Mohebook 2015

I AM TO BE

URED

In clinical studies, 96–99% of patients who had no prior treatment were cured with just 12 weeks of therapy.*

* In a study of 865 patients with genotype 1 Hep C and no prior Hep C treatment, with or without advanced liver disease (cirrhosis), 99% (210 out of 213) of those who received HARVONI once daily for 12 weeks were cured. In a separate study of 647 patients with genotype 1 Hep C, with no prior Hep C treatment and without cirrhosis, 96% (208 out of 216) of those who received HARVONI once daily for 12 weeks were cured. †In the study of 647 patients with genotype 1 Hep C, with no prior Hep C treatment and without cirrhosis, 97% (119 out of 123) of those with lower levels of the virus (less than 6 million IU/mL) who received HARVONI once daily for 8 weeks were cured.

TODAY THERE’S HARVONI. A BREAKTHROUGH TREATMENT FOR CHRONIC HEPATITIS C GENOTYPE 1 IN ADULTS. HARVONI is a prescription medicine for chronic (lasting a long time) hepatitis C (Hep C) that combines two drugs (ledipasvir and sofosbuvir) in one pill. It is not known if HARVONI is safe and effective in children under 18 years of age.

HARVONI has been proven to cure up to 99% of patients who’ve had no prior Hep C treatment.* HARVONI is the one and only cure that’s one pill, once a day for 12 weeks. And for certain patients, HARVONI has been shown to be highly effective in as little as 8 weeks of treatment.† Your Hep C specialist will decide what treatment length is right for you.

Cure means the Hep C virus is not detected in the blood when measured three or more months after treatment is completed.

With HARVONI, there’s no interferon, no ribavirin, and no complicated regimens.

So, if you don’t want to live with the uncertainties of Hep C, now may be the time to talk to your Hep C specialist about HARVONI.

IMPORTANT SAFETY INFORMATION

What should I tell my healthcare provider before taking HARVONI? • If you have: liver problems other than hepatitis C infection; severe kidney problems or are on dialysis; any other medical condition; or if you are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if HARVONI will harm your unborn baby or pass into your breast milk.

• If you take amiodarone (Cordarone®, Nexterone®, Pacerone®), rifampin (Rifadin®, Rifamate®, Rifater®), St. John’s wort or a product that contains St. John’s wort. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. HARVONI may affect the way other medicines work, and other medicines may affect how HARVONI works.

You should not take HARVONI if you also take other medicines that contain sofosbuvir (SOVALDI®).

What are the most common side effects of HARVONI? Common side effects include tiredness and headache.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Are you ready for HARVONI? Ask a Hep C specialist if HARVONI is right for you. To find one in your area visit ready4one.com or call 1-844-READY41.

Please see Brief Summary of full Prescribing Information on the following page.

THE ONE YOU’VE BEEN WAITING FOR

HARVONI® (har-VOE-nee) (ledipasvir 90 mg and sofosbuvir 400 mg) tablets Brief Summary of full Prescribing Information. See full Prescribing Information. Rx Only.

What is HARVONI? • HARVONI is a prescription medicine used to treat chronic (lasting a long time) hepatitis C genotype 1 infection in adults.

• HARVONI contains the prescription medicines ledipasvir and sofosbuvir (SOVALDI®).

It is not known if HARVONI is safe and effective in children under 18 years of age.

What should I tell my healthcare provider before taking HARVONI? Before taking HARVONI, tell your healthcare provider if you: • have liver problems other than hepatitis C infection • have severe kidney problems or you are on dialysis • have any other medical condition • are pregnant or plan to become pregnant. It is not known if HARVONI will harm your unborn baby.

• are breastfeeding or plan to breastfeed. It is not known if HARVONI passes into your breast milk.

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. HARVONI may affect the way other medicines work, and other medicines may affect how HARVONI works.

You should not take HARVONI if you also take other medicines that contain sofosbuvir (SOVALDI®).

Especially tell your healthcare provider if you take any of the following medicines: • an antacid that contains aluminum or magnesium hydroxide. If you take an antacid during treatment with HARVONI, take the antacid 4 hours before or 4 hours after you take HARVONI. • amiodarone (Cordarone®, Nexterone®, Pacerone®) • carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®) • digoxin (Lanoxin®) • efavirenz, emtricitabine, tenofovir disoproxil fumarate (ATRIPLA®) • elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate (STRIBILD®) • medicines for indigestion, heartburn, or stomach ulcers, such as nizatidine (Axid®), famotidine (Pepcid AC®), cimetidine (Tagamet®), ranitidine (Zantac®), esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®), rabeprazole (Aciphex®), or pantoprazole (Protonix®) • oxcarbazepine (Trileptal®, Oxtellar XR®) • phenytoin (Dilantin®, Phenytek®) • phenobarbital (Luminal®) • rifabutin (Mycobutin®) • rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®) • rifapentine (Priftin®) • rosuvastatin (Crestor®) • simeprevir (Olysio®) • St. John’s wort (Hypericum perforatum) or a product that contains St. John’s wort • tipranavir (Aptivus®) used in combination with ritonavir (Norvir®) • tenofovir disoproxil fumarate (VIREAD®, TRUVADA®) used in combination with atazanavir (Reyataz®) and ritonavir (Norvir®), darunavir (Prezista®) and ritonavir (Norvir®), or used in combination with lopinavir and ritonavir (Kaletra®) Know the medicines you take. Keep a list of your medicines and show it to your healthcare provider and pharmacist when you get a new medicine.

How should I take HARVONI? • Take HARVONI exactly as your healthcare provider tells you to take it. Do not change your dose unless your healthcare provider tells you to.

• Do not stop taking HARVONI without first talking with your healthcare provider. If you think there is a reason to stop taking HARVONI, talk to your healthcare provider before doing so.

• Take HARVONI 1 time each day with or without food.

• If you miss a dose of HARVONI, take the missed dose as soon as you remember the same day. Do not take more than 1 tablet of HARVONI in a day. Take your next dose of HARVONI at your regular time the next day.

• If you take too much HARVONI, call your healthcare provider or go to the nearest hospital emergency room right away.

What are the possible side effects of HARVONI? The most common side effects of HARVONI include: • tiredness • headache Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of HARVONI. For more information, ask your healthcare provider or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Keep HARVONI and all medicines out of the reach of children.

General information about the safe and effective use of HARVONI It is not known if treatment with HARVONI will prevent you from infecting another person with the hepatitis C virus during treatment.

Talk with your healthcare provider about ways to prevent spreading the hepatitis C virus.

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use HARVONI for a condition for which it was not prescribed. Do not give HARVONI to other people, even if they have the same symptoms you have.

It may harm them.

If you would like more information about HARVONI, talk with your healthcare provider. You can ask your healthcare provider or pharmacist for information about HARVONI that is written for health professionals.

For more information, call 1-844-READY41 (844-732-3941) or go to www.HARVONI.com.

Issued: March 2015 HARVONI, the HARVONI logo, SOVALDI, STRIBILD, TRUVADA, VIREAD, GILEAD and the GILEAD logo are trademarks of Gilead Sciences, Inc., or its related companies. ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. All other trademarks referenced herein are the property of their respective owners. ©2015 Gilead Sciences, Inc. All rights reserved. HVNC0217 09/15

contents John Sherrer, President CW Publishing Group Editor-in-Chief VP Publishing Operations Elaine Marotta Art Director Kara A. Kablack Creative Associate Tamara Citroen Executive VP/Sales Director Neil Agble

29

6 Well-Being 10 Steps to a Healthier Life From good nutrition and stress management to breaking bad habits, there’s no better time to take charge of your health

16 Relief

Coping With Chronic Conditions OTC products found at your local pharmacy can ease the discomfort of medication side effects

20 Vision Health A Look Ahead Protect your eyesight

24 Feeling Down

Is It Depression — Or Just the Blues?

Appropriate treatment can help the majority of people with depressive disorders www.mattersofhealth.org

29 Mental Challenges

Stay Sharp Preserve your memory — at any age

34 Prevention

Heart of the Matter Types of cardiac disease, reducing risk factors and staying healthy following an event

44 Staying Organized

Managing Medications Keeping track of when and how to take your pills is easier than you think

48 Awareness

Just the Facts What you need to know about hepatitis C

Senior Account Executives Elizabeth Glover, Mark Rogers Account Executives John Bradley, Kara Giannecchini, Gordon McNiff, Eric Oberman Financial Controller Amanda Honeyfield Operations Manager Trixzena Smith Group CFO James Ward Group CEOs Dean Citroen Oren Wolf Published by CW Publishing Group 8-10 W. 36th St., Fifth Floor New York, NY 10018 646.274.7272 www.cwpg.com Printed in the U.S.A. Copyright © 2015 CW Publishing Group All rights reserved.

CW Publishing Group is the trading name for CW Communications, Inc.

50 Be Proactive

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4 Foreword

Don’t Get Sick!

How to avoid colds & flu

3

foreword

Dear Reader,

On behalf of the nearly 23,000 independent community pharmacies across the country that the National Community Pharmacists Association represents, it is my pleasure to introduce you to the first issue of Matters of Health, a new resource to help you live a healthier life.

As small business owners, community pharmacists are proud members of the community and share the commitment of our family, friends and neighbors to see our communities be the best they can be. Your local independent pharmacy employs local residents, utilizes local suppliers when possible and contributes to the health and economy of our communities. We think of our patients as members of our extended family and are here to help you improve your health.

Knowing how to develop and maintain healthy habits is an integral part of your well-being, and inside this issue you’ll find articles about coping with chronic conditions, managing heart disease, preserving your memory, taking steps to a healthier lifestyle and managing medications, among other topics.

Your community pharmacist is uniquely positioned to answer many of your health and medication questions. Pharmacists are among the most accessible health providers and are first and foremost medication experts. From questions about side effects, dosage amounts, potential drug interactions, preventing drug abuse and more, we’ve heard it all. Consider us your one-stop resource for answers.

Community pharmacists specialize in providing high-quality, patient-centered care. Yes, we spend part of our day filling prescriptions, but we can also synchronize your medications to save time and help you better remember to take your medication as directed. More than 60 percent of community pharmacies offer on-the-spot immunizations, giving you convenient access to your annual flu shot or other vaccinations. Many pharmacies offer blood pressure monitoring and diabetes training to help patients better manage chronic conditions. Having trouble affording your prescriptions? We can often work with you and your healthcare provider to identify the most costeffective medication for you. Think of your community pharmacist as part of your healthcare team.

Thank you for visiting your local community pharmacy to meet your health needs. We hope you’ll stop by and visit again soon.

John Sherrer, RPh Pharmacy Owner, Marietta, GA President, 2014-2015 National Community Pharmacists Association

4

www.mattersofhealth.org

TASTE THE DIFFERENCE FEEL THE

RELIEF

*

Lozenges do not contain fluoride.

Did You Know?

• Over 400 medications can cause dry mouth symptoms.

• Dry mouth is associated with an increased risk of cavities.

Optaflow® is a registered trademark of Symrise AG. † among OTC mouthwashes. *from oral dryness Use as directed. ©2015 Chattem, Inc. All Rights Reserved.

well-being

10 steps to a healthier life Let’s face it: We could all do a better job of taking care of ourselves. It can be tough to make time for what we need to do to stay healthy, especially as we get older.

Here’s a quick refresher and perhaps some things you hadn’t thought of for how to get and stay healthy, no matter your age.

1. Eat right. There’s a tendency to believe that as long as you stay away from junk food, you’re probably doing a fairly good job of getting the nutrition you need. But in a culture saturated with processed and fast foods (including microwave-ready meals), that’s not necessarily the case.

2. Read labels to be sure you’re actually getting what you think you’re getting from food. Foods labeled low-fat may be loaded with high-fructose corn syrup to compensate, for example. A healthy, well-balanced meal

6

plan includes plenty of fruits and vegetables, whole grains, lean meats and low-fat or no-fat dairy products. Whole, fresh foods are much better for you than pre-packaged, processed foods. And be sure to watch your portion sizes — there is such a thing as too much of a good thing!

