This week, many will return to school, and it’s no secret that the back-to-school season often sparks a rise in infections and seasonal illnesses. While it may start in classrooms, it quickly spreads beyond schools, as parents and caregivers carry viruses into workplaces and the wider community. For those on biologic medications, we want to take a moment to remind you of a few important precautions.

If you develop an active infection, such as the flu or COVID-19, it’s important to hold your biologic dose until you’re feeling better. Once recovered, you can resume your medication and adjust the schedule accordingly. For example, if you normally give your injection every other Wednesday but you’re sick on the day it’s due and don’t feel better until Sunday, you should delay the injection until Sunday. From then on, your injection schedule would shift to every other Sunday. If you receive your biologic by infusion and are sick for your scheduled infusion, please call your clinic to cancel and reschedule your appointment as soon as possible.

Tips to Reduce Infection Risk

There are proactive steps you can take to help reduce your risk of illness and avoid potential delays to your biologic therapy:

1. Stay Up to Date on Vaccines

Non-live vaccines such as the flu shot and COVID-19 boosters can be received at any time during biologic treatment; you don’t need to skip or delay your dose. If you’d like a list of recommended vaccines including protection for shingles, RSV and pneumonia , please do not hesitate to contact us and we’ll be happy to send it to you.

2. Practice Good Hand Hygiene

Wash your hands regularly with soap and water, especially after being in public spaces and before eating.

3. Maintain a Nutritious Diet

In addition to eating a variety of fruits and vegetables, consider incorporating foods with natural antiviral and antibacterial properties. Garlic, coconut oil, lemons, ginger, turmeric, and honey are great additions to support your immune health.

4. Prioritize Sleep

Even during busy times, aim for 7 to 8 hours of sleep each night. Rest is essential for reducing stress and giving your body time to repair and restore immune function.

If you’re ever unsure about whether to hold your dose or how to manage your biologic during an active infection, don’t hesitate to reach out, our pharmacy team is here to help. Wishing everyone a safe and healthy return to school!

Janine Fletcher is a 4th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.

Staying well hydrated is important in every season, but it becomes especially crucial during the
summer. Dehydration occurs when your body loses more fluids than it takes in. In hot weather,
we lose additional fluid through sweat as the body works to cool itself down. To stay balanced
and prevent dehydration, it’s important to drink more fluids than usual during warmer months.
While many fluids can help with hydration, Canada’s Food Guide recommends water as the
beverage of choice.¹ It’s free of sugar, calories, artificial additives, and preservatives, making it
the healthiest and simplest way to stay hydrated.

It can be difficult to know exactly how much water you need, as hydration requirements vary from person to person.² However, if you experience signs of dehydration, it’s a clear indication
that you need to increase your fluid intake. Common signs include dry lips and mouth, flushed
skin, headaches, dizziness or fainting, and dark yellow, strong-smelling urine.³ On the other
hand, pale, clear urine and feeling well are good signs that you’re properly hydrated.

Some tips to stay hydrated:
– Have a glass of water as soon as you wake up and with each meal
– Carry a water bottle with you throughout your day, especially if you are going to be
outside
– Add a slice of lemon, lime, cucumber, or other fruits to your water for a refreshing twist

This marks the final blog post in our summer series. We hope you’ve had a safe, fun, and well-
hydrated summer. See you in September!

Janine Fletcher is a 4th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.

1. Health Canada. Make water your drink of choice. Canada’s Food Guide. Updated
   January 26, 2021. Accessed July 28, 2025. https://food-guide.canada.ca/en/healthy-
   eating-recommendations/make-water-your-drink-of-choice/ ↩︎
2. Government of Alberta. Drinking enough water. MyHealth Alberta. Updated September
   20, 2023. Accessed July 28, 2025.
   https://myhealth.alberta.ca/Health/pages/conditions.aspx?Hwid=abk5466 ↩︎
3. Government of Canada. Facts on fluids: How to stay hydrated. Canada.ca. Published
   August 12, 2021. Accessed July 28, 2025. https://www.canada.ca/en/department-
   national-defence/corporate/news/regional-news/western-sentinel/2021/08/facts-on-
   fluids-how-to-stay-hydrated.html ↩︎

Last week, on July 28th, we observed World Hepatitis Day, a day dedicated to raising awareness about viral hepatitis. To mark the occasion, we’d like to share some information to help you better understand hepatitis.

What is hepatitis?

Hepatitis means inflammation of the liver. When it is caused by a virus, it is called viral hepatitis. There are five types of viruses that can cause hepatitis, known as hepatitis A, B, C, D, and E. Each type affects the body in a different way and is spread differently.

