Oral Hygiene Practices for Preventing Oral Thrush

Oral hygiene background

Oral Hygiene Practices for Preventing Oral Thrush

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Good oral hygiene practices are essential in preventing oral thrush, also known as oral candidiasis, which is primarily caused by the overgrowth of Candida species, particularly Candida albicans. Here are some evidence-based strategies to maintain good oral hygiene and prevent oral thrush.

  1. Regular Brushing and Flossing: Brush teeth at least twice daily with fluoride toothpaste and floss daily to remove dental plaque, which can harbor Candida. The American Dental Association emphasizes the importance of effective plaque removal and regular dental visits to promote oral health.[1]

  2. Use of Antimicrobial Mouthwashes: Mouthwashes containing chlorhexidine digluconate or cetylpyridinium chloride have been shown to impair the virulent traits of Candida albicans and other oral pathogens, thus helping to maintain microbial homeostasis in the oral cavity. However, chlorhexidine should be used with caution due to potential side effects.[2]

  3. Maintain Salivary Flow: Adequate salivary flow is crucial as saliva has antifungal properties. Patients with dry mouth (xerostomia) should use mechanical salivary stimulants, oral moisturizers, or systemic medications to promote saliva to manage dry mouth and reduce the risk of oral candidiasis. The American Dental Association recommends these measures for managing xerostomia and preventing candidiasis.[3]

  4. Proper Denture Hygiene: For denture wearers, it is important to clean dentures daily and remove them at night. Disinfecting dentures with solutions such as 2% chlorhexidine gluconate can prevent reinfection. Denture stomatitis, a form of oral candidiasis, is often associated with poor denture hygiene. [4-5]

  5. Avoiding Risk Factors: Minimize the use of broad-spectrum antibiotics and corticosteroids, which can disrupt the normal oral microbiota and promote fungal overgrowth. Patients should also avoid high-sugar diets and smoking, as these can increase the risk of oral candidiasis.[6]

  6. Regular Dental Check-ups: Regular dental visits are essential for early detection and management of oral conditions that may predispose to candidiasis. Dentists can provide professional cleaning and tailored advice on maintaining oral hygiene.[1]

By adhering to these practices, individuals can significantly reduce their risk of developing oral thrush and maintain overall oral health.

References:

  1. Managing Xerostomia and Salivary Gland Hypofunction: Executive Summary of a Report From the American Dental Association Council on Scientific Affairs. Plemons JM, Al-Hashimi I, Marek CL. Journal of the American Dental Association (1939). 2014;145(8):867-73. doi:10.14219/jada.2014.44.
  2. In Vitro Effects of Commercial Mouthwashes on Several Virulence Traits of Candida Albicans, Viridans Streptococci and Enterococcus Faecalis Colonizing the Oral Cavity. Ardizzoni A, Pericolini E, Paulone S, et al. PloS One. 2018;13(11):e0207262. doi:10.1371/journal.pone.0207262.
  3. Common Oral Conditions: A Review.Stoopler ET, Villa A, Bindakhil M, Díaz DLO, Sollecito TP. Jama. 2024;331(12):1045-1054. doi:10.1001/jama.2024.0953.
  4. Oral Fungal Infections. Muzyka BC. Dental Clinics of North America. 2005;49(1):49-65, viii. doi:10.1016/j.cden.2004.07.007.
  5. Management of Chronic Atrophic Candidiasis (Denture Stomatitis)-a Narrative Review. Abuhajar E, Ali K, Zulfiqar G, et al. International Journal of Environmental Research and Public Health. 2023;20(4):3029. doi:10.3390/ijerph20043029.
  6. Oral Candidiasis. Akpan A, Morgan R. Postgraduate Medical Journal. 2002;78(922):455-9. doi:10.1136/pmj.78.922.455.

 

 

 

 

DSM 5 and Insomnia Basics

DSM 5 and Insomnia Basics

Viral Patel
Viral Patel

Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025

What is Insomnia?

Insomnia is characterized by dissatisfaction with sleep quantity/quality. It is associated with difficulty initiating sleep, maintaining sleep, or early-morning awakenings. These symptoms must occur for at least three nights per week and be present for at least the last three months. Untreated insomnia can cause significant distress or impairment in social, occupational, or other important areas of life.3

DSM 5 Characteristics of Insomnia

The Diagnostic and Statistical Manual of Mental Illnesses (DSM-5) provides clear and highly detailed definitions of mental health and brain related problems.1 In regard to insomnia, the following list highlights the diagnostic criteria utilized in the guideline:

  1. A predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms:
    • Difficulty initiating sleep.
      1. In children, this may manifest as difficulty initiating sleep without caregiver intervention.
    • Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings.
      1. In children, this may manifest as difficulty returning to sleep without caregiver intervention.
    • Early morning awakening with inability to return to sleep.
  2. Sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, behavioral, or other important areas of functioning.
  3. Sleep difficulty occurs at least 3 nights per week.
  4. Sleep difficulty is present for at least 3 months.
  5. Sleep difficulty occurs despite adequate opportunity for sleep.
  6. The insomnia is not better explained by and does not occur exclusively during the course of another sleep-wake disorder (e.g., narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, parasomnia).
  7. The insomnia is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).
  8. Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint of insomnia.2

