Shop Alto Essentials to add pharmacy products to any delivery!

Your partner in navigating the ins and outs of prescriptions — at no extra cost.

Alto Pharmacy Technician

Alto Pharmacist

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

Be Part of a Great Place to Work — Join Our Team

Hear first-hand from members of the Alto technology teams.

Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

Many medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD) are taken by using a metered dose inhaler (MDI), also referred to as a hydrofluoroalkane (HFA) inhaler. These handheld devices — one of several types of inhalers used to treat asthma and COPD — are pressurized canisters of aerosol medication in a plastic container with a mouthpiece. They use a chemical propellant to release medication from the canister. 

The Right Way to Use a Metered Dose Inhaler

Many individuals use a plastic tube called a spacer with their metered dose inhaler, which can help ensure that the full dose of medication is received. Spacers may also be used to reduce side effects of corticosteroid inhalers such as mouth and throat irritation. Ask your doctor if a spacer is right for your health needs.

Taking your medication exactly as prescribed is critical to managing symptoms of asthma, COPD, and other lung diseases. If you and your doctor have decided that a metered dose inhaler is a good method of medication delivery for your treatment plan, it’s important to learn about proper use and cleaning of the device. Below, we explain how to use a metered dose inhaler with and without a spacer and share other considerations when using these devices.

The steps below offer a general overview of how to use a metered dose inhaler correctly. Consult with your doctor for more specific instructions. If using your inhaler for the first time, or if it’s been at least two weeks since your last use, be sure to prime your inhaler by spraying several puffs into the air to ensure that it is working.

1. Remove the cap from the inhaler and shake the inhaler for a few seconds. If using a spacer, remove the cap from the spacer and place the inhaler into the open end of the spacer.

2. If you are using your inhaler without a spacer, exhale completely and place the inhaler’s mouthpiece in your mouth and seal your lips around it. If you are using a spacer, place the spacer’s mouthpiece in your mouth first and then exhale completely.

3. Begin to inhale slowly, pressing down on the canister once.

4. Continue to inhale slowly and deeply for about five seconds.

5. Hold your breath for ten seconds so that the medication can enter your airways.

6. If your doctor has instructed you to take more than one puff of your medication, repeat these steps as needed, waiting about a minute between puffs.

If taking a corticosteroid medication, rinse your mouth with water after each dose to prevent mouth and throat irritation and oral yeast infections. Using a spacer will also minimize the chance of these side effects.

Cleaning your metered dose inhaler and spacer

Most metered dose inhalers can be cleaned by removing the medication canister and rinsing the plastic container under warm running water. If you are unable to remove the canister from the container, wipe the mouthpiece with a cloth or cotton swab. Refer to the manufacturer’s instructions for your inhaler as needed.

To clean your spacer, remove the soft ring at the end and soak both the tube and ring in warm water with light soap. Clean and rinse thoroughly and let the pieces air dry.

Frequency of cleaning depends on how often you take your medication. Consult with your doctor about when to clean your inhaler and spacer.

Keeping track of medication in your inhaler

It’s important to keep track of how much medication is left in your metered dose inhaler so that you can stay on top of refills and avoid any missed doses. For many metered dose inhalers, the total number of puffs will be printed on the medication canister. You must discard your inhaler after you have used that many puffs even if your inhaler continues to dispense medication. Priming puffs count toward the total number of puffs.

If you use a metered dose inhaler every day to take maintenance medication, divide the total number of puffs in your inhaler by the number puffs you take every day. That number is how many days you can use your inhaler before you need a refill. If you use your metered dose inhaler as needed for quick relief, you’ll have to keep track of each individual puff. Some metered dose inhalers now come with built-in counting devices, and there are also external dose counters that can attach to the inhaler. Ask your healthcare provider for recommendations.

There are other delivery methods available for asthma and COPD medications. Your healthcare provider can advise you on the best option for your individual treatment plan.

Dry powder inhalers are another option for medication delivery. Like metered dose inhalers, dry powder inhalers are a small handheld device, but the medication is in the form of a dry powder. Many dry powder inhalers provide a visual indication that the full dose of medication has been delivered, which is helpful for many individuals, as well as a built-in dose counter.

You can also take most asthma and COPD medications using a nebulizer, which transforms liquid medication into a fine mist. Nebulizers take longer than inhalers to deliver medication, but they are often helpful for those who find it difficult to properly use an inhaler. Many children with asthma use nebulizers.

