In August, we wrote about Health Canada’s approval of a long-awaited vaccine for RSV (respiratory syncytial virus), known as Arexvy, which is for those aged 60 and older. RSV largely impacts those who are young (especially those under age 2) as well as those over age 60. In older adults who become hospitalized with this lower respiratory tract infection, the risk of death is 1 in 9. Although age alone increases risk due to aging lungs and the immune system, those with underlying medical conditions are at an even greater risk. 

Now that we have Arexvy available, we are getting many questions about timing with other vaccines that adults are updating this fall. RSV is a seasonal virus that begins its greatest spread in the fall and winter months, just like influenza. With the new COVID booster now available, this is also the time for many to be receiving it as it has been 6 months since many received their previous dose.  For those who have not yet had pneumonia or shingles vaccines, these are also ones to consider. Here are answers to some of the questions we have been receiving. Note that this is general advice and is not to replace guidance from your own healthcare team.

Is Arexvy being provided through the government?

Arexvy will be provided to all long-term care residents at no charge this fall.  All other adults aged 60 and over will either need to pay out-of-pocket or use their coverage through a private plan.  A prescription from your family’s physician’s office will be needed. It will primarily be dispensed by community pharmacies, where patients may also receive the injection if requested on the prescription by the prescriber.

How long does the protection from Arexvy last?

Arexvy provides protection for at least 2 seasons. Further ongoing research will inform us if the protection lasts even longer.

Can I get more than one vaccine at a time?  I am due for the influenza vaccine, COVID booster, and RSV this fall.

Any non-live vaccines can be given together according to the National Advisory Committee on Immunization (NACI). All the vaccines mentioned above are non-live. COVID boosters have commonly been given at the same time as the influenza vaccine in the last two seasons. When giving two vaccines, they would be given in separate arms. Although not commonly done, if multiple vaccines are needed at the same time, it is possible to receive more than one vaccine in the same arm,  if they are at least 1 inch apart. We have seen this done when a person has limited opportunity to be vaccinated or may be leaving on vacation and needs multiple vaccines before travel. Studies reported no concerns when Arexvy was given at the same time as the annual flu shot. Another consideration is that some vaccines may cause redness and soreness at the injection site along with some general aches and pains or even a low-grade fever. For this reason, some people prefer to separate vaccines to not compound this impact on the same day. Others want to assess how a new vaccine makes them feel and for that reason want to separate it from others. What is important to realize, is that by separating all vaccines you may not make the time to return and get them all done. This is why doing two at a time has become a common practice. Regardless of what preference you and your healthcare provider choose, it is safe and effective to receive vaccines together. Arexvy has the same adjuvant (vaccine booster) as Shingrix, but only half the amount, so you may have a similar reaction to it.

Do I need to delay my treatments for my autoimmune condition, such as biologics, when getting a non-live vaccine for RSV, pneumonia, shingles, COVID, or flu?

It is not necessary to hold or delay most biologic/advanced treatments. We would suggest not administering a new vaccine within a few days of a biologic injection or infusion, so if you feel unwell you can determine which was causing your symptoms. The exception to this is methotrexate, which can be held for two doses after receiving the flu shot for best effectiveness. This should only be done in a person whose condition is stable and not flaring. We only have data to support this suggestion for the flu shot, although some clinicians may advise holding methotrexate for other vaccines as well. The other exception is for people receiving a specific type of biologic that suppresses B-Cells called rituximab or ocrelizumab. When receiving these treatments, the timing for the best vaccine benefit is 2 weeks before an infusion or 5 months after the previous infusion.  If a person is on prednisone, vaccines will be most effective when the dose has been below 20mg per day for at least 2 weeks.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

This week we celebrate World Mental Health Day (October 10^th.) According to the World Health Organization, “This is an opportunity for people and communities to unite behind the theme ‘Mental health is a universal human right‘ to improve knowledge, raise awareness and drive actions that promote and protect everyone’s mental health as a universal human right.”

At Charlton Health we specialize in the treatment of autoimmune diseases.  It is well known that such conditions can take a toll on a person’s physical and mental health.  The perception of pain is also enhanced by depression and poor sleep.  The body is very interconnected.  We are fortunate to have excellent advanced therapies to treat many autoimmune conditions that affect the joints, skin, gut, and nervous system. Ensuring your condition is in a low state of disease if not remission can lead to improvement in many aspects of health, beyond the specific condition being treated.

