CEimpact Podcast

New Drugs You Need to Know About

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In today’s landscape of direct-to-consumer advertising, pharmacists are a vital source of guidance for both healthcare providers and patients seeking information on newly FDA-approved medications. Staying up-to-date on the latest drug approvals is crucial for pharmacists to ensure accurate dispensing and to offer thorough education to patients and other providers. This episode highlights several medications approved by the FDA in the last 12 to 18 months, providing essential insights into their clinical use.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Joe Strain, PharmD
Professor Pharmacy Practice
South Dakota State University
 
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. List unique pharmacological properties for each medication recently approved by the FDA.
2. Recall common side effects, contraindications, known drug interactions, and/or warnings associated with each new medication.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-267-H01-P
Initial release date: 9/30/2024
Expiration date: 9/30/2025
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Plan members From CE Impact, this is Game Changers. I'm Jen Moulton, president and Founder of CE Impact. If you're an avid listener, you know I've served as your host for quite some time now and the time has come to pass the reins to one of our very capable and gifted pharmacists, josh Kinsey. Dr Kinsey has been with CE Impact for more than three years now and is the mastermind behind our course content and curriculum. I'm so excited he's agreed to host the podcast because I think you are all going to learn so much from him and from all of our guests.

Speaker 1:

But before I pass the torch to Josh, I wanted to get in a shameless plug for subscribing to Pharmacist by Design if you don't already. You can get CE for this podcast plus so much more for less than $10 a month. You're already listening, so there's no reason not to claim CE credit for learning. Check out the link in the show notes or go to ceimpactcom to enroll. Okay, back to the episode. It's been a pleasure to serve as your host until today, and now I'm honored to pass the mic to Josh. Take it away, my friend.

Speaker 2:

Hey, CE Impact subscribers, Welcome to the Game Changers Clinical Conversations podcast. I'm your host, Josh Kinsey, and I'm excited about our conversation today. In this episode, we'll dive into the latest FDA-approved medications and their unique pharmacologic properties. With direct-to-consumer advertising on the rise, pharmacists play a critical role in providing accurate guidance and education. We'll discuss key clinical considerations, including side effects, contraindications and drug interactions, ensuring that you stay up-to-date on the latest developments for informed patient care. So it's so great to have Joe Strain with me today to learn more about new medications on the market and how they can affect our everyday practice. Welcome, Joe. Thanks for joining me today.

Speaker 3:

Thanks for having me, Josh.

Speaker 2:

Absolutely Before we jump in, just so that our listeners know a little bit about you, if you'll take just a couple minutes to tell a little bit about yourself and your practice site and then also maybe why you are so passionate about new medications, this is kind of your thing. You're definitely an expert in this field and I'd love to even.

Speaker 3:

I don't think I've ever heard why you're so passionate about this, so tell us a little about that. Yeah, so I well, my current position is I'm a professor of pharmacy practice at South Dakota State University in allied health professions, and so I've been working for the South Dakota State for 21 years now and it's kind of just stumbled into this new drug update thing that I've been doing for years. 21 years ago, when I was a new faculty member, our state association asked me to provide just a new drug update and I asked well, what's that really entail? And they kind of gave me the rundown of what they were looking for. And here we are.

Speaker 3:

I've been doing the annual update for 21 years now. In fact, just this last month it was our 21st time that I've presented on the new medications, and so yeah, and so I found it valuable because it keeps me up to date on some things. That new drugs that have come out and you know, not necessarily everything impacts my practice directly. I work in the inpatient setting, I work with our hospitalist program at Monument Health, and so primarily work with internal medicine, a little bit with our infectious disease service as well, but but you never know what you're going to get for questions from other people family members, other practitioners about medications. Maybe aren't necessarily in your area, so it's just good to have an idea of what else has been out there and what's been approved recently.

