People’s Pharmacy: Buying brand-name drugs from Canada

Q. Can a U.S. physician prescribe to a Canadian pharmacy? I take Wellbutrin XL 300, and the price is absolutely outrageous in the U.S.

The generic does not behave the same as the brand. I don’t doubt that there is 300 milligrams in the generic pills, but the way the drug is released is the problem.

My wife also pays a lot for brand-name Toprol XL to control high blood pressure. She says the generic metoprolol also has a release mechanism issue.

A. A doctor in the U.S. can fax prescriptions directly to a Canadian pharmacy. Patients could also attach a photograph or scan their prescriptions to an online pharmacy.

Prices for brand-name Toprol XL could average about $58 a month. In Canada, the same prescription might average $80 for a three-month supply.

You are right about the price of Wellbutrin XL 300. We found prices at more than $2,000 per month in the U.S. You could purchase this brand-name antidepressant from a Canadian pharmacy for about $50 a month.

If you plan to try this, make sure that the pharmacy you select is a legitimate Canadian pharmacy. You can learn what to look for in our eGuide to Saving Money on Medicines. This online resource is available in the Health eGuides section of peoplespharmacy.com.

Q. You wrote recently about the proper time of day to take medication for high blood pressure. The idea of medicating at bedtime is correct in most cases. This timing minimizes the risk of orthostatic hypotension (dizziness on standing).

However, there is a notable exception to that advice. One should avoid taking anti-hypertensive medications at bedtime if being treated for glaucoma, particularly low-tension glaucoma.

Perfusion pressure to the optic nerve is normally greatly reduced at night. Reducing it further with blood pressure medicine dramatically increases the risk of optic nerve damage.

As a recently retired optometrist who treated many patients for glaucoma, I always consulted with the patient’s general physician.

One would not want to increase the risk of advancing glaucoma by taking antihypertension medications at night. Such patients should take their medicines in the morning.

A. Thank you for alerting us to this complication. When blood pressure drops too low overnight, it might pose a risk for people with glaucoma (Expert Opinion on Pharmacotherapy, December).

Q. My 66-year-old husband clears his throat too much. He says he has drainage that has to be cleared in order to breath. He has tried many products and techniques with no relief.

The allergist tested and found the usual culprits: dust mites, ragweed and dogs. I keep the house as free of allergens as possible. The prescription allergy nose spray didn’t help. We’d appreciate a solution.

A. We heard recently from a man whose wife had somewhat similar symptoms: “She has long bouts of coughing due to congestive heart failure and allergies that cause a lot of sinus drainage. The trouble is she reacts badly to most antihistamines. What can we try?”

We mentioned Nasalcrom (cromolyn). This over-the-counter nose spray is used preventively and reduces the inflammatory response to allergens.

Later, we heard back from him: “Nasalcrom had a prompt effect. The postnasal drainage is significantly reduced. Her cough gradually improved and then dramatically disappeared. Her cardiac rehab is going well, with attention to exercise, diet and sleep.”

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website peoplespharmacy.com.