The use of medical marijuana is peaking interest in the Unit-

ed States as more and more states allow its use for medical

purposes. Although more research is needed to help guide its

use, medical marijuana has indications for symptoms and

disease states such as appetite loss, pain, multiple sclerosis,

and HIV/AIDS, just to name a few. Evaluating efficacy and

safety data is difficult due to the status of marijuana as an

illicit substance under US

federal law. Therefore,

very few studies have been

performed to weigh the

risks vs. benefits. Ran-

domized controlled trials

often have limitations and

the majority of studies

looked at pharmaceutical

cannabinoids rather than

medical marijuana. This

article will cover the defi-

nition, accessibility, uses,

risks and drug interactions

of medical marijuana, as

well as provide an over-

view of prescription cannabinoids.

What is marijuana?

Marijuana is usually used synony-

mously with cannabis and contains

hundreds of different chemical enti-

ties, including more than 100 can-

nabinoids which are the compo-

nents that give cannabis its activity

and make people “high.” There are

three major species of the Cannabis

genus and each species differs in

their percentages of different can-

nabinoids (see below). When in-

gested or inhaled, these compounds

bind to specific receptors in brain

and nerve cells which slows pain

impulses and eases discomfort:

1. Cannabis sativa (most common and usually highest

level of delta-9-tetrahydrocannabinol or THC)

2. Cannabis indica (contains typically more cannabidi-

ol or CBD than THC)

3. Cannabis ruderalis (has few psychogenic properties)

Three types of cannabinoids are:

1) Plant cannabinoids

(phytocannabinoids)- the

main plant cannabinoids

believed to have therapeu-

tic activity are:

delta-9-

tetrahydrocannabinol

(THC)- the most psycho-

tropic cannabinoid and

the most studied

cannabidiol (CBD)-

may be promising for sei-

zures and doesn’t have

the psychoactive effects

like THC

cannabinol (CBN)

cannabicyclol, cannabichromene, cannabigerol, can-

nabidivarin, tetrahydrocannabivarin

2) Synthetic cannabinoids- the two synthetic canna-

binoids which are approved for use in the US are:

Dronabinol (Marinol®, Syndros®) which is the syn-

thetic version of THC used for refractory chemo-

therapy-induced nausea and vomiting as well as an

appetite stimulant for treatment of anorexia associ-

ated weight loss in patients with AIDS. This is a

Schedule III controlled substance.

Nabilone (Cesamet®) which is chemically similar to

THC for the treatment of refractory chemotherapy-

induced nausea and vomiting. This is a Schedule II

controlled substance.

3) Endogenous cannabinoids (endocannabinoids)

Medical Marijuana: An Overview

A Publication of Neil Medical Group, The Leading Pharmacy Provider in the Southeast

September/October 2018

PHARM NOTES

Volume 21, Issue 5

Continued on page 4

Inside this issue:

Medical

Marijuana

1

Herpes Zoster

Update

2-3

Conclusion: Med-

ical Marijuana

4-5

Spotlight on

Vitamin D

6

New Shingles

Vaccination Rec-

ommendations

7

Neil Medical

Group Contact

Information

8

Herpes Zoster Update

Page 2

PHARM NOTES

OVERVIEW

Shingles, or Herpes Zoster, affects 1 out of every 3 peo-

ple in the United States at some point in their lifetime,

according to the Center of Disease and Control Preven-

tion (CDC). With an estimated one million new cases

each year in the United States, Herpes Zoster affects peo-

ple of all ages and can occur in anyone that has recovered

from the chickenpox. For this reason, herpes zoster can

even be seen in children. The risk of developing shingles

increases significantly with age, as ones immunity

against the virus decreases with age. Thus, over half of

the cases of shingles are seen in those 60 years of age

and older.

THOSE AT RISK FOR DEVELOPING SHINGLES

People with medical conditions that compromise the

normal function of their immune systems, such as

those with human immunodeficiency virus (HIV),

lymphoma or leukemia.

People receiving immunosuppressive medications,

such as those given post-organ transplant medications

and steroids.

CAUSE Shingles is caused by the varicella zoster virus or VZU.