How is hepatitis spread?

Hepatitis A spreads through what’s called fecal-oral transmission, which means the virus is passed from stool, often through contaminated food or water. Hepatitis B is passed through blood or body fluids, such as during unprotected sex, sharing needles, or from a mother to her baby during birth. Hepatitis C is spread only through direct contact with infected blood. This can happen through sharing needles or receiving unscreened blood products. Hepatitis D also spreads through blood but only affects people who already have hepatitis B. Hepatitis E is similar to hepatitis A and spreads through contaminated food or water, but it is very rare in developed countries.

Can it be treated?

Treatment depends on the type of hepatitis. Hepatitis A and E are usually mild and self-limiting, meaning they often clear without specific treatment. Hepatitis B and D cannot be cured, but there are medications that can help suppress the virus and reduce the risk of liver damage. Hepatitis C can now be cured in over 90 percent of people with a short course of oral medication taken for 8 to 12 weeks.

Why is hepatitis harmful?

If left untreated, hepatitis B and C can cause scarring of the liver, which is called fibrosis. Over time, this scarring can lead to permanent liver damage known as cirrhosis. Cirrhosis makes it harder for the liver to function properly and can increase the risk of liver cancer.

How can viral hepatitis be prevented?

You can reduce your risk of viral hepatitis by taking a few important steps. 

• Always use protection during sexual activity and never share needles or any equipment that may come into contact with blood. 
• Be careful with the food and water you consume, especially when traveling to places with limited sanitation. 
• If you have any current or past risk factors for contracting hepatitis, speak to your family doctor about getting tested. It can sometimes take years for people to become symptomatic after getting hepatitis C. Early treatment is key to reducing transmission to others and disease complications. 

In addition, getting vaccinated is one of the most effective ways to protect yourself:

• The hepatitis B vaccine is part of the routine immunization program in Ontario and is given as two doses in Grade 7.
• The hepatitis A vaccine is publicly funded in Ontario for certain high-risk groups, including men who have sex with men, people who use intravenous drugs, and those with chronic liver disease.
• Currently, there are no vaccines available for hepatitis C, D, or E.

We hope this information helps you better understand hepatitis and maybe addresses some misconceptions. With greater awareness and understanding of hepatitis, we can work together to create a more stigma-free environment!

Janine Fletcher is a 4^th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.

References

Johns Hopkins Medicine. Hepatitis. Published August 12, 2021. Accessed July 28, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hepatitis

Mayo Clinic. Hepatitis C. Published August 23, 2023. Accessed August 6, 2025. https://www.mayoclinic.org/diseases-conditions/hepatitis-c/symptoms-causes/syc-20354278#:~:text=But%20many%20people%20with%20hepatitis,symptoms%20or%20known%20liver%20disease.

Summer is a great time to get out and see new sights. Whether you’re planning a weekend getaway or a big adventure abroad, it’s important to be prepared if you’re bringing your biologic medication along for the trip.

Generally, biologics need to be stored in the fridge at 2–8°C, but many can remain stable at room temperature for a limited time. Knowing how long your medication can be out of the fridge is essential for safe travel. Below is a list of commonly used biologics and the number of days they can stay at room temperature (under 25°C and protected from light):

• 4 days: Cosentyx
• 5 days: Taltz
• 10 days: Cimzia
• 14 days: Actemra, Amgevita, Humira, Idacio, Kevzara
• 21 days: Hyrimoz
• 25 days: Bimzelx
• 28 days: Erelzi
• 30 days: Abrilada, Stelara, Simponi, Simlandi, Yuflyma
• 31 days: Steqeyma, Hadlima
• 56 days: Hulio
• 60 days: Brenzys

* Once your medication reaches room temperature, it must be used within the timeframes listed above. If not used in time, it must be discarded, even if it is put back in the fridge. 

If your travel time exceeds the durations mentioned above, we recommend using an insulated cooler bag, which can typically maintain fridge temperature (2–8°C) for approximately 6 to 8 hours. It’s a good idea to test your cooler bag in advance using a small thermometer and ice packs to ensure it stays within the recommended temperature range for the period of time you need it to. We also suggest bringing a few Ziploc bags that can be filled with ice and rotated as needed to help maintain the temperature for longer periods. When flying, be sure to keep your medication in your carry-on luggage, never in checked baggage. Some airlines may be able to store your medication in their onboard refrigerator during the flight. Please check ahead and always have a backup option available. 

Contact us in advance if you require a travel letter to carry your medication across the border or through airport security. If you need to adjust your delivery schedule or arrange for a larger supply before heading out, give us a call. We’re happy to help make your trip as smooth as possible. Wishing you safe travels and a wonderful summer! 

