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Wellbutrin, more commonly prescribed as the generic Bupropion, remains a widely prescribed therapy for depression. Popular in part because it may lead to less weight gain and sexual dysfunction compared to other antidepressants, it probably lacks significant major therapeutic advantages versus its competitors. While Bupropion may provide some relief, it neither cures depression nor completely eliminates the symptoms.
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Containing a smaller amount of amino acids than a bite of steak, chicken or salmon, this supposed human growth factor booster makes preposterous appearing claims based on extraordinarily shaky evidence. While using such enticing catch-phrases as anti-aging, breakthrough and fountain of youth, the packaging promotes SeroVital to increase lean muscle mass, reduce wrinkles and more. A $100 investment buys one month of product but at best the “increase” in growth hormone raises it only into the low normal range.
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Gabapentin: Neurontin
Lyrica and its relative Neurontin or gabapentin are widely overprescribed for pain related disorders. Although approved for treating pain after shingles, evidence for their benefit remains quite sketchy. Gabapentin now ranks as one of the top drugs of abuse with at least 50% or people abusing opioids like hydrocodone and oxycodone simultaneously taking these “johnnies” or “gabbies.” In fatal drug overdoses, gabapentin often appears as a contributing factor.
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Erectile Dysfunction or simply ED affects more than 40% of men beyond age 40. Cialis produces results within 30-45 minutes when combined with sexual stimulation. Alternatively a smaller dose on a daily basis offers advantages for unplanned activities. The drug also may offer minor assistance to men with urinary difficulty due to an enlarged prostate. Cialis neither functions as an aphrodisiac nor as a treatment for premature ejaculation.
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Amlodipine or Norvasc treats high blood pressure. This inexpensive, generically available calcium blocker relaxes smooth muscle cells lining arteries and reduces the force against which the heart must pump. Additionally the drug helps protect against chest pain or angina. It ranks among the World Health Organization List of Essential Medicines.
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Lantus Once Daily Insulin
Once the standard, long acting, once daily baseline insulin, Lantus recently encountered significant competition. This opening of the insulin markets may finally bring some pricing relief to this still expensive necessity. For most Type 2 diabetics, the need for insulin marks the failure of diet and exercise to maintain normal body weight. By itself Lantus rarely suffices to control blood sugar.
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Trulicity aids in controlling type 2 diabetes with only one shot every 7 days. It simulates the pancreas to release insulin and in addition may assist in weight reduction. Prescribed in addition to other therapies, this GLP-1 stimulator rarely causes hypoglycemia. In the near future, a once weekly form of apparently heart healthy Victoza will probably capture considerable market share from cardiac neutral Trulicity.
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Currently the most popular drug in the family of Invokana and Farxiga, Jardiance stimulates the kidneys to expel glucose from the bloodstream into the urine. As a result patients with type 2 diabetes benefit by losing weight and improving their blood pressure. A relatively large study suggests Jardiance might also slightly reduce the risk of all cause mortality and decrease the likelihood of death from cardiovascular disease. Although these results appear statistically significant, the absolute improvement remains small at less than 3%. No reduction occurs in the incidence of heart attacks or stroke. Blood glucose and hemoglobin A1c fall only modestly.
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Among the newer injectable “biologics” prescribed to treat severe psoriasis, Taltz and a competitor Cosentyx remain most likely to result in clear skin within 12 weeks. Unfortunately the cash price for one year of these drugs averages in excess of $60,000. While televised ads blanketing the airways claim discount copay cards limit out of pocket expense, insurance companies are not so fortunate. These and similar drugs largely account for the dramatic escalation in yearly drug insurance premiums.
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Irritable Bowel Syndrome or simply IBS is a condition of unknown cause that manifests as abdominal pain associated with either diarrhea or constipation. A minority of experts believe the diarrhea may result from overgrowth of bacteria in the small intestine. An oral antibiotic Xifaxan remains in the gut and may temporarily improve the condition but at a whopping cost of almost $40 a pill. At best it’s temporarily effective with multiple courses required as the drug fails to cure the condition.
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Basaglar represents the first copycat version of Lantus. These insulin products mimic each other’s actions almost exactly; effectively they function identically within the body. Marketing prowess, insurance coverage and discounting to pharmacy benefit managers more than medical requirements dictate which product a person is likely to receive.