3. Stay active and keep your weight in check. Keep moving! Research has shown that 150 minutes of exercise per week can go a long way toward helping you prevent or delay diseases such as type 2 diabetes, and experts now recommend not being sedentary for more than 90 minutes at a stretch.

Studies show that people who are sedentary for long periods of time are more likely to develop type 2 diabetes, cancer or cardiovascular disease or to die prematurely than those who are active. Not only will movwww.mattersofhealth.org

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From good nutrition and stress management to breaking bad habits, there is no better time to take charge of your health

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ALSO AVAILABLE AT © 2015 Consumer Cellular, Inc. New service activation on approved credit. Cellular service is not available in all areas and is subject to system limitations. Terms and Conditions subject to change. †Based on interpretation of Nielsen’s Mobile Insights survey data, which uses respondents’ self-reported rating (1 to 10 scale) of overall satisfaction with their carrier from a national survey of approximately 90,000 U.S. mobile phone users during Q1 ’15. AARP member benefits are provided by third parties, not by AARP or its affiliates. Providers pay a royalty fee to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. Some provider offers are subject to change and may have restrictions. Please contact the provider directly for details.

well-being

well-being

ing more help you keep off the extra pounds, it will help make you look and feel good.

Exercise provides health benefits whether you lose weight or not. So walk, run, cycle, swim or dance your way to better health.

4. Manage stress. They call it the silent killer. We’re all coping with stress of one form or another. Whether it’s coming from work or you face problems at home, stress can cause physical as well as psychological and emotional damage. The Anxiety and Depression Association of America recommends reducing the stress in your day by taking time out to practice yoga, listen to music or meditate; getting enough sleep; not skipping meals; remembering to breathe deeply; maintaining a positive attitude; talking to friends; and finding humor in life!

5. Don’t smoke. Not only does smoking cause lung cancer and other respiratory illnesses, it can harm those around you, such as spouses, children and grandchildren. It also contributes to aging and exacerbates other diseases, such as diabetes. If you smoke, ask your healthcare team for help quitting.

6. Use sunscreen. Don’t forget to protect yourself from the sun’s harmful rays on a daily

8

basis (not just at the beach). Some medications, such as antibiotics, increase the skin’s sensitivity to the sun, so remember to read the label or check with your pharmacist about taking extra precautions. If you’re going to be outdoors for long periods of time, put on a hat for extra protection.

7. Drink alcohol in moderation. A glass or two of wine is fine for most people, and may even provide some moderate health benefits.

But overindulging in alcohol can lead to extra calories, depression and, for some people, substance abuse. If you find yourself using alcohol as a crutch or drinking alone, contact a member of your healthcare team for help.

8. Stay connected. Growing older can sometimes mean becoming more socially isolated.

You may no longer go to work. Your kids are grown and friends and neighbors may move to another state to retire. But research shows there are strong correlations between social interactions and health and well-being among older adults, so be sure to make the effort to stay connected! Volunteer, take care of the grandchildren, join a club. You’ll have more friends, greater memories and better health to show for it. www.mattersofhealth.org

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Do you have trouble falling asleep and/or staying asleep? BELSOMRA is a prescription medicine for adults who have trouble falling or staying asleep.

It’s the only sleep aid that targets and inhibits the action of a neurotransmitter called orexin. Orexin is a central promoter of wakefulness.

By inhibiting orexin, BELSOMRA is thought to help quiet wakefulness.

Only BELSOMRA works this way.

Call your doctor right away if you find out About BELSOMRA • BELSOMRA is a prescription medicine for adults who have trouble falling or staying asleep (insomnia).

Selected Risk Information • Do not take more BELSOMRA than prescribed.

• Do not take BELSOMRA unless you are able to stay in bed a full night (at least 7 hours) before you must be active again.

• Take BELSOMRA within 30 minutes of going to bed.

• BELSOMRA may cause serious side effects that you may not know are happening to you. These side effects include: • sleepiness during the day • not thinking clearly • acting strangely, confused, or upset • “sleep-walking” or doing other activities when you are asleep like eating, talking, having sex, or driving a car.

that you have done any of these activities after taking BELSOMRA. • Do not take BELSOMRA if you fall asleep often at unexpected times (narcolepsy).

• BELSOMRA is a controlled substance because it can be abused or cause dependence.

• Before taking BELSOMRA, tell your doctor about all of your medical conditions, including if you: have a history of depression, mental illness, or suicidal thoughts; have a history of drug or alcohol abuse or addiction; have a history of a sudden onset of muscle weakness (cataplexy); have a history of falling asleep often at unexpected times (narcolepsy) or daytime sleepiness; have lung or breathing problems; have liver problems; are pregnant or plan to become pregnant; are breastfeeding or plan to breastfeed.

Are you looking for a different option to treat your insomnia?

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• Medicines can interact with each other, sometimes causing serious side effects. Do not take BELSOMRA with other medicines that can make you sleepy unless your doctor tells you to.

• Call your doctor if your insomnia (sleep problem) worsens or is not better within 7 to 10 days. This may mean that there is another condition causing your sleep problem.

• Do not drink alcohol while taking BELSOMRA. It can increase your chances of getting serious side effects.

• Do not drive, operate heavy machinery, do anything dangerous, or do other activities that require clear thinking after taking BELSOMRA. • You may still feel drowsy the next day after taking BELSOMRA. Do not drive or do other dangerous activities until you feel fully awake.

• BELSOMRA may cause serious side effects, including abnormal thoughts and behavior (symptoms include more outgoing or aggressive behavior than normal, confusion, agitation, hallucinations, worsening of depression, and suicidal thoughts or actions); memory loss;

anxiety; temporary inability to move or talk (sleep paralysis) for up to several minutes while you are going to sleep or waking up; and temporary weakness in your legs that can happen during the day or at night.

• The most common side effects of BELSOMRA include drowsiness the next day after you take BELSOMRA. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Please read the adjacent Medication Guide for BELSOMRA and discuss it with your doctor.

ASK YOUR DOCTOR ABOUT BELSOMRA

Having trouble paying for your Merck medicine? Merck may be able to help. Visit merckhelps.com.

Copyright © 2015 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved. NEUR-1123042-0003 04/15

MEDICATION GUIDE BELSOMRA® (bell-SOM-rah) (suvorexant) Tablets C-IV What is the most important information I should know about BELSOMRA? • Do not take more BELSOMRA than prescribed.

• Do not take BELSOMRA unless you are able to stay in bed a full night (at least 7 hours) before you must be active again.

• Take BELSOMRA within 30 minutes of going to bed.

BELSOMRA may cause serious side effects that you may not know are happening to you.

These side effects include: • sleepiness during the day • not thinking clearly • act strangely, confused, or upset • “sleep-walking” or doing other activities when you are asleep like eating, talking, having sex, or driving a car.

• Call your doctor right away if you find out that you have done any of the above activities after taking BELSOMRA. What is BELSOMRA? • BELSOMRA is a prescription medicine for adults who have trouble falling or staying asleep (insomnia).

• It is not known if BELSOMRA is safe and effective in children under the age of 18.

BELSOMRA is a federally controlled substance (C-IV) because it can be abused or cause dependence. Keep BELSOMRA in a safe place to prevent misuse and abuse. Selling or giving away BELSOMRA may harm others and is against the law. Tell your doctor if you have ever abused or have been dependent on alcohol, prescription medicines, or street drugs.

Who should not take BELSOMRA? Do not take BELSOMRA if you fall asleep often at unexpected times (narcolepsy).

What should I tell my doctor before taking BELSOMRA? Before taking BELSOMRA, tell your doctor

about all of your medical conditions, including if you: • have a history of depression, mental illness, or suicidal thoughts • have a history of drug or alcohol abuse or addiction • have a history of a sudden onset of muscle weakness (cataplexy) • have a history of falling asleep often at unexpected times (narcolepsy) or daytime sleepiness • have lung problems or breathing problems • have liver problems • are pregnant or plan to become pregnant. It is not known if BELSOMRA can harm your unborn baby.

• are breastfeeding or plan to breastfeed. It is not known if BELSOMRA passes into your breast milk.

Tell your doctor about all the medicines you take, including prescription or over-the-counter medicines, vitamins, or herbal supplements.

Medicines can interact with each other, sometimes causing serious side effects. Do not take BELSOMRA with other medicines that can make you sleepy unless your doctor tells you to.

Know the medicines you take. Keep a list of your medicines with you to show your doctor and pharmacist each time you get a new medicine.

How should I take BELSOMRA? • Take BELSOMRA exactly as your doctor tells you to take it.

• Only take BELSOMRA 1 time each night, if needed, within 30 minutes of going to bed.

• Only take BELSOMRA when you can get a full night’s sleep (at least 7 hours).

• Do not take BELSOMRA if you drank alcohol that evening or before bed.

• BELSOMRA may be taken with or without a meal. However, BELSOMRA may take longer to work if you take it with or right after meals.

• Call your doctor if your insomnia (sleep problem) worsens or is not better within 7 to

10 days. This may mean that there is another condition causing your sleep problem.

• If you take too much BELSOMRA, call your doctor right away or get emergency treatment.

What should I avoid while taking BELSOMRA? • Do not drink alcohol while taking BELSOMRA. It can increase your chances of getting serious side effects.

• Do not drive, operate heavy machinery, do anything dangerous, or do other activities that require clear thinking after taking BELSOMRA. • You may still feel drowsy the next day after taking BELSOMRA. Do not drive or do other dangerous activities until you feel fully awake.

What are the possible side effects of BELSOMRA? BELSOMRA may cause serious side effects, including: • See “What is the most important information I should know about BELSOMRA?” • abnormal thoughts and behavior. Symptoms include more outgoing or aggressive behavior than normal, confusion, agitation, hallucinations, worsening of depression, and suicidal thoughts or actions.

• memory loss • anxiety • temporary inability to move or talk (sleep paralysis) for up to several minutes while you are going to sleep or waking up.

• temporary weakness in your legs that can happen during the day or at night.

The most common side effects of BELSOMRA include drowsiness the next day after you take BELSOMRA. These are not all the possible side effects of BELSOMRA. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store BELSOMRA? • Store BELSOMRA at room temperature between

68°F to 77°F (20°C to 25°C).

• Store in the original package until use, to protect from light and moisture.

• Keep BELSOMRA and all medicines out of reach of children.

General information about the safe and effective use of BELSOMRA. Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide.

Do not use BELSOMRA for a condition for which it was not prescribed. Do not give BELSOMRA to other people, even if they have the same symptoms that you have. It may harm them.

This Medication Guide summarizes the most important information about BELSOMRA. You can ask your pharmacist or doctor for information about BELSOMRA that is written for health professionals.

For more information, go to BELSOMRA.com or call 800-622-4477.

What are the ingredients in BELSOMRA? Active ingredient: Suvorexant Inactive ingredients: Polyvinylpyrrolidone/ vinyl acetate copolymer (copovidone), microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, and magnesium stearate. The film coating contains: lactose monohydrate, hypromellose, titanium dioxide, and triacetin. The film coating for the 5 mg tablets also contains iron oxide yellow and iron oxide black, and the film coating for the 10 mg tablets also contains iron oxide yellow and FD&C Blue #1/Brilliant Blue FCF Aluminum Lake.

This Medication Guide has been approved by the U.S. Food and Drug Administration. usmg-mk4305-t-1408r001 Issued: 08/2014 Copyright © 2015 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved.

NEUR-1123042-0003 04/15

well-being

9. Get your zzzs. Sleep plays an important, and often overlooked, role in maintaining good physical and mental health. Not getting enough sleep can raise your risk for chronic health conditions, such as diabetes, heart and kidney disease and high blood pressure.

Lack of sleep also makes it harder for your body to fight infections and increases the risk of obesity.