Treatment for Insomnia

Treatment for insomnia disorder typically includes cognitive-behavioral therapy (CBT) as the first-line treatment. Pharmacotherapy may be considered when CBT is insufficient or inaccessible.2

References

  1. Cleveland Clinic. DSM-5. Published October 14, 2022. https://my.clevelandclinic.org/health/articles/24291-diagnostic-and-statistical-manual-dsm-5
  2. Sleep-Wake Disorders. Diagnostic and Statistical Manual of Mental Disorders. March 2025. doi:10.1176/appi.books.9780890425787.x12_Sleep-Wake_Disorders
  3. Winkelman JW. Clinical practice. Insomnia disorder. N Engl J Med. (2015) 373(15):1437–44. doi: 10.1056/NEJMcp1412740

 

 

 

 

Managing Breakthrough Pain in Rheumatoid Arthritis

Managing Breakthrough Pain in Rheumatoid Arthritis

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Adjusting current DMARD (Disease Modifying Antirheumatic Drugs) therapy, utilizing non-pharmacologic therapies and employing NSAIDs play significant roles in managing breakthrough symptoms for rheumatoid arthritis (RA) management.

Managing Breakthrough Pain with Current DMARD Therapy

Managing of breakthrough symptoms with current DMARD therapy, the treatment options are guided by the 2021 American College of Rheumatology (ACR) guidelines.[1]

  1. Optimization of Current DMARD Therapy: If a patient is experiencing breakthrough symptoms, the first step is to optimize the current disease-modifying antirheumatic drug (DMARD) regimen. This may involve increasing the dose of the current DMARD or adding another conventional synthetic DMARD (csDMARD) such as methotrexate, hydroxychloroquine, sulfasalazine, or leflunomide.[1]

  2. Switching or Adding Biologic DMARDs (bDMARDs): If optimization of csDMARDs is insufficient, the next step is to consider biologic DMARDs. Options include TNF inhibitors (e.g., etanercept, adalimumab, infliximab), IL-6 receptor inhibitors (e.g., tocilizumab, sarilumab), T cell costimulatory inhibitors (e.g., abatacept), and B cell depleting agents (e.g., rituximab). [1-2]

  3. Targeted Synthetic DMARDs (tsDMARDs): For patients who do not respond adequately to bDMARDs, targeted synthetic DMARDs such as Janus kinase (JAK) inhibitors (e.g., tofacitinib, baricitinib, Upadacitinib) can be considered.[1]

  4. Switching Mechanisms of Action: If a patient fails to respond to one class of bDMARDs, switching to a different mechanism of action (e.g., from a TNF inhibitor to an IL-6 receptor inhibitor or a JAK inhibitor) is recommended. [3-4]

  5. Combination Therapy: Combining csDMARDs with bDMARDs or tsDMARDs can be effective in managing breakthrough symptoms and achieving better disease control. [1-2]

  6. Glucocorticoids: Short-term use of glucocorticoids can be considered for rapid symptom relief, but long-term use is generally discouraged due to potential adverse effects.[1][5]

These strategies should be tailored to the individual patient, considering factors such as disease severity, comorbidities, and previous treatment responses. Regular monitoring and a treat-to-target approach are essential to optimize outcomes.[1][6]

Non-Pharmacologic Interventions for Breakthrough Pain

The 2022 American College of Rheumatology (ACR) guidelines recommend several non-pharmacologic interventions for RA management. [7] 

  1. Exercise Therapy: Regular aerobic and strength exercises improve physical function and reduce pain.

  2. Therapeutic Patient Education: Educating patients on self-management strategies, including joint protection and energy conservation, is beneficial.

  3. Physical and Occupational Therapy: Tailored exercise programs, assistive devices, and ergonomic advice help maintain joint function and reduce pain.

  4. Orthoses and Assistive Devices: Devices like wrist splints and foot orthoses provide joint support and pain relief.

  5. Dietary Interventions: Diets such as the Mediterranean diet, which emphasizes vegetables, fruits, whole grains, and healthy fats, may have anti-inflammatory effects.

  6. Cognitive Behavioral Therapy (CBT): CBT helps manage the psychological impact of RA, improving overall quality of life.

  7. Balneotherapy: Mineral baths can provide symptomatic relief.

  8. Mind-Body Approaches: Techniques like mindfulness, meditation, and biofeedback can help manage pain and stress.

NSAIDs for Breakthrough Pain

NSAIDs are effective for managing breakthrough pain in RA by reducing inflammation and pain. However, NSAIDs should be used at the lowest effective dose for the shortest duration to minimize risks such as gastrointestinal complications and cardiovascular events.[3]

In summary, adjusting DMARD therapy, utilizing non-pharmacologic therapies, and employing NSAIDs for the proper patient can effectively manage breakthrough symptoms in RA, enhancing patient outcomes and quality of life.

