However, the newest types of drugs are termed biologicals because they are manufactured by living organisms such as bacteria using techniques like recombinant DNA technology. Rather than tablets being produced in a pharmaceutical factory, large scale laboratories grow and harvest biologicals.

Biologicals are large complex molecules or mixtures of molecules. They are too large to be absorbed through the gastrointestinal tract, and thus need to be injected or infused.

Temperature control is key to their stability, which means refrigeration is needed.

And, of course, they are also extremely expensive.

You can identify a biological because of the common suffix — mab. The “mab” refers to monoclonal antibodies which are part of the production process, for example adalimumab (Humira), infliximab (Remicade), rituximab (Rituxan), bevacizumab (Avastin), trastuzumab (Herceptin).

Their effectiveness arises from their ability to affect the body’s immune system.

Diseases like rheumatoid arthritis, psoriasis, multiple sclerosis, Crohn’s disease, and ulcerative colitis involve the immune system and are considered auto-immune diseases. Biologicals can target specific sites in the immune system to disrupt the disease process.

The immune system is also involved in cancers like leukemia, lymphoma, breast, colorectal, and kidney cancers, and biologicals also seem to have a place here.

Often, gene testing on the cancer is performed, and with the presence of a specific gene, it is known that a specific biological will be effective.

As with any parenteral drug, injection or infusion site reactions can occur, such as soreness, bruising and pain. And as with any drug, an allergy is always possible.

Because biologicals act on the immune system, they can also reduce resistance to infections.

Prior to starting treatment, you will be tested for tuberculosis because biologicals can activate this infection. Biologicals do not increase the risk for malignancies, but may unmask or accelerate them. And these drugs seem to cause elevations in liver enzymes.

Biologicals are intended for people who have moderate to severe diseases that involve the immune system and who have failed other “standard” therapy. Individuals who have other conditions such as diabetes, chronic obstructive pulmonary disease, or kidney disease can use biologicals, but need to have their underlying medical conditions well controlled in order to gain the most benefit without causing harmful complications.

Before a biological is started you should ensure that all your immunizations are up to date, and once you are using a biological, live vaccines are not recommended. If you need a live vaccine such as one for shingles prevention, you need to stop your biological following your physician’s recommendations.

With a biological, you do have an increased risk for infections, and need to be careful. Keep in mind that with biologicals, the positive effects are not usually immediate and you may still need to use your other therapies as well. They are definitely an advancement in therapy, but not a magic cure!

The post Guide Health: The cutting edge of biologicals appeared first on Country Guide.

Now there are tablets, capsules, liquids, and even suppositories, which are all manufactured in pharmaceutical plants to ensure sterility and uniformity of dose.

Even among modern day pharmaceuticals, there are technological improvements. Your stomach contains acid which can destroy some drugs, which is why specialized tablet coatings have been developed to protect tablets, allowing them to pass to the small intestine where they are broken down and absorbed.

New technologies can bring new warnings, however. In this case, enteric coating (or “EC”) has the drawback that the tablets must be swallowed whole. Crushing or breaking the tablet destroys the coating.

Another example is prodrug technology. These are drugs that are taken in one form which your body converts into an active form. For example, you take enalapril for your blood pressure and your liver metabolizes it to the active form of enalaprilat, or you take levodopa for Parkinson’s disease and it crosses into your brain where it is metabolized to dopamine, the treatment for Parkinson’s disease.

Transdermal or patch technology enables your body to absorb medication through your skin. In the case of some patches, for example birth control patches, the technology means you don’t need to remember to take your birth control pill each day, just to change your patch once a week.

Nicotine replacement therapy for smoking cessation, nitroglycerin patches for heart pain or angina, and even fentanyl pain patches gradually release medication over time, resulting in steady blood levels.

And, by using patch technology, your medication is absorbed directly into your blood stream rather than having to pass through your stomach where absorption can be variable and where side effects like stomach irritation can happen.

When a drug is absorbed, there will be a peak blood level which slowly declines until the next dose of the drug. Ideally, if you need to take any drug on a routine basis, you want even blood levels, not the fluctuations.

This is the aim of controlled release, slow release, and extended release formulations. Many drugs have CR, SR, or XL options with once-daily dosing and steady blood levels. Again, you cannot crush or break these formulations since that destroys the technology that enables them to be active over 12 or even 24 hours.

The most recent technological advancement has been with genetics and drugs. It makes sense that your genes affect how your body handles drugs. You may be a “fast” or “slow” metabolizer of drugs, which means that you need dosage adjustments. For example “fast” metabolizers of narcotics need higher doses more often to alleviate pain.

Potentially more important in this regard, however, is targeted therapy. The idea is that you have a specific genetic makeup which will mean that you will benefit from a specific type of drug or that there is one that you should avoid.

Targeted gene therapy is starting to be used in cancer therapy. For example prembrolizumab (Keytruda) works with your immune system to fight certain types of cancer, but it is only effective if you have specific genes.

The next technological advances may be blood glucose testing systems. The technology has been developed that allows for an adhesive “tester” to be applied directly to your skin, rather than needing to take a blood sample. Regardless, stay tuned, because the next technological advance is probably just around the corner!

The post Guide Health: Your drugs and technology appeared first on Country Guide.

Just like dominoes, these prescriptions cascade, and the result may be a hospital visit or nursing home admission.

At highest risk are older individuals just because they often take more different medications and have more health conditions. Studies have reported that over half of women 65 and older take five or more different prescription medications; 12 per cent of this age group take nine or more.

