And the top 200 prescriptions for 2001 are...

May 21, 2002 4:52 PM

And the top 200 prescriptions for 2001 are... I see Claritin near the top of the charts, with zoloft and paxil not too far behind. Prozac is down, with viagra shooting up the charts like a... hmm. In total 3.1 billion prescriptions were filled in the US, which would be about an average of a dozen per citizen. Also interesting are the previous six years of data, allowing anyone to build a "Rx Zeitgeist" of the american hypochondriac.
posted by mathowie (59 comments total)

I took zero prescription drugs in 2001, but have totally blown the curve this year with, by my count, six of the the top twenty. I stopped counting at that point.

Of course, a three-day hospital stay with one of these will do that.

I'm feeling much better now, thanks.
posted by mr_crash_davis at 4:58 PM on May 21, 2002

Interesting that Vioxx, the last drug I was prescribed is pretty high up. About 4 years ago I had some teeth pulled and they prescribed Percocet; killed the pain and made me high as a kite to boot.
The next time I had a tooth pulled they prescribed Vioxx, which did kill the pain, but no buzz. For some reason I figured the buzzier stuff would rank higher, but nope. I'm not sure how to feel about that.
posted by jonmc at 5:04 PM on May 21, 2002

what's scary: how high cipro is on that list. (shudder)
posted by krewson at 5:13 PM on May 21, 2002

Good to see ol' Neurontin and Clonazepam climbing the list. It's also strange that Hydrocodone/APAP (Tylenol with codeine) is the most prescribed drug. That means were a country of ravenous opiate consumers (I know, I know, hydrocodone is synthesized, but still.) Also shocking how high on the list (no pun intended) Alprazolam (Xanax) is, beating all the antidepressants. Seems we're also a nation of barbituate addicts as well.

But, as a regular consumer of 10 of the top 50 drugs, I digress.
posted by evanizer at 5:19 PM on May 21, 2002

What I found shocking is not that Vicodin (hydrocone) is number 1 on the list, but that Synthroid, a synthetic thyroid hormone that I take, is number 5. I had no idea that there were so many people taking thyroid supplements, and I see another one not much farther down on the list, Levothroid. I wonder just how prevalent hypothyroidism is, anyway?
posted by Lynsey at 5:20 PM on May 21, 2002

Cipro is used for many other applications than anthrax prevention. It's sort of the atom bomb of antibiotics, given when other, weaker ones fail. And since this list is of prescriptions dispensed (by pharmacists, I assume) and I figure that many of the anthrax-paranoid get their cipro from other than pharmacists, perhaps the trend is not so scary.
posted by evanizer at 5:22 PM on May 21, 2002

WE BEAT PENICILLIN!
posted by WolfDaddy at 5:24 PM on May 21, 2002

Is there any data out there on the average price per-prescription? I'd be interested to see how close it comes to the UK's flat-rate £6.20 per item. (Also, I'd be a little worried by the number of antibiotics up there, given the risk of developing resistant bacteria strains...)
posted by riviera at 5:38 PM on May 21, 2002

I wonder just how prevalent hypothyroidism is, anyway?

Very. I think its boosted in the charts because we take it *every* day for an indefinite period of time. That means a lot of prescriptions. I've been taking it now for 7 years and have been looking around for ways to lower my dependence on it. Given Knolls dubious history on protecting its interests, I'm not sure that all options have been fully explored by researchers.

Also, recall that all of us ex-hyperthyroid (a much more dangerous condition esp. when you undergo toxic storm as I did) people usually end up in the hypo camp thanks to radiation treatment or other therapies.
posted by vacapinta at 5:49 PM on May 21, 2002

oh sweet, sweet, claritin, how i love thee... you make my allergies bearable.
posted by lotsofno at 6:08 PM on May 21, 2002

Bearable? Talk about going away! Around the big allergy season I got really really bad red, itchy eyes. They'd get really blood shot, dry and just unbearably itchy. Since I didn't know it was allergies it went for awhile till the outer part of my eye started peeling... Take one clariten once in a while, whenever my eyes feel the least bit dry, no problems whatsoever. Except of course the anal bleeding.
posted by geoff. at 6:27 PM on May 21, 2002

riviera:

I just did a vaguely non-scientific calculation, using the prices from CVS pharmacy's website for the top 25 drugs on this list. The average of the prices of the top 25 drugs is 46.90 USD.