Speaker 2:

Yeah, that's great, yeah, especially. You know again, as I mentioned earlier, the direct-to-consumer advertising is so popular now and I get family members all the time that'll text about something and say, oh, I saw this on TV and I'm like I haven't even seen that. I don't even know what this drug is yet you know.

Speaker 2:

So, yeah, it's really important for us to stay up to date and make sure that we're on top of things, because we all know that we get those family texts and also patients ask us questions, especially if they see it during their shows that they're watching on TV every day and yeah, so this is great, okay, awesome, so let's jump into it. Thanks for sharing about yourself. We appreciate that. And again, thanks for joining me today. So let's jump into a little bit of background just to take a couple of minutes, just as a reminder to folks that new drugs don't just randomly hit the market. They actually have to go through a process and the FDA's role in approving those. And then also, if you can just touch on briefly, maybe, a little bit about why the ones you've chosen in a day, like, how do you choose? Because there's obviously many other medications that have been approved recently, so maybe just talking about why we're talking about these specific ones.

Speaker 3:

Yeah. So I mean, obviously there's a long process and you know everyone's kind of aware that. You know it's very rigorous for a company to get a drug to market right. It takes a long time going through the FDA and there's committee meetings the FDA will have and then they go through the formal approval process where the you know when they decide whether they're going to approve it or not.

Speaker 3:

Now, if you look at kind of the last 10 years, the average number of new drugs approved is around 45 each year, and so that's quite a few. So obviously we're not going to spend, you know, the time to be talking about 45 new medications, and so we try to narrow that list down, and I do that mainly by trying to pick out medications that would impact kind of a broader audience or a broad group of patients and maybe more common disease states that they might hit and not focus so much on maybe a medication that's been developed for a really rare disease state. So trying to pick out some drugs that kind of hit more of a broad range of practice sites.

Speaker 2:

Yeah, so really seeing medications that you know anybody in their normal practice setting would potentially run across so common disease states or very, very common ailments that our patients would have.

Speaker 3:

Okay, exactly. And things that I think I could see being marketed directly to consumers.

Speaker 2:

You know, commercial advertising, exactly, okay, great, awesome, okay. Well, with that, there's one in particular that kind of was the impetus for this whole new drug update, and this one, I think, is just really interesting as it recently hit the market, but it's a new epinephrine nasal spray for, you know, anaphylactic allergic reactions. So I'll let you jump into and start with that. Yeah.

Speaker 3:

And so this has potential big implications because, you know, type one hypersensitivity reactions are quite severe, right and, and so this is now the first alternate route of administration. You know, traditionally we've relied on intramuscular products for patients to carry around, like a, for example, like an EpiPen, and there's other brand names out there as well. But so now we have the first intranasal product approved for these hypersensitivity reactions and again it's marketed under the brand name Nephi, but it's for any adult or pediatric patient that's at least 30 kilos or more that it's formally approved for and it's going to be given again intranasally and it can be self-administered or someone else could administer it if needed, if the patient was unable to do that. And basically what they've looked at with this product is looking at kinetic studies comparing it to the intramuscular injections as well as effects on blood pressure and heart rate compared to these other products, and have shown it to be basically comparable as far as the effects that we would see and the levels we would see with the menstruate that way.

Speaker 2:

We see, with the dose grant that way. Well, that was. It's interesting because I didn't obviously dig into the like the studies or the reading about it, because I was looking forward to hearing about it from you. So my question is how did they really test this Cause you obviously don't just want to like be sitting there waiting for someone to have an allergic reaction to peanut butter and then see if this works right, because then if it doesn't, then what if the next one doesn't? You know. So how do you, how do they actually know that this gets people out of an allergic response?

Speaker 3:

Yeah, so they actually didn't do any like clinical studies in humans with, you know, anaphylaxis, because that's for one hard to do logistically.