How much sleep you get every night can also affect your mood, your ability to make decisions and your capacity to get along with other people. According to the National Institutes of Health (NIH), sleep deficiency has been linked to depression, suicide and risk-taking behaviors.

Keeping a regular sleep schedule, avoiding artificial light (from TV and computer screens) and strenuous exercise an hour before bedtime, avoiding heavy meals and alcohol late at night, not drinking caffeinated beverages after lunchtime and making the last hour before bedtime a calm and quiet one can improve sleep patterns.

10. Have regular screenings. As you get older, health screenings can become more important. The sooner a condition is detected, the sooner you can begin to treat it.

The AARP lists eight screenings that

14

Eat right, avoiding fast, processed food

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Maintain a regular sleep schedule for good physical and mental health

people over the age of 50 should be sure not to miss, based on guidelines from the U.S. Preventive Services Task Force. These include a PSA test for men to check for prostate cancer (up until age 75), a mammogram every two years for women between the ages of 50 and 74 to check for breast cancer, a colonoscopy for people ages 50 to 75, cardiovascular health checks (blood pressure, cholesterol levels, blood glucose levels and weight), a pap smear for women to test for cervical cancer every three years until age 65 or 70, a bone mineral density scan for osteoporosis beginning at age 65 for women and 70 for men, a depression screening and HIV/AIDs testing for anyone under the age of 64.

Hearing loss, which grows increasingly common as people age, is not recommended across the board for seniors, but rather only in individuals who exhibit symptoms.

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relief

coping with chronic conditions Living with chronic conditions and illnesses — such as high blood pressure, high cholesterol and diabetes — can make life exhausting, painful and, even on a good day, just plain uncomfortable. Medications that help you manage these conditions may also be accompanied by unpleasant side effects. But if you’re dealing with one of these conditions, don’t despair! There are steps you can take to ease the discomfort, and over-the-counter (OTC) products that can provide some relief.

If your blood pressure is too high, your healthcare provider can help you set a reasonable goal for lowering it. Some of the things you may need to do to reach your target could include achieving and maintaining a healthy body weight; quitting smoking if you are a smoker; reducing sodium; managing stress; eating a healthy diet high in fruits and vegetables and low in saturated fats, transfats and cholesterol; limiting the amount of alcohol you drink; and taking blood pressure medications.

High Blood Pressure

High Cholesterol

Now is a good time to get your blood pressure tested if you haven’t done so in a while — and to get friends and family to do the same. According to the Centers for Disease Control and Prevention (CDC), about one in three American adults has high blood pressure. There are often no signs or symptoms, so testing is the only way to know if your numbers are too high.

Blood pressure levels contain two numbers: the top (systolic) and the bottom (diastolic). For otherwise healthy adults, normal blood pressure levels should be 120/80 mmHg or below.

High blood pressure can often be managed easily, but it is a serious condition that can lead to coronary heart disease, heart failure, stroke, kidney failure and other problems if ignored. In 2010, high blood pressure was the primary or contributing cause of death for more than 360,000 Americans.

High blood cholesterol is a major risk factor for heart disease. But not all cholesterol is bad.

Low-density lipoprotein (LDL) cholesterol is what causes people trouble, can lead to heart disease and should be kept below 100 mg/ dL. High-density lipoprotein (HDL) is good because it protects against heart disease by removing cholesterol from the body, and this number should be at least 40 mg/dL. According to the American Heart Association, more than 73 million American adults have high LDL levels, for which less than half are being treated. The CDC reports that fewer than one in three American adults has the condition under control.

Eating a high-fat, high-cholesterol diet and being overweight and physically inactive can cause LDL levels to rise. But sometimes high LDL levels are just hereditary. While there’s nothing you can do about the hereditary factor,

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www.mattersofhealth.org

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OTC products found at your local pharmacy can ease the discomfort of medication side effects

relief

Reducing fat, transfat and cholesterol and increasing soluble fiber in your diet can help to lower LDL levels

you can lower LDL levels, regardless of how they got to be high.

Reducing the fat, transfat and cholesterol and increasing the soluble fiber in your diet, exercising more, maintaining a healthy weight and drinking alcohol in moderation can all help to lower LDL levels. But sometimes medications, such as statins, are needed in addition to lifestyle changes.

Exercise is the best way to raise HDL levels.

Consult your healthcare provider to find the best and most appropriate exercise plan for your fitness level.

Diabetes If you have diabetes, controlling blood glucose levels is critical to preventing or delaying complications such as kidney disease, nerve damage that can lead to amputations, even eye and gum disease. Having diabetes is also a major risk factor for heart disease.

People with diabetes can keep blood glucose levels under control by eating a healthful diet high in fiber and low in saturated

18

fats, losing weight (if you are overweight) and exercising rigorously at least 150 minutes a week. Sometimes, however, lifestyle changes alone do not lower blood glucose levels sufficiently. If this is true in your case, your provider can prescribe one or more of a wide range of glucose-lowering medications.

What To Do If You Have Side Effects “Every medication can have a side effect, but in many patients, side effects don’t occur,” says James T. Willerson, MD, President of the Texas Heart Institute. If they do, however, an experienced doctor can adjust the dosage or switch to another medication that is better tolerated.

“There are many ways to skin a cat here!”

Chewing sugar-free gum or sucking on sugar-free candy to trigger your mouth to make more saliva can alleviate minor side effects, such as dry mouth. Ask your pharmacist about OTC medications that can help with constipation, skin rashes and headaches. For more serious side effects, consult your provider. www.mattersofhealth.org

vision health

a look ahead Protecting your precious eyesight As we grow older, almost all of us notice some changes in our vision. It’s harder to read menus, especially in candlelit restaurants. We tuck reading glasses into our purses or keep them scattered about the house so there’s always a pair on hand.

But some vision changes can be serious and require the attention of an eye doctor.

Here are conditions to watch for, and what to do if they occur.

AMD Age-related macular degeneration (AMD) is a common eye condition that affects the macula, the most sensitive part of the retina, located at the back of the eye. During the early stages of AMD, there may be no symptoms at all, but as it progresses a blurry area or blank spots near the center of vision will develop. Roughly 6.5 percent of American adults develop AMD, which is most common

20

in Caucasians over the age of 40. It is the leading cause of vision loss among people aged 50 and older.

While it does not cause complete blindness, the loss of vision can make life difficult and, currently, there is no treatment. However, the National Eye Institute (NEI) reports that if detected early enough, taking highdose vitamins and minerals on a daily basis can slow progression of the disease. Be sure to consult your healthcare provider before taking supplements, however, to ensure you are taking the same doses and combinations used in the NEI trials.

Research also suggests that the risk of AMD may be reduced through lifestyle choices, such as not smoking, exercising regularly, maintaining normal blood pressure and cholesterol levels and eating a diet rich in leafy, green vegetables and fish — many of the foods that also help to keep you healthy overall. www.mattersofhealth.org

Diabetes and Vision Most people with diabetes will develop only minor vision problems, but some diabetesrelated vision complications can and do cause blindness.

Diabetic retinopathy, caused by changes in the blood vessels in the retina, is the most common type of eye disease that affects people with diabetes. There are two kinds: nonproliferative (the most common, in which capillaries in the back of the eye balloon), and proliferative, a less common but more serious condition which can lead to blindness.

People with diabetes are also 40 percent more likely to develop glaucoma and 60 percent more likely to develop cataracts than those who do not have diabetes.

Glaucoma occurs when pressure builds in the eye and can lead to gradual loss of vision.

Cataracts occur when the lenses of the eye become clouded.

The longer people have diabetes, the more likely they are to develop vision problems, so be sure to see an eye doctor regularly for the best hope of early detection and treatment.

As we grow older, almost all of us notice some changes in our vision

Medications and Vision Sometimes the medications we take can also affect our vision. Antihistamines, steroids, erectile dysfunction and prostate drugs, for example, can all cause side effects that damage our vision. If you are taking medication and notice changes to your vision, be sure to tell your healthcare provider.

See your eye doctor regularly

www.mattersofhealth.org

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Sometimes the medications we take can affect our vision

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Millions of people have ACTINIC KERATOSIS (AK) Your sun damage could be AK—treatable skin lesions that may require medical attention

Take action with Picato®— effective AK topical treatment with the fastest dosing* To learn more about AK and Picato®, speak to your dermatologist, or visit www.TreatWithPicato.com

Not actual patient.

*In studies with Picato®, results were measured after 8 weeks.

Indication Picato® (ingenol mebutate) gel, 0.015%, 0.05% is prescription medicine used on the skin to treat actinic keratosis.

Important Safety Information For use on the skin only. Do not use in or on your eyes, mouth, or vagina. Eye problems, including severe eye pain, swelling or drooping of your eyelids, or swelling around your eyes can happen if Picato® gel gets in your eyes. Wash your hands well with soap and water after applying Picato® gel and be careful to keep Picato® gel on the treated area from coming into contact with your eyes. If you accidentally get Picato® gel in your eyes, flush them with large amounts of water and get medical care as soon as possible. Severe skin reactions in the treated areas on the face/scalp and body/arms/legs, including redness, flaking or scaling, crusting, swelling, blisters, pus, ulcers or breakdown of your skin can happen after applying Picato®. You should not use Picato® gel until your skin has healed from other treatments or surgeries. The most common side effects with Picato® gel on the face and scalp ( 2%) include skin reactions in the treatment area (94%), pain at the treatment area (15%), itching at the treatment area (8%), infection at the treatment area (3%), swelling around your eyelids (3%), and headache (2%). The most common side effects with Picato® gel on the body, arms and legs ( 2%) include skin reactions in the treatment area (92%), itching at the treatment area (8%), skin irritation at the treatment area (4%), nose and throat irritation (2%), and pain at the treatment area (2%). Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known if Picato® gel can harm your unborn baby. It is also not known if Picato® is safe and effective for the treatment of actinic keratosis in children less than 18 years of age.

Please see brief summary of full Prescribing Information on the back of this page.

You are encouraged to report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088, or LEO Pharma Inc. at 1-877-494-4536, and select option 1.

Picato is a registered trademark of LEO Laboratories Limited.

LEO and the LEO Lion Design are registered trademarks of LEO Pharma A/S. ©2015 LEO Pharma Inc. 3428-PI-15-717 All rights reserved. August 2015 Printed in USA.

feeling feeling down down

is it depression — or just the blues?

Even the happiest among us know what it’s like to feel down. The loss of a loved one, getting fired from a job or even a dear friend moving away can cause us a great deal of sadness. Sometimes those feelings can be overwhelming and last for days, weeks or even months. But there’s a difference between the kind of sadness that hits us when we experience a loss and the overwhelming malaise that signifies clinical depression.

“The blues will go away,” says Sally Winston, PsyD, Co-Director, Anxiety and Stress Disorders Institute of Maryland. “Depression feels as if you are stuck.”

While it might not be easy to distinguish between the two when you’re the one experiencing that pain, there are some very clear

24

signals that can help us to determine whether it’s a normal case of the blues, or something requiring medical attention, says Dr. Winston.

“Depression is an illness,” she says. “It may or may not involve the feeling of sadness, but often it doesn’t. There are all kinds of other feelings involved: guilt, hopelessness, feelings of being worthless, or having no meaning in life.”

Depression can include physical symptoms as well, she says, such as sleeplessness, loss of appetite, headaches, loss of libido, aches and pains, and fatigue.

“But the signature aspect of depression is anhedonia — the loss of ability to feel pleasure. Things that would normally give you pleasure just fall flat when you are depressed,” she says. www.mattersofhealth.org

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Appropriate treatment can help the majority of people with depressive disorders

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feeling down

Winston cautioned that people experiencing what they believe to be symptoms of depression should immediately be seen by a physician — not just because depression requires treatment, but because the symptoms could be caused by another illness masking itself as depression.

“Many illnesses also cause this type of fatigue,” she says, “such as pulmonary disorders, cardiovascular disease and cancer. Practically every system in the body could have a disorder that could provoke depression-like symptoms.”

