June / July 2016
Volume: 5  Issue: 6
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In This Issue
Polypharmacy, Deprescribing and Tapering Tips for Some Medications

Polypharmacy & Deprescribing medications was discussed at the NEPHO June provider POD meetings. An important messages is that the single most important predictor of medication related problems is the number of medications taken by a patient, both prescription and OTC. Adverse drug reactions, medication errors and drug interactions are increased when polypharmacy (> 5 medications) exists while medication adherence decreases.


Successful tapering, switching and/or discontinuation of medications requires time, planning, good communication and coordination between patients, caregivers and other healthcare providers. It is a  systematic process that should be individualized for each patient.  Pharmacists / Prescriber Newsletters provide some guidelines for appropriate use, switching and Tapering of Common Oral Medications
Contact Carol Freedman RPh, CGP at 978-236-1774 or [email protected]nhs-healthlink.org for more information or assistance in deprescribing and tapering medications for your patients.

               NPH Insulin:   A lower cost alternative???

                             Insulin Conversion Chart

NPH insulin is available OTC in a 10-ml vial or prefilled insulin pen without a prescription in the U.S. providing a viable option for patients requiring immediate access to insulin at a relatively low cost compared to other basal insulins. Currently available NPH Insulin (neutral protamine hagedorn) is produced via recombinant technologies, providing a human insulin with improved purity and tolerability as compared to original animal derived sources. NPH inuslin is an intermediate-acting insulin with effects lasting 8 to 24 hours; peak effect at approximately 4 hours. Because of this, NPH is often considered to possess both basal and prandial glucose-lowering effects. (see Insulin Products - Pharmacokinetic Properties). When administered at bedtime, peak effect can contribute to increased risk of nocturnal hypoglycemia as compared to other basal insulins.
NPH insulin may be used daily but is most commonly injected twice daily to achieve 24 hours of basal coverage. Some patients may require more frequent administration, depending on the duration of action achieved. NPH insulin vials or pens should be tipped or rolled prior to injection.
Walmart pharmacies distribute the ReliOn line of insulin products, meters and test strips, available at reduced prices. For example, NPH insulin can be purchased without a prescription, OTC, in 10ml vials at a cost of  "about $25 per vial". See Walmart Website - ReliOn ProductsFor patients who pay out of pocket or reach the Medicare Part D donut hole, NPH Insulin may be an alternative for the right patient.
Unfortunately, there is currently no Relion glargine (Lantus)-type or Insulin Detemir (Levemir) product, but rather two products listed below:
ReliOn Novolin N (insulin isophane)
ReliOn/Novolin 70/30 (insulin isophane and insulin regular)
See the attached Insulin Conversion Chart for guidance on switching insulins.
                                        More On Opioids...


Medication Formulary Apps / Websites 
There are several Formulary Apps / Websites to access transparent and accessible medication  formulary coverage information. Here are a few suggestions:
  • Formulary App from MMIT (Managed Markets Insight & Technology) is a powerful, real-time app for your iPad, phone or computer.


NEPHO Clinical Newsletter
Produced by Northeast Physician Hospital Organization
For more information contact: 
Carol Freedman, RPh, MAS, CGP 
Clinical Pharmacist NEPHO 
[email protected] 
Louis Di Lillo M.D., Northeast PHO Medical Director 
[email protected]
[email protected] | http://www.nepho.org
500 Cummings Center
Suite 6500
Beverly, MA 01915

Northeast Phycician Hospital Organizaion | 500 Cummings Center | Suite 6500 | Beverly | MA | 01915