Since there are variations in people's dosages and also various sizes of each medication listed (almost every one of the meds is available in various milligram pills), I used the price of the middle-sized pill of each drug. The prices I used were also based on a 30-pill supply (where applicable) although many off these meds are taken several times a day, so a one-month supply may be 60 or 90 pills rather than 30. Thus my calculation can be assumed to be innacurate, but at least gives one an idea of the average price of some of these meds.
posted by evanizer at 6:34 PM on May 21, 2002

Ouch: I think I'd need to be prescribed a tranquiliser just to cope with the shock of the bill.

And many, many thanks for doing the sums. It's appreciated.
posted by riviera at 6:41 PM on May 21, 2002

Also shocking how high on the list (no pun intended) Alprazolam (Xanax) is, beating all the antidepressants. Seems we're also a nation of barbituate addicts as well.


Maybe you're just kidding but why does this always come up? Someone always has to say something snide about psychiatric meds. Would you rather sweep mental illness under the carpet like we were doing not too long ago and let people suffer? They should make a pill that forces the "we're all over-medicated" chicken-little types to feel generalized anxiety or major depression for 48 straight hours. Or be bi-polar for a year.

Maybe someday I'll be aloof and hip enough to mock people in serious pain who are in the demographic most likely to take their own lives, but in the meantime I'll keep to my quack views about helping sick people.

Yes, some people are overmedicated and some wrongly diagnosed, but that's no reason to throw the baby out with the bathwater.
posted by skallas at 6:41 PM on May 21, 2002

I was surprised to see oxycontin so far up on the list. It's a great drug for people with severe pain. It's also one that many people are trying to make illegal.
posted by RunsWithBandageScissors at 6:48 PM on May 21, 2002

Claritin's a prescription drug? Guess I'll stay on this side of the border where it's 18+18 free tabs off the shelf for $12 CDN.
posted by djfiander at 6:53 PM on May 21, 2002

Maybe someday I'll be aloof and hip enough to mock people in serious pain who are in the demographic most likely to take their own lives, but in the meantime I'll keep to my quack views about helping sick people.

At the risk of revealing more personal information than I would like to, I take 4 different psychiatric medications and have been hospitalized for various mental/emotional ailments in my life. I do not take mental illness/emotional pain lightly. However I hold some in the psychiatric/pharmaceutical industries responsible for gross overmedication of people whose only 'illness' is being told that their normal human feelings are pathology. When I swallow my daily carnival of pills (and, believe me, I've tried to live without them), it helps to have a sense of humor about the absurdity of it all. And I feel lucky that my problems are relatively minor, that I've learned to manage them, and that I live in a time and place where medication exists.

And not to nitpick, but Alprazolam is not prescribed for depression and is not solely used for mental/emotional illness. It's a benzodiazepine tranquilizer, and I was merely noting with surprise that its sales surpassed the popular SSRIs Zoloft, Paxil, Celexa and Prozac.

Sorry to have offended you, skallas, but you're on a hair trigger (as a lot of people here seem to be lately.) Suggestion: chill out a bit.
posted by evanizer at 7:09 PM on May 21, 2002

Sorry to have offended you, skallas, but you're on a hair trigger (as a lot of people here seem to be lately.) Suggestion: chill out a bit.

I'm not offended, I'm really curious as to where the disregard for meds comes from and why there's always a someone to remind us that we're all a bunch of addicts. Sorry if I didn't get your humor, but I did ask if you were kidding.

