asthmatics from diseases other than their asthma. That would be like an asthmatic visiting their doctor for depression.
As I said before, these extra co-existing conditions in the asthmatics is interesting because we usually think of asthmatics as being young and otherwise healthy. For example of all the identified active asthmatics in the 2005 Ontario study, the average age of an active asthmatic was 31 years old. However this group had more than twice as many claims for non-asthma respiratory diseases, almost twice as many psychiatric conditions like depression and anxiety and more musculoskeletal claims than the non-asthmatic control group.
Now for the chicken and egg part. Does having asthma make you more likely to get a psychiatric condition like depression? We don’t know. Does treating asthma with inhaled steroids make you more likely to get a musculoskeletal condition like osteoporosis? We don’t know. Do some of these other conditions make it more likely to get asthma? We don’t know. We need more studies.
If you look in the sky, it can be very hard to see a tiny jet plane. But if you follow the contrails or smoke from the plane, you can more easily find it. Dr. Ballard used the debris trail to find the Titanic. Is asthma like a debris trail we can use to find more diseases in a person? We don’t know yet, but it will be interesting to follow the trail.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 09, 2010
BENIGN PROSTATIC HYPERTROPHY
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“Luke, I am your father! Join me on the Dark Side and together…Wait a minute I have to pee!” Okay, I may have butchered a classical scene from Star Wars Episode V: The Empire Strikes Back, but think about it. Luke Skywalker is in his mid-twenties. Darth Vader would then be right around 50. That is the age many of us men will begin to have problems with benign prostatic hypertrophy, or BPH.
The prostate is a walnut size gland that surrounds the urethra, the canal through which urine passes out of the body. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine. Although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.
Symptoms of BPH rarely show up before age 40. However as men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH and over 80 percent for men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination.
So what should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss your treatment options. What treatment options are available for BPH? Well there is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. Usually BPH treatment will start with medication.
Now just because you go to the doctor and complain about trouble peeing, don’t be disappointed if they don’t immediately offer you surgery or medication. If your symptoms don’t bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.
There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in two weeks to a month. As good as alpha blockers are their benefits don’t last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don’t shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy’s symptoms.
One obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. So, doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works well together.
So, yes Luke Skywalker would have won that classic, “My dad can beat up your dad” school yard controversy. But even Darth Vader would have to worry about frequent night time trips to the bathroom. So be kind to your prostate and have that talk with your doctor.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
“Luke, I am your father! Join me on the Dark Side and together…Wait a minute I have to pee!” Okay, I may have butchered a classical scene from Star Wars Episode V: The Empire Strikes Back, but think about it. Luke Skywalker is in his mid-twenties. Darth Vader would then be right around 50. That is the age many of us men will begin to have problems with benign prostatic hypertrophy, or BPH.
The prostate is a walnut size gland that surrounds the urethra, the canal through which urine passes out of the body. Benign prostatic hypertrophy (BPH) is a condition where a male's prostate becomes enlarged to the point that it starts to push against the urethra, much like clamping a garden hose. This causes the bladder wall to thicken and become irritable. The bladder starts to contract even when it contains only a small amount of urine. Eventually the bladder weakens and becomes incapable of empty itself completely, leaving behind urine. Although BPH and prostate cancer share similar symptoms, having BPH does not increase your chances of developing prostate cancer.
Symptoms of BPH rarely show up before age 40. However as men age, the chance of BPH symptoms go up. About 50 percent of men in their 60s have BPH and over 80 percent for men in their 80s have symptoms. Common symptoms of BPH include needing to urinate often, feeling like you really need to go now, straining to start urinating, a stream that starts and stops several times, feeling like you haven’t completely emptied your bladder, and more frequent nighttime urination.
So what should you do if you have trouble urinating? Visit the doctor. They can determine if your symptoms are related to BPH and discuss your treatment options. What treatment options are available for BPH? Well there is surgery and medication. The gold standard for surgery is called TURP or trans-urethral resection of the prostate. It is usually reserved for more severe cases of BPH. Usually BPH treatment will start with medication.
Now just because you go to the doctor and complain about trouble peeing, don’t be disappointed if they don’t immediately offer you surgery or medication. If your symptoms don’t bother you that much or if your prostate is still considered small, watching and waiting is a very reasonable strategy. Treatment of BPH is only recommended when it poses a health risk for the patient or when it becomes very bothersome.