Speaker 3:

You don't want to induce an anaphylactic reaction in a human. I mean, it would be hard to do in a controlled environment and everyone reacts a little bit differently to each time. You know it's not consistent. So they based it on kinetics, comparing it to the IM, because the IM is the gold standard, right as far as what we'd prescribed to people, and so they just compared it to that as far as the impact on blood pressure, heart rate as well as the kinetic levels that we'd expect to see from that. Just to basically show it was comparable and a lot of the other IM products that were developed were developed the same way. They didn't necessarily undergo rigorous clinical studies for testing that for a specific, you know, in a patient that was having a hypersensitivity reaction.

Speaker 3:

They did do some animal studies where they induced it in dogs, actually an anaphylactic reaction, and treated those, and so they did have some animal data behind it. But the human data was all with basically kinetics and the pharmacodynamic effects on heart rate and blood pressure.

Speaker 2:

Comparison. Okay, yeah, that's interesting. So my pessimistic mind goes to if I'm trying this as a patient, should I also carry the injectable, just to be safe? You know like, or or should we feel comfortable that that this is definitely going to work? You know what I mean.

Speaker 3:

Yeah, I think that's fair. You know, if you've got a gold standard product out there for years and now you've got a new delivery device, are you hesitant to use it? And I think that the big market for this, though, is really going to be for those patients that are kind of needle phobic, if you will.

Speaker 3:

And that's really one of the big reasons why patients don't carry them around, maybe as they should if they have this history of reactions. So that's that's probably the big market for. It is for those patients that just are opposed to needles or they don't want to carry around the EpiPen for some reason. I mean, this is a relatively small device, intranasal delivery system that's similar to other intranasal products on the market. It's not necessarily a whole new concept as far as how it's being delivered. We have other medications that are available in a similar manner.

Speaker 2:

Yeah, Okay, very cool, and I think I actually also read somewhere too. I think it was pointed out that it is not sensitive to sunlight like the injectables and heat correct.

Speaker 3:

Yeah, I haven't seen anything specifically on heat, I guess. But the sunlight would make sense because it's enclosed, and yeah. So I don't, I've not, I've not read anything. I did not come across anything like that in my, in my rates.

Speaker 2:

but yeah, cause I know that, I know that you know previously, if you, if you had the injectable, like you, you shouldn't leave it in the in your car, you know, or whatever, because it could, it can be affected by the heat and the sunlight.

Speaker 3:

I would still be hesitant, I guess, on the heat thing.

Speaker 2:

For sure. Temperature is a temperature, and but the direct sunlight it would be enclosed in that intranasal advice, so I could be somewhat protected from that, I guess. But Okay, that's great, okay, very interesting, all right. So the next one we have on our list is a new medication to help treat.

Speaker 3:

COPD. Yeah, so this is called encephentrine, and so this is going to be the first phosphodiesterase inhibitor available as an inhaled product. So we've had other things available, like rifumilast or theophylline that have worked by a similar mechanism of action, but this is going to be the first inhaled product with that mechanism of action, so it's going to work as an anti-inflammatory and a bronchodilator through that phosphodesterase mechanism to increase cyclic GMP and cyclic AMP. And so you know the other oral agents. You know they can be fraught with some GI side effects in some patients, and so this would present an alternative route to try to avoid and minimize some of those adverse effects.

Speaker 2:

Okay, as far as where we might see this, do you think this quickly be a first line, a primary treatment, or is it going to have to be an add-on?

Speaker 3:

I think it'd be an add-on for those patients that are really struggling, similar to how we use the other phosphodestroy inhibitors. You know those aren't first line therapies, so you know you're still going to stick with your long-acting anti-muscarinics is kind of in your other long-acting bronchodilators. Anti-muscarinics is kind of in your other long-acting bronchodilators. But this could be certainly something to be added. On the patient population, they primarily looked at was those patients with moderate to severe COPD and so they you know it was the more kind of advanced disease state and as far as efficacy goes, they were looking at FEV1. Over 12 weeks after using this medication it improved FEV1 by about 90 mils. There's some literature out there suggesting over 100 would be ideal for a clinical impact, but so it's again. It's not. It doesn't have the most profound impact on it, but it does appear to. It was enough for the FDA to at least approve it as like kind of an add-on therapy, and it's not necessarily only indicated for add-on, but I think that's where it'll primarily be used.