According to the National Institute of Mental Health (NIMH), depression can also co-exist with other illnesses, such as heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson’s disease. It’s important to see a physician to seek treatment for both conditions, because research shows that people who suffer a medical illness along with depression will experience more severe symptoms of both. Likewise, treating the depression can help improve the treatment outcome for the medical illness.

There are many things a person can do to counter the feelings of depression, says Dr. Winston. For example, exercising or forcing

26

yourself to stay active, even when you don’t feel like it, will activate endorphins — chemicals within the body that reduce the perception of pain and improve mood. Numerous studies have shown that a regular exercise program improves mood in people with mild-to-moderate symptoms of depression and may even benefit those who are severely depressed.

Just the act of getting up and out of the house and forcing yourself to stay connected to people can help, says Dr. Winston. “The worst thing you can do when you are feeling depressed is to stop moving, or withdraw from people,” she says. “Get in the shower and go out, even though it feels like a huge effort.”

But taking steps on your own may not prove sufficient, she says. Many people require psychotherapy or antidepressant medications, such as SSRIs or MAOIs, or a combination of both therapy and medication.

The good news? NIHM reports that the majority of people with depressive disorders improve after receiving appropriate treatment. If you or a loved one are experiencing depression, be sure to seek medical attention to determine what’s best for you. www.mattersofhealth.org

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Depression can co-exist with other illnesses, so it’s important to seek medical attention for both conditions

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Talk to your doctor today about your varicose vein symptoms.

For more information, visit www.Varithena.com/matters INDICATIONS Varithena®(polidocanol injectable foam) is a prescription medicine used to treat varicose veins caused by problems with the great saphenous vein (GSV) and other related veins in the leg’s GSV system. Varithena®improves symptoms related to or caused by varicose veins, and the appearance of varicose veins.

IMPORTANT SAFETY INFORMATION You should not be treated with Varithena®if you are allergic to polidocanol or have clots in your blood vessels.

Severe allergic reactions have been reported in people treated with liquid forms of polidocanol and some patients have died from these reactions.

Varithena®is a foam made from polidocanol. A healthcare professional will observe you for signs of allergic reactions for at least 10 minutes after you are treated with Varithena®.

Tell your doctor about all of your medical conditions, including if you • have arterial disease (a disease of the blood vessels) • have reduced mobility • have a history of blood clots in the veins or lungs

• have had major surgery in the past 3 months • have recently had a long hospital stay • are pregnant or have recently been pregnant The most common side effects seen with Varithena® are leg pain or discomfort, injection site bruising or pain, and potentially serious blood clots in the leg veins. These are not all of the possible side effects of Varithena®. Tell your healthcare provider about any side effect that bothers you or that does not go away. You can also report side effects to the FDA at 1-800-FDA-1088.

Varithena®is administered by your doctor. Doctors using Varithena®must be experienced in vein procedures and trained in using Varithena®.

See Full Prescribing Information for Varithena®.

Please see Brief Summary of Full Prescribing Information on the following page.

© 2015 Biocompatibles, Inc., a BTG International group company All rights reserved US-VAR-2015-0845 07/15 Varithena is a trademark of Provensis Ltd, a BTG International group company BTG and the BTG roundel logo are registered trademarks of BTG International Ltd

Varithena® (polidocanol injectable foam), for intravenous use Brief Summary of Prescribing Information. This information does not replace talking to your healthcare provider about your medical condition or your treatment. For complete Prescribing Information, visit www.Varithena.com.

Rx Only WHAT IS VARITHENA®?

Varithena® (polidocanol injectable foam) is a prescription medicine used to treat varicose veins caused by problems with the great saphenous vein (GSV) and other related veins in the leg’s GSV system. Varithena® improves symptoms related to or caused by varicose veins and the appearance of varicose veins.

Varithena® is intended for intravenous injection.

Doctors using Varithena® must be experienced in vein procedures and trained in using Varithena®.

Varithena® does not treat all forms of varicose veins.

Please talk with your doctor to see if Varithena® is right for you.

It is not known if Varithena® is safe and effective in children.

WHO SHOULD NOT BE TREATED WITH VARITHENA® You should not be treated with Varithena® if you are allergic to polidocanol or have clots in your blood vessels.

BEFORE RECEIVING TREATMENT WITH VARITHENA® TELL YOUR DOCTOR IF YOU: • Are allergic to polidocanol • Have a history of blood clots in the veins or lungs • Have arterial disease (a disease of the blood vessels) • Have Buerger’s Disease • Have reduced mobility • Have had major surgery within the past 3 months • Have been hospitalized for an extended period of time • Are pregnant. It is not known if Varithena® will harm your unborn baby. Talk to your doctor if you are pregnant or planning to become pregnant.

• Are breastfeeding. It is not known if Varithena® passes into breast milk. You should not use Varithena® if breastfeeding.

A healthcare professional will observe you for signs of allergic reactions for at least 10 minutes after you are treated with Varithena®.

Blood Supply Restriction and Death of Tissue Polidocanol that is injected into an artery or that leaks into the tissues around the injection site can cause serious blood supply restriction, death, or infection of tissues.

Blood Clots Varithena® can cause blood clots in the veins or lungs.

Your doctor will observe you for signs of blood clots after you are treated.

Neurologic or Visual Changes Some patients who received Varithena® experienced a neurologic or visual side effect within 1 day of treatment.

Tell your doctor if you experience any unusual symptoms or headaches after receiving Varithena®.

Skin Color Changes Some patients who received Varithena® experienced skin color changes.

Tell your doctor if you have any side effect that bothers you or does not go away.

These are not all the possible side effects of Varithena®. For more information, ask your doctor.

Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088.

TELL YOUR DOCTOR ABOUT ALL OF THE MEDICINES YOU TAKE No specific tests have been conducted to determine if Varithena® interacts with other drugs. There are no known drug interactions with Varithena®.

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT VARITHENA®?

Side effects have been reported with Varithena®, including: Anaphylaxis Severe allergic reactions have been reported in people treated with liquid forms of polidocanol and some patients have died from these reactions.

© 2015 Biocompatibles, Inc., a BTG International group company All rights reserved US-VAR-2015-0845(a)1 08/15 Varithena is a registered trademark of Provensis Ltd, a BTG International group company BTG and the BTG roundel logo are registered trademarks of BTG International Ltd

mental challenges

stay sharp Who hasn’t misplaced a set of keys, walked into a room only to wonder seconds later why or sworn something was in a drawer that clearly wasn’t anymore?

Memory loss can be frustrating. But as we get older, it’s sometimes accompanied by a nagging feeling that perhaps these are more than mere senior moments — that maybe there’s something far more serious occurring in our brains, such as dementia.

How can we tell? A certain amount of memory loss should be expected as we age.

Misplacing keys or forgetting someone’s name shouldn’t be cause for alarm. But forgetting a person altogether, what day it is or how to get to a familiar place is a signal that www.mattersofhealth.org

something could be amiss.

Dementia is a general term describing a wide range of symptoms associated with memory and skills for daily living. Alzheimer’s disease is a type of dementia that accounts for 60 to 80 percent of all cases.

The Alzheimer’s Association notes that at least two of the following must be present for a diagnosis of dementia: problems with memory, problems with communication and language, inability to focus or pay attention, difficulty with reasoning and judgment, or difficulty with visual perception.

They also list ten warning signs for Alzheimer’s disease: memory loss that disrupts daily life, challenges in planning or problem-

29

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Preserve your memory — at any age

mental challenges

Staying socially active reduces the risk for depression and stress, which can contribute to memory loss

30

new friends and spend time with old ones. It’s good for your mental and emotional health.

Organize your life. You’re less likely to misplace things if you keep your home and office organized. Make lists, keep a calendar Learn something new, such as playing a musical instrument

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solving skills, difficulty completing familiar tasks, confusion with time or place, trouble understanding visual images, problems with speaking or writing, misplacing things or being unable to trace your steps, decreased judgment, withdrawal from work or social activities, and changes in mood or personality.

If you, a loved one or a caretaker notice these signs, consult your healthcare provider.

Most people, however, are likely just experiencing the normal decline in memory that occurs as we grow older. And just as we strive to keep our bodies in shape, there are steps we can take to prevent or delay these lapses.

The Mayo Clinic offers the following tips for keeping our brains sharp — at any age.

Stay mentally active. Do crossword puzzles.

Sudoku. Learn a new language or how to play a musical instrument. Challenge your brain.

Check medications. Ask your pharmacist if you take any medicines that may cause memory problems.

Socialize. Staying socially active reduces the risk for depression and stress, which can contribute to memory loss. So get out, make

www.mattersofhealth.org

mental challenges

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Stay physically active. Exercise increases blood flow to the brain

and reduce clutter. Keep your keys in a place where you won’t forget them.

Get plenty of rest. A lack of sleep can contribute to memory loss. So be sure to stay well rested!

Eat well. A healthy diet also helps to preserve memory. In contrast, drinking too much alcohol or not taking in enough water can damage one’s memory.

Stay physically active. Exercise increases the blood flow to the brain. If you need another reason to get up and move, here it is!

Keep chronic conditions under control.

Chronic conditions such as kidney problems, depression or thyroid issues can also damage memory, as can some medications. So stay on top of any illnesses and consult your provider if medications are causing troublesome side effects.

If you’ve tried all of these to no avail — or if you fear a loved one may be experiencing the symptoms of dementia — don’t hesitate to seek medical care.

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Challenge your brain regularly

www.mattersofhealth.org

Fighting for:

every section to be a smokefree section.

The American Lung Association is fighting for a day when we can all breathe easier. That’s why we champion smokefree public spaces and workplaces, and everyone’s right to breathe healthier air. Until that day, we are fighting for air. Join the fight at FightingForAir.org.

prevention

heart of the matter According to the Centers for Disease Control and Prevention, heart (or cardiac) disease is the leading cause of death for both men and women in the United States. It is responsible for about one in four deaths, or 610,000 lives lost annually.

Every year, about 735,000 Americans suffer a heart attack, but studies show only 27 percent of Americans recognize the major symptoms or know to call 911 when they occur. This may be why nearly half of all cardiac deaths occur outside of a hospital.

There are many kinds of heart disease, the most common of which is coronary heart disease, a disease of the arteries of the heart and their resulting complications, such as angina (chest pain, caused by reduced blood flow to the heart muscle due to blocked or narrowed arteries), atherosclerosis (thicken-

34

ing of the artery walls due to plaque) and heart attacks (when the heart’s supply of blood is stopped). The more general term for them, ischemic heart disease, refers to any condition caused by narrowing of the arteries.

Other types of heart disease include hypertensive heart disease, in which high blood pressure can overburden the heart; inflammatory heart disease, in which the heart muscle, membrane surrounding the heart or inner lining of the heart becomes inflamed; rheumatic heart disease, caused by one or more attacks of rheumatic fever, which damage the heart; congenital heart disease, when someone is born with malformations of the heart’s structure; and heart failure, a chronic condition that occurs when the heart’s muscle becomes too damaged to pump blood adequately.

While people may not always recognize www.mattersofhealth.org

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Types of cardiac disease, reducing risk factors and staying healthy after an event

BRAND NAME

LOPRESSOR (metoprolol tartrate) IS BACK!!

Individual’s pictures are models and are used for illustrative purposes only.