References:

  1. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Fraenkel L, Bathon JM, England BR, et al. Arthritis Care & Research. 2021;73(7):924-939. doi:10.1002/acr.24596.
  2. Optimizing Outcomes in Rheumatoid Arthritis Patients With Inadequate Responses to Disease-Modifying Anti-Rheumatic Drugs. Pavelka K, Kavanaugh AF, Rubbert-Roth A, Ferraccioli G. Rheumatology (Oxford, England). 2012;51 Suppl 5:v12-21. doi:10.1093/rheumatology/kes111.
  3. The Management of First-Line Biologic Therapy Failures in Rheumatoid Arthritis: Current Practice and Future Perspectives. Favalli EG, Raimondo MG, Becciolini A, et al. Autoimmunity Reviews. 2017;16(12):1185-1195. doi:10.1016/j.autrev.2017.10.002.
  4. Optimizing Outcomes in Patients With Rheumatoid Arthritis and an Inadequate Response to Anti-TNF Treatment. Emery P. Rheumatology (Oxford, England). 2012;51 Suppl 5:v22-30. doi:10.1093/rheumatology/kes115.
  5. Strategies Toward Rheumatoid Arthritis Therapy; The Old and the New. Abbasi M, Mousavi MJ, Jamalzehi S, et al. Journal of Cellular Physiology. 2019;234(7):10018-10031. doi:10.1002/jcp.27860.
  6. Treating to Target in Established Rheumatoid Arthritis: Challenges and Opportunities in an Era of Novel Targeted Therapies and Biosimilars. Woodworth TG, den Broeder AA. Best Practice & Research. Clinical Rheumatology. 2015 Aug-Dec;29(4-5):543-9. doi:10.1016/j.berh.2015.10.001.
  7. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. England BR, Smith BJ, Baker NA, et al. Arthritis & Rheumatology (Hoboken, N.J.). 2023;75(8):1299 1311doi:10.1002/art.42507.

 

 

 

 

Alternative Therapies to Relieve Muscle Tightness

man with muscle tightness in neck

Alternative Therapies to Relieve Muscle Tightness

Viral Patel
Viral Patel

Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025

What is muscle stiffness/tightness?

  • A sensation of tightness or pain in the muscles, making it difficult to move them freely, often occurring after intense exercise, prolonged inactivity, or due to injury, causing discomfort and sometimes accompanied by cramps or spasms. (1)

Non-Pharmacological Treatment Options to Relieve Muscle Tightness:

  1. Self-Massage: Utilizing self-massage techniques, such as foam rolling, can help alleviate muscle tightness. Foam rollers have been shown to be effective in reducing pain perception and improving a patient’s range of motion. (2)
     
  2. Stretching: Engaging in regular stretching exercises can improve flexibility and reduce muscle tightness. The American College of Sports Medicine recommends static stretching, which involves holding a stretch for 10-30 seconds, and dynamic stretching, which involves gradual transitions and progressive increases in a patient’s range of motion. (3)
  3.  
people stretching
  1. Active Breaks: Taking short breaks to perform light physical activity or stretching during prolonged periods of sitting can reduce muscle stiffness. Roller massagers have been shown to be effective in reducing back muscle stiffness after long sitting periods. (4) 

  2. Massage Therapy: Therapeutic massages can significantly reduce muscle activity and tension, particularly in the upper trapezius muscles, which are commonly associated with increased muscle tension. (5)
  1. Hydration and Nutrition: Ensuring adequate hydration and proper nutrition can help maintain muscle function and reduce the risk of muscle tightness. Most experts recommend drinking at least 64 ounces of water daily. Magnesium and calcium are important micronutrients for muscle health. Adults under the age of 50 should have at least 1 gram of calcium daily. Older adults should aim for 1.2 grams daily. It is also recommended for adults to have 310 milligrams of magnesium daily.(1) 

  2. Heat and Cold Therapy: Applying heat or cold to the affected muscles can help in reducing muscle tightness. Cold therapy followed by static stretching has been found to be particularly effective in reducing muscle pain and promoting relaxation. (6)
hot cold therapy

These strategies can be integrated into daily routines to manage and alleviate muscle stiffness effectively.

References

  1. Professional CCM. Muscle stiffness. Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/25147-muscle-stiffness. Published May 1, 2024.
  2. MacLennan M, Ramirez-Campillo R, Byrne PJ. Self-Massage Techniques for the Management of Pain and Mobility With Application to Resistance Training: A Brief Review. J Strength Cond Res. 2023;37(11):2314-2323. doi:10.1519/JSC.0000000000004575
  3. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334-1359. doi:10.1249/MSS.0b013e318213fef
  4. Kett AR, Sichting F. Sedentary behaviour at work increases muscle stiffness of the back: Why roller massage has potential as an active break intervention. Appl Ergon. 2020;82:102947. doi:10.1016/j.apergo.2019.102947
  5. Domingo AR, Diek M, Goble KM, Maluf KS, Goble DJ, Baweja HS. Short-duration therapeutic massage reduces postural upper trapezius muscle activity. Neuroreport. 2017;28(2):108-110. doi:10.1097/WNR.0000000000000718
  6. Prentice WE. An electromyographic analysis of the effectiveness of heat or cold and stretching for inducing relaxation in injured muscle. J Orthop Sports Phys Ther. 1982;3(3):133-140. doi:10.2519/jospt.1982.3.3.133

 

 

 

 

The Importance of Proper Sleep Hygiene

The Importance of Proper Sleep Hygiene: How to Improve Your Sleep

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Sleep is a crucial part of our health and well-being, yet many of us struggle to get enough of it. Busy schedules, stress, and lifestyle habits can all interfere with our ability to rest properly. Good sleep hygiene involves practicing behaviors that help optimize the quality and duration of sleep, improving both physical and mental health.