Janine Fletcher is a 4^th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.

Now that the warmer weather is here, many of us are spending more time enjoying the outdoors. Whether you’re heading to the beach, going for a walk, or just relaxing in your backyard, it’s important to keep sun safety top of mind. Research has shown that people with immune-mediated inflammatory conditions like rheumatoid arthritis, inflammatory bowel disease, and psoriasis have a higher baseline risk of skin cancer compared to the general public.^1,2 Annual skin checks with your health care provider are recommended. Additionally, applying sunscreen to all exposed skin while outdoors helps protect against skin cancer.

The Canadian Cancer Society offers the following sunscreen recommendations⁴:

• Choose a sunscreen with an SPF of 30 or higher
• Use about 2-3 tablespoons of sunscreen to cover your body, and 1 teaspoon for your face and neck
• Reapply sunscreen at least every 2 hours 
• Apply sunscreen before makeup or insect repellent
• Check the expiry date to ensure the sunscreen is still effective 

For people taking medications that increase sensitivity to the sun, a sunscreen of SPF 50 or greater is often recommended. For such medications, the pharmacy will place a sun warning sticker on the medication label.  

 Sun safety is a small step that can make a big difference. Studies have shown that daily use of sunscreen can reduce the risk of developing squamous cell carcinoma (SCC) by about 40% and lower your melanoma risk by 50%.⁵ By taking a few minutes to apply (and reapply) sunscreen, you can enjoy the outdoors this summer while protecting your health. Be sure to apply the sunscreen 15 minutes before going outside to allow it to absorb in advance of sun exposure.

Janine Fletcher is a 4^th-year pharmacy student from the University of Waterloo and is currently completing a rotation at Charlton Health. She is passionate about improving health outcomes for patients with chronic conditions and is on track to become a licensed pharmacist this year.

References

1. Rabah S, Kang X. Assessment of Skin Cancer Risk in Autoimmune Diseases: A Multivariate Analysis Using a National Inpatient Database [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/assessment-of-skin-cancer-risk-in-autoimmune-diseases-a-multivariate-analysis-using-a-national-inpatient-database/. Accessed July 6, 2025.
2. Singh S, Nagpal SJ, Murad MH, et al. Inflammatory bowel disease is associated with an increased risk of melanoma: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2014;12(2):210-218. doi:10.1016/j.cgh.2013.04.033
3. Vaengebjerg S, Skov L, Egeberg A, Loft ND. Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-analysis. JAMA Dermatol. 2020;156(4):421–429. doi:10.1001/jamadermatol.2020.0024
4. Canadian Cancer Society. Spotlight on sun safety. Updated 2025. Accessed July 6, 2025. https://cancer.ca/en/cancer-information/reduce-your-risk/be-sun-safe/spotlight-on-sun-safety
5. Skin Cancer Foundation. Sunscreen. Accessed July 6, 2025. https://www.skincancer.org/skin-cancer-prevention/sun-protection/sunscreen/#:~:text=Studies%20show%20that%20regular%20daily,melanoma%20risk%20by%2050%20percent.

Biosimilars are becoming more common in Canada, offering patients trusted alternatives to the originator biologic medication. Biosimilars are not the same as generics. Generics are exact chemical copies of brand-name drugs, like acetaminophen for Tylenol. Biosimilars are made from living cells and are highly similar, but not identical, to the original biologic. Because of this, they go through extensive testing to confirm they work just as well and are just as safe.

Two new biosimilars, Omlyclo (omalizumab), the biosimilar to Xolair, and Tyenne (tocilizumab), the biosimilar to Actemra, have now been approved in Canada.

Omlyclo is used for asthma, chronic hives, nasal polyps, and food allergies. Clinical trials showed that people who switched from Xolair to Omlyclo experienced the same level of safety and effectiveness. Interestingly, in the U.S., Omlyclo is even approved as interchangeable with Xolair, meaning a pharmacist can substitute it without a new prescription. While Canada doesn’t allow for interchangeability within biosimilars, the U.S. designation highlights how closely the two products match.

Tyenne is used for rheumatoid arthritis, giant cell arteritis, and juvenile arthritis. Just like Actemra, it’s also available in the intravenous and injectable formats.

Biosimilars like Omlyclo and Tyenne meet Health Canada standards. They offer more treatment options and improve access to drugs, without compromising quality. At Charlton Health, our pharmacists are here to support you and answer any questions you may have about switching to a biosimilar.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

If you have a weakened immune system due to a condition (for example, rheumatoid arthritis) or due to a treatment (for example, chemotherapy), you may be at higher risk of developing shingles (herpes zoster). Shingles can have serious complications such as long-lasting nerve pain, vision problems, increased risk of stroke and heart attack, and even hospitalization. The good news is that the shingles vaccine, Shingrix, is now officially recommended for adults aged 18 and over who are immunocompromised.