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The inexpensive drug generically available as metformin remains the first choice for type 2 diabetics in whom diet and exercise fail to work. Not only does it dramatically improve blood sugar levels and hemoglobin A1c, but unlike other diabetes drugs, its use may lead to weight loss and is rarely associated with hypoglycemia. When necessary it may be combined with additional anti-diabetes medicines. Additionally preliminary reports suggest metformin may act to prevent a variety of tumors and even increase survival in colon cancer.
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Chronic use of opioids for pain control almost always results in severe constipation often with as few as one bowel movement a week. Relistor prevents binding of the pain medicine to the bowel wall and in the process modestly improves bowel function compared to an inactive placebo. Unfortunately this extremely expensive medicine must be injected just below the surface of the skin on a daily basis. Severe complications may occur. The company behind Relistor, Valeant Pharmaceuticals, gained unwanted notoriety for its business model of buying drug manufacturers and drastically raising prices.
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Diovan or valsartan treats high blood pressure. In the category of ARBs or angiotensin receptor blockers, the drug reduces the likelihood of cough, a major factor associated with the even more popular ACE inhibitors such as lisinopril or enalapril. Controversy surrounds falsified medical investigations in Japanese studies which led to major embarrassment for the Kyoto Heart Study. Worse yet, relatively recent questions exist about ARBs and their potential relation to cancer.
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Beta blockers like Bystolic typically represent second or third tier therapy for high blood pressure. Most drugs in this class share similar features and are available as relatively inexpensive generic versions. Bystolic offers no obvious advantage and remains extraordinarily pricey compared to metoprolol, atenolol or nadolol. Copay assistance cards temporarily shift the financial burden to the insurance company until they next year’s premium increase.
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Diabetes affects tens of millions of Americans with the number growing alarmingly rapidly. Invokana represents a new concept in therapy. Rather than stimulating the body’s metabolism of sugar, this drug leads to elimination of glucose through the kidneys into the urine. Relatives include Jardiance and Farxiga. Recent concerns suggest some association with kidney failure, bone fractures, ketoacidosis, genital yeast infections and possibly an increased risk of amputations. Cash price may exceed $15 each day.
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PreserVision - Preventing Age Related Macular Degeneration
Vitamins marketed to prevent progression of age-related macular degeneration or AMD combine Vitamins C and E along with zinc, copper and at times carotene family members lutein and zeaxanthin. Although claims suggest major benefits, the evidence favoring their use seems rather meager. At best they may slightly delay progression in those with moderate to advanced disease. They neither prevent AMD nor do they cure the disease. A low fat diet with generous quantities of fruit, vegetables and nuts along with participation in regular exercise and avoidance of tobacco offer more protection than vitamins.
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Onexton combines benzoyl peroxide with the antibiotic clindamycin. Although this expensive topical preparation improves moderate acne by only about 50%, whether it offers significant advantage in excess of readily available, over-the-counter 10% benzoyl peroxide remains debatable. The manufacturer Valeant offers a discount card to blunt the more than $500 retail cost of the prescription drug.
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Flu Vaccine
Surprisingly whether the yearly flu vaccine actually prevents influenza related complications and death remains controversial. The mortality rate from this virus fell to its current level long before widespread vaccination became available and basically remained flat ever since. Deaths failed to increase in years with a mismatch between strains in the vaccine and those in circulation. Supposed benefits may relate more to the health, lifestyle and income of those opting for vaccination than to the immunization itself – something referred to as the healthy user effect.
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Constipation as an integral part of the Irritable Bowel Syndrome refers to fewer than 3 weekly bowel movements and may be associated with abdominal pain. A recently approved and of course obscenely expensive drug, Linzess, seems to stimulate the bowels so well that it either causes diarrhea in as many as 1 in 5 people or results in only modest symptom improvement in others. Of course the drug company’s copay card shields the patient, but not the insurance company, until next year’s premium increase.
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Hetlioz - Non 24
Ads blanketing the airways for Non-24 inform the public about sleep deprivation among those who are both totally blind and lack any light perception. Under normal circumstances light rays travel through the retina to the brain and synchronize the sleep-wake cycle. Interruption of this pathway leads to insomnia and daytime sleepiness. The newly FDA approved relative of melatonin marketed as Hetlioz functions modestly better than placebo but costs about $440 a pill or around $160,000 a year. It has not been tested against the inexpensive and formerly recommended melatonin or other much less expensive options. Studies of Hetlioz by Vanda Pharmaceuticals are ongoing for jet lag.