This is the same virus that causes chickenpox. Once one

recovers from the chickenpox, this virus remains inactive

or dormant in the body. Though it is unclear why, the

virus can reactivate years to decades later causing one to

develop shingles. Ninety nine percent of adults 50 or

older are infected with the virus that causes shingles.

SIGNS AND SYMPTOMS Shingles is manifested as a painful rash that develops on

one side of the face or body. The rash consists of blisters

that typically scab over in 7 to 10 days and clear up with-

in two to four weeks. Before the rash develops, people

often have tingling, itching, and pain in the area where

the rash will develop one to five days later. The rash

most commonly occurs in a single stripe around the left

or right side of the body. In some cases, the rash occurs

on one or the other side of the face. On a rare occasion,

the rash may be more widespread and look more like

chickenpox. This is typically seen in those with weak-

ened immune systems. The shingles rash can also affect

the eye, causing loss of vision. Other symptoms of the

shingles may include, fever, headache, chills, and upset

stomach.

TRANSMISSION

Shingles is not contagious. One will not get shingles

from a person that has the shingles. Also, shingles will

not occur in individuals that have not had chickenpox.

However, the virus that causes both the chickenpox and

shingles can be spread from a person with active shingles

to a person that has never had chickenpox or been vac-

cinated through direct contact with the rash. The person

exposed would then develop chickenpox, not shingles.

Once the active chickenpox resolves, the virus would re-

main in that person’s body and could then reactivate later

in life in the form of shingles.

The virus is spread through direct contact with fluid from

the rash blisters. A person with active shingles can

spread the virus when the rash is in the blister phase. A

person is not infectious before the blisters appear or once

the rash has crusted over.

It is also important to note that the shingles is less conta-

gious than the chickenpox and the risk of a person with

shingles spreading the virus is low if the rash is covered.

IS SHINGLES A FORM OF HERPES ?

Shingles results from the reactivation of the varicella

zoster virus, or human herpes virus type 3, which is the

virus that causes the chicken pox.

Herpes simplex virus (HSV) type 1 causes oral lesions,

or cold sores.

Herpes simplex virus (HSV) type 2 causes genital herpes,

a sexually transmitted disease.

COMPLICATIONS Not only does the risk of shingles increase with age but

older individuals are much more likely to experience post

-herpetic neuralgia (PHN), which is the most common

complication of shingles. PHN is rarely seen in people

under 40, however it can occur in up to a third of untreat-

ed people 60 years old and older. PHN involves severe

nerve pain in the areas where the shingles rash occurred

and often remains once the rash clears up. The pain

Page 3

Volume 21, Issue 5

from PHN can be quite severe and debilitating. Though

PHN pain usually resolves in a few weeks or months,

some experience PHN pain for many years, often inter-

fering with daily life.

Shingles may also lead to serious complications involv-

ing the eye. Though rarely seen, shingles can also lead to

pneumonia, hearing problems, blindness, brain inflamma-

tion (encephalitis) or death.

TREATMENT:

Acyclovir, valacyclovir, and famciclovir are antivirals

available to treat shingles and shorten the length and se-

verity of the illness. One of these medications should be

started as soon as possible after the rash appears in order

to be most effective.

Analgesics, may help relieve the pain caused by shingles.

Wet compresses, calamine lotion, and colloidal oatmeal

baths may help relieve some of the itching.

One with the shingles rash should be instructed to:

Keep the rash covered

Avoid touching or scratching the rash.

Wash hands frequently to prevent the spread of the

varicella zoster virus.

Avoid contact with the following until rash has devel-

oped crusts:

Pregnant women that have never had chicken-

pox or the chickenpox vaccine

Premature or low birth weight infants

Those with weakened immune systems, such

as those undergoing chemotherapy or receiv-

ing immunosuppressive medications, organ

transplant recipients, or those with HIV

PREVENTION

One half of people living to the age of 85 will develop

shingles. The only way to reduce the risk of shingles and

the long term post herpetic neuralgia pain is to get vac-

cinated. Until recently, Zostavax was the only FDA ap-

proved vaccination against the herpes zoster virus. Zos-

tavax was licensed by the FDA in 2006. Since this time,

over 30% of the US population over 60 years of age and

older, or approximately 20 million people, have been vac-

cinated against Herpes Zoster.