1. Maintain a Consistent Sleep Schedule

One of the most effective ways to improve sleep hygiene is to go to bed and wake up at the same time every day, even on weekends. This consistency helps regulate your body’s internal clock, known as the circadian rhythm. Studies show that irregular sleep schedules can lead to poor sleep quality and daytime fatigue.

Tip: Try setting a consistent bedtime routine, including a wind-down period before bed to signal to your body that it’s time to sleep.

2. Create a Relaxing Bedtime Routine

Engaging in relaxing activities before bed can help you unwind and prepare for restful sleep. This might include reading a book, meditating, or taking a warm bath. Avoid stimulating activities such as using electronic devices, which emit blue light that can interfere with melatonin production, the hormone responsible for sleep.

Tip: Consider using dim lighting and staying away from screens at least 30 minutes before bed.

3. Optimize Your Sleep Environment

Your bedroom environment plays a crucial role in sleep quality. A cool, quiet, and dark environment is ideal for promoting restful sleep. Using blackout curtains or a sleep mask can help block out light, while earplugs or white noise machines can minimize noise distractions.

Tip: Make sure your mattress and pillows are comfortable and supportive to prevent waking up with aches or pains.

4. Be Mindful of Your Diet

What you eat and drink can have a significant impact on your sleep. It’s best to avoid large meals, caffeine, and alcohol close to bedtime. Caffeine is a stimulant that can interfere with your ability to fall asleep, while alcohol might make you feel sleepy initially but can disrupt your sleep later in the night.

Tip: Consider having a light snack before bed if you’re hungry, such as a banana or a small bowl of oatmeal, which can promote sleep by increasing serotonin levels.

5. Get Regular Exercise

Regular physical activity can enhance sleep quality, reduce the time it takes to fall asleep, and even increase the amount of deep sleep you get. However, exercising too close to bedtime can be stimulating and interfere with sleep.

Tip: Aim to finish vigorous exercise at least three hours before bedtime to allow your body to wind down.

6. Limit Naps During the Day

While short naps can be refreshing, longer naps during the day, especially in the afternoon, can make it harder to fall asleep at night. If you need to nap, try to keep it to 20-30 minutes.

Tip: If you feel the need for a nap, consider doing it earlier in the day to avoid interfering with nighttime sleep.

7. Manage Stress and Anxiety

Stress and anxiety are common causes of sleep difficulties. Incorporating relaxation techniques into your daily routine, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation, can help ease your mind and promote better sleep.

Tip: Journaling before bed can help clear your mind by writing down any worries or thoughts that might keep you awake.

Conclusion

Improving sleep hygiene is a process that involves making small, consistent changes to your daily habits. By following these strategies, you can create a sleep-friendly environment and develop routines that help you get the restful sleep your body needs. Proper sleep doesn’t just improve how you feel today, it contributes to long-term health and well-being.

References:

  1. Harvard Health Publishing. (2019). Blue light has a dark side. Retrieved from https://www.health.harvard.edu
  2. National Sleep Foundation. (2021). The connection between sleep and physical activity. Retrieved from https://www.sleepfoundation.org
  3. Centers for Disease Control and Prevention. (2020). Sleep Hygiene Tips. Retrieved from https://www.cdc.gov
  4. American Sleep Association. (2021). The effects of alcohol on sleep. Retrieved from https://www.sleepassociation.org
  5. Mayo Clinic. (2022). Sleep tips: 6 steps to better sleep. Retrieved from https://www.mayoclinic.org

Rising Stronger – Celebrating the Galt Journey and Embracing the Future

Rising Stronger – Celebrating the Galt Journey and Embracing the Future

Barry Patel
Barry Patel

CEO and Co-Founder

As 2024 draws to a close, we take a moment to reflect on an extraordinary year that marks a turning point in our journey. After eight years of perseverance, innovation, and an unwavering commitment to helping patients, 2024 has been our best year yet at Galt Companies.

Galt’s story is one of resilience and determination. As a self-funded company, we’ve faced significant challenges, from navigating the complexities of the pharmaceutical industry to weathering the storm of the Covid-19 pandemic. While the early days tested our resolve, they also defined who we are today—a company built on the foundation of grit, adaptability, and a steadfast mission to serve patients with innovative, non-opioid, non-addictive pain management solutions.

barrrypatel_wadesmith

The pandemic was a particularly difficult chapter, as it limited our ability to connect directly with healthcare providers and disrupted many of our traditional avenues for growth. Rather than retreat, we used those challenges to strengthen our core by finding ways to diversify our approaches to the market. We invested in building robust systems, refining our processes, and aligning our operations to support our unique model—one that prioritizes collaboration with entrepreneurs and local, community-based independent pharmacies. We emerged from those challenging times stronger and more prepared for the opportunities ahead.

