Q. Canadian online pharmacies charge ridiculously high prices for generic medicine compared with the U.S. For example, Metformin 500 mg tablets can be bought here for about 2 U.S. cents each. They are charging more than 10 times that price.
A. You are right that generic drugs often are more expensive in Canada. According to PharmacyChecker.com, 500 mg metformin from a Canadian online drugstore costs between 20 and 50 cents a pill. The cutthroat competition on generic-drug prices in the U.S. usually makes such medicines much cheaper here.
Brand-name drugs, on the other hand, frequently are much less expensive in Canada. People who buy medicine from an online Canadian pharmacy to save money should be very careful to verify the pharmacy is actually in Canada. Some unscrupulous operators have taken advantage of the good reputation these online drugstores enjoy. They may pretend to be Canadian although they are located elsewhere in the world and not subject to Canadian regulation.
We discuss the ins and outs of Canadian online pharmacies and how to determine which are legitimate in our updated Guide to Saving Money on Medicines. This online resource is available at www.PeoplesPharmacy.com.
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Q. I appreciate you reporting side effects of PPIs. It was because you wrote about a small study from Denmark that I learned what was causing a horrible scaly, patchy rash all over my husband's body. It was driving him crazy, and none of his doctors, including a dermatologist, could diagnose the rash. It turned out to be a rare side effect of omeprazole.
The rash disappeared in two weeks after he stopped taking the medicine. When I looked into other side effects, I found that his muscle weakness and mental confusion also were related to the drug.
Just days before I read your article, he had said that he didn't see the point of living if he would always feel like this. I have not seen the study reported anywhere else, and I am eternally grateful to you.
A. We are glad that reading about this unusual reaction to acid-suppressing drugs like omeprazole was the key to alleviating your husband's suffering. Proton-pump inhibitors (PPIs) are used to treat acid reflux and heartburn.
Subacute cutaneous lupus erythematosus is an autoimmune condition that can be triggered by certain medications, including PPIs (Drugs -- Real World Outcomes, June 2016).
PPIs also can lower absorption of magnesium and vitamin B-12. That might explain the muscle weakness and confusion your husband experienced.
Q. Ibuprofen is the only pain medication that works to stop an absolutely debilitating pain that I get. Thankfully, the pain does not occur all of the time, but when it hits, Advil works. I have tried aspirin and Tylenol, and neither works for me. I don't know what I would do without it.
A. There are others who feel as you do that ibuprofen makes their lives bearable. It is appropriate to have a therapy that eases pain in an emergency. Anyone who takes ibuprofen or other NSAIDs on a regular basis should be aware of the hazards, however.
One serious side effect is bleeding ulcers. A reader wrote: "Both my mother and my mother-in-law almost died because of ibuprofen. I told the ambulance driver I thought my mother was bleeding internally; she was! She almost died. Something similar happened to my mother-in-law."
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them at Questions@PeoplesPharmacy.com. Their newest book is "Top Screwups Doctors Make and How to Avoid Them."