Our team of pharmacists is here to help you get started with your medication for asthma or COPD. We can walk you through the steps of using your inhaler, discuss potential side effects, and answer any other questions you may have. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with managing your asthma. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Inhalers and nebulizers are both effective at delivering medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). A nebulizer is a device that transforms a liquid medication into a fine mist which is then inhaled into the lungs through a mouthpiece. While nebulizers take longer to deliver medications than inhalers, their accurate dosage delivery is often a good fit for children living with asthma and other lung diseases, and many adults find them helpful as well. Here’s what to know if you’re considering using a nebulizer.

What to Know About Nebulizers

Three types of nebulizers can be used to treat asthma, COPD, and other lung diseases like pulmonary fibrosis.

Jet nebulizers transform liquid medication into an aerosol or fine mist using an air compressor. They are the most common type of nebulizer.

Mesh nebulizers use a fine mesh to create an aerosol from the liquid medication. They are the newest type of nebulizer and emit the smallest particles.

Ultrasonic nebulizers create an aerosol through high-frequency vibrations. They are typically used in hospitals or at doctors’ offices.

There are different models of nebulizers, including portable, battery-run nebulizers that can be taken with you on the go and larger tabletop nebulizers that require an electrical outlet. These devices can deliver a variety of medications, including quick-relief medications that treat acute symptoms of lung diseases as well as longer-term maintenance medications. They may even be used to deliver more than one medication at once.

Your healthcare provider can advise you on the best method of medication delivery for your individual treatment plan. As you explore your options, be mindful of the key differences between nebulizers and inhalers.

Inhalers deliver medication quickly, but they require enough coordination to inhale and spray the medication at the same time. Some individuals, particularly young children, may find it challenging to properly use an inhaler. This can result in not receiving the full dose of medication.

To receive a dose of medication from a nebulizer, all that’s required is to breathe normally. However, nebulizers will take at least five to ten minutes to fully deliver the medication. You may want to ask your doctor which type of device they recommend for treating acute symptoms during an asthma attack or COPD flare-up.

If you and your doctor have decided that a nebulizer is a good fit for your needs, learning about proper use and cleaning of the device is a key part of managing your health. It will also ensure that you are taking your medication as prescribed. Be sure to follow your doctor’s instructions and review the manufacturer’s instructions for your nebulizer before using it for the first time, as there is some variation among these devices.

All nebulizers have a medicine cup, a mask and/or mouthpiece, an air compressor, and plastic tubing to connect the compressor to the medicine cup. Always wash and dry your hands before using your nebulizer and make sure that all the pieces of your nebulizer are clean. Pour the correct dose of your medication into the medicine cup and connect the tubing to the air compressor and medicine cup. Turn on your nebulizer and ensure that it’s properly working. You should see a fine mist coming from the mask or mouthpiece.

Once you see a mist appear, your nebulizer is ready for use. To inhale your medication, secure the mask over your nose and mouth or put the mouthpiece in your mouth. Sit upright and breathe normally. Taking slower breaths can help the medication enter your airways. Continue to breathe normally until the medication is gone from the cup.

Bacteria and other germs can grow inside of a nebulizer that has not been properly cleaned, so it’s important to clean your device after every use and disinfect it once a week.

After you’ve finished using your nebulizer, wash the mouthpiece or mask and the medicine cup in warm soapy water and let them air dry. For weekly disinfecting, soak these pieces in a vinegar solution for 30 to 60 minutes, or for the amount of time specified by your doctor or in the manufacturer’s instructions. Your doctor may provide you with a disinfectant solution, but if not, you can mix one part white vinegar with three parts hot water. After the pieces are done soaking, let them air dry. Put these pieces in a plastic container or bag and store it in a cool, dry place.

As part of nebulizer maintenance, you should replace the plastic tubing on a regular basis. Ask your healthcare provider how often to replace the tubing.

When deciding whether a nebulizer is a good fit for your needs, be sure to consider your health insurance benefits. Most insurance plans have separate medical and pharmacy benefits in addition to a Durable Medical Equipment (DME) section. Many nebulizers fall under the DME category of your policy. There may be restrictions on the brands, suppliers, or types of nebulizers that are available, and it’s important to check with your specific policy to understand what will be covered and under which sections.

Alto makes it easy to stay on top of your asthma or COPD treatment, with free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone or chat. 

Inhalers and nebulizers are both effective at delivering medications for respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD).