Speaker 2:

Okay, great, that's very interesting. All right, so another hot topic just keeps coming up because of different medications and different treatment options and also just the studies on Alzheimer's just to see where we are, how can we treat it. So it looks like there's a new drug in that category as well.

Speaker 3:

Yeah, so Denanumab was approved this last July, just a couple months ago and this is our third monoclonal antibody that has been approved in the last couple years for treating Alzheimer's. We had Adacanumab and then Lacanumab. Now Adacanumab is not marketed anymore, but Lacanumab is still on the market, and so this is our kind of the third one, though, if you will, that's made it to market and essentially what it is, that the monoclonal antibody is going to help reduce amyloid beta plaques that we can see in Alzheimer's disease. Now the thing we don't really know is you know, we know we see amyloid plaques in Alzheimer's, but is that the cause or is this just something that goes along with Alzheimer's and so does reducing it really improve clinical?

Speaker 2:

outcomes? That's really the question. Okay, so do you think? Obviously this one is probably going to be in that same high price category as the others were?

Speaker 3:

it is, it's, it's, you know. In fact, the exact price on this is about thirty two thousand dollars for the whole treatment course. If you go through the full treatment course now, there's a couple differences with this one compared to lacanium, and I always kind of look at when these drugs come out and it's like another one that works very similar. Well, how does it differ? Right, it's kind of what we look for.

Speaker 3:

And so if you're familiar with lacaniumab, the couple differences with this one is that it's not going to be administered as often. Lacaniumab was every two weeks, this one's going to be once a month.

Speaker 3:

It has a longer half-life, that's the reason why behind that, the other thing we have to watch out for, though, still with this drug similar to Leucanumab, is this amyloid related imaging abnormalities, and so what we can see with this is effusions, so brain effusions, so fluid on the brain, or kind of these micro hemorrhages within the brain. So you have to have serial MRI screenings every so often when you're using this medication, and that's very similar to the other product too. In fact, there's actually one more MRI screen you're required with this one compared to the other one, so that's maybe looked at as a potential disadvantage, whether you have one more MRI screening, but it's something that's going to have to be monitored, ongoing, to make sure you're not seeing these imaging related abnormalities okay, great.

Speaker 2:

When is this one scheduled to come out?

Speaker 3:

So it's out, it's available. Oh, it's out now, Yep yep, We've only had one request for it and I think that's still in the works. I don't believe we've administered it yet. This is going through our outpatient infusion center, where these will generally be administered in a kind of an infusion center setting or clinic.

Speaker 2:

Okay. Well, it's good to know that this is kind of in the same category as the previous ones that have come out, but also good to know that the less frequent dosing, which could be potentially beneficial to some patients as well. So, because we know giving care for that patient, it's difficult sometimes to get them into the doctor's office for the infusion and things like that. So I think that's good to know for this drug. Okay great.

Speaker 3:

The other little caveat with this medication.

Speaker 3:

I think that that's got some people's attention is that in the clinical trial they were doing PET scanning at six months and a year and then again at 18 months, which was the duration of the trial. It was 18 months, but if they had a certain reduction in their beta amyloid they stopped the medication. So it kind of gives people I've heard it well, it gives them a goal endpoint, I guess, if you will, to stop the medication, because other than that, these trials went on for 18 months and it's like, well, do we keep going with it? What do we do? There's really no firm data published beyond 18 months, and so what do we do at that point.

Speaker 3:

But this at least gives them a marker in order to kind of say well, we're seeing the benefit from the beta amyloid, let's stop the medication. Now. What does that mean long-term from a clinical efficacy standpoint? We don't really know that yet, but that's one thing that's got people's attention as far as how this study was kind of set up with this medication.