Zostavax is approved for those between 50 and 59 but

recommended by the CDC for adults age 60 and older.

Zostavax offers 70 percent protection against shingles for

those between 50 and 59, but only 18 percent in people

age 80 and older. Thus all ages taken into consideration,

this single dose vaccine reduces the risk of developing

shingles by 51% and PHN by 67%. The effectiveness of

Zostavax lasts just five years, according to the CDC.

On October 20, 2017, the U.S. Food and Drug Admin-

istration (FDA) licensed Shingrix for adults aged 50 years

and older to prevent shingles. On October 25, 2017, the

Advisory Committee on Immunization Practices (ACIP)

voted that Shingrix is:

Recommended for healthy adults aged 50 years and

older to prevent shingles and related complications.

Recommended for adults who have previously re-

ceived the current shingles vaccine Zostavax to pre-

vent shingles and related complications.

The preferred vaccine for preventing shingles and re-

lated complications.

Once approved by the CDC director, the above recom-

mendations will become official policy.

Shingrix is a two-dose vaccine felt to provide substantial-

ly longer, persistent protection. Clinical trials show Shin-

grix to offer 97 percent protection in those in their 50’s

and 60’s and roughly 91 percent protection in those in

their 70’s and 80’s.

KEY DIFFERENCES IN SHINGRIX & ZOSTAVAX

Shingrix contains an adjuvant, a substance that boosts

the immune system’s response, which may be what

makes it more effective and last longer than Zostavax.

Zostavax contains live herpes zoster virus, and is

therefore not recommended in those with significantly

weakened immune systems. Shingrix contains a

nonliving viral particle and may ultimately be deter-

mined appropriate for use in the immunocompro-

mised, a community greatly affected by herpes zoster

at this time. Article by Wendy Singleton, RPh, BCGP, FASCP

Page 4

Medical Marijuana: An Overview……………………continued from page 1

PHARM NOTES

The current US federal law prohibits all possession, sale,

and use of marijuana. It is a Schedule I controlled sub-

stance in the US which means it has a high potential for

abuse, has no current accepted medical use, and lacks

accepted safety for use under medical supervision. In

opposition to federal law, over half of US states now al-

low medical marijuana use for medical purposes. In

some states, it must be dispensed by a pharmacist in an

authorized dispensary. In others, a physician issues a

medical document for a patient who may be appropriate

for treatment with marijuana. Then the marijuana can be

bought or grown by the individual. Each state has devel-

oped a list of their own approved conditions as well as

the amount of marijuana patients may have in their pos-

session. There is definitely a lack of standardization for

dosing medical marijuana and smoking it is a highly un-

predictable route of administration. With inhalation, pa-

tients measure the “dose” in terms of puffs. Doses

should be started low and slowly adjusted. Several

healthcare professions support the change of marijuana

from Schedule I to Schedule II in order to facilitate re-

search and development. A patient who may be consid-

ered for using medical marijuana should have:

A debilitating medical condition that evidence shows

may respond to medical marijuana

Multiple failed trials of approved medications for

their condition

A failed trial with an FDA-approved dronabinol or

nabilone

Absence of contraindications to medical marijuana

Residence in a state that permits use of medical mari-

juana

Compliance with their state’s medical marijuana

laws

There are several forms of medical marijuana available,

as well as delivery routes:

Cannabis plant- seen as dried leaves, stems, and

flowers. Mostly smoked or vaporized, but also

brewed as tea or cooked into an edible (i.e. brownies,

cookies, candy, etc.)

Extracts-usually given sublingually.

Infusions-usually used in edibles, topically, or vapor-

ized.

The most common route is inhalation since the onset of

effect is faster with inhaled versus the oral route. Pa-

tients smoke marijuana in hand-rolled cigarettes, pipes or

water pipes (bongs). To avoid inhaling smoke, some pa-

tients are using vaporizers. These devices pull the active

ingredi-

ents from

the mari-

juana and

collect

their va-

por in a

storage

unit. A

patient

then in-

hales the

vapor, not the smoke.