Emphysema — which falls under the umbrella of chronic obstructive pulmonary disease (COPD), along with chronic bronchitis — is a lung disease that most often develops as the result of many years of heavy smoking. It affects more than 3 million people in the United States.

Emphysema: Causes, Symptoms and Treatments

As a progressive lung disease, symptoms of emphysema become more pronounced over time. While there is no cure, emphysema is both manageable and preventable. You can slow the progression of the disease by following the treatment plan your doctor recommends and maintaining a healthy lifestyle.

Read on to learn more about the causes and symptoms of emphysema and common treatment options.

Emphysema involves slow and gradual damage to the tiny air sacs in your lungs (alveoli). As these air sacs weaken over time, the surface area of the lungs is reduced, limiting how much oxygen can travel to your bloodstream.

Since emphysema progresses gradually, signs and symptoms may not appear until the lung tissue has already been significantly weakened. For many people, the first noticeable symptoms include shortness of breath and more frequent coughing, especially during physical activities. Other symptoms of emphysema include wheezing, exhaustion, and chest tightness, and producing greater amounts of mucus.

In some cases, the lack of oxygen can cause blue or gray lips or fingernails. If you experience this symptom, seek immediate medical attention.

The majority of emphysema cases occur as the result of cigarette smoking, with heavier smoking linked to a higher risk of developing emphysema. Additional risk factors for emphysema include the following:

Age — in many cases of smoking-related emphysema, symptoms first become noticeable between the ages of 40 and 60

Exposure to high pollution chemical fumes or lung irritants

Having a history of childhood respiratory infections

To determine if you have emphysema, your doctor will ask about your health history and the potential symptoms of emphysema that you are experiencing. They may ask you questions about your smoking history, your exposure to secondhand smoke or chemical fumes, and if you have a family history of lung health issues.

After taking your health history, they may order one or more of the following tests to confirm a diagnosis of emphysema:

Imaging tests, including chest X-rays and computerized tomography (CT) scans, which combines X-ray images taken from different angles.

An arterial blood gas test, which measures how well your lungs transfer oxygen to your bloodstream and remove carbon dioxide.

An electrocardiogram (ECG) to check your heart’s function and rule out a diagnosis of heart disease.

A pulse oximetry, which measures the oxygen level of your blood. This can show how well oxygen travels to the parts of your body furthest from your heart.

Lung function tests, which measure how much air your lungs can hold, how easy it is for them to empty air, and how well they deliver oxygen into your bloodstream.

Quitting smoking is the most important thing you can do to slow the progression of emphysema. If you are having trouble quitting, ask your doctor for smoking cessation resources like nicotine replacement therapy to help manage withdrawal symptoms and cravings. In addition, the treatment options below can slow the progression of emphysema and help you live an active lifestyle.

Several types of medications are used to manage and treat emphysema.

Bronchodilators like albuterol (Ventolin®, Proventil®, AccuNeb®), albuterol sulfate (ProAir® HFA®, ProAir RespiClick), and levalbuterol (Xopenex®) help relax your airway muscles and open your lungs to reduce discomfort. Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator when building your treatment plan.

Inhaled corticosteroids reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They may be taken via inhaler or nebulizer. Corticosteroids commonly prescribed to treat emphysema include beclomethasone dipropionate (branded options include Qvar Redihaler®), budesonide (Pulmicort®), ciclesonide (Alvesco®), flunisolide (Aerospan®), fluticasone propionate (Flovent®), and mometasone (Asmanex Twisthaler®). 

Inhaled corticosteroids typically do not cause long-term side effects, but mouth and throat irritation and oral yeast infections may occur. As a precaution, rinse your mouth with water after each dose to prevent infections.

Antibiotics may also be used to fight infections that can lead to emphysema-related complications like acute bronchitis or pneumonia.

Pulmonary rehabilitation is an outpatient educational program that provides the skills and knowledge needed to manage your emphysema and increase your level of physical strength and fitness. The classes are led by a team of healthcare professionals, physical therapists, and dietitians and taught in a group setting, giving you the opportunity to connect with other individuals living with emphysema and other lung diseases. Pulmonary rehabilitation is often a good fit for individuals who frequently experience shortness of breath when performing daily activities despite taking medication as prescribed.

Supplemental oxygen, or oxygen therapy, can relieve shortness of breath and increase your tolerance for physical activities. There are several devices used in oxygen therapy. Your doctor can guide you in choosing the right oxygen delivery system based on your health needs, lifestyle, and insurance benefits. You may be prescribed one oxygen device to use at home and one to use when you are on the go.

