New Twists to Old Meds: Fresh Formulations of Losartan, Minocycline, and More

In this episode, TRC Healthcare editor, Vickie Danaher, PharmD, discusses recently approved drug formulations that bring fresh options—and new challenges—to the pharmacy counter. 

From Arbli, the first ready-to-use losartan suspension, to Emrosi, a low-dose minocycline for rosacea, and Opipza, an oral film version of aripiprazole, we’ll walk through what makes each product unique and what pharmacy teams should watch for. We also cover HemiClor, a 12.5 mg chlorthalidone tablet that may help patients avoid splitting unscored tabs, Neffy, a needle-free epinephrine nasal spray now available in a pediatric strength, and wrap up with biosimilar updates on Merilog and Omlyclo. 

This is an excerpt from our June 2025 Pharmacy Essential Updates continuing education webinar series.

The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Watch for New Twists to Older Medications
• Chart: Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors
• Chart: Treatments for Rosacea
• Chart: Comparison of Commonly Used Diuretics
• Chart: Comparison of Atypical Antipsychotics
• Chart: Emergency Epinephrine Devices
• Chart: Facts About Biosimilars

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Chapters

• 0:00 Introduction
• 1:47 Background
• 3:00 Arbli
• 5:38 Emrosi
• 7:47 HemiClor
• 9:29 Opipza
• 10:53 Neffy
• 13:39 Merilog
• 16:30 Omlyclo
• 18:42 Conclusion

Transcript

This transcript is automatically generated. 

00:00:04 Narrator

Welcome to Clinical Capsules from TRC Healthcare, your go-to podcast for fast, evidence-based insights. 

00:00:11 Narrator

On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher spotlights newly approved formulations of familiar meds—like Arbli, Emrosi, Opipza, and Neffy—and breaks down what pharmacists and pharmacy technicians need to know in an excerpt from our popular Pharmacy Essential Updates webinar series.  

00:00:31 Narrator

TRC has been a trusted resource for healthcare professionals for over 40 years—and now we’re bringing that expertise straight to your ears every 2nd and 4th Tuesday, in bite-sized, actionable episodes…right here on Clinical Capsules.

00:00:45 Narrator

With that, Let's get started…

00:00:54 Vickie Danaher

So let's talk about some recently approved drugs and dosage forms that bring some new twists to older medications.

00:01:02 Vickie Danaher

And we know it's not uncommon to see new versions of existing meds enter the market, especially as patents expire on original products or to try to meet an unmet need…

00:01:12 Vickie Danaher

Such as using a drug to treat a different condition or patient population.

00:01:17 Vickie Danaher

But as multiple formulations of the same medication become available, it often leads to questions about substitution, how the various products stack up, or how to prevent confusion or errors. Among the different options.

00:01:30 Vickie Danaher

So today we're going to hone in on some notable new products and dosage forms of older meds that many of us are used to dispensing.

00:01:38 Vickie Danaher

For example, there's a new version of Losartan for high blood pressure that goes by the brand name Arbli.

00:01:45 Vickie Danaher

A new minocycline product called Emrosi.

00:01:49 Vickie Danaher

And a new formulation of aripiprazole known as Opipza.

00:01:53 Vickie Danaher

There's also new biosimilar products that have also been recently approved, Such as Insulin aspart-szjj (or Merilog) which is highly similar to the insulin aspart product NovoLog which has been around for ages..

Arbli

00:02:08 Vickie Danaher

Alright, let’s start off by exploring the new losartan product Arbli, which will be the first ready to use oral Losartan suspension.

00:02:17 Vickie Danaher

And you can think of its brand name Arbli to remember that it's an angiotensin receptor blocker or ARB or A R B that comes in a liquid which begins with Li.

00:02:28 Vickie Danaher

Now, historically, some pharmacies have been compounding oral Losartan liquids, especially for pediatric patients with high blood pressure or patients who can't swallow certain tablets.

00:02:39 Vickie Danaher

But Arbli will be commercially available without the need for compounding or mixing.

00:02:45 Vickie Danaher

So this means that you'll likely see patients start to switch from a compounded Losartan liquid to this ready to use Losartan suspension.

00:02:54 Vickie Danaher

And it's critical to stay alert for these patients because there's some key differences between these products to be aware of.

00:03:01 Vickie Danaher

One of the biggest things to pay attention to is the concentration and dose.

00:03:05 Vickie Danaher

Losartan liquids that are compounded are often made in a 2.5 milligram per ML concentration.

00:03:12 Vickie Danaher

But Arbli is 10 milligram per ML concentration, so it's four times more potent.