However I hold some in the psychiatric/pharmaceutical industries responsible for gross overmedication of people whose only 'illness' is being told that their normal human feelings are pathology.

If your post was about disease mongering, well I certainly didn't see it. After reading it again I still don't see it.
posted by skallas at 7:22 PM on May 21, 2002

skallas, you brought it up first, and quite succinctly. I didn't read any of that into evanizer's comment.

It is amazing, tho, to see how much is being prescribed, how much it may cost, and what these drugs are. It makes me wonder what we did before these wonderful little pills came along. And is it really for the people or for the pharmaceutical companies?
</obvious rhetoric>
posted by ashbury at 7:23 PM on May 21, 2002

I wish the data presented here would have included the ratio of generic drugs to brand drugs produced, which as the success of McKesson and the spike in generic manufacturing demonstrates is where the real money is in the phramaceutical drug business. Based on the dramatic rise, I honestly hope the FDA has the manpower to ensure its "therapeutically equivalent" standards.
posted by ed at 7:24 PM on May 21, 2002

djfiander: Claritin is prescription only in the US for the rest of this year, then becomes over-the-counter. Hence the $$$ ad campaign by Schering-Plough (set to the Overture from "Tommy") to convince us to move to the (allegedly) superior Clarinex.
posted by pmurray63 at 7:25 PM on May 21, 2002

It makes me wonder what we did before these wonderful little pills came along. And is it really for the people or for the pharmaceutical companies?

Lets see Phenobarbital, Lithium, and Thorazine all came about from the early to mid 20th century. So I'm going to guess and assumed you meant what 19th century treatment was like. Wacky demonology was replaced Benjamin Rush's 'Moral treatment' system, though most likely an ill person would spend the rest of his or her life in an asylum. Phrenologists were quite big then too. Then Eugenics comes on the scene with all its social darwinistic evil. The eugenics crowd later gets a beating from Freud and others who don't blame mental illness purely on genetics but on effects of the subconscious.

I think its fairly obvious that modern pharmacology isn't some get rich scheme, but a serious medical advance. Sounds like your cyncism has more to do with how pharmacutical companies work in a free market than on the drugs themselves.
posted by skallas at 7:45 PM on May 21, 2002

Just heard this today; prescribed drugs are the fourth leading cause of death in the USA.

I've found various numbers ranging from 3 to 4, but this article seems pretty credible (if you're into that peer-reviewed science thing).

"106,000 deaths/year from non-error, adverse effects of medications"

Forget hypochondria, this borders on suicide.
Or criminal wrongdoing on par with the tobacconists.
posted by a_green_man at 8:04 PM on May 21, 2002

skallas, I believe that drugs are a wonderful invention. I don't know anybody who hasn't benefitted in some way from them, be that directly or indirectly. I myself haven't yet had the need for any of the more serious ones, but members of my family have. So yes, you have caught me out--I don't appreciate how the pharmaceuticals have done their business. I have no doubts that the money they make is the primary reason they operate; relieving humanity's pains is a wonderful byproduct. Don't believe me? Why all the advertising on television and in magazines for pharmaceutical products? You know that it's not altruism.

Furthermore, I also believe that we are over-medicated because it's easier to give us a pill than to give us what we often need more of: love and affection. It's said that the touch of another human being is more reassuring than any medication.

I almost forgot--thanks for reminding me of the asylums, phrenology and eugenics. I'd taken all that in a criminology course in college but had let it slide into the depths of my brain.
posted by ashbury at 9:00 PM on May 21, 2002

Benzos. Mmmmmmmmm.
posted by JohnBigBoots at 9:24 PM on May 21, 2002

In total 3.1 billion prescriptions were filled in the US, which would be about an average of a dozen per citizen

these numbers are incredibly shocking to me, i don't understand how so many people can be sick with so many things at once, all the time... i'm 41 this june and i haven't needed a prescription, outside of my birth control pills, in over 20 years. i can't think of anyone in my family or circle of closest friends who are on prescription drugs either, except for an 89 year old aunty. i wonder what the stats in this area are for canadians...i'm guessing we're not as medicated. well i hope not at any rate.