Be sure to follow all of your doctor’s instructions when using your oxygen device, including the flow rate setting (how much oxygen you’ll need per minute). In addition, you may find it helpful to explore the American Lung Association's resources on oxygen therapy.

We’re here to support your emphysema treatment

Sticking to the treatment your doctor has recommended is critical to managing emphysema. At Alto, we make that as easy as possible by offering free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone or through the Alto app. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can support your emphysema treatment plan.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

From vigilant hand-washing to getting enough vitamin C and D, here are a few ways to give yourself an immunity boost in advance of cold and flu season.

How to Prepare for Cold and Flu Season

The leaves are turning and the days are getting shorter, which means it’s time to start preparing for cold and flu season. The flu — shorthand for influenza — is a respiratory illness caused by viruses that affect your nose, throat, and lungs. In the U.S. and the rest of the Northern Hemisphere, flu cases typically ramp up toward the end of October and peak between December and February.

One reason the flu spreads more easily during the winter months is that cold air protects the virus as it travels through the air in the form of tiny droplets. The other main reason is that people socialize indoors more frequently, where it’s easier for the flu to spread when someone affected by the virus coughs or sneezes.

The good news is that there are simple steps you can take to strengthen your immunity. From vigilant hand-washing to getting enough vitamin C and D, here are a few ways to give yourself an immunity boost in advance of cold and flu season.

The number one thing you can do to protect your health and that of your loved ones is to get an annual flu shot, which will prompt your immune system to create antibodies that will defend you against the flu. Medical experts recommend getting the vaccine each and every year. every year.

Keep in mind it can take up to two weeks for the antibodies to provide sufficient protection. Given that flu season often peaks around December, the best time to get vaccinated is during September and October, and ideally no later than the end of October.

The flu can cause more serious health problems for people over the age of 65 and individuals living with chronic conditions such as COPD or diabetes, so it’s even more important to be proactive about flu vaccination if you fall into one of these groups.

Good personal hygiene can lower your risk of getting the cold or flu and spreading it to others. Practice simple preventative measures like frequently washing your hands, disinfecting frequently touched surfaces, and keeping a healthy distance from anyone who isn’t feeling well.

And yes, there is a “right way” to wash your hands when it comes to cold and flu prevention. The CDC recommends following the simple steps below to stay healthy and avoid spreading germs.

1. Wet your hands with warm or cold running water and apply soap.

2. Lather your hands, including the backs of your hands, between your fingers, and beneath your nails. 

3. Scrub your hands for at least 20 seconds. (Singing “Happy Birthday” twice is one option for timing yourself.)

Get a good night’s sleep and regular exercise

Your body is better prepared to defend against infectious diseases when it’s well-rested. Research has found that sleep can strengthen your T cells’ ability to help you fight infection. (T cells are a specific type of white blood cell and an important part of your immune system.)

To strengthen your immunity, aim for 7 to 9 hours every night. If you’re having difficulty falling asleep or sleeping through the night, there are some steps you can take to improve the quality of your sleep. Try to follow a consistent schedule: go to bed at the same time each night and wake up at the same time each morning, even on the weekends. And avoid consuming heavy meals or caffeine or using electronic devices close to your bedtime.

Staying physically active can also help you sleep better. In fact, exercise may boost your immunity in other ways, too, such as increasing your circulation, which helps white blood cells and antibodies travel to parts of your body where they’re needed. 

Studies have found that U.S. adults tend to exercise less during winter and fall than they do during spring and summer, so be sure that your calendar can still accommodate your fitness routine during the colder months. Whether you explore virtual workout classes or bundle up to brave the cold, aim for about 150 minutes of exercise a week or 30 minutes per day.

Your dietary choices can strengthen your immune system, not only during cold and flu season but all year round. 

Probiotics are tiny organisms that can help you maintain a healthy balance of bacteria in your digestive system, which will also support your immune system. Fermented foods like kimchi, sauerkraut, and kefir all contain live probiotics, as does greek yogurt. In addition, legumes like chickpeas and lentils contain prebiotics, a type of fiber consumed by probiotics which also contributes to a healthy digestive system.

Oranges, tomatoes, and spinach each offer up plenty of Vitamin C, a powerful nutrient with many health benefits, including the ability to boost immunity and fight inflammation.