If you or a loved one is suffering from mental health concerns, reach out to your medical team for support.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

This week marks World Pharmacist Day.  This day is intended to recognize and honour pharmacists for their significant contributions to improving global health. At Charlton Health, I am privileged to work alongside several excellent pharmacists whose dedication to patient care is exemplary.  Their expertise in our areas of specialization benefits patient’s knowledge to support them on their treatment journey. We take great pride in our profession and acknowledge our many colleagues working in specialty pharmacies, community pharmacies, hospitals, family health teams, medical information services, research, and the pharmaceutical industry. 

Happy World Pharmacist Day!

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Even if you don’t have school-age children or aren’t attending a fall semester as an adult, there is something about the September start of school that causes us to take a pause and reset; to revisit our lifestyle and reflect on our eating, sleeping, and exercise routines. We know that these aspects are the fundamentals of health, and no medication can replace them. 

• Do you get 7-8 hours of sleep? 
• Do you exercise (such as walking) 150 minutes a week?
• Do you drink 2- 3 litres of water per day?
• Do have healthy snacks such as fruits, vegetables, nuts, and seeds?
• Do you have protein at breakfast?
• Do you have leafy greens and vegetables and protein at lunch and dinner?
• Do you stop eating when you feel full?
• Are you eating larger portions than you need? 
• Do you avoid eating close to bedtime?

Beyond these measures, it is also important to spend time with people who lift your spirits and bring you positivity.  Artistic outlets such as playing an instrument, working with clay, painting, needlework, woodworking, etc., can reduce stress and bring joy.  What hobbies have you put aside because you were too busy?  Only you can make these things a priority in your schedule. 

Best of luck with your reset this fall!

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

We are very excited to report Health Canada’s recent approval of a long-awaited vaccine for RSV (respiratory syncytial virus) for those aged 60 and older. It will be marketed under the name Arexvy and is produced by GSK.

RSV is a common contagious virus that affects the lungs and respiratory airways. Although all ages can be affected by the virus causing cold-like symptoms, those over age 60 years of age have increased risk which can lead to complications such as pneumonia, hospitalization, and even death. The risk is even greater in people with underlying medical conditions such as diabetes, chronic heart disease, and lung disease. RSV caused an estimated 470,000 hospitalizations and 33,000 deaths in those aged 60 years and above in high-income countries in 2019. The vaccine was 82.6% effective for the prevention of lower respiratory tract disease caused by RSV in older adults, and 94.6% efficacy in those with underlying medical conditions.

The vaccine is expected to be available before the RSV season, which typically starts in October. It is given as a single dose and the need for booster doses is not yet known. This non-live vaccine has been studied in combination with the flu vaccine and may be given at the same time. It is not yet publicly funded in Ontario but may be covered as a benefit on some private health plans. The cost of the vaccine has not yet been announced. Adverse events included injection site pain, fatigue, myalgia, and headache. These were typically mild to moderate and transient.

More information, including the product monograph, can be found here and should be consulted for complete administration and safety information.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

At least 387 different medications can cause phototoxic or photoallergic reactions.  As we hit the peak of summer weather,  it is important to take precautions when seeing an auxiliary label on your prescription warning of sun exposure.  These colourful warning labels put on your prescription are important.  The sun warning label is usually bright yellow with an image of a sun.  Anti-inflammatory medications fall in this group, such as naproxen seems to have the greatest impact. Other medications used by many of our blog followers that can increase sun sensitivity include sulfasalazine and hydroxychloroquine.  Methotrexate can cause a reaction known as radiation recall,  causing irritation in areas where you have had a past sunburn.

Protecting yourself from the sun calls to mind the famous phrase: SLIP, SLAP, and SLOP.  Slip on a long sleeve shirt and pants that are photoprotective, slap on a wide-brimmed hat, and slop on sunscreen with an SPF 30 or greater.  Sunscreen should be applied at least 15-30 minutes before going out in the sun and needs to be reapplied throughout the day, especially after swimming or excessive sweating.  We advise looking for sunscreens that have been endorsed by the Canadian Dermatology Association, which will be evident on the label. Of course, seeking out shade is key, especially during the peak sun hours of 11AM – 4PM.

If a sun sensitivity reaction happens,  seek medical attention as prescription medication may be needed to combat the reaction.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

As a pharmacy specializing in the treatment of autoimmune diseases, we are privileged to speak to many patients who have found life-changing benefits from the use of advanced therapies.  Hidradenitis Suppurativa is one such condition where biologic therapies such as Adalimumab (originator drug Humira) have had a significant impact.  The sad thing is that many people with this condition are not diagnosed until they have had symptoms for over 8 years.  Early treatment is important. 