Speaker 2:

Okay, yeah, that's great to know.

Speaker 3:

Thanks Okay. Yeah, that's great to know. Thanks Okay. So next up is it looks condition that can lead to cirrhosis. I mean it's a fibrotic condition with the liver. Now they've renamed it. So if you look at the drug labeling you won't see NASH. You're going to see the metabolic dysfunction associated steatohepatitis. So it's called NASH now and that's just a renaming of it. So you'll see, in literature it'll be referred to as NASH. You'll see MASH. They're talking about the same thing but in the formal labeling it does say MASH.

Speaker 2:

Okay, good to know. Yeah, and pharmacologically I'm not aware of that change. So that's a change across the board in practice, right? It?

Speaker 3:

is, and I actually wasn't aware of it either until I read about this medication coming coming out, and so that kind of yeah, that was news to me too.

Speaker 2:

Okay, good deal, all right, go ahead. So tell us a little bit about that one.

Speaker 3:

Pharmacologically it's unique too. It's called a selective thyroid hormone receptor, beta agonist, and so it works through that receptor within the liver and that's going to work to decrease intrahepatic triglycerides. And so that's a little bit of again a unique mechanism, as far as we don't have another medication on the market that does specifically that. Anyway, the other thyroid hormone effects are done through alpha, outside the liver, the alpha receptor, and so this is the beta receptors within the liver to again reduce those intrahepatic triglycerides.

Speaker 2:

Okay, interesting. So I always felt like I had a very interesting clinical mind and how it would try to like make these connections. So I'm hearing that this is a unique way to really decrease triglycerides. Could this have benefits beyond MASH?

Speaker 3:

Yeah, so like does it lower LDL? I mean that's right.

Speaker 1:

Does it lower?

Speaker 3:

triglycerides, and actually it does. It was originally studied as an LDL lowering therapy. And so it does. You know, as far as the studies go, it looks like 20 to 30% reduction in LDL is kind of what was seen again at kind of various doses that were looked at, and it will decrease triglycerides as well.

Speaker 2:

Interesting and is this one so for the way it's coming out of for MASH. Is it infusion or is this a pill or Simple oral therapy once a day so it's fairly straightforward as far as its administration.

Speaker 3:

There's just a couple different doses, just based on weight. If you're 100 kilos or more, you get 100 milligrams. If you're less than that, you get 80 milligrams. So it's fairly simple as far as how it's going to be dosed and administered.

Speaker 2:

So potentially we could, I mean, maybe see this marketed later for LDL or other things.

Speaker 3:

Well, I think, yeah, I think you'll get that benefit from it as far as additional lowering. Now you know. The other question is well, can you use it with statins, right? I? Mean a lot of these patients are on statins. They may be on other medications. I think one thing to note, though, with this is that it does have a significant interaction with gemfibrozil.

Speaker 3:

And if you think about metabolic conditions, you could you know you got high triglycerides. You could run into a patient where you're starting this medication for them and they're already on gemfibrozil and you're going to get a warning about that. At least you should if you're dispensing this, and that is something they should stop.

Speaker 1:

They should stop the gemfibrozole because of a metabolism interaction with the.

Speaker 3:

CYP2C8 interaction is what specifically it is. The other thing is there's a limitation on some of the statin doses, so you can use it with statins. About half the patients in the trial were on a statin, but there is a limitation to what dose of statin you should be on again because of some drug interactions. So that's all in the labeling, Just be aware of that. And so these are common things you could run into.

Speaker 2:

Yeah, I'm just thinking, for you know, there are patients out there who cannot tolerate a statin or do not want to tolerate the statin, and so, you know, could this move into that space and become a treatment for those patients who couldn't tolerate or don't want to tolerate a statin? So, okay, yeah, all right, awesome. Next up is, of course, a very popular disease state Popular in the sense of common, I guess, and not popular. Nobody really wants to have hypertension. There's a new medication coming out for hypertension. Tell us about that one.

