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PULMONARY
DISORDERS
DEVRA
K. DANG, SECTION ADVISOR
HFA inhalers replacing generic albuterol inhalers, driving up
costs
Inhalers with CFC propellent being replaced by more expensive
branded products.
Key point: Branded albuterol inhalers containing the
newer and more environmentally friendly propellant hydrofluoroalkane
(HFA) are as safe and effective as generic inhalers that contain the
propellant chlorofluorocarbon (CFC), but they cost nearly three times as
much.
Finer points: In 2005, FDA ruled that U.S. sales of CFC
albuterol inhalers would be prohibited after 2008 due to growing
concerns regarding the detrimental effects of CFCs on stratospheric
ozone levels and American obligations under an international treaty, the
Montreal Protocol. This decision led manufacturers to reformulate their
products using the propellant HFA.
Currently, three branded HFA albuterol inhalers are available in the
U.S.: Proventil HFA (Schering-Plough), Ventolin HFA (GlaxoSmithKline),
and ProAir HFA (IVAX). In addition, Xopenex HFA (Sepracor), which
contains levalbuterol, uses HFA as a propellent. Currently, all generic
forms of albuterol contain CFC. Generic versions of the albuterol HFA
inhalers are not expected to reach U.S. markets until after 2012.
Each year about 52 million prescriptions are dispensed in the U.S. for
albuterol inhalers, making it the seventh most prescribed drug in the
U.S. The majority of these prescriptions are dispensed using generic
albuterol products. Because generic albuterol is so widely used, the
authors of a review article recently published in the New England
Journal of Medicine predicted that Americans will spend an additional
$1.2 billion a year for the new HFA products. Those who pay for their
own medications will be most affected by the increased
costs—seeing average increases of $26 per prescription and
spending an additional $312 per year. For those with prescription
benefit plans, copayments are likely to increase.
What you need to know: There are pros and cons
associated with the various HFA formulations. Ventolin HFA is currently
the only HFA inhaler that comes with a counter to track how much active
drug remains. Ventolin HFA also comes sealed in a protective pouch since
it is susceptible to moisture penetration. After the Ventolin HFA pouch
is opened, the inhaler expires in 60 days, unlike the other HFA
inhalers, which can be stored for 15–24 months. Proventil HFA
contains small amounts of ethanol, and patients with religious
objections to use of alcohol may not want to use this formulation. This
product can temporarily cause a false elevation in results of breath
alcohol tests (up to 35 mcg/mL for up to 5 minutes after 2 puffs).
Remind patients who use inhalers other than Ventolin HFA to always have
a backup inhaler since it is impossible to predict when the inhalers
will become empty. Finally, remind patients to never immerse HFA
inhalers in water to determine if the canisters are empty. This method
is not only unreliable but can also damage inhalers.
What your patients need to know: Differences in price
are not the only changes patients will encounter with the
“newer” HFA inhalers. Many patients report that the
actuations from the HFA inhalers feel and taste differently. This is not
surprising since the HFA inhalers use a different propellant and sprays
emitted from the actuators have less force. Clogging of HFA actuators
has also been reported. Remind patients to clean their inhalers at least
once a week by removing the metal canister, running water through the
plastic actuator for 30 seconds, shaking the actuator to remove excess
water, and allowing it to dry. Finally, HFA inhalers typically require
less frequent repriming than CFC inhalers.
Source:
Related Resources on Pharmacist.com:
Contact the editor: L.
Michael Posey, BPharm, APhA
DrugInfoLine
Posted May 1, 2007, 3:46 pm EST
| Inhalers with CFC propellent being replaced by more expensive branded products. |
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