00:03:19 Vickie Danaher

And a fourfold dosing error could occur if the volume isn't adjusted.

00:03:24 Vickie Danaher

So to help clarify the dose ask for the patient’s weight if the prescription is for a child.

00:03:29 Vickie Danaher

The usual pediatric starting dose for Arbli is 0.7 milligrams per kilogram by mouth once daily.

00:03:37 Vickie Danaher

Also point out that a little certain oral suspension has different storage requirements than some compounded formulations.

00:03:45 Vickie Danaher

For instance, Arbli should be dispensed in its original container, which is 165ML bottle and it should be kept at room temperature.

00:03:54 Vickie Danaher

Whereas compounded Losartan liquids often need to be refrigerated.

00:03:59 Vickie Danaher

Direct patients or caregivers to shake the ready to use losartan suspension for 20 seconds before each use to ensure the product is adequately mixed and to discard the bottle 60 days after it's first opened.

00:04:11 Vickie Danaher

This is also different than most compounded losartan products, which are usually only good for 28 days.

00:04:19 Vickie Danaher

And then for any Losartan liquid, make sure to dispense an appropriately sized oral syringe or dosing cup to help ensure patients get the right amount of medication and that they avoid using household spoons which aren't accurate.

00:04:31 Vickie Danaher

And for more on how Losartan stacks up to other meds for high blood pressure or heart conditions, check out our Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors chart.

Emrosi

00:04:46 Vickie Danaher

The next drug we have to discuss is the Minocycline, ER 40 milligram capsule called Emrosi and it's being touted as the lowest dose oral Minocycline product for rosacea.

00:05:00 Vickie Danaher

Limited data suggests that Minocycline ER, 40 milligrams improves lesion count and treatment success better than oral doxycycline 40 milligrams or Oracea.

00:05:11 Vickie Danaher

But expect that many patients and insurance companies will balk at the price Emrosi costs about $1300 per month and also be ready for prior authorizations.

00:05:25 Vickie Danaher

And that's also because many patients with rosacea should often try other measures to manage symptoms and prevent flares and not jump to systemic meds first.

00:05:35 Vickie Danaher

For example, emphasize using nondrug strategies such as gentle skin care with mild cleansers and identifying and avoiding triggers such as alcohol and hot or spicy foods or beverages.

00:05:47 Vickie Danaher

Point out that topical meds such as metronidazole or azelaic acid are usually first line from mild to moderate symptoms of rosacea such as papules or pustules.

00:05:59 Vickie Danaher

And then recommend adding oral antibiotics such as doxycycline or Minocycline to topical therapy for more severe rosacea to treat flares or when topicals aren't enough.

00:06:13 Vickie Danaher

If patients do get the new Minocycline, ER 40 milligram capsules or Emrosi to treat rosacea, take care to avoid mix ups with other Minocycline products and don't automatically substitute amongst these products since they aren't considered equivalent.

00:06:29 Vickie Danaher

Let patients know they can take Minocycline ER, 40 milligrams once daily, with or without food. But taking it with food may lower the risk of irritation or ulcers in the esophagus.

00:06:40 Vickie Danaher

And remind them to swallow the capsule hole, since it's an extended release product.

00:06:46 Vickie Danaher

And if you'd like to take a much deeper dive into other meds used to treat rosacea, see our chart treatments for rosacea.

HemiClor

00:06:55 Vickie Danaher

Moving along, the next product on our list is chlorthalidone 12.5 mg tablets, or HemiClor.

00:07:02 Vickie Danaher

It contains half or Hemi as much chlorthalidone than the 25 milligram tablets we're used to dispensing.

00:07:11 Vickie Danaher

Now, traditionally, patients who need 12.5 milligrams of chlorthalidone could cut the 25 milligram strength in half to get their dose.

00:07:21 Vickie Danaher

But the 25 milligram tablets are not scored and there may be some patients who can't or prefer not to cut an unscored tablet.

00:07:30 Vickie Danaher

So HemiClor tablets may be an option for these patients

00:07:34 Vickie Danaher

But this does come at a cost.

00:07:36 Vickie Danaher

HemiClor costs about $1.00 per tablet or $30.00 per month, compared to about $6 per month if the patient split the 25 milligram tablets and take half of that tablet once daily.

00:07:51 Vickie Danaher

If you get a prescription for HemiClor, stay alert for look-alike sound alike mix ups and avoid trying to abbreviate this medication.

00:07:59 Vickie Danaher

HemiClor could be confused with H-Chlor a sodium hypochlorite product used for wound care.

00:08:07 Vickie Danaher

And when patients start or switch thiazides, keep in mind dosing equivalencies to ensure patients get an appropriate dose.