Approved Use Lopressor®(metoprolol tartrate) tablets can be used to treat: • high blood pressure • long-term chest pain • acute heart attack Important Safety Information Do Not Use: • To treat high blood pressure and chest pain if you also have low heart rhythm, slow heart hate, heart block, sudden heart attack, or obvious heart failure • If you have an allergy to Lopressor or any of its ingredients • If you have disorders caused by plaque build-up in your arteries such as PAD • If you have skipped heart beats or an inability of the heart to pump blood to the rest of the body • If you have consistent low blood pressure • If you have moderate-to-severe cardiac failure Risk of Severe Allergic Reaction: May require higher than usual doses of epinephrine therapy The Most Common Side Effects: Low blood pressure, chest pain, tiredness, dizziness, shortness of breath or slow heart beat, wheezing, diarrhea, rash You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/ medwatch or 1-800-FDA-1088 Please see next page for the Brief Summary of the Product Information

Available in 50mg tablets* – and – 100mg tablets* Call 1-866-9VALIDUS for more information or help in obtaining Lopressor. *

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PATIENT INSTRUCTIONS: Present this coupon, your insurance card, and your prescription for Lopressor® (metoprolol tartrate) Tablets to the pharmacist to receive up to $25 off your out-of-pocket expense. Keep this coupon, which can be used for your first prescription plus 2 refills. For additional savings, please download a new coupon from www.validuspharma.com. Please read IMPORTANT PRODUCT INFORMATION by visiting www.validuspharma.com. Please find program restrictions and conditions on the back of this coupon.

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on each of your next 3 prescriptions Decorative Element: PMS 7461 C 60% Breakdown: C=46.8 M= 16.8 Y=0 K=0 Breakdown: R=146 G= 188 B=229 “Validus” Type Size: 64 pt Typeface: Optima Regular PMS #: 7461 C Breakdown: C=78 M= 28 Y=0 K=0 Breakdown: R=13 G= 147 B=210 “Pharmaceuticals” Type Size: 16 pt Typeface: Optima Bold PMS #: 7461 C Breakdown: C=78 M= 28 Y=0 K=0 Breakdown: R=13 G= 147 B=210 Total Logo Dimensions: 2.7171 x 1.3145''

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SUMMARY OF INFORMATION ABOUT LOPRESSOR® (metoprolol tartrate) Tablets What is this drug used for: be necessary to lower the dose of Lopressor • Lopressor® (metoprolol tartrate) tablets or discontinue therapy. are used for the treatment of high Reduced Blood Supply to Heart: Lopressor blood pressure, either alone or in should not be abruptly discontinued if combination with other treatments you have damaged blood vessels due to for high blood pressure. coronary artery disease; Lopressor dosage • Lopressor is also used in the long-term should be gradually reduced over a period treatment of chest pain, and in the of 1-2 weeks, and may be prescribed again treatment of definite or suspected if chest pains or heart failure develop. heart attack.

Slow Heart Beat: Heart block and heart Do not use Lopressor: If you are attack can occur with the use of Lopressor. using Lopressor for the treatment of Use During Major Surgery: If Lopressor is high blood pressure and chest pain, administered frequently it should not be do not use Lopressor if you also have withdrawn prior to major surgery. low heart rhythm, slow heart rate, Increased Asthma and COPD: If you heart block, sudden heart attack, or have asthma, COPD, or other breathing obvious heart failure. problems, Lopressor should only be used Do not use if you have: if you do not respond to other treatments.

• An allergy to Lopressor, any of its Diabetes and Hypoglycemia: Beta blockers ingredients, or any allergies to other may mask abnormally rapid heart rate beta blockers that may occur with diabetes or low • Severe disorders caused by plaque blood sugar. build-up in your arteries, such as Adrenal Tumor: If you have a type Peripheral Artery Disease of adrenal tumor known as a • Consistent low blood pressure pheochromocytoma, Lopressor should • Moderate-to-severe heart failure or be given in combination with an alpha congestive heart failure blocker, and only after the alpha blocker If you are using Lopressor for the treatment has been initiated. of definite or suspected heart attack, do Overactive Thyroid: Lopressor may mask not use Lopressor if you also have slow signs of an overactive thyroid. heart beat or abnormal heart beat (such Risk of Severe Allergic Reaction: If you as skipped or irregular heart beat), or an have a history of severe allergic reactions, inability of the heart to pump blood to the you may have a severe allergic reaction rest of the body to Lopressor and may need higher-thanWarnings: Lopressor may have different normal doses of epinephrine therapy. effects depending on your condition Ask a healthcare provider before you use being treated.

Lopressor if you are pregnant, nursing, Heart Failure: Lopressor may cause heart or seeking to become pregnant. failure and the inability of the heart to Lopressor has been approved for adult pump blood correctly. If this occurs, it may use only.

Ask a health care provider before use if you are on any other prescription drugs.

Lopressor may cause interactions with the following drugs: • Catecholamine-depleting drugs • Hydralazine • Digitalis glycosides and beta blockers • Alpha-adrenergic agents • Calcium channel blockers • Ergot alkaloid • CYP2D6 inhibitors • Dipyridamole When using this product for high blood pressure or chest pain you may have: Tiredness, dizziness and depression, diarrhea, rash, shortness of breath, or slow heart rate.

When using this product for treatment of definite or suspected heart attack you may have: Heart failure, low blood pressure, slow heart rate, or slow or irregular heart beat.

The risk information provided here is not comprehensive. To learn more, talk about Lopressor with your healthcare provider or pharmacist.

How to get more information: • Visit http://validuspharma.com/ lopressor/wp-content/uploads/ sites/4/2014/06/Lopressor_PI.pdf to obtain the FDA-approved package labeling • 1-866-9VALIDUS • info@validuspharma.com

©2015 Validus Pharmaceuticals LLC LOP-060-15

ELIGIBILITY REQUIREMENTS

Pharmacist: Please submit the claim to the Primary Third Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer as a copay-only billing, using a valid Other Coverage Code indication. Therapy First Plus has been authorized to reimburse you up to $25 plus a handling fee for processing this coupon when accompanied by a prescription. Cannot be combined with any other offers. For questions regarding claims processing, please call the Help Desk at 1-800-422-5604. Offer good only in the USA. Expires 05/31/2016.

Dear Patient: Please follow the patient instructions in front of the coupon to receive full benefits. This offer is not valid where prohibited by law. [No discounts will be allowed for prescription cost paid in whole or in part by insurance plans or purchased under any federal healthcare program, including Medicare or Medicaid, TRICARE, federal, or state programs. Patients may use this coupon if they are paying the full cash price and no claim is submitted to Medicare.

This coupon is not valid in Massachusetts.] Validus Pharmaceuticals reserves the right to rescind, revoke, or amend this offer without notice. You understand and agree to comply with the terms and conditions of this offer as set forth above.

For Product and Safety Information please visit www.validuspharma.com.

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04/15

prevention

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Americans are becoming more familiar with risk factors for heart disease

the signs and symptoms of heart disease, Americans are becoming more familiar with factors that put them at risk for developing it: high blood pressure, high cholesterol, smoking, diabetes and prediabetes, being overweight or obese, being sedentary, having a family history of early heart disease, not eating healthfully and getting older.

While nothing can be done to prevent a genetic predisposition to risk, there is much people can do to reduce their other risk factors, says James T. Willerson, MD, President of the Texas Heart Institute. “Don’t smoke,” he says. “Be on a good, low-cholesterol diet, manage your weight and be sure your blood pressure is well-controlled.”

There are many medications for lowering blood pressure if it’s too high. Diuretics help rid the body of excess sodium and water.

Beta-blockers reduce the heart rate and how hard the heart is working. ACE inhibitors help blood vessels relax and open up, thereby lowering blood pressure. These are just some of the medications available.

Dr. Willerson also recommends using diet, exercise and, if necessary, medication to keep low-density lipoprotein (LDL, the bad cholesterol) under control. LDL, the most important type of cholesterol for predicting heart disease, www.mattersofhealth.org

should be kept under 100 mg/dL. People with persistently high levels of LDL cholesterol are often given drugs called statins to bring those levels into the target range.

Another type of heart problem that occurs as people age is atrial fibrillation, or afib, an irregular heartbeat that can lead to blood clots, stroke, heart failure and other complications.

When this occurs, it feels as if the heart is skipping beats or banging against the chest wall, and can cause nausea or light-headedness.

If sustained over several weeks, a very rapid heartbeat can injure the heart, says Dr. Willerson, so arrhythmia medications, such as amiodarone and beta-blockers, are used to bring the heartbeat back to a slower, regular rhythm. To prevent blood clots, Dr. Willerson also gives patients blood thinners.

And once a patient has recovered? What does life after a cardiac episode look like?

“It means correcting all the possible contributions that led to that heart attack or stroke,” says Dr. Willerson. “Lowering your blood pressure, if it’s been uncontrolled. Losing weight. Keeping LDL as far under 100 mg/ dL as possible. It means taking aspirin and other medications to prevent blood from clotting. If you’ve had a heart attack, you may need to undergo a procedure to have your arteries unblocked. It means never smoking, not taking drugs, getting rest and avoiding stress.”

“All of these are important,” he says.

Many medications are available for those at risk for heart disease or recovering from a cardiac event

A FLU SHOT CREATED DIFFERENTLY.

FLUCELVAX® (Influenza Vaccine)—rethinking flu protection.

FLUCELVAX was the first FDA-approved influenza vaccine made with modern, cell-culture technology1 • Contains same flu strains as trivalent vaccines made in chicken eggs2 • Manufacturing technology eliminates the need for the use of antibiotics2 • Approved for adults aged 18 and older2 • Offers similar efficacy and safety profiles as traditionally manufactured egg-based vaccines2 This flu season, think FLUCELVAX. Want to learn more? Contact us at: 855-358-8966 cs.flu@novartis.com FLUCELVAX.com

Indication and Usage for FLUCELVAX® (Influenza Vaccine) FLUCELVAX is indicated for active immunization for the prevention of influenza disease caused by influenza virus subtypes A and type B contained in the vaccine. FLUCELVAX is approved for use in persons 18 years of age and older.

Important Safety Information Contraindication • Do not administer FLUCELVAX to anyone with a history of severe allergic reaction (e.g. anaphylaxis) to any component of the vaccine.

Warnings & Precautions • Guillain-Barré Syndrome (GBS): If GBS has occurred within 6 weeks of receipt of a prior influenza vaccine, the decision to give FLUCELVAX should be based on careful consideration of the potential benefits and risks.

• Latex: The tip caps of the pre-filled syringes may contain natural rubber latex which may cause allergic reactions in latex-sensitive individuals.

• Preventing and Managing Allergic Reactions: Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine.

• Syncope: Syncope (fainting) can occur in association with administration of injectable vaccines, including FLUCELVAX. Syncope can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements. Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope by maintaining a supine or Trendelenburg position.

• Altered Immunocompetence: After vaccination with FLUCELVAX, immunocompromised individuals, including those receiving immunosuppressive therapy, may have a reduced immune response.

• Limitations of Vaccine Effectiveness: Vaccination with FLUCELVAX may not protect all vaccine recipients against influenza disease.

Most Common Adverse Reactions • The most common (≥10%) solicited adverse reactions occurring in adults 18-64 years of age within 7 days of vaccination with FLUCELVAX were pain at the injection site, erythema at the injection site, headache, fatigue, myalgia and malaise. The most common (≥10%) solicited adverse reactions occurring in adults ≥65 years of age within 7 days of vaccination were erythema at the injection site, fatigue, headache and malaise.

Please see adjacent Brief Summary of Prescribing Information for FLUCELVAX. References: 1. FDA approves first seasonal influenza vaccine manufactured using cell culture technology [news release]. Silver Spring, MD: U.S. Food and Drug Administration; November 20, 2012.

2. FLUCELVAX [package insert]. Cambridge, MA: Novartis Vaccines and Diagnostics, Inc.; 2015.

Influenza Vaccine RETHINK FLU

© 2015 NVS Influenza Vaccines

Printed in USA

August 2015

GMCC-464_2015-07-21

FLUCELVAX (Influenza Virus Vaccine) Suspension for Intramuscular Injection 2015-2016 Formula Initial U.S. Approval: 2012 BRIEF SUMMARY: See package insert for full prescribing information.

1 INDICATIONS AND USAGE FLUCELVAX® is an inactivated vaccine indicated for active immunization for the prevention of influenza disease caused by influenza virus subtypes A and type B contained in the vaccine.

FLUCELVAX is approved for use in persons 18 years of age and older.

