Watch for New Twists to Older Medications

You’ll see new versions of existing meds enter the market.

Arbli (losartan) will be the first ready-to-use oral suspension of this angiotensin receptor blocker. Pay close attention to the concentration and dose when patients switch from a compounded liquid.

For instance, losartan compounds are often 2.5 mg/mL...but Arbli is 10 mg/mL. A 4-fold dosing error could occur if the volume isn’t adjusted.

Emrosi (minocycline ER 40 mg cap) is being touted as the lowest dose oral minocycline for rosacea. Limited data suggest it may work better than doxycycline 40 mg (Oracea).

But most patients should still usually try topicals (azelaic acid, metronidazole, etc) first. And Emrosi costs $1,300/month.

If patients get Emrosi, don’t auto-substitute with other minocycline products...they’re not considered equivalent.

Hemiclor (chlorthalidone 12.5 mg) is an oral tab with half (“hemi”) as much med as chlorthalidone 25 mg. It’s an option if patients can’t or prefer not to cut chlorthalidone 25 mg tabs...which aren’t scored.

But Hemiclor costs $30/month...splitting the 25 mg tabs is $6/month.

Watch for confusion between Hemiclor and H-Chlor, a sodium hypochlorite product for wound care.

Merilog (insulin aspart-szjj) will be the first biosimilar to NovoLog...and the first rapid-acting insulin biosimilar for diabetes.

But Merilog is not yet designated as interchangeable to NovoLog...so your pharmacy will need to get the prescriber’s approval to switch.

Make sure patients don’t accidentally get more than one insulin aspart product. Doubling up could lead to dangerous drops in blood sugar.

Neffy (epinephrine nasal spray) now comes in a 1 mg strength for ages 4 years and up who weigh 33 to less than 66 lb (15–30 kg). Think of it as a junior version of the 2 mg spray for patients 66 lb (30 kg) or more.

Continue to ask for the patient’s weight and watch for mix-ups...the 2 strengths come in cartons with a similar-looking design, font, etc.

Omlyclo (omalizumab-igec) will be the first interchangeable biosimilar to Xolair for allergic asthma, chronic hives, and food allergy.

But its approval is only for the 75 mg/0.5 mL or 150 mg/mL syringes...NOT the auto-injectors, vial, or 300 mg/2 mL strength.

Expect that Omlyclo or omalizumab-igec will cost less than Xolair...but payers will drive choices. Keep in mind, you can automatically substitute a biosimilar that’s interchangeable...if your state allows.

Opipza (aripiprazole) is the oral FILM version of this atypical antipsychotic...and comes in 2 mg, 5 mg, and 10 mg strengths. It’s an option if patients can’t swallow oral aripiprazole forms.

But thirty 10 mg films cost about $2,300...versus $10 for tabs, $175 for ODTs, or $375 for the 1 mg/mL solution. Anticipate prior auths.

• Chart: Comparison of Atypical Antipsychotics (United States)
• Chart: Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors
• Chart: Treatments for Rosacea
• Chart: Comparison of Commonly Used Diuretics
• Chart: Comparison of Insulins (United States)
  
• FAQ: Emergency Epinephrine Devices
  
• FAQ: Facts About Biosimilars