You’re automatically exposed to Vitamin D — another crucial immunity-related nutrient — on hot, sunny days, but during winter, it’s extra important to add it to your diet. Sources of Vitamin D include egg yolks, mushrooms, canned tuna, and salmon, which also contains other immunity-boosting nutrients like zinc and omega-3 fatty acids. There is evidence that taking Vitamin D daily can significantly lower your risk of getting sick with the cold or flu, and you may also consider taking Vitamin D supplements.

Lastly, if you’re feeling under the weather, be sure to drink 6-8 cups of water a day, as you can become dehydrated more easily when sick.

When you’re chronically stressed, your body releases a hormone called cortisol very frequently. Cortisol helps the body fight inflammation and infection, but its continual release can lessen its effectiveness as part of your immune system. 

Some degree of stress is inevitable, but there are healthy ways to keep it under control, like practicing meditation, exercising, and staying connected to family and friends. If stressors at work or at home feel difficult to manage, your primary care provider can help you find mental health resources. 

In addition, check out free mental health apps like What’s Up?, which helps you manage stress and negative thoughts through a therapy approach called cognitive behavioral therapy (CBT), and Insight Timer, which has a diverse library of free guided meditations.

We’re here to help you navigate this year’s cold and flu season

We hope that the immunity-boosting tips above will help you enjoy a healthy fall and winter. If you do develop flu symptoms, remember to keep others safe by staying home and reporting your symptoms to a doctor as soon as possible (ideally within 48 hours to reduce the severity and duration of your illness). And with a strong immune system, you’re likely to be on the mend in no time at all.

Many mild cases of the cold or flu can often be treated with rest and extra self-care, but if your doctor prescribes an antiviral medication, we’ll hand-deliver it to your door for free. 

When there are issues with your heart’s electrical signals it may beat too quickly, too slowly, or irregularly. This is called an arrhythmia. Learn more about the primary types of arrhythmias and the medications most commonly used to treat them.

Medications Commonly Used to Treat Arrhythmias

While a resting heart rate — the number of times your heart beats per minute when you’re at rest — will vary from one individual to the next, the healthy range for an adult is between 60 and 100 beats per minute. However, when there are issues with your heart’s electrical signals, which trigger each individual heartbeat, your heart may beat too quickly, too slowly, or irregularly. This is called an arrhythmia.

The best course of action depends on the type of arrhythmia you have and your overall health. Many cases of mild arrhythmias do not require any treatment. But your doctor may recommend medication to control or resolve your arrhythmia if there is a risk that your arrhythmia could cause more serious heart health issues.

Below, we explain more about the primary types of arrhythmias and the medications most commonly used to treat them.

Arrhythmias are categorized by the speed of the resulting heart rate and the area of the heart in which they originate.

A tachycardia is a fast heart rate, typically over 100 beats per minute when you’re at rest. There are many different types of tachycardias, including the following:

Atrial fibrillation is a rapid heart rate caused by irregularities in the electrical signals in the heart’s upper chambers, or atria. The condition may be temporary in some cases, but it often requires retreatment. It has been linked to more serious health issues including strokes.

Ventricular tachycardia is a rapid but steady heart rate caused by irregular electric signals in the heart’s lower chambers, or ventricles. The condition may lead to health complications depending on your overall cardiovascular health.

A bradycardia is a slow heart rate, typically under 60 beats per minute when you’re at rest. There are several types of bradycardias, including:

Sick sinus syndrome is a condition in which your sinus node — the heart’s natural pacemaker — doesn’t properly send electrical signals, causing your heart rate to beat slowly. (In some individuals, sinus node problems may result in a heart rate that alternates between too slow and too fast, which is also called bradycardia-tachycardia syndrome.)

Heart block, or atrioventricular block, is a condition in which electrical signals running through the atria don’t reach the ventricles. There’s a wide range in the severity of heart blocks, so they are subclassified into first-degree (mildest), second-degree, and third-degree (complete) heart blocks.

It’s also possible to experience a premature heartbeat, which often feels like a skipped heartbeat but is actually an additional beat. Premature heartbeats may occur when you are at rest, or they may be caused by stress, physical exertion, or stimulants like caffeine or nicotine.

For many individuals, premature heartbeats do not lead to more serious health problems, but it may trigger a more persistent arrhythmia in others. If you have a preexisting heart disease, you are more likely to experience complications as the result of a premature heartbeat.

Monitoring your heart rate and diagnosing an arrhythmia

Regularly monitoring your heart rate and heart rhythm can help you identify any potential issues in advance and avoid more serious health complications. Read our previous blog, ‘What Your Heart Rate Can Tell You About Your Health’ for additional guidance on measuring your resting heart rate. And if you have any concerns about your heart rate, consult with your doctor for an evaluation of any heart-related health issues.