This updated guidance comes from Canada’s National Advisory Committee on Immunization (NACI), which reviewed research showing that Shingrix is both effective and safe in people with lower immunity. The vaccine can lower your risk of shingles by up to 90%, and even helps prevent post-herpetic neuralgia, a long-lasting nerve pain that can follow a shingles infection.

If you’re immunocompromised, you should receive two doses of Shingrix, ideally 2 to 6 months apart, but it can be taken as early as one month apart. This update makes it clear that preventing shingles is possible, and you don’t have to wait until you’re 50!  

Public health supply of this vaccine is made available to physician offices for people aged 65 to 70.   Outside of that age range, many people use a private insurance plan or pay out of pocket.  Several patient support programs for advanced therapies in rheumatology, dermatology, and gastroenterology will support the cost of vaccines, such as Shingrix. 

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

If you have Crohn’s disease or ulcerative colitis (IBD), you might also have joint pain—and it may not be a coincidence. This type of joint pain could be linked to your IBD and is called enteropathic arthritis. It is more common than you may think and affects more than half of people with IBD.

Enteropathic arthritis can show up in different ways. The most common kind affects big joints like your knees, wrists, or elbows, and it often flares up when your IBD does. A less common type affects smaller joints (like the ones in your hands) and doesn’t always follow the same pattern as your gut symptoms.

It’s important to know that your joint pain could be part of your IBD, because it can change how your treatment is managed. Some IBD medications – for example, infliximab (i.e. Remicade) or adalimumab (i.e. Humira) – can also help with joint pain. But on the contrary, common arthritis medications, such as NSAIDs (ex. ibuprofen) can make IBD worse, so they would need to be avoided. In some cases, other treatments like methotrexate or azathioprine may be added to help with both joint and gut inflammation.  People with both conditions often see a gastroenterologist and rheumatologist who coordinate the choice of treatments. 

Besides medication, gentle activities like swimming, yoga, or biking can help keep your joints from feeling stiff and improve movement.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

Though HIV and autoimmune diseases both involve the immune system, they operate very differently. Autoimmune diseases occur when the immune system mistakenly attacks the body’s own healthy cells, often requiring immunosuppressant treatments to control inflammation and prevent further harm. On the other hand, HIV is a virus that specifically targets and destroys immune cells, weakening the body’s defense against infections and leading to increased susceptibility to various illnesses. Understanding this distinction is vital for understanding the nature of these conditions and the different treatment methods available.

Autoimmune diseases are typically managed with medications that suppress the immune system’s overactivity. In contrast, HIV treatment focuses on antiretroviral therapy (ART) to lower the viral load and improve immune function, preventing the progression to acquired immunodeficiency syndrome (AIDS). Although individuals with HIV may have autoimmune-like symptoms, HIV is not classified as an autoimmune disease. However, the long-lasting immune activation and damage caused by HIV can increase the risk of developing certain autoimmune conditions. Regular monitoring and individualized treatment plans are key for effectively managing both HIV and autoimmune diseases.

Joyce Ayad is a pharmacist at Charlton Health, who believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. 

Every day, Charlton pharmacists counsel patients on advanced therapies for many immune-mediated conditions. Some of this discussion focuses on how the medication works to treat a particular condition. We discuss the risks and benefits of treating vs. not treating a condition. It is important to note that if the benefits of any treatment do not outweigh the risks, the medication is not approved by Health Canada. Patients may respond differently because of their individual characteristics, medical histories, other medications, and their level of disease. However, an expert health professional who understands the disease and medications can effectively put all the risks and benefits into context, allowing patients to make an informed decision about their care.

It is common for some patients to rely on information from various internet sites, including “chat groups” where certain adverse effects of a medication are highlighted by others who have used the treatment. This can often lead people to avoid treatments that could be beneficial for them. It is important to note that the thousands of people who are doing well may not be sharing their experiences on these sites. This results in a skewed sense of the actual risk.  

Keep in mind that not all internet sites are misleading. In fact, there are many sites that are validated by medical experts and are excellent sources of general information.

For example, The Arthritis Society, The American College of Rheumatology, and the Crohn’s and Colitis Foundation of Canada are great websites run by medical experts. See a full list of our recommended resources here.

Remember, we are here to answer your questions. If you read something that concerns you, reach out to fully understand the context of this information and how it may or may not impact you.

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.