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Recently approved Xiidra, a topical eye drop for the Dry Eye Syndrome, appears likely to dethrone Restasis as the treatment of choice for this common malady. Xiidra begins to work more quickly and causes fewer side effects. Unfortunately both of these drugs cost about $5000 each year and fail to eliminate the need for supplements of artificial tears.
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This variant of the date rape drug received FDA approval as a $100,000.00+ a year treatment for narcolepsy. Available only though one pharmacy in the United States, a prescription must be faxed to that certified pharmacy followed by two phone interviews – one with a nurse and another with a pharmacist. It is delivered only through the mail and requires signed confirmation of its arrival. Disasters or death may follow when combined with alcohol, a sleeping pill, muscle relaxants, hydrocodone, anti-depressants or tranquilizers like Ativan and Xanax. Other safer and more reasonably priced alternatives exist.
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At a price in excess of $50 a pill, Viagra seems extraordinarily expensive. While it adequately treats Erectile Dysfunction or ED, it only provides relief in a brief window extending from 45-60 minutes until 4 hours after each dose. For inexplicable reasons Pfizer, the manufacturer, continues raising the price. Fortunately a much less expensive alternative generic form of sildenafil exists.
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Once it appears, Alzheimer’s Disease steadily and progressively interferes with memory, cognitive function and personality. No currently available therapy significantly alters the continuous downward spiral of the disease. Although marketed to favorably improve the course, Namenda seems relatively ineffective. Even when combined with Aricept, another commonly prescribed drug, Namenda regularly fails to alter the prognosis. Side effects and cost remain concerns.
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Dry Eye Syndrome manifests as burning, stinging, tenderness and blurred vision along with pain and the sensation of something in your eye. The commonly prescribed medicine to combat this situation, Restasis, often requires months to relieve symptoms. In early studies Restasis drops and its non-medicated vehicle marketed separately as Refresh Endura seemed equally effective although the annual price for Restasis approaches $5000. Uncomfortable adverse reactions routinely prompt many to opt in favor of the newly available competitor Xiidra.
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Red inflamed pimples of acne often improve with antibiotics. Tetracycline products remain most popular with Minocycline and Doxycycline available as relatively inexpensive generic examples. An extended release version of minocycline sold as Solodyn has not been compared to the traditional antibiotics, yet the cash price averages about $1200 a month. So called co-pay savings cards shift the burden to insurance companies. Valeant Pharmaceuticals is currently being investigated for its pricing practices.
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Lexapro or escitalopram may treat depression and anxiety. Actually Lexapro contains the same active component as Celexa. Aggressive marketing promoting the drug as superior to other available options succeeded in boosting total sales well in excess of $14 billion. Unfortunately studies fail to show Lexapro offers any unique advantages over other similar SSRIs such as Prozac, Paxil and Zoloft. Recent investigations suggest not only are antidepressants overprescribed but their effectiveness compared to inactive placebo therapy remains subject to debate.
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Combining an anti-depressant and smoking cessation medicine with a drug for narcotic dependence results in a new pill known as Contrave which supposedly leads to weight loss. Results unfortunately fail to impress. Weight loss averages as little as one pound every month or two with as many as half of individuals prematurely discontinuing therapy often due to troublesome side effects. An FDA mandated black box warns of suicidal thoughts and behavior as well as such neuropsychiatric reactions as depression and mania. Due to some corporate hanky-panky, it is currently unknown whether the drug increases heart related disease or death.
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While televised ads for Namzaric suggest it helps individuals suffering from Alzheimer’s disease, the company’s website clearly states: “There is no evidence that NAMZARIC prevents or slows the underlying disease process…” This expensive combination of donepezil or Aricept together with a long acting form of memantine fails to provide meaningful relief for the overwhelming majority of individuals treated. Additionally the frail elderly population appears prone to significant side effects from this relatively useless drug.
Views: 506 wellnowdoctor
Advertisements champion Entresto as a phenomenal treatment for heart failure capable of reducing cardiovascular death and heart related hospitalization. Many peculiarities exist in the study leading to FDA approval. It was principally conducted in Eastern European countries, Russia, the Philippines, Venezuela, Brazil, Mexico and India. Only 5% of the patients resided in the United States. Actually Entresto basically combines the anti-hypertensive Diovan with a new compound Sacubirtil. Entresto with the maximum amount of Diovan was evaluated against a modest dose of another drug for high blood pressure rather than Diovan. So all of the benefits might actually stem from the Diovan component. Generic Diovan or valsartan costs less than $25 a month. Entresto’s cash price of $6000 a year or about $16 a day caused insurance companies initial hesitation which led to a lengthy authorization process. Due to the high drop-out rate, the benefits may much less than reported. Additionally it apparently works only in the milder forms of heart failure.
