Sep 12, 2011

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

If something is to hard to do, then it's not worth doing. You just stick that guitar in the closet next to your shortwave radio, your karate outfit and your unicycle and we'll go inside and watch TV. Ive learned so much from Homer Simpson over the years. He has taught me how to parent with such pearls of wisdom as: It's not easy to juggle a pregnant wife and a troubled child, but somehow I managed to squeeze in 8 hours of TV a day. He has taught me how to motivate my children to be their best. I just pull out gems like:

Trying is the first step towards failure. Finally, Im sure I have a better marriage because of Homer. Homer came up with: I won't sleep in the same bed with a woman who thinks I'm lazy! I'm going right downstairs, unfold the couch, unroll the sleeping ba- uh, goodnidght.


So what is Homers message? Aside from the obvious that beer and donuts fix everything, Homer espouses the value of laziness. Drug companies can be lazy too. Coming with brand new drugs is difficult. Viagra was the first drug in its class to effectively treat erectile dysfunction. Fluoxetine or prozac was the first SSRI used to treat depression. Captopril was the first ACE inhibitor to treat high blood pressure. It is really hard to develop a break through drug like these. It is much easier to tweak the drug molecule that someone else came up with and say I have a drug like Viagra too, or I have a SSRI too or I have an ACE inhibitor too. I call these me too drugs.


Me too drugs dont usually impress me much because they usually dont do anything better than the original. While it is always nice to have another tool in the tool box, it would be nice if every tool wasnt a different color of ball-peen hammer.


I shouldnt be impressed by Twynsta, because it is worse than a me too drug. Twynsta has telmisartan and amlodipine in it. We already have telmisartan and amlodipine available as separate pills. There are two reasons why twynsta impresses me, though. It is a combination pill. Combination pills are more convenient for people to than taking separate pills. The combination of telmisartan and amlodipine is a good choice. Telmisartan is an ARB or angiotension 2 receptor antagonist. Amlodipine is a calcium channel blocker. We havent had a combination pill with those two choices in it before.


The second reason Twynsta impresses me is that it is cheap. Twynsta 40/5 (40mg of telmisartan and 5 mg of amlodipine) will cost you about $35 a month. Telmisartan 40 mg is about $50 per month by itself and amlodipine 5 mg is about $30 per month by itself. So if your doctor gave you a prescription for Twynsta 40/5 you would pay about $35 per month, but if you got the pills separately you would spend about $80 per month. That is a nice savings. On the down side, Twynsta is new so it is not covered by Pharmacare. So if you are over your pharmacare deductible, Twynsta wont help you save any money.


Why do we need a combination blood pressure pill? About 1 in 5 Canadians has high blood pressure. Over your life time, you have a 90% chance of getting high blood pressure. Why should you care about if you get high blood pressure? Well high blood pressure increases your chance of a stroke, a heart attack, heart failure and kidney disease and other problems. So shouldnt one blood pressure pill be enough? For better or worse, the Canadian Hypertension or CHEP 2011 guideline have looked at this. Many of the studies that looked at blood pressure control found patients needed at least two different medications to get their blood pressure to a safe level. If you probably need two medications to get your blood pressure to a safe level, wouldnt it be easier if they were combined in one pill?


So be like Homer Simpson. Be lazy. If your doctor has you on two different blood pressure pills, ask your pharmacist if a combination pill is available. That way you can avoid the strain and agony of using two different pills everyday. And if Twynsta happens to be an appropriate medication for you, you might even be rewarded for your laziness by saving money. Why should you listen to anything I have to say? Well you dont, but as Homer Simpson would say: I'm a white male, age 18 to 49. Everyone listens to me, no matter how dumb my suggestions are.


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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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Canadian Hypertension Guidelines.


Bruno Mars Lazy Song featuring Homer :


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