Many therapeutic uses exist for the marijuana plant and

synthetic cannabinoids:

Appetite loss in patients with AIDS/HIV

Cancer-associated anorexia

Chronic pain and neuropathic pain

Spasticity of multiple sclerosis or stroke

Seizures/Epilepsy

Nausea and vomiting

Glaucoma

Anxiety

Migraines

PTSD-Post traumatic stress disorder

Insomnia

Inflammatory bowel disease

Appetite Loss: Smoking marijuana seems to stimulate

the appetite of patients with AIDS/HIV. In fact, medical

marijuana has been found to be superior to established

treatments of AIDS-related cachexia. THC is the main

active component believed to increase appetite.

Anorexia: THC has been reported to increase appetite in

patients with anorexia, but more studies are needed.

Dronabinol (Marinol®) has been studied in Cancer-

associated anorexia and appears to be less effective than

megestrol (Megace®). One study of orally administered

marijuana found it was no better than placebo in stimu-

lating appetite or improving quality of life.

Pain: THC has been shown to have analgesic effects in a

variety of types of chronic pain such as neuropathic pain,

osteoarthritis, rheumatoid arthritis, and fibromyalgia.

Studies are limited and adverse effects such as altered

perception and altered cognitive function could be mod-

erate to high. Preliminary evidence suggests that pa-

tients who add vaporized medical marijuana to existing

Page 5

Volume 21, Issue 5

opioid treatment may have improvement in analgesia with

a subsequent decrease in their opioid dose. In Canada

after a review of 18 trials with cannabinoids in chronic

pain, the Canadian Pain Society’s consensus statement on

the treatment of chronic neuropathic pain was revised and

now includes cannabinoids as a third-line choice.

Spasticity: When taken orally as an extract or smoked,

marijuana seems to be effective for the treatment of spas-

ticity and tremor associated with multiple sclerosis. Oral

cannabinoids may also decrease urge incontinence in pa-

tients with MS.

Seizures: As reviewed earlier, cannabidiol (CBD) is a

non-psychoactive cannabinoid which is receiving interest

in treating childhood epilepsy. Scientists have been spe-

cially breeding marijuana plants and making CBD in oil

form for treatment purposes. In April 2018, a panel of

experts analyzed the safety and effectiveness of a drug

called Epidiolex®, the first plant-derived CBD medicine

for prescription use in the United States and unanimously

voted in favor of FDA approval. The FDA's staff en-

dorsed Epidiolex® to treat Dravet syndrome and Lennox-

Gastaut syndrome, rare forms of epilepsy most resistant to

other treatment that affect children 2 years of age and old-

er. The liquid could become the first cannabis-derived

drug to get the federal government’s seal of approval

when the FDA makes its final decision in late June 2018.

Nausea and vomiting: Some studies have been done com-

paring cannabinoids (both synthetic and smoked marijua-

na) to standard anti-emetic medications for chemotherapy

-induced nausea and vomiting patients and found canna-

binoids may be useful. Cannabinoids act through a differ-

ent mechanism than other antiemetics so they may be use-

ful as adjunctive therapy in patients whose nausea and

vomiting is not controlled with other drug therapies.

Glaucoma: Smoking marijuana seems to reduce intraocu-

lar pressure in patients with glaucoma for a short period

of time, but there is limited evidence. It also isn’t known

if marijuana can improve visual function.

There is unreliable data about the effectiveness of mariju-

ana for other uses previously listed.

Adverse Effects/Risks

Prescription cannabinoids can have mild to moderate ad-

verse effects, such as dizziness, drowsiness, and dry

mouth. Most studies done with medical marijuana report

no serious adverse drug reactions. Short term effects in-

clude impaired short-term memory/motor coordination/

judgment, cognitive/psychomotor/perceptual alterations,

euphoria, and increased risk of car accidents. Long term

effects include impaired brain development, a decline in

IQ, new or worsening anxiety, depression, paranoid idea-

tions and psychotic illness. Marijuana smoke contains

many of the same carcinogenic chemicals found in tobac-

co smoke so it may exacerbate respiratory conditions.