Views: 261 wellnowdoctor
Nexium 24HR
Proton Pump Inhibitors or PPIs including Nexium, Prevacid, Prilosec and Omeprazole improve symptoms of heartburn medically referred to as GERD or Gastroesophageal Reflux Disease. They also assist in treating ulcers and protecting the stomach from irritation by aspirin. Unfortunately an increasing number of significant side effects appear associated with long term use. In spite of advertising claims highlighting superiority of one drug over another, differences between the products are minor. For many people with “acid reflux,” antacids like Maalox, Mylanta, Rolaids and Tums or antihistamines including cimetidine and ranitidine provide faster relief with fewer adverse reactions.
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Crestor, just recently available as generic rosuvastatin, reduces bad cholesterol or LDL. Available in multiple different strengths, Crestor may prevent heart attacks, stroke and death from cardiovascular related causes. More obvious risk reduction occurs in those already suffering from cardiac disease; use in otherwise healthy individuals provides much less apparent benefit. Increasingly doctors are questioning the role of cholesterol as a risk factor.
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Opioid Induced Constipation
Real and imagined pain leads to abuse of opioids including hydrocodone, oxycodone, methadone and fentanyl. Among the most annoying adverse effects are constipation, abdominal discomfort and straining to evacuate the bowels. These adverse effects rarely improve without reducing the opioid dose or discontinuing their use altogether. Recommendations to minimize these symptoms with exercise, increased fluids and fiber supplements typically fail to remedy the situation. Similarly laxatives rarely provide the desired relief.
Views: 1448 wellnowdoctor
Osteoporosis is a risk factor for bone fracture much as high blood pressure is a risk factor for heart disease. Prolia helps prevent bone loss and actually results in some new bone formation. With 2 injections under the skin’s surface each year, it requires minimal hassle. The so-called FRAX score, available online, rates the likelihood of a bone fracture and assists in determining an individual’s need for therapy. Unfortunately it may overestimate the need for medical intervention.
Views: 1356 wellnowdoctor
Zovirax Ointment
Topical therapy for herpes simplex infection, also referred to as fever blisters or cold sores, remains popular but provides limited or no benefit. Approved only for the initial manifestations of genital herpes and limited use in people with impaired immune systems, this drug seems totally superfluous and a waste of time and money. At a price of around $1100-$1300 per tube, this Valeant product is better left at the pharmacy. Oral medication is effective, inexpensive and much easier to use.
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Whether Claritin now available as the generic loratadine actually works at the currently approved dose remains an issue. Originally an FDA examiner believed no less than 40 mg was necessary to provide effective relief of allergic nasal symptoms. Unfortunately at this dose drowsiness occurs and the label could no longer boast of non-sedating qualities. At the current daily dose of 10mg, the drug works somewhat better than a placebo. For most people troubled by seasonal or perennial allergies, Flonase, Rhinocort or Nasonex remain more effective.
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Xyzal contains the active ingredient in Zyrtec. Frequent televised advertisements claim this anti-histamine treats such allergic symptoms as sneezing, runny nose and itchy eyes. Once selling as a prescription for about $3 a pill, it now commands a tiny fraction of the price as an over-the-counter drug. While many people still choose these supposedly non-sedating anti-histamines for allergic rhinitis; nasal corticosteroids including Flonase, Nasonex and Rhinocort are much better options.
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The newer shingles virus vaccine Shingrix provides much better coverage than the much weaker, shorter lasting Zostavax. It seems quite effective in preventing post-herpetic neuralgia. It contains no live virus but for full effect requires an initial injection and another 2-6 months later. Local side effects may last up to several days. Certainly a lot of hype urges consumers to get this expensive vaccine which is only partially covered by Medicare part D or its various supplements.
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Supposedly beginning a course ofTamiflu within 48 hours of flu symptoms limits the course of the disease by anywhere form half a day to slightly more than one day. While major controversy exists regarding whether the pill actually provides any benefits, drug companies continue to hide data from many of the research studies that might shed light on the medicine’s potential.
