At Charlton Health we specialize in providing biologic medications for many autoimmune conditions. 

Some of these medications have been on the Canadian market for several years and their patent to be the only company who can make the medicine has ended.

This allows other manufacturers to make their own version of the biologic medication. A new supplier of a biologic that has lost its patent, is called a biosimilar. 

The reason for the name “biosimilar” is because a biologic is produced by programming a living cell to make specific protein-based medication. The specific type of cell used will be different depending on the manufacturer, so their medication must be called “similar” rather than identical. Even batch to batch, the original producer of a biologic can have slight differences. This is why Health Canada requests studies be done with all biosimilars to ensure they are as effective and safe as the original biologic. Studies have also shown that safety and efficacy remain the same when a patient makes this switch.   

Due to the cost savings, many patients around the world have switched from an originator biologic to a biosimilar with great success. In Canada, most provinces have also switched patients to a biosimilar for the purpose of cost savings that would not impact patient outcomes. 

This is referred to as a non-medical switch. 

Ontario recently announced that the process of switching existing patients to a biosimilar will begin March 31^st and this transition period will go until the end of 2023. 

Some of the treatments for autoimmune diseases that are affected by this switch include infliximab (Remicade^©), rituximab (Rituxan^©), adalimumab (Humira^©) and etanercept (Enbrel^©).  

At Charlton Health we have dispensed ALL the biosimilars available for each of these treatments over the last several years. They are all very familiar to us and your specialist.

We will work with your specialist to provide any biosimilar needed. 

Our pharmacists will help you be educated on any change!

Charlton works with all support programs; you will have the same financial support you have received from the originator biologic program. 

If you receive an infused medication in one of our clinics, you will continue at the same site with your care team.  If you receive an injectable medication, you will be trained on any device change as each manufacturer has their own patented device. Some of the biosimilar injections offer different features to enhance injection comfort. 

Our pharmacists can review these options with you.  

Based on the worldwide experience and evidence with the biosimilars that exist today, many medical professionals and patient support groups endorse this switch with the understanding that patients are well-informed and educated on any switch.

As always, never hesitate to reach out with any questions or concerns regarding your specialty treatment.  Our team of health professionals and reimbursement specialists are here to support 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.

Many of our patients have indicated they are planning a vacation over the winter months to a sunny destination. It is important to note that medication requiring refrigeration is to be kept at 2-8^oC during your journey. To ensure the medication is not lost in transport, it must be in your carry-on bag and never under the plane where temperature changes are uncertain.  

Carrying empty Ziploc bags with you is also a good idea. You can get ice from the in-flight attendant to help maintain the temperature in your cooler bag, should your ice packs not be enough for the length of the trip. Soft-sided cooler bags may help maintain fridge temperature for 6-8 hours. However, you may be in transit much longer from the time you leave your home until you arrive at your destination.  In preparation for your trip, you may wish to test your cooler using a small thermometer along with ice packs to mimic the time you will be in transit. This will ensure that when you put the medication in the cooler at the time of travel, you can trust it will remain within the suggested temperature range (2-8^oC). 

Biologic medications differ in the amount of time that they can remain at room temperature, ranging from 4 hours to 60 days. If you inadvertently leave your medication out of the fridge, contact us immediately for further direction. Depending on the medication and the amount of time it was left at room temperature, it may not be appropriate to return it to the fridge.

Don’t hesitate to reach out for the pertinent information needed for your specific medication during travel. We are also happy to provide a travel note which may be needed when going through security with a fluid-containing injectable device. Of most importance is to calculate how much medication you will need while away and to order this well in advance of your travel date.

Bon Voyage!

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. Since January 2021, 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. 

Publicly funded shingles vaccination has been available for many years for adults aged 65-70. Initially, the vaccine provided was Zostavax, which was a live vaccine given as a single dose. Protection decreased with time and by 8 years, very little protection remained. Zostavax is no longer marketed in Canada. In the last few years, the newer non-live shingles vaccine, Shingrix became publicly funded for the 65-70 age group. It is given as 2 doses, two-six months apart. We are still seeing excellent effectiveness 10 years after giving the vaccine. The likelihood of getting shingles increases with age, and 1 in 2 people will get shingles at age 80 and above. Vaccination is recommended for the public from age 50 but is not funded until age 65. For adults who are immunocompromised either by a medical condition or treatment, shingles vaccination is suggested from age 18.

Some private insurance plans pay for vaccinations, however, there are many adults who could benefit from protection who are paying out of pocket. Shingrix does not require a prescription and can be purchased at the pharmacy where a pharmacist can also provide the injection. As a catch-up for those aged 65-70 who did not have access to getting their vaccine due to COVID, the government is extending the publicly funded vaccines to those born in 1949,1950, 1951, and 1952. This means you can still get your complimentary Shingrix if you are turning 71, 72, 73, or 74 up until the end of December 2023. In 2024, the coverage will go back to just 65-70 years of age.

Click here for more information on the shingles vaccine and government coverage.

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.

Happy New Year to our Charlton Family! We enter 2023 with much excitement as treatments for autoimmune diseases continue to expand making our ‘tool chest” bigger. Therapies marketed for psoriasis and psoriatic arthritis are being approved for inflammatory bowel diseases, and new technologies are being implemented to offer slow subcutaneous injections as an alternative to infused medications. Newly discovered mechanisms for treating autoimmune conditions will offer new classes of medication. Advances in COVID prevention and treatment have evolved over the last year with Evusheld and Paxlovid. Pharmacists in Ontario can also prescribe Paxlovid for eligible adults either based on age (people over 60) or high level of infection risk. The RSV (respiratory syncytial virus) vaccine is expected to be approved this year for adults. This comes after the release of the newest pneumonia vaccine, Prevnar 20, in August of 2022. Each year at national and international rheumatic disease, dermatology, and gastroenterology meetings, thousands of posters are presented showing research in these fields. It is inspiring!