And what a year 2024 has been! This year, we added Tolectin®DS to our Norgesic® promotions to give healthcare providers ‘muscle or bone’ options in providing effective pain relief without the risks associated with opioids. We also expanded our distribution network, welcoming new franchisees and independent pharmacy partners who share our vision and values. These collaborations bring our medications to more patients and communities across the country. Additionally, we undertook a comprehensive upgrade of our CRM platforms, empowering our sales professionals and franchisees with cutting-edge tools to better serve healthcare providers and ensure that our products reach those who need them most.

While 2024 has been a banner year, we know it’s just the beginning. The foundation we’ve laid over the past eight years positions us for even greater achievements in the years to come. Our journey continues as we are more motivated than ever to innovate, collaborate, and make a meaningful impact in the lives of patients. To our team, our franchisees, our distributors, our independent pharmacy partners, and all our supporters: thank you for believing in our vision and for being part of this incredible journey. As we look ahead to 2025 and beyond, we do so with excitement and confidence that the best is yet to come.

Here’s to rising stronger together!

 

 

 

Brief History and Proper Utilization of NSAIDs

Brief History and Proper Utilization of Nonsteroidal Anti-inflammatory Drugs

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

Background on NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) have a long and storied history, beginning with the use of salicylate-containing willow bark for pain and fever relief in ancient cultures. The active component, salicylic acid, was chemically synthesized in 1860, leading to the development of acetylsalicylic acid (aspirin) in 1897. Aspirin’s success spurred the development of other NSAIDs, which were initially organic acids but later included non-acidic compounds.

NSAIDs exert their effects primarily through the inhibition of cyclooxygenase (COX) enzymes, which are crucial for prostaglandin synthesis. There are two main isoforms: COX-1, which is involved in maintaining physiological functions such as gastrointestinal protection and platelet aggregation, and COX-2, which is induced during inflammation and mediates pain and fever. The discovery of these isoforms in the 1990s led to the development of selective COX-2 inhibitors (coxibs), designed to reduce gastrointestinal side effects associated with non-selective NSAIDs. However, the introduction of coxibs like celecoxib and rofecoxib revealed significant cardiovascular risks, leading to the withdrawal of rofecoxib from the market in 2004. This highlighted the need for a balance between efficacy and safety in NSAID therapy.

NSAIDs have widespread use and therapeutic benefits, but note that they are associated with adverse effects, including gastrointestinal ulcers, cardiovascular events, and renal toxicity. Strategies to mitigate these risks include using the lowest effective dose for the shortest duration and co-prescribing gastroprotective agents like proton-pump inhibitors for high-risk patients. The ongoing evolution of NSAIDs aims to enhance their safety while maintaining their efficacy in treating pain, inflammation, and fever.

Mitigating the Risks for Patients Who Need to use NSAIDs

To monitor and mitigate the risks for patients who need to use NSAIDs, especially those with a history of gastrointestinal (GI) bleeding, cardiovascular disease, or renal impairment, several strategies can be employed:

  1. Use the Lowest Effective Dose for the Shortest Duration: This is a fundamental principle to minimize adverse effects. The FDA emphasizes this approach to reduce the risk of GI bleeding, cardiovascular events, and renal toxicity.
  2. Gastrointestinal Protection: For patients with a history of GI bleeding or at high risk, co-therapy with proton-pump inhibitors (PPIs) or misoprostol is recommended. The American College of Gastroenterology advises using a COX-2 inhibitor plus a PPI or misoprostol for high-risk patients. Testing and eradicating  pyloriinfection can also reduce the risk of peptic ulcers in NSAID users.
  3. Cardiovascular Risk Management: The American Heart Association recommends avoiding NSAIDs, particularly COX-2 inhibitors, in patients with cardiovascular disease. If NSAIDs are necessary, naproxen may be preferred due to its relatively lower cardiovascular risk. Monitoring blood pressure and managing other cardiovascular risk factors are crucial.
  4. Renal Function Monitoring: Regular monitoring of renal function, fluid retention, and electrolyte levels is essential, especially in patients with preexisting renal impairment, heart failure, or those on diuretics or ACE inhibitors. The FDA and other literature recommend avoiding NSAIDs in patients with advanced renal disease and using alternative therapies when possible.
  5. Patient Education and Monitoring: Educate patients about the signs and symptoms of GI bleeding, cardiovascular events, and renal impairment. Regular follow-up and prompt evaluation of any adverse symptoms are critical.

By implementing these strategies, clinicians can better manage the risks associated with NSAIDs used in vulnerable patient populations.

Patient Groups That Should Avoid NSAIDs

Certain patient groups should avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) due to their potential adverse effects, including gastrointestinal (GI) ulcers, cardiovascular events, and renal toxicity.

