Pharmacy/protopic

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Question
my doctor wants me to try a drug called PROTOPIC because of an itch I have that steroids don't seem to work on the problem I have. my insurance does not pay for this drug and it is very expensive, is there any drug out there that works similar to  PROTOPIC.

Answer
Dear Tony,
My sincere apologies for not replying sooner.  This is a tough one for me in that I am unfamiliar with how insurance companies manage this drug for re-imbursement in USA.  I practice pharmacy in Australia where the cost of drugs is subsidized by the government.  Similarly, however, the Australian government does not subsidize this drug for indications other than prevention of organ/tissue rejection after transplant.  So, if one were to require it for the treatment of a skin condition, they would, too, be out of pocket by hundreds of dollars.  

There are a few ways of tackling this dilemma.  The first is to have a discussion with your dermatologist.  I am assuming it was a dermatologist who prescribed this drug.  Or rather, I 'hope' that it was.  This is not a 'simple' drug.  It is known to have the potential for serious side effects (even when applied topically), and is regarded as second line treatment because of this very reason. Your dermatologist should be able to offer an alternative based on your clinical presentation.  An alternative solution should be sought if you are unable to afford the ridiculous cost of this medication.  A dermatologist may also be aware of special 'treatment deals' that the pharmaceutical company is offering.  These 'deals' don't happen often, but occasionally they do.  I have seen this a number of times throughout my years of practice and it is great for patients just commencing treatment.  And ask the dermatologist for samples.  Maybe a short course is all that you will need to nudge your condition into remission.  If, however, you have not been seen by a dermatologist, I would highly recommend visiting one.  If your condition is not improving after the use of steroids, it would seem most appropriate to consult with a specialist.

I am not entirely familiar with FDA-approved drugs.  In Australia, we have a topical drug called Elidel (Primecrolimus), which belongs to the same class as Protopic.  You might want to check with your insurance people if they cover this one.  It might exist in the US under a different brand name, so check under its generic name: Primecrolimus.  If you find that it is covered (fingers crossed), then have a chat with your dermatologist about prescribing it in place of Protopic.

There are other 'milder' (or safer) agents that could be tried.  I suspect, however, that to be at the Protopic stage, you would have already tried these.  But before an alternative recommendation can be made, it would be a good idea to try to understand what is causing the itch to begin with.  Without a full medical history and list of current medications, it will be difficult for me to ascertain this.  When itch is not responding to steroids, one must consider the underlying cause.  Feel free to send me a follow-up question with more info if you'd like me to look into this for you in more detail.  Itch can be caused by any number of things.  Including, but not limited to, new shower gel or body wash products, skin products/cosmetics, new detergent (or poorly rinsed garments), body sprays, allergies to synthetic textiles etc etc.  If you do identify a possible topical culprit, then eliminate it from your daily routine.  Certain diseases can produce itchy symptoms including skin infections (especially fungal), liver disease, anxiety, stress, allergies to foods, insect/topical parasites (scabies) etc etc.  It could also be caused by other medications.  Proper diagnoses of your condition would be essential in determining the underlying cause.  This will also allow a more targeted and effective treatment.  

Other solutions for itch include topical over-the-counter preparations that contain menthol/camphor or local anaesthetics, Eurax cream (crotamiton), cool baths or cold compresses.  Oral antihistamines are also very effective, and I believe topical antihistamines are also available in the US, although I cannot personally recommend topical antihistamines.  They were removed from the Australian market years ago for being ineffective and causing unacceptable side effects.  Unfortunately, the best oral antihistamines for itch are the sedating ones, otherwise, you should have benefit from non-sedating AH (usually at higher doses, though).  Note that antihistamines have other side effects and contra-indications, and so you may wish to speak to your doctor or pharmacist about other conditions you may have or other meds you are taking.  You could also consider an alternative steroid if you haven't already done so.  And although a prescription is required, you physician may wish to consider a short course of oral steroids (eg, prednisone) before resorting to Protopic.

Tony, I hope this answer hasn't come too late for you.  Please feel free to send me a follow-up question should you require further information.  

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Gisella Campanelli

Expertise

I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.

Experience

I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

Education/Credentials
I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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