There are two main types of medications used to treat BPH. They are alpha blockers and 5-alpha-reductase inhibitors. Alpha blockers include alfuzosin, doxazosin and tamsulosin. Alpha blockers relax the smooth muscle in the prostate and the bladder neck. They work quite quickly, and gentlemen say they can pee more easily in two weeks to a month. As good as alpha blockers are their benefits don’t last a long time. Their effects usually only last 6 months to a year and then symptoms often return. And alpha blockers don’t shrink the prostate. 5-alpha-reductase inhibitors like dutasteride and finasteride stop the conversion of testosterone to dihydrotestosterone (DHT). DHT causes the prostate to grow. 5-alpha-reductase inhibitors help BPH symptoms and also reduce the size of the prostate. Unfortunately these medications work slowly. It takes 6 months to a year for a 5-alpha-reductase inhibitor to help a guy’s symptoms.
One obvious solution to the problem of quick acting but no staying power alpha blockers and slow acting but good in the long haul 5-alpha-reductase inhibitors is to use them together. So, doctors often put guys on both an alpha blocker and a 5-alpha-reductase inhibitor. That way the alpha blocker can get the guy to urinate more easily within two weeks while the 5-alpha-reductase inhibitor is slowly starting to shrink the gland. Recent studies like the Combination of Avodart and Tamsulosin (CombAT) study have showed that the combination of these two types of drugs works well together.
So, yes Luke Skywalker would have won that classic, “My dad can beat up your dad” school yard controversy. But even Darth Vader would have to worry about frequent night time trips to the bathroom. So be kind to your prostate and have that talk with your doctor.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, July 02, 2010
BuTrans - Audio
Click to hear Trevor's Pharmacy Feature-Audio Segment Thanks to all the good people at the Parkland's Best Music 730 CKDM Return to Dauphin Clinic Pharmacy site
BuTrans
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There is a new pain patch on the market. It is called BuTrans. It contains the narcotic buprenorphine which is new to Canada but has been in other countries like Australia for several years. The medication buprenorphine in the patch is very potent. That means the patch only needs to contain a tiny amount of the buprenorphine to be a good pain killer. The three things that caught my attention, though, were how long the patch lasts, what type of pain it is aimed at, and if it can used early or late in the course of pain treatment.
When I first heard about the BuTrans patch, I assumed it would be very similar to the fentanyl pain patch. In pharmacy world we call that a “me-too” drug. One company develops an innovative product and many other companies market products that are very similar, offer no real advantages and just let the other companies say “me-too”. I could be wrong about BuTrans. It seems not to be a me-too of the fentanyl patch. The first difference is duration. The fentanyl pain patch is designed to release pain medication for 72 hours or 3 days. BuTrans is different. The BuTrans patch is designed to release pain medication at a steady rate for 7 days.
The second big difference between the two is what type of pain they are used for. Fentanyl pain patches are usually reserved for very severe pain. Although I have seen fentanyl patches used in all sorts of severe pain from severe arthritis to severe nerve pain, the most common use I see for fentanyl patches is still cancer pain. Again, BuTrans is different. The official indication says it is aimed at moderate persistent pain that lasts longer than 6 months. Notice it doesn’t say severe pain, and it doesn’t mention cancer pain.
So, what kind of pain is BuTrans for? Two studies I looked at examined BuTrans versus osteoarthritis of the knee and hip and BuTrans versus lower back pain. These two types of pain would usually be considered not severe enough warrant a fentanyl patch. The first study was a small trial with 327 patients in it that took people with osteoarthritis of the knee and/or hip and put everyone on BuTrans. Once they got their pain under control, the patients were randomly split into two groups. Half the people got a BuTrans patch and half got a placebo patch. The amount of time it took for the “first pain episode” in the placebo group was 7 days. The amount of time it took for the “first pain episode” in the BuTrans group was 21 days. So BuTrans did better than placebo.
The second study was more interesting, but smaller. It was more interesting because it compared BuTrans versus an established pain killer. Unfortunately being a smaller study, we are less confident about the results. The study looked at lower back pain. It only had 134 patients in it, but it looked at BuTrans, oxycodone/acetaminophen (Percocet, oxycocet) and placebo. Again BuTrans was better than placebo, but that wasn’t a big surprise. The part I found more interesting was BuTrans seemed to be a similar strength pain killer as taking 2 tablets of oxycodone/acetaminophen four times a day. So if a patient required 2 tablets of oxycodone/acetaminophen four times a day for over six months to treat their lower back pain, their doctor may be able to switch them to one BuTrans patch every week instead.
The third thing that surprised me about the marketing of BuTrans is the company, Purdue, is aiming BuTrans at opioid naïve patients. Opioid naïve patients means they haven’t had any narcotics before. For example 80% of the patients in the lower back pain study mentioned earlier were opioid naïve. In contrast, the fentanyl patch, must only be used in someone who has tried other weaker narcotics before. It usually goes something like this: the patient gets a fast acting narcotic pain killer like morphine which is given 4 to 6 times a day. Once the doctor figures out what dose controls the patient’s pain, they are converted to long acting morphine that can be given twice a day. If the pain control remains stable, the patient is then converted to the fentanyl patch which only needs to be changed every three days.