Speaker 3:

Yeah. So aprocytentin, you're going to see this one as marketed as the first new mechanism of action for hypertension in over like 40 years. So now how it works is it's an endothelial receptor antagonist, and so if that sounds familiar, it's because we do have other drugs on the market that with this mechanism, but they're approved for pulmonary hypertension, whereas this drug, you know, could hit a potentially a broader audience because just it's for generalized hypertension. But now, having said that, it's meant to be used as an add on to other therapies. It generally this is more of a treatment resistant hypertensive medication, and so patients were on at least three other medications before going to this. As far as how it was studied, you know, these patients were at least on three other therapies this as far as how it was studied.

Speaker 2:

You know these patients were released on three other therapies. Okay, gotcha, and is this one?

Speaker 3:

is this oral form like what's the yep yeah, so oral therapy, fairly straightforward as far as how to use um, it's going to be once daily, just a once daily tablet. Um 12 and a half milligrams is the dose, but it just comes as one dosage form. They actually looked at a higher dose too, but one of the things you'll have to watch out for with this medication is edema.

Speaker 3:

And so what they found in the clinical trial when they looked at they actually looked at 12 and a half and a 25 milligram dose. They actually showed more edema with the 25 milligram with no additional benefit in lowering blood pressure. So they just approved the one dose. So it keeps it fairly simple.

Speaker 2:

Okay gotcha. So it keeps it fairly simple Okay gotcha. Yeah, so likely in practice we would see this. Maybe not across the board with everybody. This is going to be more of an add-on therapy for those individuals who either have failed on something or need that additional mechanism of action to try to control the pressure.

Speaker 3:

Yeah, and really, if you look at the side effect of edema, I would really suggest it to probably use it in conjunction with a diuretic to try to combat some of that.

Speaker 3:

The patients in a clinical trial were all on hydrochlorothiazide, gotcha. So in addition to a couple other medications, they're actually on a calcium channel blocker and an ARB as well. So, yeah, you're going to see this as an add-on therapy. It was not studied as a monotherapy. In fact, in it as a monotherapy, in fact in the formal labeling it's, it says to be used in addition to other. Got it? So not mono? Yeah, exactly, and and this one's not out yet, but it's it's supposed to be out fall of 2024, so any day now.

Speaker 2:

So you can see this one's um start to start to show up. Okay, all right, good, okay, uh, let's jump into a new medication for GERD.

Speaker 3:

Yeah, so bonoprazine was actually a medication that was approved in conjunction with amoxicillin and as well as amoxicillin and clarithromycin for H pylori a couple of years ago, but now it's actually available by itself, so it's a monotherapy agent for erosive GERD and as well as non-erosive GERD.

Speaker 3:

So they've got a couple of different indications of a couple of different time points in the last year. Now you want to think of this as kind of like a PPI. It's, as far as it acts on those proton pumps, the mechanism is slightly different and it's perhaps maybe slightly more potent than a PPI, but we know that PPIs are pretty effective for a lot of these conditions, right, and so the one little caveat I'd give you with this one is if you have a case of severe erosive esophagitis like a grade C or a grade D and again those will be your gastroenterologist will be diagnosing that. When they do the scope to report that out, there is a little bit of evidence that it may work a little better in those situations. But for the kind of the more mild you know mild cases, it's basically been shown to be similar to a PPI as far as its efficacy goes.

Speaker 2:

Okay. So from someone who takes a PPI daily and has for a long time and has tried to stop, you know, given the negative parts of a PPI and the long-term effects and bone density, you know all that kind of thing and I do try. I have actually I've decreased my dose, so I'm getting there. I'm not on 40 milligrams a day anymore, so that's good. But do we? Are we seeing the same sort of long-term issues with this? So about bone density and you know those sorts of things, are we seeing that with this medication?