  • Elderly patients are at increased risk for NSAID-related adverse effects, including GI bleeding, renal impairment, and cardiovascular events. Elderly patients, especially those with comorbidities, are particularly vulnerable to these risks.
  • Patients with a history of peptic ulcer disease or gastrointestinal bleeding should avoid NSAIDs due to a significantly increased risk of GI bleeding. The FDA notes that these patients have a greater than 10-fold increased risk for developing a GI bleed when using NSAIDs.
  • Patients with cardiovascular disease or patients at high risk for cardiovascular events should avoid NSAIDs, particularly COX-2 inhibitors, due to the increased risk of myocardial infarction and stroke. The American Heart Association advises against the use of NSAIDs in patients with established cardiovascular disease.
  • Patients with renal impairment, heart failure, or chronic kidney disease (CKD) should avoid NSAIDs due to the risk of worsening renal function and potential for acute kidney injury. The National Comprehensive Cancer Network (NCCN) guidelines recommend caution in these patients to prevent renal toxicities.
  • Patients on concurrent anticoagulant or corticosteroid therapy should avoid NSAIDs due to the increased risk of GI bleeding and other complications. The NCCN guidelines also emphasize the increased bleeding risk when NSAIDs are used with anticoagulants.

List of NSAIDs Available in the United States

The following is a list of commonly available NSAIDs in the United States by generic and brand name:

Ibuprofen (Advil®, Motrin®, IBU®)

Naproxen (Aleve®, Naprosyn®, Naprelan®)

Diclofenac (Voltaren®, Cataflam®)

Celecoxib (Celebrex®)

Meloxicam (Mobic®)

Indomethacin (Indocin®)

Ketorolac (Toradol®)

Etodolac (Lodine®)

Piroxicam (Feldene®)

Sulindac (Clinoril®)

Diflunisal (Dolobid®)

Salsalate (Disalcid®)

Oxaprozin (Daypro®)

Nabumetone (Relafen®)

Flurbiprofen (Ansaid®)

Fenoprofen (Nalfon®)

Meclofenamate (Meclomen®)

Tolmetin (Tolectin®DS)

NSAIDs are commonly used to treat a range of conditions, from minor aches and pains to chronic diseases such as arthritis. As a result, NSAIDs are highly effective for conditions like headaches, menstrual cramps, sprains, and inflammatory disorders such as osteoarthritis and rheumatoid arthritis.

NSAIDs are highly beneficial for managing pain and inflammation, but like all medications, they should be used with care, balancing their effectiveness against potential side effects.

References

  1. Vane JR, Botting RM. Mechanism of Action of Nonsteroidal Anti-Inflammatory Drugs. The American Journal of Medicine. 1998;104(3A):2S-8S; discussion 21S-22S.K. D.
  2. Rainsford, “ANTI-INFLAMMATORY DRUGS IN THE 21ST CENTURY,” Sub-Cellular Biochemistry. 2007;42:3-27
  3. Vonkeman HE, van de Laar MA. “Nonsteroidal Anti-Inflammatory Drugs: Adverse Effects and Their Prevention,” Seminars in Arthritis and /Rehumatism. 2010;39(4):294-312.
  4. Wehling M., Non-Steroidal Anti-Inflammatory Drug Use in Chronic Pain Conditions With Special Emphasis on the Elderly and Patients With Relevant Comorbidities: Management and Mitigation of Risks and Adverse Effects. European Journal of Clinical Pharmacology. 2014;70(10):1159-72.
  5. Antman EM, Bennett JS, Daugherty A, et al. Use of Nonsteroidal Antiinflammatory Drugs: An Update for Clinicians: A Scientific Statement From the American Heart Association. Circulation. 2007;115(12):1634-42.
  6. Bouck Z, Mecredy GC, Ivers NM, et al. Frequency and Associations of Prescription Nonsteroidal Anti-Inflammatory Drug Use Among Patients With a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease. JAMA Internal Medicine. 2018;178(11):1516-1525. doi:10.1001/jamainternmed.2018.4273.
  7. Lanza FL, Chan FK, Quigley EM. Guidelines for Prevention of NSAID-related Ulcer Complications. The American Journal of Gastroenterology. 2009;104(3):728-38.
  8. Wilcox CM, Allison J, Benzuly K, et al. Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin. Clinical Gastroenterology and Hepatology : The Official Clinical Practice Journal of the American Gastroenterological Association. 2006;4(9):1082-9.
  9. Domper Arnal MJ, Hijos-Mallada G, Lanas A. Gastrointestinal and Cardiovascular Adverse Events Associated With NSAIDs. Expert Opinion on Drug Safety. 2022;21(3):373-384.
  10. Ković SV, Vujović KS, Srebro D, Medić B, Ilic-Mostic T. Prevention of Renal Complications Induced by Non- Steroidal Anti-Inflammatory Drugs. Current Medicinal Chemistry. 2016;23(19):1953-64. 
  11. LaForge JM, Urso K, Day JM, et al. Non-Steroidal Anti-Inflammatory Drugs: Clinical Implications, Renal Impairment Risks, and AKI. Advances in Therapy. 2023;40(5):2082-2096.
  12. Ribeiro H, Rodrigues I, Napoleão L, et al. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Pain and Aging: Adjusting Prescription to Patient Features. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2022;150:112958.
  13. Domper Arnal MJ, Hijos-Mallada G, Lanas A. Gastrointestinal and Cardiovascular Adverse Events Associated With NSAIDs. Expert Opinion on Drug Safety. 2022;21(3):373-384.
  14. Nam YH, Brensinger CM, Bilker WB, et al. Nonsteroidal Anti-Inflammatory Drug Choice and Adverse Outcomes in Clopidogrel Users: A Retrospective Cohort Study. PloS One. 2018;13(3):e0193800. doi:10.1371/journal.pone.0193800.