The side effects of BuTrans are similar to other narcotic pain killers and include nausea, vomiting, dizziness, sleepiness, constipation, itchy skin and dry mouth. Not everyone will get every side effect. Effects like nausea, vomiting and sleepiness are common at the start of taking a narcotic pain killer, but go away as you get used to the medication. Effects like constipation will usually last as long as you are on the medication and should be treated with stool softeners.
Now the bad news. BuTrans is new which means it is not paid for by pharmacare, Indian Affairs, Social Assistance or any insurance company I am aware of. That will probably change over time, but as with most new drugs, there is no coverage yet. And it isn’t cheap. BuTrans can run from $70 to $200 a month depending on the strength you need.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
There is a new pain patch on the market. It is called BuTrans. It contains the narcotic buprenorphine which is new to Canada but has been in other countries like Australia for several years. The medication buprenorphine in the patch is very potent. That means the patch only needs to contain a tiny amount of the buprenorphine to be a good pain killer. The three things that caught my attention, though, were how long the patch lasts, what type of pain it is aimed at, and if it can used early or late in the course of pain treatment.
When I first heard about the BuTrans patch, I assumed it would be very similar to the fentanyl pain patch. In pharmacy world we call that a “me-too” drug. One company develops an innovative product and many other companies market products that are very similar, offer no real advantages and just let the other companies say “me-too”. I could be wrong about BuTrans. It seems not to be a me-too of the fentanyl patch. The first difference is duration. The fentanyl pain patch is designed to release pain medication for 72 hours or 3 days. BuTrans is different. The BuTrans patch is designed to release pain medication at a steady rate for 7 days.
The second big difference between the two is what type of pain they are used for. Fentanyl pain patches are usually reserved for very severe pain. Although I have seen fentanyl patches used in all sorts of severe pain from severe arthritis to severe nerve pain, the most common use I see for fentanyl patches is still cancer pain. Again, BuTrans is different. The official indication says it is aimed at moderate persistent pain that lasts longer than 6 months. Notice it doesn’t say severe pain, and it doesn’t mention cancer pain.
So, what kind of pain is BuTrans for? Two studies I looked at examined BuTrans versus osteoarthritis of the knee and hip and BuTrans versus lower back pain. These two types of pain would usually be considered not severe enough warrant a fentanyl patch. The first study was a small trial with 327 patients in it that took people with osteoarthritis of the knee and/or hip and put everyone on BuTrans. Once they got their pain under control, the patients were randomly split into two groups. Half the people got a BuTrans patch and half got a placebo patch. The amount of time it took for the “first pain episode” in the placebo group was 7 days. The amount of time it took for the “first pain episode” in the BuTrans group was 21 days. So BuTrans did better than placebo.
The second study was more interesting, but smaller. It was more interesting because it compared BuTrans versus an established pain killer. Unfortunately being a smaller study, we are less confident about the results. The study looked at lower back pain. It only had 134 patients in it, but it looked at BuTrans, oxycodone/acetaminophen (Percocet, oxycocet) and placebo. Again BuTrans was better than placebo, but that wasn’t a big surprise. The part I found more interesting was BuTrans seemed to be a similar strength pain killer as taking 2 tablets of oxycodone/acetaminophen four times a day. So if a patient required 2 tablets of oxycodone/acetaminophen four times a day for over six months to treat their lower back pain, their doctor may be able to switch them to one BuTrans patch every week instead.
The third thing that surprised me about the marketing of BuTrans is the company, Purdue, is aiming BuTrans at opioid naïve patients. Opioid naïve patients means they haven’t had any narcotics before. For example 80% of the patients in the lower back pain study mentioned earlier were opioid naïve. In contrast, the fentanyl patch, must only be used in someone who has tried other weaker narcotics before. It usually goes something like this: the patient gets a fast acting narcotic pain killer like morphine which is given 4 to 6 times a day. Once the doctor figures out what dose controls the patient’s pain, they are converted to long acting morphine that can be given twice a day. If the pain control remains stable, the patient is then converted to the fentanyl patch which only needs to be changed every three days.
The side effects of BuTrans are similar to other narcotic pain killers and include nausea, vomiting, dizziness, sleepiness, constipation, itchy skin and dry mouth. Not everyone will get every side effect. Effects like nausea, vomiting and sleepiness are common at the start of taking a narcotic pain killer, but go away as you get used to the medication. Effects like constipation will usually last as long as you are on the medication and should be treated with stool softeners.
Now the bad news. BuTrans is new which means it is not paid for by pharmacare, Indian Affairs, Social Assistance or any insurance company I am aware of. That will probably change over time, but as with most new drugs, there is no coverage yet. And it isn’t cheap. BuTrans can run from $70 to $200 a month depending on the strength you need.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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