Drug Topics - March 2009 - (Page 26) Special Report COMPLEX SLEEP-RELATED BEHAVIOR sent letters to manufacturers for Employer-Based Pharof the products, asking them maceutical Strategies LLC in to provide healthcare pro- Cranston, R.I., offering the example of viders with Ambien CR, risk inforthe extendmation and “I know I can ed-release to develop help people by medication patient discussing their that helps medication problems with patients not guides for prescriptions. only fall consumers. I don’t want the asleep, but Medicamedications stay asleep. tions that “A generic to just become fall under may work the warna commodity.” for one pering include –Leonard Edloe, PharmD son, while a butabarbidrug on the tal, carbromal, estazolam, eszopiclone, third tier may be better for ethchlorvynol, flurazepam, someone else.” quazepam, ramelteon, secobarbital, temazepam, triazol- Pharmacists know am, zaleplon, and zolpidem. the drill As with most drugs, sleep Stephen Amira, PhD, associmedications do not work ef- ate psychologist at Boston’s fectively across the board; Brigham and Women’s what’s good for one person Hospital and an instructor may not be the right medi- at Harvard Medical School, cation for someone else. believes many patients feel Some are more effective such desperation from inin inducing sleep; others somnia that once they obmaintain sleep or prevent tain a prescription, they feel awakening during the night. reassured, anticipate relief, Some have a longer half-life, and find no need to ask while others have a higher questions about the drugs. risk of becoming addictive. “Once at the pharmacy, they In addition, the dosage and are feeling such urgency that length of time the drug may they are not looking for any be used differ among indi- reasons to dissuade them viduals. from their choice to take the “Sleeping medications are drug,” Amira said. more individualized these From his vantage point days,” said Randy Vogen- as a psychologist associated berg, chief strategic officer with several sleep clinics affiliated with the Harvard health system, he said he recognizes the importance of patients consulting with a professional before they start a prescription and submitting to a follow-up to ensure the medication is working effectively. Since he is not a psychopharmacologist, he readily refers patients to a pharmacist for advice and for better understanding of each sleep drug. “Pharmacists serve as a really good resource,” he said. “They can give appropriate information so that patients can make the right decisions.” LeAnn Causey-Boyd, PharmD, interacts with consumers when they pick up their prescriptions for sleep medication at Causey’s Pharmacy in Natchitoches, La., where she serves as director of clinical services. She makes a point of offering basic counseling if the drug is new to a patient. “But a well-known drug like Ambien usually generates few questions,” she said. “If a doctor recommends taking one or two pills, we explain what might work best for the patient. We are also on hand to discuss how different treatments work more effectively for specific problems – falling asleep, waking up with trouble falling back to sleep,” she said. If necessary, she will recommend that patients discuss concerns with their doctors. She said it is important for patients to explore the underlying cause of insomnia before getting a prescription. Convinced that consumers don’t read the entire label on a drug prescription, Leonard Edloe, PharmD, owner/pharmacist of Edloe’s Professional Pharmacy in Richmond, Va., accepts the opportunity to counsel patients about sleep drugs. And if they do read labels, he is still concerned the label does not caution users against taking the drugs every night. One of the biggest problems he confronts is consumers coming in early for refills. Edloe considers his pharmacy to be a community health center; he knows the majority of his customers, mostly elderly people taking many medications, and whose incomes are limited. He said many of his customers cannot read or write, so face-to-face communication is even more important. “I know I can help people by discussing their problems with prescriptions. I don’t want the medications to just become a commodity,” he said. He works to maintain a high profile with his own newsletter and call-in radio show, so that customers will feel comContinued on pg. 28 fortable Sedative hypnotics The most popular sleep medications are the sedative hypnotics − both the benzodiazepines and nonbenzodiazepines − which work on receptors in the brain to slow down the nervous system, thus helping to induce and maintain sleep. Benzodiazepines hold a higher risk of dependence and include the long-lasting urazepam (Dalmane) and quazepam (Doral), while triazolam (Halcion) and alprazolam (Xanax) are two well-known medium-to-short-acting drugs in the class. Zalepon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta) are the most popular nonbenzodiazepines and although they are considered controlled substances, they have less chance of becoming habit-forming and have fewer side effects than the benzodiazepines. See www.mayoclinic.com for an outline of the different kinds of sleep medications available, their potential adverse effects, for whom they are most effective, and recommended duration of use. 26 DRUG TOPICS March 2009 W W W.D R U GTO P I C S .C O M http://www.mayoclinic.com http://WWW.DRUGTOPICS.COM
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