To make a formal diagnosis of an arrhythmia, your doctor may use one or more tests to capture your heart’s rhythm. The process often begins with an electrocardiogram (ECG), a test performed in your doctor’s office in which patches attached to various places on your chest, arms, and legs record your heart’s activity.

If you have a chronic, consistent arrhythmia, the ECG may accurately capture your arrhythmia. However, if your arrhythmia is less frequent, an ECG may not necessarily give your doctor the information needed for a diagnosis. If that’s the case, they may recommend additional tests, including monitors you can use at home to record your heart’s activity over a longer period of time.

Treating an arrhythmia with antiarrhythmics

Antiarrhythmics help restore a regular heart rhythm by acting on the electrical currents that cause your heart to beat. They are most commonly used to treat tachycardias or premature heartbeats, and the majority are taken orally as a pill on an ongoing basis.

These are some of the most commonly prescribed antiarrhythmics and their side effects:

Amiodarone works by slowing down your heart’s nerve activity. It will likely take several weeks of amiodarone use before you experience the medication’s full effects.

It isn’t uncommon to experience nausea, vomiting, constipation, loss of appetite, abdominal pain, or a combination of these effects from taking amiodarone. For that reason, your doctor may recommend that you take amiodarone with meals.

Additional side effects include tremors, lack of coordination, weakness, fatigue, and difficulty sleeping. If any of these are severe or long-lasting, or if you experience more serious side effects such as abdominal swelling or painful breathing, contact your doctor right away.

Flecainide is typically started in the hospital if you are admitted for an arrhythmic-related health issue so that your doctor can closely monitor your response to it. It comes in tablet form and is usually taken twice a day. If you experience an upset stomach from the medication, your doctor may recommend that you take it with food or milk.

Flecainide is most effective when there is a constant level of it in your bloodstream so it’s important that you take it exactly as directed by your doctor. Abruptly stopping use of flecainide can cause serious health complications, so be sure to follow your doctor’s recommendations and consult with them if you have any concerns.

Common side effects of flecainide include nausea, vomiting, or diarrhea; loss of appetite; tremors; blurred vision; sleep disruptions; weakness; and dizziness or faintness. Contact your doctor if these side effects are severe or long-lasting. If you experience any severe side effects such as chest pain, yellow eyes or skin, fever, or difficulty breathing, contact your doctor as soon as possible.

Standing up slowly from sitting or lying down can alleviate dizziness and drowsiness caused by the medication. You should also ask your doctor if there are any activities to avoid while taking this medication given these side effects.

Propafenone acts on the heart muscle to improve your heart rhythm. It is typically taken three times a day. You may begin taking it in the hospital so that your doctor can observe how it affects you.

To maintain a consistent level of propafenone in your bloodstream, it’s important to follow your healthcare provider’s recommendations and to take the medication exactly as prescribed. If you have any concerns about taking this medication, consult with your doctor, as abruptly stopping use of propafenone may lead to an irregular heartbeat. One exception is if you experience excessive drowsiness or a slow or irregular heartbeat, in which case you should stop taking the medication right away and contact your doctor.

Side effects are less common with propafenone than with other antiarrhythmics. However, you may experience nausea, vomiting, constipation, diarrhea, loss of appetite, stomach cramps, weakness or muscle aches. Contact your doctor if you have any concerns about these side effects.

Ask your doctor about any possible food restrictions or necessary changes to your diet, as potassium can interact with propafenone.

Dronedarone is primarily recommended for individuals who have previously had atrial fibrillation but now have a normal heart rhythm. It can reduce the likelihood of being hospitalized for the condition in the future.

Your doctor will likely consider your overall health when determining if dronedarone is a good fit for you, as the medication may increase your risk for complications of other heart conditions. It is not typically recommended for individuals who have severe heart failure or worsening heart failure symptoms, or if your atrial fibrillation has remained consistent.

This medication has been known to interact with other medications, including other heart rhythm medications; antiviral medications like ritonavir; certain antibiotics including clarithromycin and telithromycin; certain antidepressants including amitriptyline, clomipramine, and nefazodone; antifungal medications like itraconazole, ketoconazole, and voriconazole; and antipsychotic medications like chlorpromazine, fluphenazine, and thioridazine. Make sure your doctor is aware of any medications you take.

