For people who need to take insulin, there are a couple of different types—long-acting, short-acting, rapid-acting, intermediate-acting, etc. That’s a lot of options!
One question I see most often is the difference between rapid-acting and long-acting insulins. So, let’s get into it.
What is rapid-acting insulin?
Rapid-acting, or meal-time insulin, is a type of insulin that’s usually taken before, during, or after a meal to lower your blood sugar levels associated with meals.
How long does it take rapid-acting insulin to begin working?
The onset of action varies between rapid-acting insulin products, but can begin working in as little as 5 minutes, or could take as long as 30 minutes, depending on the insulin.
The following are the typical onset of action times for each individual rapid-acting insulin products.
What is long-acting insulin?
Long-acting, or basal insulin, is a type of insulin that gives you a slow steady release of insulin that helps control your blood sugar between meals, and overnight.
How long does long-acting insulin last?
The duration of action varies between long-acting products but should last anywhere between 22-24 hours. The following are the typical duration of action times for each individual long-acting insulin product:
Do I need more than one insulin?
Maybe. It’s up to your doctor to determine the best medication regimen for you.
Some type 2 diabetes patients may only need to use a long-acting insulin to get their blood sugar control on track; whereas others may need a combination of meal-time and long-acting insulin to best control their blood sugar.
If you are using an insulin pump, you will only need to use a rapid or short-acting insulin. The pump is able to give you a slow and steady amount of insulin to cover you all day like a long-acting insulin would do. However, it’s a good idea to have a back-up of long-acting insulin on hand in case your pump should fail.
Is there anything in between rapid-acting and long-acting?
Yes. There are short-acting and intermediate-acting insulins available.
- Short-acting insulins are used like rapid-acting insulin to cover blood sugar elevation from eating.
- Intermediate-acting insulins are similar to long-acting insulins as they are used to cover blood sugar elevations when the rapid-acting or short-acting insulins finish working.
Are there any combination options available for those who don’t want to inject themselves so often?
Yes. Some insulin products combine fast and longer-acting insulins that work together to help manage blood sugar between meals and at night, as well as blood sugar “spikes” that happen when you eat. Here are a few examples of these:
- Humalog 50/50
- Humalog 75/25
- Novolog 70/30
- Humulin 70/30
- Novolin 70/30
- Ryzodeg (FDA approved but not yet available)
Combination insulin products typically only need to be injected twice daily since they are single insulin products that work in 2 ways.
Are there any insulin products that last longer than long-acting insulins?
Does all insulin need to be injected?
No. Currently, there’s 1 rapid-acting insulin product, Afrezza, that’s inhaled through the mouth.
Eliquis is a common anticoagulant medication that helps prevent blood clots, stroke, and pulmonary embolism. Common, but not cheap: cash prices average around $488 for a 30-day supply. Currently, there is no Eliquis generic alternative available, but one could be available as early as 2018. Since Eliquis tends to be a maintenance drug, taken for a longer period of time, it can break the bank.
If your doctor thinks Eliquis is right for you, how can you make it more affordable? Here’s some information on Eliquis and how you can save.
How popular is Eliquis?
Eliquis (apixaban) is the second most popular anticoagulant, a class of medications that also includes Coumadin (jantoven, warfarin), Xarelto, and Pradaxa. Commonly referred to as blood thinners, drugs in this class help to prevent blood clots that can cause deep vein thrombosis, pulmonary embolism, angina, stroke and heart attack.
When will generic Eliquis be available?
There are two things keeping generic Eliquis off the market for now. First, the FDA has granted Eliquis market exclusivity, which expires on December 24, 2017 (Market exclusivity prevents competitors from submitting new drug applications). There is also a patent on Eliquis which expires in February 2023. The patent prevents competitors from manufacturing and distributing alternatives.
This double-barreled protection means that we can’t be sure when generic Eliquis will be available. A generic alternative could be approved by the FDA as early as 2018, but the new generic might not hit pharmacies until 2022.