4 CONTRAINDICATIONS Do not administer FLUCELVAX to anyone with a history of severe allergic reaction (e.g. anaphylaxis) to any component of the vaccine [see Description (11) in the full prescribing information].

5 WARNINGS AND PRECAUTIONS 5.1 Guillain-Barré Syndrome The 1976 swine influenza vaccine was associated with an elevated risk of Guillain-Barré syndrome (GBS).

Evidence for a causal relation of GBS with other influenza vaccines is inconclusive; if an excess risk exists, it is probably slightly more than 1 additional case per 1 million persons vaccinated. If GBS has occurred within 6 weeks of receipt of a prior influenza vaccine, the decision to give FLUCELVAX should be based on careful consideration of the potential benefits and risks.

5.2 Latex The tip caps of the pre-filled syringes may contain natural rubber latex which may cause allergic reactions in latex-sensitive individuals. [see Description (11) in the full prescribing information] 5.3 Preventing and Managing Allergic Reactions Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine.

5.4 Syncope Syncope (fainting) can occur in association with administration of injectable vaccines, including Flucelvax.

Syncope can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements. Procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope by maintaining a supine or Trendelenburg position.

5.5 Altered Immunocompetence After vaccination with FLUCELVAX, immunocompromised individuals, including those receiving immunosuppressive therapy, may have a reduced immune response. [See Concurrent use with Immunosuppresive Therapies (7.2)] 5.6 Limitations of Vaccine Effectiveness Vaccination with FLUCELVAX may not protect all vaccine recipients against influenza disease.

6 ADVERSE REACTIONS Overall, the most common (≥10 %) solicited adverse reactions occurring in adults 18 to 64 years of age within 7 days of vaccination with FLUCELVAX were pain at the injection site (28%), erythema at the injection site (13%), headache (16%), fatigue (12%), myalgia (11%) and malaise (10%). The most common (≥10%) solicited adverse reactions occurring in adults 65 years of age and older within 7 days of vaccination were erythema at the injection site (10%), fatigue (11%), headache (10%) and malaise (10%).

6.1 Clinical Trials Experience Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a vaccine cannot be directly compared to rates in clinical studies of another vaccine, and may not reflect rates observed in clinical practice.

The safety of FLUCELVAX was evaluated in seven randomized, controlled studies conducted in the US, Europe and New Zealand. The safety population includes 5709 adults 18 through 64 years of age and 572 adults 65 years of age and older administered FLUCELVAX.

In all studies, solicited local injection site and systemic adverse reactions were collected from subjects who completed a symptom diary card for 7 days following vaccination.

One of the 7 clinical trials (Study 1) was a randomized, double-blind, placebo-controlled study that evaluated three vaccines including: FLUCELVAX (N=3813), placebo (N=3894) and another influenza vaccine. The population was 18 through 49 years of age (mean 32.8 years), 55% were female and 84% were Caucasian. Solicited adverse reactions for FLUCELVAX and placebo are summarized in Table 1.

Table 1: Solicited Adverse Reactions in the Safety Population Reported Within 7 Days of Vaccination in Study 1* Adults 18 through 49 Years Percentages (%) FLUCELVAX Placebo N=3813 N=3894

B:7.625”

T:7.375”

S:6.875”

Local adverse reactions Injection site pain Erythema Induration Swelling Ecchymosis Systemic adverse reactions Headache Fatigue Myalgia Malaise

Chills Arthralgia Sweating Fever (≥38° C) * NCT00630331

30 13 6 6 4

10 10 3 3 4

15 10 12 8

15 10 7 6

6 3 3 1

6 3 3 <1

Study 2 was a randomized, double-blind study comparing FLUCELVAX (N=1330) to a U.S. licensed inactivated influenza vaccine (N=1324) in adults 18 years of age or older. The mean age was 43.7 years of age for adults 18 to 64 years of age and 71.3 years of age for adults 65 years of age and older; 57% of subjects were female and 100% were Caucasian. The safety data observed are summarized in Table 2.

Table 2: Solicited Adverse Reactions in the Safety Population Reported Within 7 Days of Vaccination in Study 2* Adults 18 through 64 Years Adults 65 Years of Age and Older Percentages (%) FLUCELVAX Comparator** FLUCELVAX Comparator** N=821 N=841 N=509 N=483 Local adverse reactions Injection site pain Erythema Induration

20 14 6

15 15 6

8 10 5

4 11 4 (continued)

Table 2: Solicited Adverse Reactions in the Safety Population Reported Within 7 Days of Vaccination in Study 2* Adults 18 through 64 Years Adults 65 Years of Age and Older Percentages (%) FLUCELVAX Comparator** FLUCELVAX Comparator** N=821 N=841 N=509 N=483 Local adverse reactions Swelling Ecchymosis Systemic adverse reactions Headache Fatigue Myalgia Malaise Chills Arthralgia Sweating Fever (â&#x2030;Ľ38° C) * NCT00492063

4 3

4 3

4 4

2 4

12 11 7 11 4 5 5 1

11 11 8 11 4 5 4 1

10 11 6 10 3 6 7 <1

11 13 8 11 4 7 8 1

**AGRIFLU Unsolicited adverse events, including serious adverse events (SAEs), were collected for 21 days after vaccination in five studies. In adults 18 through 64 years of age (N=4038), 13% (284 out of 2266) of subjects who received FLUCELVAX and 13% (224 out of 1772) of subjects who received a U.S. licensed inactivated influenza vaccine reported at least one unsolicited adverse event within 21 days after vaccination. The most commonly reported unsolicited adverse events after FLUCELVAX vaccination were rhinitis (3%), headache (2%) and oropharyngeal pain (2%). In adults 65 years of age and older (N=2013), 11% (110 out of 997) of subjects who received FLUCELVAX and 9% (95 out of 1016) of subjects who received a U.S. licensed comparator vaccine reported at least one unsolicited adverse event within 21 days after vaccination. Within this age group, the most commonly reported unsolicited adverse events after FLUCELVAX vaccination were rhinitis (3%) and cough (2%). In both age groups, all other unsolicited adverse events were reported in 1% or less of subjects.

In the seven controlled studies of FLUCELVAX, the rates of serious adverse events were collected for 21 days in two studies and for 6 to 9 months in five studies. The rates (in all seven controlled studies) of serious adverse events among adults 18 through 64 years of age were 1% (84 out of 6388) in groups that received FLUCELVAX, 1% (55 out of 5745) in groups that received US licensed comparator vaccines and 1% (37 out of 3894) in groups that received placebo. The rates of serious adverse events among adults 65 years of age and older were 4% (36 out of 997) in groups that received FLUCELVAX and 4% (44 out of 1016) in groups that received a US licensed comparator vaccine.

6.2 Postmarketing Experience The following additional adverse events have been identified during post-approval use of FLUCELVAX. Because these events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to the vaccine.

Nervous systems disorders: Syncope, Presyncope, General disorders and administration site conditions: Extensive swelling of injected limb.

Immune system disorders: Anaphylactic reaction, angioedema.

Skin and subcutaneous tissue disorders: Generalized skin reactions including pruritus, urticarial or non-specific rash.

7 DRUG INTERACTIONS 7.1 Concomitant use with Other Vaccines No data are available to assess the concomitant administration of FLUCELVAX with other vaccines.

If FLUCELVAX is to be given at the same time as another injectable vaccine(s), the vaccine(s) should always be administered at different injection sites. Do not mix FLUCELVAX with any other vaccine in the same syringe or vial.

7.2 Concurrent use with Immunosuppressive Therapies Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses) may reduce the immune response to FLUCELVAX. [See Altered Immunocompetence (5.4)] 8 USE IN SPECIFIC POPULATIONS 8.1 Pregnancy Pregnancy Category B: A reproductive and developmental toxicity study has been performed in rabbits with a dose level that was approximately 15 times the human dose based on body weight.

The study revealed no evidence of impaired female fertility or harm to the fetus due to FLUCELVAX. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this vaccine should be used during pregnancy only if clearly needed.

In a reproductive and developmental toxicity study, the effect of FLUCELVAX on embryo-fetal and postnatal development was evaluated in pregnant rabbits. Animals were administered FLUCELVAX by intramuscular injection 3 times prior to gestation, during the period of organogenesis (gestation day 7) and later in pregnancy (gestation day 20), 0.5 mL/rabbit/occasion (approximately 15-fold excess relative to the projected human dose on a body weight basis). No adverse effects on mating, female fertility, pregnancy, embryo-fetal development, or post-natal development were observed. There were no vaccinerelated fetal malformations or other evidence of teratogenesis.

8.3 Nursing Mothers FLUCELVAX has not been evaluated in nursing mothers. It is not known whether FLUCELVAX is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when FLUCELVAX is administered to a nursing woman.

8.4 Pediatric Use Safety and effectiveness have not been established in children less than 18 years of age.

8.5 Geriatric Use Of the total number of subjects who received one dose of FLUCELVAX in clinical studies and included in the safety population (6711), 9% (572) were 65 years of age and older and 2% (140) were 75 years or older.

The majority of local and general adverse events were reported less frequently in adults 65 years of age and older as compared to adults <65 years of age. [See Adverse Reactions (6.1)] Antibody responses to FLUCELVAX were lower in the geriatric (adults 65 years and older) population than in younger subjects. [see Clinical Studies (14.3) in the full prescribing information] FLUCELVAXÂŽ is a registered trademark of Novartis Vaccines and Diagnostics, Inc. Manufactured by: Novartis Vaccines and Diagnostics, Inc. 350 Massachusetts Avenue Cambridge, MA USA 02139 1-877-683-4732

staying organized

managing medications As you get older, especially if you are living with chronic conditions, you may need to take a variety of over-the-counter (OTC) and prescription medications, along with vitamins and supplements.

The good news is that all these pills can improve your health and make you more comfortable. The bad news? It can get increasingly difficult to keep track of them all, and the chances of dangerous interactions and overdoses increase with every new pill — even the vitamins.

Here are simple ways to help keep it all straight and protect yourself and your family.

• Make a list of all of your medications and their current dosages. Keep a copy in your purse or wallet and one in the home where it is easily accessible to other family members in case of an emergency. Include OTC products, vitamins and other supplements. Give a copy

44

to a loved one or a trusted neighbor.

• Update the list whenever there is a new medication or dosage change.

• Get all of your prescriptions filled at the same pharmacy, and talk to your pharmacist (as well as your doctors) about any potential adverse interactions or side effects.

• Store medications in a safe place, away from children, in their original containers. Keep them in a dry, cool place as moisture and the sun can affect potency.

• Never change the dosage without consulting your healthcare provider.

• Having trouble remembering which pills to take when? Use a pillbox labeled with the days of the week and different times of day. Refill it once a week on the same day. If you forget to take a pill, you will know because it will still be in the box.

• Set an alarm on a watch or phone if you have www.mattersofhealth.org

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Keeping track of when and how to take your pills is easier than you think

staying organized

Talk to your pharmacist about any potential reactions or other concerns you may have about your medicines

trouble remembering to take your medications at a certain time of day.

• Pay attention to which medications must be taken with food or any other special instructions.

• Some medications may make you more susceptible to the sun’s harmful rays. Read all directions carefully and make a note on your

medication list of special circumstances.

• Finally, when disposing of unused medication, the U.S. Food and Drug Administration recommends mixing medication with an unpalatable substance, such as coffee grounds or cat litter, and sealing in a plastic bag before tossing into the trash.

Most people taking multiple prescription medications didn’t get started on all of them at the same time. They started with one or two, then added another, then another. Often, these prescriptions are due to be refilled at different times of the month.

Did you know that you can ask your pharmacist to help arrange it so that all your medications need refills at the same time so you can pick them up all at one time? Well, you can, and most pharmacies will gladly do it.

In addition to the convenience factor, studies have shown people do a better job of taking their medicines as prescribed by their doctor if they are

46

enrolled in this type of program that pharmacists refer to as “medication synchronization.”