Antiarrhythmics may also be administered intravenously in the hospital during a medical emergency. Ibutilide (Corvert®) and lidocaine (Xylocaine®) are two of the most commonly used antiarrhythmics that are administered through an IV.

General guidance about antiarrhythmic use

There are some general practices to follow when taking any medication in this class to avoid more serious health complications and manage side effects:

Inform your doctor of any underlying health conditions you have, as these may interact with your medication, especially kidney disease, congestive heart failure, liver disease, diabetes, or respiratory disease.

Your doctor may recommend exams, electrocardiograms (ECGs), and blood tests to monitor the medication’s effectiveness. Stay current with these follow-up appointments and lab work. 

Use caution when driving, particularly while you are still adjusting to the medication, and ask your doctor if there are any activities that you should avoid.

Depending on the type of arrhythmia you have and your overall health history, your doctor may also recommend calcium channel blockers or beta blockers. Here’s what to know about these medication classes.

If you have chest pain or high or low blood pressure in addition to your arrhythmia, your doctor may prescribe a calcium channel blocker. Commonly used to treat high blood pressure, calcium channel blockers open up narrowed blood vessels, allowing for more blood to flow to your heart. They are also used to treat arrhythmias since the opening of blood vessels can also slow your heart rate.

Most calcium channel blockers prescribed for arrhythmias are taken orally as pills, but some of them may be taken intravenously, which is when a medication is sent directly into your veins using a needle or a tube, typically in a hospital or doctor’s office.

Calcium channel blockers commonly used to treat arrhythmias include:

Common calcium channel blocker side effects include dizziness, constipation, and headaches. More severe side effects include rash or swelling in your legs and feet. Contact your doctor if you have any concerns about these side effects.

Beta blockers are commonly used to treat high blood pressure. Since they cause the heart to beat more slowly and less forcefully, they are also effective at treating tachycardias.

Beta blockers commonly used to treat tachycardias include:

Common beta blocker side effects include cold hands, fatigue, headache, and weight gain. They may also affect your digestive system.

If you have diabetes and take insulin, it’s important to check your blood sugar levels often while taking beta blockers as beta blockers may block typical signs of low blood sugar such as a rapid heart rate. Beta blockers are not typically used by people with asthma, as they may trigger severe asthma attacks.

If your arrhythmia puts you at a greater risk for blood clots or a stroke caused by a blood clot, your doctor may add an anticoagulant to your medication protocol. These medications reduce the blood’s ability to form new blood clots and prevent existing clots from growing. They will not address your arrhythmia, however, so they are typically taken in combination with one of the medications described above.

Choose a pharmacy that never skips a beat

At Alto, we’re committed to making it as simple as possible to manage your arrhythmia and strengthen your heart. We offer free same-day delivery and medication management tools like reminders and auto refills in our app. And our team of pharmacists is always here to answer your questions by phone or through the Alto app, and will even remind you when your medications are due for a refill.

Reach out any time via phone at 1-800-874-5881 or in-app messaging.

Pharmacist discussing medication with patient

September is Pulmonary Fibrosis Awareness Month, an annual month of education and action to bring attention to chronic lung disease.

Pulmonary Fibrosis Awareness Month: Understanding the Lung Disease

September is Pulmonary Fibrosis Awareness Month, an annual month of education and action to bring attention to chronic lung disease. A 2020 survey conducted by the Pulmonary Fibrosis Foundation found that 86% of Americans did not know the symptoms of pulmonary fibrosis, which affects more than 130,000 people in the United States. 

This lack of awareness may stem from the fact that pulmonary fibrosis presents with symptoms similar to more common respiratory conditions like COPD, as well as the fact that pulmonary fibrosis is a group of many lung diseases.

Greater education around this progressive lung disease is critical: the more you know how to recognize the signs of pulmonary fibrosis, the more likely you are to receive a diagnosis at an earlier stage, should you be affected. Better understanding of pulmonary fibrosis starts by simply knowing the facts, so, take a few minutes to learn more.

There are more than 200 types of pulmonary fibrosis. In each type, the lungs become scarred, making it difficult to breathe. Unlike COPD and some other lung diseases, pulmonary fibrosis falls under the umbrella of interstitial lung disease. Pulmonary fibrosis damages interstitial lung tissues, which are the cells that fill the space between blood vessels and other structures inside the lungs like the trachea and bronchial tubes.

Another way that pulmonary fibrosis differs from COPD is that it has a wider range of causes beyond cigarette smoking alone. Long-term exposure to pollutants and toxins, certain medical conditions and medications, and radiation therapy can also play a role in causing pulmonary fibrosis.