Speaker 3:

Right, I would expect you would. I don't know that the clinical data is out there yet because we haven't had at least available in the United States that long, but this is a drug that has been out in Japan since 2015. So they have a fair amount of experience with it over there. You know, based on the mechanism though I don't know that there would be a reason to think it would be different I would still try to get off of it Again. There's not a lot of published long-term data in the United States about with using it.

Speaker 2:

Okay, I was hoping it was going to be the new shining drug that didn't have that effect and I could jump on that one.

Speaker 3:

Well, we can hope and maybe time will tell. But I think as of right now, given the cost of it, you're going to see it used as more as a backup plan to the PPIs for maybe patients that aren't seeing the benefit from the PPI or with more severe disease. Then you might see it tried. I think that's going to be the primary role for it right now.

Speaker 2:

Okay, I'll keep holding out for the new version of PPIs that don't give me those long-term bad effects. So, yeah, okay. So next up looks like we've got one on excessive sweating. Yeah so always a fun topic. Yeah, so it's.

Speaker 3:

Sulfuronium is the brand name or generic name, sulfuronium under the brand name Sulfdra, and so this is kind of an interesting medication. It's actually formally indicated for primary axillary hyperhidrosis, which in layman's terms is excessive armpit sweating, and so it's certainly unpleasant for patients that suffer from that, and so it's approved all the way down to age nine. So it is approved in some of the pediatric population as well, and it's basically a topical gel and it's an anticholinergic agent essentially is what it is and so it comes as a pump, and so it's one pump under the arm nightly. You just have to allow five minutes for it to dry. It does have a very high alcohol content alcohol content and so the big warning in the packaging is to avoid any sort of flame or anything you know, any sort of match, or don't be around your gas stove if you're applying it, or something like that right, don't apply while lighting a candle.

Speaker 3:

Yeah don't yep exactly okay wherever you're at and we're just avoid all flames because it could, it would. It would light on fire pretty easily. So that's one of the. That's the reason you see the big warning about it, though, in the labeling. If you come across that, it's because of the high alcohol content. And then a couple other counseling points is they don't recommend shaving for at least eight hours before applying or showering 30 minutes before applying.

Speaker 2:

So okay, as far as know. Obviously, what we've seen in the past recently for excessive sweating is the injections. You know how is this? Is this comparative? Is it working just as well as or?

Speaker 1:

Yeah, that's tough.

Speaker 2:

I would not want to be pricked, you know, 40 times with the injections. So if this could work just as well I would. I would jump on this bandwagon for sure.

Speaker 3:

So you know yeah, for sure, and there's a number of different types of products out there that have been, that have been tried, and certainly a topical gel would seem to be pretty amendable. As far as you know, patient acceptance to do something like that once a day not a huge deal, right? So unfortunately there's no. I didn't see any direct head-to-head comparisons with other therapies out there. It was all against placebo as far as patient rating scales and then reducing the amount of sweat production that patients were having, and so I think it's going to be something that hopefully a patient could try. I mean, most of these companies do have a patient assistance program and so if you could qualify for that, at least give it a try for a month, see if it helped you, and then you know if you had to pay for it. Beyond that, if you you know, then you could at least weigh the benefit you were getting from it and see if it's worth. You know the money that it would cost you.

Speaker 2:

Okay, okay, interesting, sounds good. I'm looking at one here with you know, just a very unfamiliar medications, a group together ibuprofen and acetaminophen. So that's novel and new. Tell me about this new product.

Speaker 3:

Yeah, so not exactly a new drug, right Ibuprofen and Tylenol.