Picking up all your refills on one day also gives you and your pharmacist a good opportunity to discuss any questions or concerns you may have about your medicines. Are they working as expected? Are you experiencing any side effects that the pharmacist could help you avoid?

One more thought. Getting refills all at once can be for your whole household; it doesn’t have to be for just one person. Don’t be afraid to ask your pharmacist to help you simplify your life by simplifying your medications!

www.mattersofhealth.org

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Refill All Your Medicines Together

Community

pharmacists are a

valuable

& trusted part of your

health care

team.

Talk to your pharmacist about any of your medications, both prescription and over-the-counter medications.

Pharmacists are medication experts, so donâ&#x20AC;&#x2122;t hesitate to take advantage of our knowledgeâ&#x20AC;&#x201D;think of us as your one-stop resource for answers.

In addition, your pharmacist can offer insights related to managing diabetes, heart disease, chronic conditions, and many other issues affecting your well-being.

Your support of your local pharmacy helps us contribute more to our community. Thank you.

www.ncpanet.org

awareness

just the facts What you need to know about hepatitis C If you were born between 1945 and 1965, the Centers for Disease Control and Prevention (CDC) has some advice for you: Get tested for hepatitis C. “Why boomers?” Several reasons. First, according to the CDC, about 75 percent of Americans who have hepatitis C are baby boomers. In fact, this group is five times as likely as others to have the disease, which is caused by a virus that infects the liver and can lead to cirrhosis, with complications such as bleeding, jaundice, infections or liver cancer.

While it’s unclear why this particular demographic has such high rates of hepatitis C, it’s believed that most boomers became infected during the 1970s and 1980s, when rates were particularly high. Hepatitis C is spread through contact with blood from another person who is infected, and can live in the body for years without any noticeable symptoms, so someone who was infected during those years still might not realize it.

Some of the ways the disease was spread during those decades included sharing needles while taking drugs (even if only one time), having sex with someone who was infected, or receiving contaminated blood and blood products, which weren’t routinely screened until years later.

Getting tested is particularly important because the disease can cause damage even though an infected person might not have any symptoms. According to the CDC, liver disease, liver cancer and deaths from hepatitis C are on the rise. But often, it’s not until tests show some kind of damage to the liver that people find out that they have had the disease for

48

www.mattersofhealth.org

Baby boomers are not the only people at high risk for hepatitis C

decades. Hepatitis C is usually chronic (75 to 85 percent of the time), meaning the person has had it for six months or more.

Also at Risk Baby boomers aren’t the only people at high risk for hepatitis C, which affects roughly 3 to 4 million Americans. According to the American Liver Foundation, those at high risk also include anyone who: • Got tattoos or body piercings in an unclean environment, using equipment that was not sterile.

• Shared needles to inject drugs or straws to inhale them.

• Received a blood transfusion or organ transplant before 1992.

• Received a blood product for clotting problems made before 1987.

• Needed to have blood filtered by a machine for long periods of time (hemodialysis) due to kidney failure.

• Was born to a mother with hepatitis C. 70 to 80 percent of those with chronic hepatitis C will not show symptoms

• Had unprotected sex with multiple partners.

• Had a sexually transmitted disease.

• Has tested positive for HIV. • Came into contact with infected blood or needles, e.g., healthcare workers.

Symptoms Though 70 to 80 percent of those with chronic hepatitis C will not show symptoms, some people will notice signs of infection within several months of exposure. These can include flulike symptoms, such as fatigue, sore muscles, joint pain, fever, stomach pain, nausea or poor appetite. You may also have itchy skin, dark urine or notice a yellowing of the skin and eyes, called jaundice.

Treatment for hepatitis C infection is complicated, expensive and doesn’t result in a cure for every patient.

Newer drugs may cause fewer side effects, and adherence to dosing instructions is important for a chance of curing the infection.

If you have hepatitis C, be sure to consult your physician about your treatment options. www.mattersofhealth.org

49

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Treatment

be proactive

don’t get sick!

With summer slipping away, it’s time to think about protecting yourself from the kinds of illnesses that seem to emerge more frequently during the cooler months, when people are more likely to be grouped together indoors, making it easier to pass around germs.

Respiratory infections can range from colds, which are most common and least dangerous, to the flu, which is far less common but can result in far more serious complications. The National Institutes of Health (NIH) estimate 5 to 20 percent of Americans get the flu each year, resulting in 200,000 hospitalizations and up to 49,000 deaths.

Get Your Shots Ever since 2010, the Centers for Disease Control and Prevention (CDC) has recommended

50

yearly flu vaccines for everyone over the age of six months and those at high risk of serious flu complications. Complications can include ear infections, sinus infections, pneumonia and bronchitis, and can lead to hospitalization and even death. Those at high risk include children younger than five, pregnant women, adults older than 65 and residents of nursing homes and other long-term-care facilities, which may experience widespread outbreaks of the disease.

People who have other medical conditions, such as asthma or heart disease, or who have a weakened immune system are also at higher risk for serious complications from the flu.

You can get a flu shot at your doctor’s office or at your local pharmacy. Seniors www.mattersofhealth.org

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How to avoid colds & flu

Nexafed® Benefits Communities with Meth Abuse Problems Cold, sinus and allergy products made with pseudoephedrine (PSE) are highly effective nasal decongestants for people who need them.

But these products are also in demand for the clandestine production of methamphetamine, a highly addictive, illicit drug abused by an estimated 595,000 Americans each month.1 An economic analysis notes that meth abuse cost taxpayers up to $48.3 billion annually in 2005, including costs associated with the burden of addiction, premature death, drug treatment, crime, health care and child endangerment.2 A growing number of pharmacies are stocking meth-resistant PSE products, which offer the same nasal and sinus congestion relief. By asking for meth-resistant PSE products, consumers can be a part of the solution to meth abuse in their community.

Nexafed® is a next-generation PSE brand using Acura Pharmaceuticals’ meth-deterring IMPEDE® technology. IMPEDE® is a combination of safe ingredients that significantly disrupt the conversion of PSE into methamphetamine, making Nexefed® unsuitable for meth cooks.

In 2014, pharmacies in West Virginia voluntarily replaced all single ingredient, immediate-release PSE products with meth-resistant PSE alternatives such as Nexefed®. The impact was immediate and sustained, with law enforcement agencies reporting a 40 percent drop in meth lab seizures from 2013 to 2014 and another 20 percent drop in the first half of 2015.3 1 ZĞƐƵůƚƐ ĨƌŽŵ ƚŚĞ ϮϬϭϯ EĂƟŽŶĂů ^ƵƌǀĞLJ ŽŶ ƌƵŐ hƐĞ ĂŶĚ ,ĞĂůƚŚ͗ ^ƵŵŵĂƌLJ ŽĨ EĂƟŽŶĂů &ŝŶĚŝŶŐƐ͘ ĐĐĞƐƐĞĚ ƵŐƵƐƚ ϭϵ͕ ϮϬϭϱ͘ ŚƩƉ͗ͬ​ͬǁǁǁ͘ƐĂŵŚƐĂ͘ŐŽǀͬ ĚĂƚĂͬƐŝƚĞƐͬĚĞĨĂƵůƚͬĮůĞƐͬE^ h,ƌĞƐƵůƚƐW &t,dD>ϮϬϭϯͬ tĞďͬE^ h,ƌĞƐƵůƚƐϮϬϭϯ͘ƉĚĨ 2 dŚĞ ĐŽŶŽŵŝĐ ŽƐƚ ŽĨ DĞƚŚĂŵƉŚĞƚĂŵŝŶĞ hƐĞ ŝŶ ƚŚĞ hŶŝƚĞĚ ^ƚĂƚĞƐ͕ ϮϬϬϱ͘ ĐĐĞƐƐĞĚ ƵŐƵƐƚ ϭϵ͕ ϮϬϭϱ͘ ŚƩƉ͗ͬ​ͬǁǁǁ͘ƌĂŶĚ͘ŽƌŐͬƉƵďƐͬŵŽŶŽŐƌĂƉŚƐͬ D'ϴϮϵ͘Śƚŵů 3 LJĞƌ͕ ƌŝĐ͕ DĞƚŚ ůĂďƐ ŝŶ ĚĞĐůŝŶĞ ŝŶ ts͕ ŚĂƌůĞƐƚŽŶ 'ĂnjĞƩĞͲDĂŝů͘ ĐĐĞƐƐĞĚ ƵŐƵƐƚ ϭϵ͕ ϮϬϭϱ͘ ŚƩƉ͗ͬ​ͬǁǁǁ͘ǁǀŐĂnjĞƩĞŵĂŝů͘ĐŽŵͬĂƌƟĐůĞͬϮϬϭϱϬϳϬϰͬ ' ϬϭͬϭϱϬϳϬϵϴϬϳ

“Acura Pharmaceuticals is committed to addressing the methamphetamine problem through its products,” said Bob Jones, CEO of Acura Pharmaceuticals. “The public health strategy of stocking meth-resistant PSE products has made a real difference in West Virginia, and we’re sharing the story with other states with severe meth lab problems,” he said.

By asking your pharmacist for meth-resistant PSE products, you can help fight meth in your community. Learn more about Nexafed® at https:// www.nexafed.com and share your thoughts on the Join the Fight Against Meth Facebook page at O[[WZ! ^^^ MHJLIVVR JVT QVPUÄNO[TL[O

be proactive Avoid close contact with people you know are sick

and those with weakened immune systems should also get a pneumococcal vaccine to prevent against pneumonia.

Ward Off Germs Here are some simple steps the CDC recommends to help prevent infectious disease: • Avoid close contact with people you know are sick. If you’re sick, try limiting your contact with others to avoid infecting anyone else.

• If you are sick with flulike symptoms, stay home and limit contact with others until your fever has been gone a full 24 hours.

• Cover your nose and mouth with a tissue when you cough or sneeze, and then throw the tissue in the trash.

• Wash your hands frequently, using soap and water.

• Avoid touching your eyes, nose and mouth, where germs are spread.

If you have flulike symptoms, stay home until your fever has been gone a full 24 hours

• Clean and disinfect objects and surfaces that come into contact with germs (e.g., kitchen and bathroom counters and door knobs, keyboards and phones).

Cold Remedies While there’s still no cure for the common cold, there are remedies that have been shown to reduce the length and severity of this bothersome illness.

Zinc According to the NIH, studies have shown that taking zinc orally, if done within 24 hours of the onset of symptoms, can reduce the length and severity of a cold. However, there are side effects, such as nausea and gastrointestinal problems, and zinc can interact negatively with some prescription medications.

Echinacea and Probiotics There is no scientific evidence to support taking echinacea to treat or prevent colds, and the evidence supporting probiotics is weak, according to NIH.

54

www.mattersofhealth.org

ISTOCK.COM

Vitamin C The CDC reports that taking vitamin C regularly can also slightly reduce cold symptoms, but will not prevent colds. Taking it after symptoms appear does no good.

N EW

“My friends all hate their cell phones… I love mine!”

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Say good-bye to everything you hate about cell phones. Say hello to Jitterbug.

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Enough talk. Isn’t it time you found out more about the cell phone that’s changing all the rules? Call now, Jitterbug product experts are standing by.

IMPORTANT CONSUMER INFORMATION: WEMTALK offer valid on 400 minute plan and applies to new GreatCall customers only. Offer valid until plan is changed or cancelled. Jitterbug is owned by GreatCall, Inc.Your invoices will come from GreatCall. All rate plans and services require the purchase of a Jitterbug phone and a one-time set up fee of $35. Coverage and service is not available everywhere. Other charges and restrictions may apply. Screen images simulated. There are no additional fees to call GreatCall’s U.S. Based Customer Service. However, for calls to an Operator in which a service is completed, minutes will be deducted from your monthly balance equal to the length of the call and any call connected by the Operator, plus an additional 5 minutes. Monthly minutes carry over and are available for 60 days. If you exceed the minute balance on your account, you will be billed at 35¢ for each minute used over the balance. Monthly rate plans do not include government taxes or assessment surcharges. Prices and fees subject to change. We will refund the full price of the GreatCall phone and the activation fee (or set-up fee) if it is returned within 30 days of purchase in like-new condition. We will also refund your first monthly service charge if you have less than 30 minutes of usage. If you have more than 30 minutes of usage, a per minute charge of 35 cents will be deducted from your refund for each minute over 30 minutes.You will be charged a $10 restocking fee.The shipping charges are not refundable. Jitterbug and GreatCall are registered trademarks of GreatCall, Inc. Samsung is a registered trademark of Samsung Electronics Co., Ltd. ©2015 Samsung Electronics America, LLC. ©2015 GreatCall, Inc. ©2015 firstSTREET for Boomers and Beyond, Inc.