How common are prescription cascades? No one really knows for sure because they remain underidentified, although you may actually hear news reports about them. For example, a 71-year-old Montreal woman was admitted to the hospital because of a fall. She had been prescribed an antihypertensive for her high blood pressure; then two diuretics or water pills for edema that may have been caused by the antihypertensive; then a drug to combat her overactive bladder and increased trips to the bathroom; and then finally a drug to ease her dry mouth side-effects. All the medications contributed to her dizziness, thereby increasing her risk for the fall. Luckily, the hospital sorted out her medication regime and she returned home.

Often, when an individual is admitted to a nursing home, all their medications are stopped, then started again one by one. This isn’t a cost-saving measure, but an attempt to ensure that the new resident is only taking what they need for their health, as opposed to something to treat a side-effect. As a result, dosages often differ after admission in the hope that side-effects will be reduced.

While the elderly are more often affected, anyone can be at risk especially if they take medications routinely, and almost everyone can benefit from these measures to avoid taking drugs unnecessarily. First, you want to understand exactly why you are taking the medication and what the potential side-effects could be. (Yes, that means you should read the prescription information that your pharmacist gives you!)

Whenever you have a new medication added to your regime, also have your doctor, nurse or pharmacist review your complete medication profile. You’re looking for something that you may not need, something that may be causing you side-effects, or something that may be just as effective in a lower dose. Never be afraid to ask if you could change a drug or its dose. If you see specialists besides your family doctor, make sure that everyone has a copy of your up-to-date medication list. (Don’t forget to include herbal remedies, natural products, and non-prescription medications that you take on a regular basis.)

As you age, your body’s ability to use medication changes and this may mean you need to lower a drug dose or even stop it completely.

A great resource is the Beers’ Criteria. It lists drugs that older adults need to use with caution, together with the reasons why. It’s available online and is easily understood.

One class of side-effects that are especially bothersome the older you get are the anticholinergic side-effects, such as dry mouth, difficulty urinating, constipation, blurred vision, drowsiness, or memory lapses. A wide variety of drugs has these side-effects, including antihistamines, muscle relaxants, overactive bladder drugs, antidepressants, antipsychotics, and drugs used to treat Parkinson’s.

Ideally you want to take the most effective drugs in the lowest effective doses, especially if you are older. Remember too that knowledge is power when it comes to avoiding side-effects and the prescription cascade.

The post Guide Health: A cascade you don’t want appeared first on Country Guide.

To understand drug recalls, you need to be aware of how sales of a drug are allowed in the first place, which begins when a drug manufacturer applies to Health Canada for authorization to sell its drug here.

Canadians are often surprised that it isn’t researchers or health professionals who start the process, but rather drug manufacturers. Included in the submission is information about the drug such as its intended use, safety, effectiveness, adverse reactions, and contraindications. Research studies that support the drug’s use are also provided, as well as samples of its label and the suggested product monograph.

Scientists at Health Canada review the material, although there are no timelines set out for this process. Rather, the quality and quantity of the submitted material play a role, as does the workload of staff at Health Canada. However, if the drug is for what is considered a critical illness like cancer, Alzheimer’s disease or AIDS, times may be faster just because there are few treatments for these types of diseases.

Finally, a notice of compliance is issued and the drug can be sold in Canada. But a certificate doesn’t necessarily mean that the drug will in fact be sold. If you check out Health Canada’s database you will see a listing for notices of compliance (i.e. those drugs approved for sale) and a listing called the drug product database, that is, the drugs that are actually being sold in Canada.

Thus, a drug may be approved but still not be available on our market. The drug manufacturer may sell it in other countries, but decide, perhaps for financial reasons, against selling it in Canada.

Licensed natural health products like vitamins, minerals, herbs, and traditional medicines, also undergo a process to be sold in Canada, but their approval focuses on safety and labelling.

Drug recalls occur when a drug is defective or potentially harmful. For example, the drug may be mislabelled, poorly packaged, subtherapeutic, more potent than labelled, or contaminated. Every drug manufacturer is required to have quality control and safety procedures, and to also have recall mechanisms in place. Ideally problems are prevented, but when a problem does occur the manufacturer is obligated to contact everyone to whom it has sold the drug. Health Canada must be notified within 24 hours of a manufacturer making a recall decision. If a licensed natural health product is involved, the manufacturer has three days to contact Health Canada.

So if you take a prescription drug, how do you as a patient find out about the recall? For a recall that involves a batch or lot of a drug, memos are faxed to all Canadian wholesalers and pharmacies which then check their stock on hand. A response to the fax is required, and the drug manufacturer will ensure they receive one. It is the pharmacy’s obligation to contact you, although if your prescription was for 20 capsules three months ago, your pharmacist will know you have completed your prescription and not contact you. For recalls that involve a newly discovered adverse effect or contraindication, the recall information is disseminated more widely and you may even hear about it in the news.

Sometimes a drug is removed completely from the market, for example the pain reliever rofecoxib or Viox, which was associated with serious cardiovascular problems. Not only did the drug manufacturer contact all their customers, but pharmacists also contacted all their clients with the aim that ALL tablets be returned.

Sometimes, however, there may be new information that is important enough to be communicated to prescribers and pharmacists, but not serious enough to warrant a recall, for example, the use of atypical antipsychotics like risperidone for behaviour problems in elderly dementia patients. Risperidone is indicated for psychosis, but it can be prescribed “off label” for other reasons with the prescriber deciding its appropriate use. However, new research has linked the use of these drugs in elderly patients to an increased incidence of cardiovascular deaths. A warning, not a recall, was issued by both Health Canada and drug manufacturers, with prescribers and pharmacists checking their patient profiles for any patients who might be at increased risk.

Health Canada’s recalls and warnings are available on its website, and you can even subscribe to the service. If you take a recalled medication, you certainly want to know about it!

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