Speaker 3:

But it's combined together as an IV product now, so an intravenous product called Combogezic, and this has been used in other countries. I think it's been out in Australia for a number of years but under some different brand names. But the it's basically indicated for mild to moderate post-op pain. So patients that come out of surgery maybe they're there they can't take or they're not eating well or can't take anything oral. So using fuse for the short term really less than five days, so short-term use is what it's indicated for and it's a combination of a thousand milligrams of Tylenol and 300 milligrams of ibuprofen and so that's recommended every six hours post-op, essentially for just up to five days. We use IV Tylenol commonly in a hospital setting post-op. It helps, you know, try to control pain, maybe reduce some of the opioids we'd have to use.

Speaker 2:

I was going to say. I would imagine, you know, probably one of the reasons for this coming out is to try to decrease opioid use and, you know, maybe potentially for those patients who have to undergo surgery, who are recovering and do not want to take opioids obviously, so this could be options as well. So okay, Absolutely.

Speaker 3:

It provides another option. It's been basically shown to be better than either agent alone, which I guess isn't incredibly surprising. It's a little more expensive than the IV Tylenol though, so that's something that you know. Hospitals are going to have to weigh as far as how they're going to utilize that and appropriately from a cost standpoint.

Speaker 2:

Yeah, okay, that's great. Well, this is so good. It's always just really great to hear some updates and new medications that have come out. It's always just really great to hear some updates and new medications that have come out. You know, like I said, I could see a couple or three of these probably on my TV screen soon. I could see some of those coming on as a commercial and people asking more questions about it. So it's good to kind of have a little bit of knowledge base there. So what I'd like to do at the end of every episode, joe, is to just ask the guests what the game changer is. Why do we need to stay up to date with new medications? And I think you touched on it briefly, but just summarize that for us again why is it important for us to stay up to date with this stuff?

Speaker 3:

Yeah, and I think you're right. We have commented on a little bit about it. But I think the big thing is there's so much direct consumer, you know marketing, you know whether commercials or whatnot, and these are common disease states. They affect a lot of people and so patients are constantly looking for something you know, maybe new or therapy, or if they're not tolerating what they're taking, would this be better? And so just being equipped to be able to at least be familiar with the medication, kind of have an idea of what it's used for.

Speaker 3:

We may not have all the answers up front, but it's certainly helpful to have an idea of what they are in, maybe kind of one or two major you know major caveats about each medication to kind of start the conversation. And certainly you can always do some more research on your own as needed. I mean, we certainly all do that with new medications. I think most patients are understanding when something's new, that we, you know we have to get up to speed on those things too. But I think just if you can kind of keep up to date with you know, maybe it's a new drug update podcast or maybe it's you know some sort of other way to keep up with new drugs that are coming out through other literature. It's very helpful to have an idea of what's out there, to be able to answer questions from our patients as well as physicians yeah, I work with physicians on a daily basis and they'll approach me and ask me questions about some new medications that have come out, and it's just nice to have an idea.

Speaker 2:

Well, yeah, I mean that's. That's a great point, especially if you know they're being hit heavy with. You know the pharma marketing you know for for that particular drug, or if they're being told by their reps that you know this, this thing's coming, or whatever. They may very well ask our opinion, especially if we have a good collaborative relationship with you know some providers. So, yeah, that's a great point as well.

Speaker 1:

Good call out.

Speaker 2:

Yeah, all right. Well, that's all we have time for this week. Thanks, joe, again for joining us. So great to have you. Always, I'm always fascinated by your passion for it. You, just, you, just you love the new drugs and you're always just telling us all about them. And so I've now got to hear you do new drug updates I guess five times now, four or five times. So this is it's always always a treat. So thanks for taking time out of your day.

Speaker 3:

Thanks for having me Appreciate it.

Speaker 2:

Absolutely All right. So if you are a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in to CEimpactcom and, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week. Until next time.

Speaker 4:

Thanks for listening in. Claim your CE credit by clicking on the link in the show notes and check out CE Impact's other education at CEImpactcom, where we curate the most important information in pharmacy and medicine to deliver straight to you. Join today to connect your learning to practice.