Marijuana may also increase heart rate, increase or de-

crease blood pressure and is linked to a higher risk of

heart attack and stroke. It is not recommended in women

who are pregnant or are planning to become pregnant.

Prenatal exposure to marijuana is associated with neuro-

developmental changes in neonates and developmental

changes in children. About 9% of persons using marijua-

na will become dependent and may experience withdraw-

al symptoms such as irritability, craving, dysphoria, anxi-

ety, and insomnia.

Drug Interactions

Using marijuana with CNS depressants such as opioids,

sedatives, and benzodiazapines, may add to drowsiness

and dizziness, impaired memory, etc. Synthetic canna-

binoids like dronabinol (Marinol®) carry drug interaction

warnings for additive effects with sedatives/hypnotics,

psychotropics, and alcohol. THC is highly protein bound

so it has the potential to displace other medications that

are protein bound such as warfarin and digoxin. THC and

CBD are primarily metabolized by CYP1A2, CYP2C9,

CYP2D6, CYP2C19, and CYP3A4. Inhibitors of these

enzymes such as clarithromycin (Biaxin®) and amioda-

rone, could increase cannabinoid blood concentrations,

while inducers of these enzymes such as carbamazepine

(Tegretol®) and rifampin may lower cannabinoid blood

concentrations.

While experts point out that much of the evidence for the

use of medical marijuana is not high quality and unscien-

tific, more rigorous testing and human studies are needed

to be sure medical marijuana has a legitimate use in socie-

ty. Its benefits can vary from one person to another and

may be influenced by factors such as medical history and

family predisposition. Initial findings suggest marijuana

may help with certain age-related ailments and there is

good evidence to support its use for the treatment of

chemotherapy-induced nausea and vomiting, cachexia in

AIDS/HIV, as well as neuropathic pain. Use of medical

marijuana should be reserved for patients who failed mul-

tiple trials of approved medications for their condition

and where it’s not contraindicated. Please keep in mind

that Medicare and other insurances do not cover medical

marijuana.

Article by Heather Eaton-Erskine, Pharm D, BCGP, FASCP

Regional Clinical Manager, Neil Medical Group

Spotlight on Vitamin D

Page 6

PHARM NOTES

Vitamin D, also known as the sunshine vitamin, is considered

a pro-hormone. While Vitamin D is produced by the body as

a response to sun exposure, it can also be consumed in food

and supplements. Making sure we consume enough Vitamin

D is important for many reasons. Vitamin D helps maintain

healthy bones and teeth; it may also protect against other

conditions such as type 1 diabetes, multiple sclerosis, and

cancer. Vitamin D helps support lung function and cardiovas-

cular health. It supports the health of the immune system,

brain, and nervous system, regulates insulin levels and aids in

diabetes management. Vitamin D also influences the expres-

sion of genes involved in cancer development. Vitamins are

nutrients that cannot be created by the body and must be tak-

en in through our diet. Vitamin D can be synthesized by our

body when sunlight hits our skin. It’s estimated that sun ex-

posure on bare skin for five to ten minutes two to three times

per week allows people to produce sufficient Vitamin D.

Vitamin D has many health benefits. We need vitamin D to

help maintain healthy bones. Vitamin D plays a huge role in

the regulation of calcium and maintenance of phosphorus

levels in the blood. Vitamin D absorbs calcium in the intes-

tines and reclaims calcium that would normally be excreted

through the kidneys. In adults, Vitamin D deficiency results

in osteoporosis or osteomalacia. Sufficient Vitamin D levels

has proved to decrease ones risk of developing influenza.

