Q: I have been on the blood pressure medicine quinapril/HCTZ for many years. Last year, I switched health care providers and the cost went from $8 to $10 per month.
That is the only prescribed medicine that I take, so the bump wasn’t too big a deal. However, this year it went from $10 to $15, a 50 percent increase. I contacted the insurer and was told that both quinapril and HCTZ are Tier 1, so they have $0 co-pay. Combined in a single pill, the drug becomes Tier 2, which has a $15 co-pay.
When I have to refill this prescription, I will ask the doctor to write two prescriptions, one for each medicine. Then I will be taking two pills, but I won’t have any co-pay.
A: Thank you for pointing out how important it is to learn what tier your medicines occupy. This can make an enormous difference in your monthly drug bill. Your solution to get your medication into Tier 1 by splitting it into its components is clever. Others might have similar success, but they will need to pay careful attention to the different dosages and do their homework to learn the particulars of their insurance coverage.
Q: I am a 43-year-old male. My eye doctor suspects that I am developing glaucoma, since it runs in my family and my pressure has been rising. He initially prescribed Betagan, but it lost effectiveness, so now I am on Timoptic-XE. It is working.
How much do these drugs lower my heart rate? When I go to the gym, it is more difficult to hit my target heart rate since I’ve been on the drops. Are there any alternatives?
A: For many years, beta blockers such as levobunolol (Betagan) and timolol (Timoptic-XE) were the drugs of choice to lower intraocular pressure and prevent eye damage from glaucoma (Cochrane Library, Oct. 17, 2007). Unfortunately, beta blockers can slow heart rate significantly, as you discovered.
Currently, medications such as latanoprost (Xalatan) and bimatoprost (Lumigan) are considered first-line treatment for glaucoma (Journal of Glaucoma, online, Aug. 14, 2018). These drugs act somewhat like the hormone prostaglandin. They don’t affect heart rate, but they may change the color of the iris. You might ask your ophthalmologist if one such medication might be an appropriate substitute for your beta blocker so that you can continue to benefit from your workouts.
Q: Recently I learned that I have hypothyroidism. I am looking forward to taking Synthroid, hoping it will relieve my constant fatigue, dry skin, hair loss and constipation.
The doctor is starting me on a very low dose of levothyroxine. What can you tell me about how and when to take it? The first doctor I saw said I must avoid taking anything else for at least two hours after taking it. The coordinator who instructed me about the medication this time said to take it on an empty stomach. I asked about taking it with other medications and she said that didn’t matter, just to take it on an empty stomach.
Most of the time I can take the levothyroxine when I first get up. But if I have morning appointments, it isn’t convenient to wait two hours. What should I do?
A: The most important guideline for taking levothyroxine (Levothroid, Levoxyl, Synthroid) is to take it the same way every day. Some people take it before bed, having eaten at least two hours earlier. But even taking the pill in the morning a half-hour before breakfast can work if you do that consistently.
Our “eGuide to Thyroid Hormones” tells you about timing your thyroid pills and foods and drugs that may interact with them. You will find it at www.PeoplesPharmacy.com.
Your symptoms often are associated with an underactive thyroid gland, so you may find that you feel much better once the dose has been adjusted properly. That sometimes takes quite a while, however.
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