This chronic inflammatory skin disease causes lesions to develop in areas of the body that contain a high density of apocrine sweat glands. Common areas where HS develops include the armpits, underneath the breasts, inner thighs, groin, and buttocks.  The lesions can be misdiagnosed as boils.  The condition usually starts at puberty when hormonal level change and apocrine sweat glands develop.  The tissue is painful and left untreated can lead to scaring and many negative health impacts.  According to the HS Foundation,  the exact cause of HS is not currently known. Still, research so far suggests that a combination of factors of genes, defects in the structure of hair follicles and sweat glands, immune system activation, and hormones may all play a role in the development of HS.

We also recommend you have a look at the HS Foundations Guidebook for patients living with HS as it is an excellent resource that was last updated in 2022.

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Charlton Health is inspired by our patients living with lupus and we are privileged to provide advanced therapies that control this condition. We are pleased to share information about the WALK for Lupus.

WALK for Lupus Ontario registration is open and now finally in-person! Join thousands of participants through various WALKS across Ontario. 

The next 5 WALKS take place in:

• Richmond Hill – June 24 
• Barrie – July 7
• Hamilton/Halton – July 8
• Toronto – July 15
• Windsor – July 29

To participate in one of your local walks, visit WALK for Lupus Ontario. Registration/donation information can be found here.

The WALK for Lupus is Lupus Ontario’s largest provincial fundraising and awareness event. Over the years, the WALK for Lupus has raised over $1 million to fund the Lupus Ontario Geoff Carr Research Fellowship, support and education programs for lupus patients and their families, and advocacy projects aimed at improving programs and services for lupus patients. Lupus is a complex autoimmune disease that can impact virtually any bodily organ – skin, kidneys, brain, heart, eyes, and others – with profound life-altering and life-limiting consequences.

5 million people globally have some form of lupus, yet little is known about the disease as each patient presents with a differing array of symptoms. Hence, there is a consistently high demand for funding directed towards pioneering research, proactive advocacy, and inventive approaches that can enhance the health outcomes of individuals impacted by lupus.

Maher Jibrini is a Student Pharmacist from the University of Waterloo currently doing a rotation at Charlton Health as part of his final year of studies. Maher holds a strong passion for interprofessional collaboration at all levels of healthcare and looks forward to applying his knowledge across various professions in the healthcare & pharmaceutical industry.

The ‘nocebo effect’ is an interesting concept where negative expectations and beliefs about treatment or medicine can actually have a negative impact. This is opposite to the placebo effect, where positive expectations can result in positive outcomes. It shows how our thoughts and beliefs can affect how we feel, physically and emotionally. It’s important to be aware of our negative expectations and try to focus on positive thoughts to support our well-being. It is important to keep in mind that there are many factors that influence treatment success and this is only one of them. 

One such example of the nocebo effect was seen when studying patients who were switched from an originator molecule, such as Humira, to a biosimilar, as previously discussed on our blog. Patients who had not received the education needed to understand the effectiveness and safety of the biosimilar and alleviate any negative perceptions about the switch experienced adverse effects not seen in the group that had been fully educated. Sometimes misinformation regarding a treatment from various sources (e.g. social media), can lead to negative opinions about the treatment.

When starting a new medication or treatment, it’s important to remain aware of the nocebo effect and seek reliable sources for your information. 

To combat a potential nocebo effect, you can:

1. Stay positive
   • Maintain a positive mindset and focus on the potential benefits of your treatment. Believe in your ability to heal and stay hopeful.
2. Communicate openly
3. Talk to your healthcare provider about any concerns or fears you may have. Ask questions and seek clarification about the treatment plan, potential side effects, and realistic expectations.
4. Trust your healthcare provider
5. Build a strong relationship with your healthcare provider. Believe in their expertise and guidance.
6. Seek reliable information
7. Be cautious of unreliable sources of information that may exaggerate the negative aspects of treatment. Consult reputable sources and ask your healthcare provider for reliable information to understand your treatment better.
8. Stay engaged in your treatment

Maher Jibrini is a Student Pharmacist from the University of Waterloo currently doing a rotation at Charlton Health as part of his final year of studies. Maher holds a strong passion for interprofessional collaboration at all levels of healthcare and looks forward to applying his knowledge across various professions in the healthcare & pharmaceutical industry.