Vitamin D has been shown to decrease the risk of diabetes. In

one study that was done, infants who received 2,000 Interna-

tional Units per day of Vitamin D had an eighty-eight percent

lower risk of being diagnosed with type 1 diabetes before the

age of thirty two. Several studies have shown a relationship

between blood concentrations of Vitamin D in the body and

risk of type two diabetes. In people with type two diabetes,

insufficient Vitamin D levels may negatively affect insulin

secretion and glucose tolerance. Low Vitamin D levels has

been associated with a higher risk of allergic diseases and

childhood diseases such as asthma, eczema, and atopic der-

matitis. Vitamin D may enhance the anti-inflammatory ef-

fects of glucocorticoids, making it useful as a supportive

therapy for those with steroid-resistant asthma. Vitamin D is

very important in helping maintain a healthy pregnancy. A

poor Vitamin D level in a pregnant woman is associated with

gestational diabetes and bacterial vaginosis. Pregnant women

who also are deficient in Vitamin D are also more at risk for

preeclampsia and needing a cesarean section. Pregnant wom-

en with high Vitamin D levels were associated with a higher

risk of food allergy in the child during the first two years of

life. Vitamin D also plays a very important role in regulating

cell growth and for cell to cell communication. There are

some studies that suggest that calcitriol can reduce cancer

progression by slowing the growth and development of new

blood vessels in cancerous tissue, which increases cancer cell

death, and reduces cell proliferation and metastases. Vitamin

D deficiency has been shown to increase cardiovascular dis-

ease, multiple sclerosis, hypertension, rheumatoid arthritis,

Alzheimer’s disease, swine flu, asthma severity, and autism.

The body can create Vitamin D, however there are many rea-

sons Vitamin D deficiency can occur. For example, a darker

skin color and using sunscreen reduce the body’s ability to

absorb the ultraviolet radiation B rays from the sun which are

needed to produce Vitamin D. To start Vitamin D production,

the skin has to be directly exposed to sunlight, not covered by

clothing. That is the reason why even people who work out-

doors year round may also be deficient in Vitamin D.

Symptoms of Vitamin D deficiency include: muscle pain,

hair loss, depressed mood, impaired wound healing, fatigue,

painful bones, and greater risk for infection and sickness. If a

person is deficient in Vitamin D for a long period of time it

can result in: osteoporosis, fibromyalgia, neurodegenerative

deficiency and may also contribute to certain types of cancers

including: breast, colon, and prostate cancer.

Sunlight is the most efficient source of Vitamin D. The rich-

est food sources of Vitamin D are fatty fish and fish oil.

Foods rich in Vitamin D include: egg, chicken, skim milk,

tuna canned in water, cooked swordfish, herring, cod liver

oil, cooked salmon, canned sardines, oysters, shrimp, and

mushrooms.

Article by Stephanie Joye, RN, BSN

NMG Nurse Consultant

Page 7

Volume 21, Issue 5

Since 2006 the vaccination of choice for the prevention of

shingles (also known as herpes zoster) has been the Zostavax

vaccine, but recently the recommendation has changed. On

October 25th, 2017 the Centers for Disease Control (CDC) an-

nounced that Shingrix is now the preferred vaccine for the pre-

vention of shingles. In addition to recommending Shingrix as

the preferred vaccination for shingles prevention, the CDC

also announced Shingrix is recommended for healthy adults

over age 50 years old and is recommended for adults who pre-

viously received the Zostavax vaccine. This means that Shin-

grix is now recommended for everyone 50 years old and over.

This increases the number of people needing the vaccination

by 62 million! With the new recommendations from the CDC

it is very likely that many residents in the long-term care facili-

ties will be receiving the new Shingrix vaccination.

This new recommendation is based upon an announcement

from the Advisory Committee on Immunization Practices

(ACIP) stating that Shingrix is more effective that Zostavax in

preventing cases of the shingles. According to the Zoster – 006

clinical trial, Shingrix decreased the risk of developing shin-

gles by 97.2% compared to placebo. A similar clinical trial

researching Zostavax showed an overall efficacy of 51% in

decreasing the risk of developing shingles. Moreover, the Zos-

ter – 006 trial also showed that Shingrix works just as well in

older patients compared to younger populations unlike the

Zostavax vaccination that had decreased efficacy in older pa-

tients.

Although Zostavax is approved for use in patients over 50

years old the immunization guidelines only recommend it’s

use in patients over age 60 due to concerns of lasting effective-

ness. On the other hand, Shingrix is now approved and recom-

mended for use in patients age 50 years and older regardless if

they already received the Zostavax vaccination. Shingrix can

be administered as soon as 8 weeks after Zostavax has been

administered.