The most common type of pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF), which literally means pulmonary fibrosis of an unknown cause. While doctors are unable to isolate a single cause of the condition in these cases, the following risk factors may increase your chance of developing IPF:

A diagnosis of a condition that often co-occurs with pulmonary fibrosis (also referred to as a comorbidity) such as acid reflux, sleep apnea, or pulmonary hypertension

While researchers continue to work toward a cure, a combination of medications, oxygen therapy, and active lifestyle choices can slow the progression of pulmonary fibrosis. Getting diagnosed at an early stage is key to a better prognosis.

These are the most common symptoms of pulmonary fibrosis:

Since many of these symptoms overlap with those of COPD and other lung diseases, additional tests, including blood and imaging tests and pulmonary function tests, are often needed to confirm a pulmonary fibrosis diagnosis. Your doctor may also take into account the presence of the known risk factors mentioned above when determining if you have pulmonary fibrosis, including any related health conditions.

A long-term lung disease like pulmonary fibrosis may affect you both physically and emotionally, and it’s important to surround yourself with support. In addition to having a strong care team, there are many opportunities to connect with other individuals living with the condition, who understand your experience better than anyone.

The Pulmonary Fibrosis Foundation offers both virtual and in-person support groups. The PFF also has a phone group for all members of the pulmonary fibrosis community called PFF Voices, where you can discuss any pulmonary fibrosis-related topic or concern. The group meets on the third Thursday of every month.

The American Lung Association’s Better Breathers Club has a variety of resources for individuals living with lung diseases, including virtual meetings. The ALA also supports free online communities on Inspire.com that offer peer-to-peer support for people living with lung diseases, and there is a group specifically focused on living with pulmonary fibrosis. You need to create an Inspire.com account to access the group.

If you are caring for someone with pulmonary fibrosis, there are also resources to help you navigate your loved one’s treatment needs.

Read the Pulmonary Fibrosis Foundation’s suggestions for caregivers.

The PFF also offers a phone group created specifically for caregivers called PFF Caring Conversations, where you can share your experiences as a caregiver. The group meets on the first Tuesday of every month.

The American Lung Association supports an Inspire.com group for pulmonary fibrosis caregivers called Caring for Pulmonary Fibrosis. You need to create an Inspire.com account to access the group.

Alto is here for you, too. We want to make it as easy as possible to follow the treatment your doctor has recommended, so we offer free hand-delivery of your medication, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions.

Reach out any time by phone at 1-800-874-5881 or in-app messaging.

Lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Here's what to know.

What to Know About Lung Cancer Screening

Lung cancer, the leading cause of cancer death among both men and women, is more likely to be cured when detected early. The five-year survival rate is about 60% when the disease is confined to one lung. 

However, the majority of cases are diagnosed after the cancer has already spread to both lungs or other organs, at which point  the five-year survival rate is 20% or less. Delayed diagnoses are due in part to the fact that lung cancer symptoms often do not appear until the disease has progressed to more advanced stages.

This is why lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Some studies have found that screening detects 80% of lung cancer cases at an early stage. Read on to learn more about what to expect during lung cancer screening and whether it may be right for you.

Smoking is the number one cause of lung cancer, contributing to 80-90% of lung cancer fatalities. However, there are additional risk factors to developing lung cancer:

Exposure to radon, a naturally occurring gas that can get trapped in houses and buildings, and the second leading cause of lung cancer

Exposure to asbestos or other carcinogens like uranium, diesel exhaust, and inhaled chemicals in the workplace

Radiation therapy to the chest during cancer treatment

While lung cancer symptoms typically appear once the disease has progressed to a more advanced stage, some people do experience some of the following early signs of lung cancer:

A cough that does not go away or gets worse

Blog

The Right Way to Use a Metered Dose Inhaler

What to Know About Nebulizers

Emphysema: Causes, Symptoms and Treatments

How to Prepare for Cold and Flu Season

Medications Commonly Used to Treat Arrhythmias

Pulmonary Fibrosis Awareness Month: Understanding the Lung Disease

What to Know About Lung Cancer Screening

Prioritize Your Health with Preventative Care

Pulmonary Fibrosis: What to Know About Symptoms and Treatment

Common Types of Blood Pressure Medications

What to Know About the Four Stages of COPD

Five COPD Lifestyle Changes for a Healthier Life

Switch to a better pharmacy.