00:08:16 Vickie Danaher

For instance, Chlorthalidone 12.5 milligrams per day is comparable to indapamide 1.25 milligrams per day or to hydrochlorothiazide 25 milligrams per day.

00:08:29 Vickie Danaher

And for more specifics on these and other diuretics, check out our comparison of commonly used diuretics chart.

Opipza

00:08:37 Vickie Danaher

Let's keep going and chat about aripiprazole, which is now available in an oral film called Opipza.

00:08:45 Vickie Danaher

We know that this atypical antipsychotic can be used for schizophrenia, major depressive disorder, and other conditions, and a film dosage form may be an option for patients who can't swallow oral area proposal formulations.

00:09:00 Vickie Danaher

The films also reach peak concentrations in about 1 1/2 hours, versus about three to five hours for the oral tablets.

00:09:09 Vickie Danaher

But don't suggest switching to the oral film without a good reason and anticipate prior auths.

00:09:16 Vickie Danaher

30 of the 10 milligram films cost about $2300 versus $10.00 for the tablets, $175 for orally disintegrating tablets or $375 for the oral 1 milligram per ML solution.

00:09:34 Vickie Danaher

And if you do dispense the Opipza films, watch for mix ups among the three different strengths. It comes as 2 milligrams, 5 milligrams and 10 milligram films.

00:09:45 Vickie Danaher

Educate patients to dissolve these oral films on the top of the tongue once daily with or without food.

00:09:52 Vickie Danaher

Explore our chart Comparison of Atypical Antipsychotics for more insights on aripiprazole and similar meds.

Neffy

00:10:03 Vickie Danaher

Next up is Neffy or epinephrine nasal spray for the emergency treatment of allergic reactions, including anaphylaxis.

00:10:12 Vickie Danaher

We talked about Neffy in episode 5 of Clinical Capsules back in March, But the new twist now is that it also comes in a lower strength, making it a new option for many children.

00:10:26 Vickie Danaher

So the new 1 milligram strength of Neffy is for ages 4 years and up who weigh 15 to less than 30 kilograms, which is 33 to less than 66 lbs.

00:10:38 Vickie Danaher

And we can kind of think of this as the junior version of the original 2 milligram epinephrine nasal spray, which is for patients 30kg or 66 lbs or more.

00:10:51 Vickie Danaher

Each carton comes with two nasal spray devices, and each device is single use only.

00:10:57 Vickie Danaher

Point out that each device contains enough medication for one dose, and that the device should not be primed or tested since this will discharge the dose.

00:11:07 Vickie Danaher

Explain to patients or caregivers to hold the device with a thumb on the bottom of the plunger and a finger on each side of the nozzle. Insert the nozzle fully into one nostril. Either nostril is OK, and then press the plunger to give a dose.

00:11:24 Vickie Danaher

And then 5 minutes after the first dose, a second dose can be given if needed with the second device.

00:11:31 Vickie Danaher

But that second dose should be given in the same nostril as the first.

00:11:38 Vickie Danaher

When you get prescriptions for epinephrine nasal spray, ask for and document the patients weight to double check doses, especially as children grow.

00:11:46 Vickie Danaher

Also watch for mix ups and continue to use barcode scanning since the two strengths of the nasal spray come in cartoons that have a similar looking design and font.

00:11:56 Vickie Danaher

Remind patients and caregivers to store them at properly check the expiration date on their device and make a note on their calendar or in their phones to refill the medication before it expires.

00:12:08 Vickie Danaher

Neffy 1 milligram has a shelf life of 24 months, but Neffy 2 milligram has a shelf life of 30 months.

00:12:17 Vickie Danaher

Both of the products should be kept at room temperature, but they can withstand temperatures up to 122°F for a few days, such as if they're accidentally kept in a hot car.

00:12:28 Vickie Danaher

And we in the pharmacy can also continue following good inventory control practices such as by monitoring expiration dates regularly and rotating stock.

00:12:37 Vickie Danaher

And for more information about intranasal epinephrine as well as injectable epinephrine devices for anaphylaxis, read our emergency Epinephrine devices chart.

Merilog

00:12:48 Vickie Danaher

Now the last two new products that I'll highlight today are approved as biosimilars.

00:12:53 Vickie Danaher

And we'll review what that means in a minute.

00:12:56 Vickie Danaher

But Merilog or (insulin aspart-szjj) will be the first biosimilar to NovoLog, or insulin aspart, and it's the first rapid acting insulin biosimilar for diabetes.

00:13:11 Vickie Danaher

Like NovoLog, Merilog will come in a 10 milliliter vial or a carton of five 3-mL prefilled pens.