Understanding Oral Thrush

Understanding Oral Thrush

Viral Patel
Viral Patel

Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025

Overview

Oral thrush is a type of fungal infection caused by an overgrowth of yeast. This opportunistic infection is also referred to as oropharyngeal candidiasis. This condition is primarily caused by the overgrowth of Candida species, most commonly Candida albicans. This condition disrupts oral mucosa and impairs innate and adaptive immune responses, particularly in immunocompromised individuals (1-2).

Risk factors

• Immunosuppression: Conditions such as HIV/AIDS, diabetes mellitus, cancer, and the use of immunosuppressive therapies significantly increase the risk (3-5).
• Medications: Broad-spectrum antibiotics can disrupt normal oral microbiota and can facilitate Candida overgrowth (4).
• Age: Both extremes of age, such as neonates and the elderly are susceptible due to immature or declining immune function (1)(6).
• Local factors: denture use, poor oral hygiene, and xerostomia are notable local predisposing factors (1)(6).
• Lifestyle factors: smoking has been associated with an increased risk of developing oral thrush (1).

Symptoms

Oral thrush can have many different symptoms including:

• White patches on inner cheeks, tongue, roof of the mouth, and throat
• Redness or soreness
• Cotton-like feeling in the mouth
• Loss of taste
• Pain while eating or swallowing
• Cracking and redness at the corners of the mouth (7)

Prevention

Populations that are at risk can prevent oral thrush using a combination of antifungal prophylaxis, maintaining good oral hygiene, and using antibiotics as appropriate to remediate risk of infection (3).

Conclusion

Oral thrush is a fungal infection with multiple risk factors, predominantly related to immunosuppression and local oral conditions. Effective management involves addressing these risk factors and utilizing appropriate antifungal therapies.

References

1. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J. 2002;78(922):455-459. doi:10.1136/pmj.78.922.455.
2. Yang L, Cheng T, Shao J. Perspective on receptor-associated immune response to Candida albicans single and mixed infections: implications for therapeutics in oropharyngeal candidiasis. Med Mycol. 2023;61(8). doi:10.1093/mmy/myad077.
3. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4). doi:10.1093/cid/civ933.
4. Stoopler ET, Villa A, Bindakhil M, Díaz DLO, Sollecito TP. Common oral conditions: a review. JAMA. 2024;331(12):1045-1054. doi:10.1001/jama.2024.0953.
5. Erfaninejad M, Zarei Mahmoudabadi A, Maraghi E, Hashemzadeh M, Fatahinia M. Epidemiology, prevalence, and associated factors of oral candidiasis in HIV patients from southwest Iran in post-highly active antiretroviral therapy era. Front Microbiol. 2022;13:983348. doi:10.3389/fmicb.2022.983348.
6. Campisi G, Panzarella V, Matranga D, et al. Risk factors of oral candidiasis: a twofold approach of study by fuzzy logic and traditional statistics. Arch Oral Biol. 2008;53(4):388-397. doi:10.1016/j.archoralbio.2007.11.009.
7. Centers for Disease Control and Prevention. Candidiasis. Available at: CDC.

The Fentanyl Crisis in the United States

The Fentanyl Crisis in the United States: Understanding the Danger

Scott Chappell
Scott Chappell

Galt Pharmaceuticals Director of Medical Affairs

The United States is currently grappling with a severe and escalating public health crisis: the widespread abuse of fentanyl. This synthetic opioid, which is 50 to 100 times more potent than morphine, has become a major driver of overdose deaths across the nation. Understanding why fentanyl is so dangerous is crucial to addressing this urgent issue.

The Rise of Fentanyl

Originally developed for pain management in cancer patients, fentanyl’s medical use was strictly controlled. However, over the past decade, illicit production and distribution have surged. This shift is largely due to fentanyl’s potency and the relative ease with which it can be synthesized in underground laboratories.

Fentanyl is often mixed with other drugs like heroin, cocaine, and methamphetamine, sometimes without the user’s knowledge. This practice increases the risk of overdose significantly, as even a minuscule amount of fentanyl can be lethal. According to the Centers for Disease Control and Prevention (CDC), fentanyl and its analogs were involved in more than 67,000 overdose deaths in the United States in 2021 alone.

Why Fentanyl is So Dangerous

  • Extreme Potency: Fentanyl’s high potency means that very small doses can cause severe respiratory depression and death. This makes it much more dangerous than other opioids. A few milligrams—the equivalent of a few grains of salt—can be lethal.

  • Unpredictable Dosing: When mixed with other drugs, users have no way of knowing the exact dose of fentanyl they are consuming. This unpredictability greatly increases the risk of overdose. Even experienced drug users can easily misjudge the amount, leading to accidental death.