Another caveat: While generic manufacturers like Mylan are currently developing generic versions of Eliquis, multiple lawsuits from brand manufacturer Bristol-Myers Squibb are preventing these cheaper alternatives from making it to the market. With no end in sight for these lawsuits, it’s hard to say when we could see a generic alternative.
We will be sure to update with any information regarding a cheaper alternative for Eliquis.
Are there any cheaper alternative medications?
- Coumadin (warfarin, jantoven). Coumadin is a popular coagulant that has two affordable generic alternatives, warfarin and jantoven, that can cost less than $10, and often as little as $4. $4 a month vs $488 a month? What’s the downside? Well, Coumadin can raise your risk of bleeding and bruising and requires regular blood work to ensure its effectiveness.
- Other anticoagulants. Pradaxa or Xarelto are both still only available in brand form – so no cheaper generic versions. Still, these alternatives may be cheaper, especially considering your prescription insurance coverage.
- For more information on how Eliquis compares to other anticoagulants, check out Iodine’s page on Eliquis alternatives. As always, you’ll want to speak with your doctor if you think another medication might work better for you.
Eliquis works best for me—can I still save?
Once you find a medication that works for you, it can be difficult to switch. But don’t worry, there are still other ways to save.
- Fill a 90-day supply. This can help shave a little more off of your out-of-pocket costs. Be aware that you will need a new prescription from your doctor, and approval from your insurance to fill for a higher quantity. Check in with your doctor, insurance, and/or pharmacist.
- Use an Eliquis coupon from GoodRx. GoodRx offers discounts for Eliquis online which can usually save at least 15% off the full retail price.
- Save with a manufacturer coupon or the Eliquis patient assistance program. Eliquis’s two manufacturers, Pfizer and Bristol-Myers Squibb offer multiple ways to save. Manufacturer coupons can reduce your co-pay to as little as $10 per fill, while patient assistance programs can help you receive your medication at no cost. For more information on these programs, eligibility, and how to apply, be sure to read through our Eliquis Savings Tips or visit the Pfizer website.
- Split a higher dosage pill. This can help reduce costs, especially if two strengths are priced similarly. You’ll want to check in with your doctor to see if this is a safe option for you.
Try to appeal your coverage. If you have insurance and your plan doesn’t cover Eliquis, ask your doctor about submitting an appeal. Some plans require prior authorizations—meaning you need permission from your insurance plan and a special request from your doctor before you can fill your prescription. If you have insurance, call your provider and ask how to get this process started.
Currently, spironolactone is only available in tablet form, which is not an option for those who have difficulty swallowing pills. In order to make this drug more accessible to all, the FDA approved CaroSpir, the 1st liquid version of spironolactone.
What is CaroSpir indicated for?
CaroSpir is for the treatment of heart failure, high blood pressure, and water retention (edema) in certain patient populations.
How is CaroSpir sold?
CaroSpir is available as a liquid suspension in a 118 ml bottle with a strength of 25 mg/5 ml. It is banana flavored and can be stored at room temperature.
Before the approval of CaroSpir, what did patients do?
Before the approval of CaroSpir, if a patient needed liquid spironolactone the medication would need to be compounded. The compounding pharmacy would crush up spironolactone tablets and place them into a suspension formula typically using water for irrigation or propylene glycol and cherry flavored syrup.
The main disadvantage to compounded spironolactone liquid is dosing inconsistency which has been a persistent challenge for physicians.
How much will CaroSpir cost?
At the moment, patients can use a GoodRx Coupon and get CaroSpir for around $1000. Not cheap.
However, there is a way to make it more affordable! CaroSpir has a prescription savings program called the EasyPay Program so patients can lower the out-of-pocket costs associated with a CaroSpir prescription. Patients can save up to $75 on each prescription using their EasyPay Card.
For more information, see the CaroSpir website here.