As Health Canada approves new therapies, we will share this information with you through our blog series. Stay tuned for the exciting year ahead.

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 we near the end of 2022, we thought we would share some of our most popular blog posts of the past year with you. We’ve talked about a huge number of subjects this year, but these ones were your favourites!

3. Opening of the Charlton Digestive Disease Centre

2. Health Canada Approves Three New Adalimumab Biosimilars

1. Paxlovid Information

We want to hear from you! Is there a blog topic that you haven’t seen us write about yet? Let us know what you would like to learn about in 2023 by sending us an email!

According to Health Canada’s guidance on fall prevention, falls are the leading cause of injury among older Canadians.  In fact, 20-30% of seniors experience one or more falls each year.  As winter is upon us, so comes the ice and an increased risk of falls. However, falls don’t just occur on icy pavement; 50% of falls causing hospitalization occur at home.   

Reducing the risk of falls is important in preventing fractures.  95% of all hip fractures are caused by falls.   When a person has osteoporosis, a broken bone does not heal in the same way as a healthy bone and this puts extreme stress on the body as a whole.  For people on blood thinners, a fall can lead to bleeding risk which can be life-threatening when hitting the head. 

Many factors increase the risk of a fall: poor balance, decreased muscle and bone strength, reduced vision or hearing, and unsafe conditions in and around your home.  Exercises that promote muscle strength and balance are excellent ways to reduce falls.  Daily walks, Tai Chi, core exercises, and lifting weights are all helpful.  Eating a balanced diet that contains protein also helps build muscle and promote strength.  Vision and hearing tests are suggested to be sure you have the support needed to see and hear well.

It is also important to look at every room of your house to ensure floor surfaces are clear of clutter to avoid tripping. Bathroom supports including grab bars,  shower chairs, and anti-slip surfaces should be in place.  Good footwear, even inside the house,  provides good stability.  Mobility aids (walkers, wheelchairs, etc) can be purchased from authorized dealers where the proper assessment of your needs can be made and government financial assistance offered.  Occupational therapists can perform these assessments as well as do home visits to be sure fall risk is minimized.

In the winter ensure ice has been cleared on your walkway.  Ice grips can also be added to the bottom canes and to footwear as additional protection from falls.

For further information, click here.

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. Since January 2021, 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. 

We have had many calls asking about the timing of vaccines this fall. As clinical pharmacists working at Charlton Health, we are happy to answer any questions regarding vaccines and the timing of medications. There is no need to separate the COVID-19 bivalent booster doses from other vaccines including the influenza vaccine. Many vaccines can be given on the same day. As the newest pneumonia vaccine, Prevnar 20 was released this summer, many people are also upgrading to this lifelong protection against 20 strains of bacterial pneumonia. It can also be given at the same time as other vaccines. Shingrix for shingles protection is offered in two doses, usually 2 months apart, and can also be given with other vaccines. So when getting vaccinated, consider other vaccines that you may require.

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. Since January 2021, 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. 

Atopic Dermatitis is commonly referred to as eczema. The foundation of the condition is skin barrier dysfunction, whereby allergens and infectious organisms can penetrate below the skin. This results in the release of histamine and other inflammatory chemicals causing redness of the skin and a frequent intense itch. Scratching the skin causes further irritation, making the inflammation and itch even worse. About 85% of people with atopic dermatitis experience their first flare before age 5. Approximately 25% of pediatric patients have recurrent symptoms into adulthood. 

Regular moisturizing is vital to maintain a healthy skin barrier along with avoiding triggers such as perfumes, air fresheners, candles, and smoking. Using soapless cleansers and shampoos, stress reduction, and avoiding curtains and carpets to reduce pollen, dander, and dust mites can all be beneficial. Although most people have mild to moderate symptoms that can be managed with these strategies and prescription creams, about 10% of people have moderate to severe symptoms that may require advanced therapies that reduce the immune response. Some of these advanced therapies include biologic treatments composed of protein, typically given as an injection.  However, there are some newer targeted treatments made available in tablet form. The latest addition to the list of oral targeted treatments for atopic dermatitis is called Abrocitinib, marketed as CIBINQO. It joins another medication in the same family, upadacitinib (Rinvoq) which is also approved for atopic dermatitis. Both medications are swallowed once a day and prevent immune cells from generating excess inflammation. Charlton Health is pleased to offer advanced therapies for many conditions, and we welcome this new addition to our treatment offerings.

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. Since January 2021, 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. 

Health Canada has approved Evusheld as a preventative treatment for COVID-19. It is not intended to replace COVID-19 vaccinations, but rather to add another layer of protection in patients who are predicted to have a poor antibody response to the vaccine. It is a biologic therapy composed of 150mg of Tixagevimab and 150mg of Cilgavimab. These proteins are antibodies that are designed to block the entrance of the virus into human cells. The treatment is given as a set of two injections given in the buttocks. Over the last several months this preventative treatment has been made available to oncology and transplant patients. As of October 2022, Evusheld is also being made available to individuals receiving intravenous medications rituximab (commonly used in rheumatology) and ocrelizumab (widely used in the treatment of Multiple Sclerosis). A prescription is required, and injections are being offered through many clinics throughout the province and in some physician offices.

If you are receiving either of these medications, you can contact your prescriber to see if this therapy is appropriate for you. In the event that you contract COVID-19, antiviral treatment should be initiated as soon as possible to further decrease the risk of developing severe outcomes from the virus.

As a reference, we have provided a document to share some general information about this treatment made available by Ontario Health.

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. Since January 2021, 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.