  • Rapid Onset of Effects: Fentanyl acts quickly, often faster than users can react. This rapid onset leaves little time to seek help or administer life-saving interventions such as naloxone, an opioid overdose reversal drug.

  • Availability and Distribution: The illicit production of fentanyl is widespread, and it is often pressed into counterfeit pills that mimic prescription medications. These fake pills can be nearly indistinguishable from legitimate pharmaceuticals, leading to unintentional use by individuals seeking prescription drugs for legitimate purposes.

  • Challenges in Law Enforcement and Healthcare: Detecting and seizing fentanyl is challenging due to its high potency and the small quantities needed for distribution. Additionally, first responders and law enforcement officers are at risk of accidental exposure, which can be fatal. The healthcare system is also strained by the need for increased naloxone availability and the treatment of overdose survivors.

Addressing the Crisis

Efforts to combat the fentanyl crisis require a multifaceted approach. Key strategies include:

  • Education and Prevention: Public awareness campaigns can help inform people about the dangers of fentanyl and the risks of illicit drug use.

  • Enhanced Law Enforcement: Strengthening the capabilities of law enforcement to detect and intercept fentanyl shipments is crucial. This includes international cooperation to dismantle production and distribution networks.

  • Access to Treatment: Expanding access to addiction treatment services and harm reduction programs, such as supervised injection sites and needle exchange programs, can save lives.

  • Improved Data Collection: Better data on overdose deaths and drug use trends can inform targeted interventions and policy decisions.

Conclusion

The fentanyl crisis in the United States is a complex and deadly issue that continues to devastate communities across the nation. Understanding the unique dangers posed by fentanyl is essential for developing effective responses and ultimately saving lives. Through comprehensive efforts encompassing education, enforcement, and treatment, it is possible to mitigate the impact of this crisis and work towards a safer future.

Sources

  1. Centers for Disease Control and Prevention (CDC). “Drug Overdose Deaths in the U.S. Top 100,000 Annually.” Available at: CDC Newsroom
  2. National Institute on Drug Abuse (NIDA). “Fentanyl DrugFacts.” Available at: NIDA
  3. Drug Enforcement Administration (DEA). “Counterfeit Prescription Pills Containing Fentanyls: A Global Threat.” Available at: DEA
  4. By raising awareness and taking decisive action, we can hope to turn the tide on this devastating epidemic.

Simplifying the Prescribing Process

prescriber writing

Simplifying the Prescribing Process and How It Impacts Providers and Patients

Jimmy Fanning
Jimmy Fanning

Galt Pharmaceuticals Manager of Pharmacy Solutions

One of the greatest challenges that pharmaceutical reps face in the field is the one that begins after a prescriber has been sold on a product. From insurance coverage to assistance programs, many manufacturers choose to cut corners on support systems and instead pass the burden of effort onto office staff. This can result in burnout for the staff and negative feedback to providers, limiting prescription volume.

Galt Pharmaceuticals seeks to create a better system for prescribers and their support staff, one that minimizes effort while maximizing patient value. This process begins with the pharmacy that the provider chooses to send the prescription to and helps see that every prescription makes it into the patient’s hands while avoiding added stress to office staff.

Prescribing: Galt Sales Representatives encourage providers to send prescriptions for Galt Products to a small network of partner pharmacies. These pharmacies are specially trained in patient communication and insurance processing to help each patient attain the lowest possible price for their prescription. This avoids calls back to offices regarding product availability or price that may otherwise be made by large chain pharmacies.

Prior Authorization: Galt Pharmaceuticals contracts with CloudTop Health to streamline the Prior Authorization process. Once the case is initiated by a Galt Partner Pharmacy, the provider office receives a simple, 1 page request for patient diagnosis and medical history. Each request is custom tailored to the drug under review, eliminating the ambiguity of universal forms used by most PA vendors. The provider’s office needs to simply check boxes that apply to a given patient and provide one signature. CloudTop will then handle the filing of the case to insurance and the communication to the pharmacy, which would typically be the responsibility of the provider and their staff.

Insurance Coverage: Galt’s goal is to maximize the number of patients who are able to receive their prescription through their insurance plan at no out-of-pocket cost to them. Although most insurers assign copays to patients, Galt Pharmaceuticals pays these down to $0 where eligible. As an added bonus to patients, if they have a deductible as part of their insurance plan, they receive credit for the money Galt spends toward this deductible on their behalf.

Patient Assistance: For patients who are uninsured or underinsured and not able to receive Galt Products through their insurance, Galt offers a special Patient Assistance Program, also called Cash Pay. This allows patients to fill their Galt prescriptions for as little as $30 with no exclusion criteria. Many pharmaceutical manufacturers will require patient enrollment into these programs as well as exclude patients who do not meet specific criteria. Galt removes these barriers in order to maximize the number of patients with affordable access to its products.

All these programs come together to create a streamlined process that minimizes unnecessary effort from providers. Galt Pharmaceuticals understands that providers can be most effective when their focus and effort is dedicated to the patient’s needs rather than the needs of an insurance company or pharmacy. By investing in vendors and programs that increase patient access to its products, Galt seeks to provide value in every office that it works with.