New Medication Approvals and Tips on Resident Discharge

Abstract

Indacaterol inhalation powder (Arcapta Neohaler) is soon to be available for chronic obstructive pulmonary disease (COPD). The long-acting beta-2-adrenergic agonist provides once-daily dosing from a 75-mcg capsule, not to be ingested orally. I found the drug's unique inhalation device, with no moving parts, easy to load with the capsule and to manipulate. The drug is not indicated for asthma, nor is it intended for acute exacerbations of COPD. There is no dose adjustment necessary for geriatric patients. However, care must be taken when administering indacaterol with inhibitors of CYP3A4, such as verapamil, ketoconazole, erythromycin, and ritonavir. As with any beta-2-adrenergic agonist, typical side effects are headache, nausea, and cough. The average wholesale price per capsule is $6.53. Linagliptin (Tradjenta) is a new adjunct to diet and exercise for the treatment of type 2 diabetes. The drug, a dipeptidyl peptidase-4 (DPP-4), is the only one approved for once-daily dosing in type 2 diabetes. The 5-mg oral dose requires no adjustment for renal or hepatic impairment. In two double-blind, placebo-controlled studies including 730 patients with type 2 diabetes, monotherapy with 5-mg tablets of linagliptin improved hemoglobin A1C (HbA1C) during fasting, and 2-hour postprandial plasma glucose concentrations didn't differ. One quarter of the patients taking linagliptin achieved an HbA1C concentration of less than 7%. The only side effect showing up in more than 5% of study participants receiving the drug was nasopharyngitis. Linagliptin has not been studied in combination with insulin. The new drug's efficacy may decline when it is administered with a strong P-glycoprotein or CYP3A4 inducer. The average wholesale price per tablet is $8.53. A move from a nursing facility to home can burden patients and caregivers with the procurement and coordination of medications. I have experienced this twice as a caregiver. Although I'm a pharmacist, on both occasions I found it daunting to obtain and organize the needed drugs. A big reason was that the nursing facilities wouldn't send medications home. This policy often leads to missed doses, relapses, and rehospitalizations, I believe. I suggest that all facilities work with their pharmacy providers and medical directors to better serve discharged patients in this area by sending patients home with supplies of their prescription drugs. It's a win-win policy First and foremost, the family or other caregiver thus relieved of one frustrating task has more time to make the transition as smooth as possible. The process is simple. The facility can provide an inventory of all of a patient's drugs, doses, and quantities to be sent home and can provide drug information sheets to guide caregivers. The discharging nurse should review the administration times and other pertinent information with the involved parties. Then, the medications should be packaged in a bag or box and handed to the responsible person. Remember, a physician's order to discharge with medications is required. If the pharmacy is working closely with the facility, the inventory can be used to transfer some charges to the patient's Part D provider. One major long-term care pharmacy chain has begun a unique program to facilitate all these steps. Coattail effects of sending patients’ drugs home with them include less waste and less time destroying drugs. Let's do this simple thing to make more patients’ transitions home as smooth and stress-free as possible.