Prescription opioids like oxycodone, hydrocodone, codeine, and morphine have long been considered some of the most helpful drugs for managing acute pain, where the body is immediately reacting to trauma or injury. Each year, over 200 million opioid prescriptions are given out in the United States.
Unfortunately, the rates of opioid abuse and overdose deaths have skyrocketed in recent years, leading healthcare providers and patients alike to be cautious about the use of opioids. And now it turns out that there is another reason to avoid opioids: they may not be the most effective treatment for acute pain after all.
Do opioids work better than other drugs?
A recent study in the Journal of the American Medical Association throws into question how well opioid drugs actually treat acute pain.
In the study, researchers assigned 416 emergency room patients with moderate-to-severe pain to one of four treatment groups. Three of the treatment groups received a combination of a common opioid painkiller (either oxycodone, hydrocodone, or codeine) plus 300 mg of acetaminophen, a common non-opioid pain medication often sold over the counter as Tylenol. The fourth group received 400 mg of ibuprofen, a non-opioid painkiller, plus 1,000 mg of acetaminophen.
The result? All four groups experienced the same levels of pain relief. While opioid drugs did help to reduce pain, they were no more effective than a combination of non-opioid painkillers.
What are other options for pain treatment?
While opioids are usually given for acute pain, some of the following options also work well for chronic pain, or pain that lasts longer than six months.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Ibuprofen, naproxen, and aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDs). They control pain, lower fevers, and reduce inflammation. NSAIDs are often considered to be the first line of defense for acute pain, especially pain that doesn’t respond to non-drug treatments.
NSAIDs are available over-the-counter with brand names including Advil, Motrin, Aleve, Bayer, and Excedrin. NSAIDs are also available in prescription strength, with common brand names like Celebrex, Naprelan, Anaprox, Voltaren, and Feldene.
One word of caution: long-term use of NSAIDs can lead to stomach distress or bleeding in your gastrointestinal tract, and the FDA warns that non-aspirin NSAIDs may increase the risk of heart disease and stroke.
Acetaminophen is used on its own as a painkiller and is also an active ingredient in many combination medicines for pain and colds. It is a popular over-the-counter option, sold under brand names like Tylenol. Acetaminophen is especially helpful in addressing acute pain for conditions like headache, arthritis, and cancer pain.
Acetaminophen does not cause the gastrointestinal or cardiovascular side effects of NSAIDs, but taking amounts in excess of the recommended dosage may lead to liver damage or even liver failure. Because acetaminophen is present in so many medications, check whether other medications you’re taking contain acetaminophen as well.
A category of antidepressants called tricyclic antidepressants have the most evidence for treating pain, especially nerve pain. Imipramine (Tofranil), nortriptyline (Pamelor), desipramine (Norpramin), and amitryptiline (Elavil) are tricyclic antidepressants. While these drugs can be helpful, they aren’t effective for everyone.
Some evidence shows that two other categories of antidepressants–selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), or serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta)–are also helpful for chronic pain, but more research is needed.
Anti-epileptics can be taken to address chronic nerve pain and chronic pain from conditions like diabetes, shingles, chemotherapy, herniated disks, and fibromyalgia. Research on how well anti-epileptic medications work for pain is unclear. Some people may receive significant benefits while others may not receive any pain relief at all.
Newer anti-epileptic drugs such as gabapentin (Neurontin), and pregabalin (Lyrica) have more evidence of being effective painkillers than older drugs, and they carry fewer side effects. But, some studies have shown that older antiepileptic drugs such as carbamazepine (Tegretol) and phenytoin (Dilantin) can also help for certain pain conditions. However, these older medications cause more side effects.
Corticosteriods, commonly referred to as just steroids, decrease inflammation and reduce the activity of the immune system. They can reduce swelling and pain for conditions like cancer, back injuries, arthritis, joint pain, and nerve pain. Steroids can be helpful for short-term treatment of acute pain and are also used for the management of some chronic pain conditions., Common steroids used for pain relief are dexamethasone (DexPak), prednisone (Deltasone), and prednisolone (Prelone).
