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Comment by moh_maya | Hacker News Reader

Just a tangential headsup for others if they are paying for vimovo (out of pocket, or significant co-pay).

Vimovo is a combination of two generics (naproxen & esomeprezol) delayed release. You can probably get OTC versions of the two pills for much cheaper than what Vimovo charges.

This drug falls into (IMO) ethically grey area in terms of drug pricing & marketing; on the one hand, it is (was?) priced much higher than the individual generics that are part of the combination; on the other hand, it is a convenience.

Horizon pharma, which markets the drug, is not the cleanest of the bunch either [1,2] .. They have a really good understanding of the healthcare market, and know exactly how to game it.

[1] https://www.bloomberg.com/news/features/2018-04-06/when-thes...

[2] https://www.forbes.com/sites/johnlamattina/2018/03/15/physic...

(edit: added 2nd link)

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Naproxen (anti-inflammatory) isn't the kind of thing that you want to be on long-term, if it can be avoided, either. I have just been diagnosed with autoimmune psoriatic arthritis. I had three months of Naproxen, which made it possible to walk a couple of miles each day, but they were basically handed out as a "Here, this should take down the inflammation, now wait for your specialist appointment."

Having said that, I'm not sure Naproxen is any worse than the Prednisolone (steroid) tablets I'm now on for two months while I wait for the Methotrexate (nasty cytotoxic) to work.

If there's a stem cell treatment on the horizon, I'd love to hear about it.

Naproxen is vastly superior to prednisone.

The side effects from prednisone are wretched, and long term use is way worse than the impact of naproxen.

I was on nsaids for a decade due to poorly constructed skeleton. I only moved off because I became tolerant to them.

Agreed. I think Predisolone is probably a bit better than Prednisone too. Yes, the side-effects of Naproxen were not as bad, but I'm only on Prednisolone for 8 weeks. I wouldn't want it for longer, given how sick it's making me feel right now. Thing is, it is being way more effective on the first dose than Naproxen ever was.

Naproxen can restrict blood flow to the kidneys so need to be cautious in the long term.

Yeah, but compared to prednisone it's water :)

The NSAIDs are all remarkably safe, as opposed to steroids, and the non-steroidal non-NSAIDs (wtf thought it was good to make NSAID mean just a specific group??).

I'm on Celebrex, which is much more exciting in its side effect profile, but is still preferable to prednisone :-/

Has your doctor talked about Otezla (aprimelast) or biologics?

Otezla inhibits PDE4, an enzyme which regulates pro-inflammatory cytokines, and has the benefit of being an oral medication; one tablet a day. Biologics such as Humira and Stelara are more potent and even more targeted, but need to be injected.

What Otezla and biologics have in common is that they're much more narrowly targeted to the immune pathways of PsA/PsO than older systemic treatments such as prednisolone, methotrexate, cyclosporine, etc.

Thanks for the info. It looks like I only get Otezla if Methotrexate fails to work, or I pay a lot.

You may want to look into Taltz. It has really helped me, and practically no side effects aside from some injection site reactions.

If your insurance won't cover it (mine wouldn't without trying older ones with way worse potential side effects) the drug company offers a program that only requires a $25 copay.

> You can probably get OTC versions of the two pills for much cheaper than what Vimovo charges.

I don't think you can, specifically:

I don't think naproxen (as distinct from naproxen sodium, which has more rapid effect) is available OTC at all, much less in enteric coated delayed-release capsules.

Esopremazole is available OTC, but AFAICT only in delayed release form, and not in the same dosage used in Vimovo, which is immediate release esopremazole magnesium with a delayed release naproxen core; the esopremazole is to manage the side effects of the naproxen.

So, kitchen-table Vimovo from OTC supplies is not simple.

Naproxen sodium is merely a more stable version of naproxen. It’s effect and onset are identical. You just need to adjust the dosage. 220mg of Naproxen sodium is the same as 200mg of naproxen. As far as nexium, it’s not an extended release tablet, it just has an effect that lasts for 24 hours as it’s a non-reversible blocker of proton pumps in the stomach and it takes about a day for the body to make more of them.

Point is, aleve and nexium taken in an equal dose is almost identical to vimovo.

> Naproxen sodium is merely a more stable version of naproxen

Every source I can find that discussed the rationale for the development of the sodium salt says it was for more rapid uptake, not stability.

But the fact that Vimovo is an extended release naproxen tablet core and normal Aleve is not is a bigger deal than he naproxen/naproxen sodium distinction.

> As far as nexium, it’s not an extended release tablet

OTC Nexium 24 Hr is a delayed release esopremazole magnesium tablet according to the PDR and every other source. There are other Nexium-branded products (prescription) which are not delayed-release.

> Point is, aleve and nexium taken in an equal dose is almost identical to vimovo.

That might be true of prescription enteric-coated naproxen and immediate release esopremazole; it's not of OTC versions of Aleve and Nexium.

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