In addition to the efficacy of the Shingrix vaccination, there

are also some other key differences as well. The Shingrix vac-

cination contains not only the herpes zoster vaccine, but also

an adjuvant to boost immune response. Adjuvants are com-

monly found in many vaccinations to boost the potency and

quality of a specific immune response. The Zostavax vaccina-

tion does not contain an adjuvant and is thought to have a

shorter duration of efficacy compared to Shingrix. Moreover,

the Shingrix vaccine is a recombinant non-live vaccine com-

pared to Zostavax which is a live vaccination. Live vaccina-

tions typically need to be used cautiously in immunocompro-

mised patients. There is no definite information regarding the

safety of Shingrix use in immunocompromised patients, alt-

hough Shingrix is thought to be safer in this population com-

pared to Zostavax.

Live vaccines also typically have more strict storage require-

ments compared to non-live vaccinations. Zostavax must be

stored frozen, but Shingrix is stored in the refrigerator. The

vaccinations are also administered differently with Zostavax

given as one single subcutaneous injection and Shingrix given

intramuscularly in 2 doses separated by 2 to 6 months.

Adverse effects are similar between the two vaccinations.

The most common adverse effects associated with the Zos-

tavax vaccination are: pain and redness at the injection site and

localized tenderness. There are very few reports of headache

and diarrhea after receiving the Zostavax vaccination. On the

other hand, the most common adverse effects associated with

the Shingrix vaccination are pain and redness at the injection

site, fatigue, headache, fever and shivering. There are also very

few reports of chills and nausea after receiving the vaccine.

Regarding cost, the Shingrix vaccination is $168.00 per shot

compared to $267.74 per shot for the Zostavax vaccination.

Per Medicare.gov, both shingles vaccinations are covered by

Medicare Part D but may still require a copay.

The emergence of the new Shingrix vaccination has shifted the

recommendations of the CDC regarding shingles prevention

which affects many of the residents under our care. It is im-

portant to educate residents on the importance of receiving this

vaccination and to ensure compliance with all recommended

vaccinations to prevent any unnecessary illnesses.

Article by Anna Bruckelmeyer , Pharm D Candidate

New Shingles Vaccination Recommendations

PHARM NOTES

Kinston Pharmacy

2545 Jetport Road

Kinston, NC 28504

Phone 800 735-9111

Louisville Pharmacy

13040 East Gate Parkway

Suite 105

Louisville, KY 40223

Phone 866-601-2982

Mooresville Pharmacy

947 N. Main Street

Mooresville, NC 28115

Phone 800 578-6506

To all the Pharm Notes Family,

I am continuing to share excerpts from “The Letter”…...which was given to my granddaughter on

her 1st birthday and will be saved until she turns 18. This is the conclusion of……..

“Ten Ways to Not Make Your Life Harder than it Has to Be”

9. Don’t be Unwilling to ‘Let it Go’

Do you need to forgive someone? Do you need to turn your back on a failed relationship? Do you

need to come to terms with the death of a loved one? Life is full of loss. But, in a sense, true hap-

piness is not possible without it. It helps us appreciate and savor the things that really matter. It

helps us grow. It can help us help others grow.

10. Always Give Back

Immerse yourself in doing something good. Volunteer. Get involved in life. This doesn’t require

doing something structured or big. Say a kind word. En-

courage someone. Pay a visit to someone who is alone.

Get away from your own self absorption. When it comes

down to it...there are two types of people in the world:

Givers and Takers. Givers are happy. Takers are misera-

ble. Be a giver and you will always find happiness and sat-

isfaction in life.

Till next time……..

Cathy Fuquay

Pharm Notes is a bimonthly publication by Neil

Medical Group Pharmacy Services Division.

Articles from all health care disciplines pertinent

to long-term care are welcome. References for

articles in Pharm Notes are available upon request.

Your comments and suggestions are appreciated.

Contact: Cathy Fuquay (cathyf@neilmedical.com)

1-800-735-9111 Ext 23489

...a note from the Editor

Thank you for allowing Neil Medical Group to partner with

you in the care of your residents!