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Although more than 500,000 cases of shingles or Herpes zoster occur yearly. While intuitively the vaccine known as Zostavax seems like a good idea, protection from reactivation of the chickenpox virus lasts only several years. Vaccination at age 60 leaves more elderly seniors susceptible at an age associated with the greatest risks. A competing product may pass F.D.A. muster in late 2016 and provide considerably greater benefits.
Views: 339 wellnowdoctor
The newest injectable treatment for moderate to severe psoriasis, Cosentyx, works through a novel pathway and appears more effective than its competitors. It quiets the inflammation necessary for skin and joint manifestations of psoriasis. After an initial intensive regimen, a single, monthly, self-administered injection appears sufficient. However at a cost of about $4400 per dose, Cosentyx ranks as the most expensive biologic for psoriasis. Alternative drugs in the same family appear to increase suicide risk. Whether the same will plague Cosentyx remains unknown.
Views: 341 wellnowdoctor
Oxycodone and Oxycontin
Oxycodone and its extended release version belong to the narcotic family of opioids. Closely related to codeine and hydrocodone, extreme care must be exercised in prescribing oxycodone in combination with muscle relaxants, sleeping pills, anxiety medications and other pain relievers. Surprisingly even the antibiotics erythromycin and clarithromycin or the stomach acid reducer Tagamet generically available as cimetidine may increase the risk of complications. Almost everyone taking this drug suffers from dreadful constipation. Chronic use to combat pain appears inappropriate.
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Xarelto and Eliquis compete for the same patients. These oral anticoagulants appear useful in reducing the risk of stroke associated with atrial fibrillation. They also minimize the risk for deep vein thrombosis and blood clots capable of traveling to the lungs as sometimes fatal pulmonary emboli. Unfortunately the once daily Xarelto might not provide round the clock protection. Serious concerns exist regarding its merits compared to other similar drugs.
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The most profitable drug for many years running, Humira counters the effects of a chemical known as TNF and in doing so dramatically improves moderate to severe plaque stage psoriasis. Maintenance requires twice monthly self-administered injections just under the skin akin to insulin therapy. Effectiveness may decrease over time. Since it suppresses the immune system, it may lead to spread of serious infections such as hepatitis, staphylococcus and TB. A small increase in cancers may occur. The drug costs about $50,000 each year.
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Safer and equally effective therapies for psoriasis should take preference to Siliq. The original clinical studies were halted when an inordinate number of suicides occurred. Perhaps even worse Siliq also seems associated with an increase in cardiovascular events and related death. Valeant Pharmaceuticals, a company with a checkered past, markets the drug after the original stakeholders – Amgen and AstraZeneca - washed their hands of this troublesome drug.
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As men age, the prostate enlarges which creates difficulty urinating. Although the prostate itself does not shrink with Flomax, the smooth muscle component of the gland relaxes. This effect on the involuntary muscle allows easier passage or urine with less hesitation and dribbling. Benefits appear extraordinarily rapidly. Also know as tamsulosin, the drug improves the symptoms of BPH rather than curing the condition. Lightheadedness frequently occurs on arising from a seated position. A recent evaluation of 500,000 men unexpectedly revealed those taking tamsulosin might face an increased risk of dementia. Studies to confirm or refute this possible association must be undertaken.
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This expensive drug basically offers the same anti-depressant activity as the generic forms of Prozac, Zoloft, Paxil or Celexa but at a much greater price. For some unknown reason nausea remains a common, long lasting side effect. Nowhere in the barrage of televised advertising is there mention that the daily cost of the drug exceeds $10 versus $3-10 for one month of the generic versions of selective serotonin reuptake inhibitors.
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Most cancers in the brain originate in the lungs, breast or colon. Glioblastoma, a primary tumor of the brain, develops and remains within the cerebral hemispheres. Previously referred to as Glioblastoma Multiforme, it grows rapidly and almost always recurs within months of radiation and chemotherapy even after apparent complete surgical removal. It affects approximately 18,000 people each year and foretells a grim prognosis.
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Competition between Kerydin and Jublia fuels dueling television ads. Kerydin, although a novel boron containing compound, must also be applied daily for 48 weeks and only to nails no more than moderately affected. This topical preparation boasts less than a 10% cure rate – 90% of those using it will not be cleared of their infection after investing thousands of dollars and considerable time and effort. A simpler and less expensive option might be an oral generic – terbinafine. Actually one study even showed Vicks VapoRub provided a better outcome than Kerydin.
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