00:13:21 Vickie Danaher

And again, Merilog is biosimilar to its reference product, which is NovoLog. So that means that Merilog is shown to be highly similar to NovoLog. It has the same dosage form, route of administration, strength, and mechanism, and it shows no clinically meaningful differences in safety, purity, and potency.

00:13:43 Vickie Danaher

Now be aware that federal law allows automatically substituting a biosimilar for the original reference product if it's also approved as interchangeable and interchangeable means that the product meets additional requirements for switching.

00:13:59 Vickie Danaher

But Merilog is not yet designated as interchangeable to NovoLog.

00:14:04 Vickie Danaher

So if a patient wants to switch from NovoLog to Merilog or a payer requires this you'll still need to get the prescriber’s approval to switch products.

00:14:15 Vickie Danaher

You also want to consider costs and coverage when talking with patients about switches.

00:14:20 Vickie Danaher

The manufacturer of insulin aspart- szjj or Merilog, will offer it to all patients for $35 or less for a 30 day supply and copays under some plans, or in some states may be capped at $35 per month. And this is similar to other covered insulin prescriptions.

00:14:39 Vickie Danaher

Plus, right now, the wholesale acquisition cost or WAC of Merilog is about the same as NovoLog. So about $70 per 10ML vial or $140 per carton of 5 pens.

00:14:54 Vickie Danaher

If patients switched from insulin aspart or NovoLog to insulin aspart-szjj, or Merilog advise a unit per unit conversion and closer blood glucose monitoring when switching.

00:15:08 Vickie Danaher

Also make sure that patients don't accidentally get both NovoLog and Merilog. Doubling up on insulin aspart could lead to severe hypoglycemia, or dangerous drops in blood sugar.

00:15:20 Vickie Danaher

Another difference to mention is that Merilog comes in a SoloStar pen that delivers up to 80 units per dose. But NovoLog flex pen dials up to 6 units per dose.

00:15:32 Vickie Danaher

So that may be a consideration when deciding on a product. If a patient needs these higher doses.

Omlyclo

00:15:40 Vickie Danaher

And then the last one I'll go through today is Omalizumab-igec, or Omlyclo.

00:15:47 Vickie Danaher

And this will be the first interchangeable biosimilar to Xolair for allergic asthma, chronic hives and food allergy.

00:15:57 Vickie Danaher

But its approval is only for certain products and dosage forms.

00:16:01 Vickie Danaher

In particular, Omalizumab-igec is approved as the 75 milligram per 0.5 ML or 150 milligram per ML syringes, not the auto injectors file or 300 milligram per two ML strength.

00:16:20 Vickie Danaher

Expect that Omalizumab-igec will cost less than Xolair, since biosimilars often costs about 20 to 35% less or so than the original versions, but payers will ultimately drive the choice of which product a patient will get.

00:16:37 Vickie Danaher

Remember that you can automatically substitute a biosimilar that's also approved as interchangeable if your state allows.

00:16:46 Vickie Danaher

So in most areas you can dispense Omalizumab-igec if the prescription is for still there.

00:16:54 Vickie Danaher

But keep in mind that many states still require you to inform the patient or prescriber even when substituting an interchangeable biosimilar and a handful do require contacting the prescriber before substituting. So good idea to always double check your state laws.

00:17:10 Vickie Danaher

If biosimilars are on your mind after hearing about Merilog and Omlyclo, we’ve got more for you.

00:17:16 Vickie Danaher

For a comprehensive overview, check out our resource called Facts About Biosimilars, you can find the link to this in the show notes.

00:17:24 Vickie Danaher

And for a deeper dive in audio format, give Episode 13, Biosimilars 101, a listen.

00:17:33 Vickie Danaher

And we’re wondering—across all of these 'new twist' medications we covered today, have you seen any prescriptions for them yet? Or had patients asking about them? Let us know using the 'Send us a text' link in the show notes.

00:17:49 Narrator

We hope you enjoyed and gained practical insights from listening to this episode! 

00:17:53 Narrator

We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights, where you’ll find even more concise, evidence-based tools.

00:18:09 Narrator

If you’re not yet a subscriber, now’s the time—sign up today to stay ahead with trusted, unbiased insights, and continuing education. And as a listener, you can save 10% on a new subscription with code cc1025 at checkout.

00:18:25 Narrator

Also, be sure to check out our other TRC content—podcasts like Medication Talk and Rumor vs Truth, plus our full Pharmacy Essential Updates webinar series for deeper dives.

00:18:37 Narrator

Thanks for listening… stay sharp, stay current—and we’ll catch you next time on Clinical Capsules!