Steroids can be taken orally, applied as a cream, injected, or inhaled. Steroids do come with side effects such as weight gain, high blood pressure, and weakened immune system. Taking low doses of steroids for short periods can minimize those side effects. Injecting steroids directly into an area of pain also reduces side effects and promotes targeted treatment of the affected area.
Non-drug treatments like exercise, physical therapy, yoga, acupuncture, cognitive behavioral therapy, biofeedback, chiropractic, and relaxation training can provide pain relief, especially for chronic pain., In fact, organizations as diverse as the American College of Physicians, the U.S. Department of Veterans Affairs, and the Centers for Disease Control and Prevention recommend non-drug treatments as the first course of action for chronic pain. Although side effects for non-drug treatments tend to be minimal, be sure to consult with a healthcare provider before beginning any new treatment activities.
One of the biggest downsides to taking a medication is side effects. After a dose of most drugs, the amount in the bloodstream spikes quickly, and then is flushed away within the course of a few hours. This means the amount of medicine in the body can vary at any point in time – and that spike can mean nasty side effects.
This problem is exactly what extended release (often noted as ER or XR) drugs were designed for. Typically taken once a day, these formulations keep the therapeutic dose at a steady level in the body for longer periods of time. So if you’re not getting the response you want from your current medication, it may worth talking to your doctor about trying an XR version. But bear in mind: the XR formulation can often be much more expensive.
How do XR drugs work?
Drugs are usually broken down by the liver or kidneys, which means that after taking a dose, the body begins to naturally clear the medication from the system. As their name suggests, XR drugs typically include special coatings or mixers that make the drug take longer to clear from the body than ordinary or immediate-release (IR) drugs. Many popular drugs are now available in XR; there are well over 30 for pain alone.
The graph below shows blood concentrations of the pain medication Ultram (tramadol) after taking the immediate-release version (the white dots) every six hours, compared to the extended-release version (the dark dots), taken once every 24-hours.
Notice how the amount of drug in the bloodstream spikes for the IR drug. XR drugs eliminate this problem. Though they typically have a slightly slower onset compared to their IR counterparts, they maintain a more consistent level of the drug in your body, which could mean better treatment outcomes for longer periods of time while also lowering the occurrence of side effects. You also don’t have to take the drug as often, which may mean that you are less likely to forget to take your medication, especially when multiple doses are needed throughout the day.
But about that price
So why doesn’t everyone just take the XR versions? Usually because of the price. Typically, XR formulations go through a new drug approval process with the FDA and are granted an additional patent as a new drug. This means that an XR version often doesn’t have a generic alternative, making it more expensive – and giving the drug company more time to make more money. This is why new extended-release versions of popular drugs turn up just before the patent expires (such as a new version of Lyrica). Some XR drugs – such as Adzenys or Concerta, for ADHD; or Zohydro for pain – can be nearly 10 times as much as generic alternatives.
But that’s not always the case. Extended release versions of alprozolam (Xanax) and metformin (Glucophage) are available in generic form, and aren’t much more than twice their regular version. Depending on how often you take your medicine, these versions can actually be cheaper than the old versions when you factor in the number of pills. Also keep in mind that some health insurance plans will only cover traditional immediate release drugs, so call your pharmacist or insurance provider – and check GoodRx – to check the price first.
Are XR drugs right for me?
If you are taking prescription meds every day, you should work with your physicians to ensure you’re taking the right form of medication for you. This may mean tracking your side effects and getting blood tests to get a better handle on what the highest and lowest concentrations of the drug is best for you personally. There’s also a small chance that your body might not be able to break down the slow release coatings or ingredients fast enough to hit that targeted therapeutic level in the bloodstream, so be sure to go back to your doctor if you don’t think it’s working.