Brief Summary of Important Risk Information NAMZARIC [nam-ZAIR-ick] (memantine hydrochloride extended-release and donepezil hydrochloride) capsules This information does not take the place of talking to your healthcare provider about your medical condition or your treatment.

What is NAMZARIC? NAMZARIC is a prescription medicine used to treat patients with moderate to severe Alzheimer’s disease. NAMZARIC contains 2 medicines, memantine HCl and donepezil HCl. NAMZARIC is for people who are currently taking and can continue to take certain doses of memantine HCl and donepezil HCl. Who should not take NAMZARIC? NAMZARIC should not be taken by anyone who is allergic to memantine HCl, donepezil HCl, medicines that contain piperidines, or any of the ingredients in NAMZARIC.

B:11.125”

S:9.5”

T:10.5”

What should I discuss with the healthcare provider before taking NAMZARIC? Before starting NAMZARIC, talk to the healthcare provider about all your past and present medical conditions, including: • heart problems including an irregular, slow, or fast heartbeat • asthma or lung problems • seizures • stomach ulcers • liver, kidney, or bladder problems • surgical, dental, or other medical procedures scheduled when anesthesia may be used Tell the healthcare provider about all the medicines you are taking, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What are the possible side effects of NAMZARIC? NAMZARIC may cause serious side effects, including: • muscle problems if you need anesthesia • slow heartbeat and fainting. This happens more often in people with heart problems. Call the doctor right away if the patient faints while taking NAMZARIC. • more stomach acid. This raises the chance of ulcers and bleeding especially when taking NAMZARIC. The risk is higher for patients who had ulcers, or take aspirin or other NSAIDs. • nausea and vomiting • difficulty passing urine • seizures • worsening of lung problems in people with asthma or other lung disease.

The most common side effects in patients taking memantine HCl include: headache, diarrhea, and dizziness. The most common side effects in patients taking donepezil include: diarrhea, not wanting to eat (anorexia), and bruising.

These are not all the possible side effects of NAMZARIC. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088.

How should I take NAMZARIC? • Take NAMZARIC exactly as your doctor tells you to take it.

• Do not change your dose or stop taking NAMZARIC without talking to your doctor.

• Take NAMZARIC by mouth 1 time each evening before going to bed, with or without food.

• NAMZARIC capsules may be opened and sprinkled on applesauce before swallowing. Sprinkle all of the medicine in the capsule on the applesauce. Do not divide the dose.

• If you do not open and sprinkle NAMZARIC capsules on applesauce, the NAMZARIC capsules must be swallowed whole. Do not divide, chew, or crush NAMZARIC capsules.

• If you miss a dose take NAMZARIC at your next scheduled dose. Do not take 2 doses of NAMZARIC at the same time.

• Do not use any NAMZARIC capsules that are damaged or show signs of tampering.

What if I take more NAMZARIC capsules than I should?

If you take too much NAMZARIC, call your doctor or Poison control center at 1-800-222-1222, or go to the nearest hospital emergency room right away.

What other information should I be aware of?

• The use of NAMZARIC in children is not recommended.

• You should not breast-feed during treatment with NAMZARIC. • Tell your healthcare provider if you are pregnant or planning to become pregnant.

This section summarizes the most important information about NAMZARIC. Talk to your healthcare provider for more information.

To learn more, go to NAMZARIC.com or call 1-800-678-1605.

Please also see full Prescribing Information at NAMZARIC.com.

Manufactured by: Forest Laboratories Ireland Ltd Manufactured for: Forest Pharmaceuticals, Inc. | Subsidiary of Forest Laboratories, LLC. Licensed from Merz Pharma GmbH & Co. KGaA and Adamas Pharmaceuticals, Inc. Based on PI NMZ24835-F-12/14

NAMZARIC.COM | NAMZARIC™ and its design are trademarks of Merz Pharma GmbH & Co. KGaA. Actavis® and its design are trademarks of Actavis, Inc. or its affiliates. | © Actavis 2015. All rights reserved. | NMZ33121 | 07/15

NEW

Same hands. Same eyes.

Same will to fight

her Alzheimer’s symptoms.

NEW NAMZARIC is the FIRST AND ONLY treatment for moderate to severe Alzheimer’s disease that combines 2 proven medicines, NAMENDA XR® (memantine HCl) extended release and donepezil HCl, in a single, once-a-day capsule.

NAMZARIC is approved for the treatment of moderate to severe Alzheimer’s disease in patients who are currently taking and can continue to take certain doses of both NAMENDA® (memantine HCl) or NAMENDA XR and donepezil HCl, the active ingredient in Aricept®. NAMZARIC is available by prescription only.

NAMZARIC works in 2 ways to fight moderate to severe Alzheimer’s disease DONEPEZIL HCl (ARICEPT)

NAMENDA XR

TM

With NAMZARIC, you may see: ° An improvement in cognition, also known as mental function ° An improvement in overall function ° A slowdown in the worsening of symptoms for a while ASK YOUR LOVED ONE’S DOCTOR ABOUT NAMZARIC TODAY. LEARN ABOUT A 30-DAY TRIAL OFFER* AT NAMZARIC.COM

[nam-ZAIR-ick] *Restrictions may apply.

There is no evidence that NAMZARIC prevents or slows the underlying disease process in patients with Alzheimer’s disease.

IMPORTANT RISK INFORMATION Who should not take NAMZARIC? NAMZARIC should not be taken by anyone who has an allergy to memantine HCl, donepezil HCl, medicines that contain piperidines, or any of the ingredients in NAMZARIC. What should be discussed with the healthcare provider before taking NAMZARIC? Before starting NAMZARIC, talk to the healthcare provider about all of the patient’s medical conditions, including: ° heart problems including an irregular, slow, or fast heartbeat ° asthma or lung problems ° seizures ° stomach ulcers ° bladder, kidney, or liver problems ° any surgical, dental, or other medical procedures scheduled when anesthesia may be used Tell the healthcare provider about all the medicines the patient is taking, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Aricept® is a trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.

Please see Brief Summary of Patient Information for NAMZARIC on reverse side.

What are the possible side effects of NAMZARIC? NAMZARIC may cause serious side effects, including: ° muscle problems in patients given anesthesia ° slow heartbeat and fainting. This happens more often in people with heart problems. Call the doctor right away if the patient faints while taking NAMZARIC ° more stomach acid. This raises the chance of ulcers and bleeding especially when taking NAMZARIC. The risk is higher for patients who have had ulcers, or take aspirin or other NSAIDs ° nausea and vomiting ° difficulty passing urine ° seizures ° worsening of lung problems in people with asthma or other lung disease The most common side effects of memantine HCl include: headache, diarrhea, and dizziness.

The most common side effects of donepezil HCl include: diarrhea, not wanting to eat (anorexia), and bruising.

These are not all the possible side effects of NAMZARIC. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1.800.FDA.1088.

For more information, call 1.844.626.9274.

NAMZARIC.COM | NAMENDA®, NAMENDA XR®, NAMZARIC™ and their designs are trademarks of Merz Pharma GmbH & Co. KGaA. Actavis® and its design are trademarks of Actavis, Inc. or its affiliates. | © Actavis 2015. All rights reserved. | NMZ36105 | 09/15

NEW

Same hands. Same eyes.

Same will to fight

her Alzheimer’s symptoms.

NEW NAMZARIC is the FIRST AND ONLY treatment for moderate to severe Alzheimer’s disease that combines 2 proven medicines, NAMENDA XR® (memantine HCl) extended release and donepezil HCl, in a single, once-a-day capsule.

NAMZARIC is approved for the treatment of moderate to severe Alzheimer’s disease in patients who are currently taking and can continue to take certain doses of both NAMENDA® (memantine HCl) or NAMENDA XR and donepezil HCl, the active ingredient in Aricept®. NAMZARIC is available by prescription only.

NAMZARIC works in 2 ways to fight moderate to severe Alzheimer’s disease DONEPEZIL HCl (ARICEPT)

NAMENDA XR

TM

With NAMZARIC, you may see: ° An improvement in cognition, also known as mental function ° An improvement in overall function ° A slowdown in the worsening of symptoms for a while ASK YOUR LOVED ONE’S DOCTOR ABOUT NAMZARIC TODAY. LEARN ABOUT A 30-DAY TRIAL OFFER* AT NAMZARIC.COM

[nam-ZAIR-ick] *Restrictions may apply.

There is no evidence that NAMZARIC prevents or slows the underlying disease process in patients with Alzheimer’s disease.

IMPORTANT RISK INFORMATION Who should not take NAMZARIC? NAMZARIC should not be taken by anyone who has an allergy to memantine HCl, donepezil HCl, medicines that contain piperidines, or any of the ingredients in NAMZARIC. What should be discussed with the healthcare provider before taking NAMZARIC? Before starting NAMZARIC, talk to the healthcare provider about all of the patient’s medical conditions, including: ° heart problems including an irregular, slow, or fast heartbeat ° asthma or lung problems ° seizures ° stomach ulcers ° bladder, kidney, or liver problems ° any surgical, dental, or other medical procedures scheduled when anesthesia may be used Tell the healthcare provider about all the medicines the patient is taking, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Aricept® is a trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.

Please see Brief Summary of Patient Information for NAMZARIC on reverse side.

What are the possible side effects of NAMZARIC? NAMZARIC may cause serious side effects, including: ° muscle problems in patients given anesthesia ° slow heartbeat and fainting. This happens more often in people with heart problems. Call the doctor right away if the patient faints while taking NAMZARIC ° more stomach acid. This raises the chance of ulcers and bleeding especially when taking NAMZARIC. The risk is higher for patients who have had ulcers, or take aspirin or other NSAIDs ° nausea and vomiting ° difficulty passing urine ° seizures ° worsening of lung problems in people with asthma or other lung disease The most common side effects of memantine HCl include: headache, diarrhea, and dizziness.

The most common side effects of donepezil HCl include: diarrhea, not wanting to eat (anorexia), and bruising.

These are not all the possible side effects of NAMZARIC. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1.800.FDA.1088.

For more information, call 1.844.626.9274.

NAMZARIC.COM | NAMENDA®, NAMENDA XR®, NAMZARIC™ and their designs are trademarks of Merz Pharma GmbH & Co. KGaA. Actavis® and its design are trademarks of Actavis, Inc. or its affiliates. | © Actavis 2015. All rights reserved. | NMZ36105 | 09/15

FDA approved for adults 18 and older

The PURE choice Because you have a choice in flu vaccines

No gelatin

100% egg-free

Gluten-free No influenza virus

No antibiotics

Ask your pharmacist for

Pure Safe Effective protection against the flu

No preservatives

No formaldehyde

Latex-free

Flublok Safety Information Flublok is approved for people 18 and older to prevent influenza disease. The most common side effect from Flublok is pain at the site of injection. Headache, fatigue or muscle ache may occur.

Tell the doctor if you have ever experienced Guillain-BarrĂŠ syndrome (severe muscle weakness) or have had a severe allergic reaction to any component of Flublok vaccine. Vaccination with Flublok may not protect all individuals. Clinical effectiveness in adults 50 and older is based on the immune response elicited

by Flublok and not on demonstration of decreased influenza disease. Please see the complete Package Insert available at www.flublok.com or call 203-686-0800 for more information.

www.flublok.com