Why all the advertising on television and in magazines for pharmaceutical products?

come to think of it, the glut of pharmaceutical ads on american tv make it seem as tho' the entire nation has herpes and some form of depression/anxiety. it's a tad creepy. but maybe it's of benefit to someone who may not be aware of a new medication for whatever ails them...? mind you, i'd rather be getting this info from a doctor and not an advertising campaign...
posted by t r a c y at 10:02 PM on May 21, 2002

these numbers are incredibly shocking to me, i don't understand how so many people can be sick with so many things at once, all the time...

Polypharmacy is a tremendous problem in medicine. One occasionally runs into the (usually elderly) patient who may be on as many as 30 or 40 different prescription meds. Sometimes this is a result of a patient having several docs, but the good physician will have a patients bring in all their meds for periodic review. Other physicians are just lazy and don't take the time to see that the 60 year old who develops those mysteriously elevated liver enzymes just happens to be on three statins.

Drug advertising and the glut of pharmaceutical reps laying out football tickets, gourmet dinners, vacation junkets disguised as "seminars" and other "perks" to prescribing physicians is a factor in both pricing and demand. It is unethical to accept these gifts, but many physicians do anyway. I'd like to say it's unethical to offer them, but most people just laugh if pharmaceutical marketing and pricing is mentioned in the same sentence with the word ethics. Business as usual, in my view.
posted by fold_and_mutilate at 11:18 PM on May 21, 2002

I second those sentiments, foldy. Polypharmacy was indirectly responsible for the death of my grandmother.

And as for small-time pharmaceutical 'swag', my therapist used to give me all the drug-related advertising paraphernalia that he received, including a Zoloft clock that reads "Time for Zoloft", a small Zyprexa level (Zyprexa is an antipsychotic), and, my favorite, a Paxil (antidepressant) disposable camera featuring a pictures of a guy in a business suit with his head against the wall and the words "Social Anxiety Disorder..." printed on the front (no joke), and my favorite: a Paxil foam rubber squeezy stress reliever- in the shape of a little pink brain. I used to sit there during the sessions and squeeze that little brain until my knuckles were white. Once the therapist said: That's exactly what Paxil does to your brain. A classic moment.
posted by evanizer at 11:52 PM on May 21, 2002

So much for the war on drugs. Most Americans are already drug addicts.
posted by pracowity at 11:52 PM on May 21, 2002

(no joke), and my favorite

That should read "and my other favorite..."
posted by evanizer at 11:53 PM on May 21, 2002

On a slightly different tack, it's interesting to look through this list and check out the "Indications and Dosages." Vioxx, is being pushed in their ad campaigns as a revolutionary breakthrough for treating arthritis, is actually just a NSAID -- like Aleve -- analgesic which can also be given for acute pain (hence the tooth-pulling script, I guess) and dysmenorrhea, aka painful cramps. Some breakthrough!

Claritin is prescription only in the US for the rest of this year, then becomes over-the-counter. Hence the $$$ ad campaign by Schering-Plough (...) to convince us to move to the (allegedly) superior Clarinex.

"Claritin is the poor man's Zyrtec."
posted by Dreama at 12:17 AM on May 22, 2002

Polypharmacy was indirectly responsible for the death of my grandmother.

Sorry to hear it. Hang in.
posted by fold_and_mutilate at 12:32 AM on May 22, 2002

In total 3.1 billion prescriptions were filled in the US, which would be about an average of a dozen per citizen

these numbers are incredibly shocking to me, i don't understand how so many people can be sick with so many things at once, all the time

Matt's simple division isn't a meaningful figure. Its not exactly a random sample. Lets look at the top 5

1. Hydrocodone is a painkiller used after all sorts of surgery, dentistry, and injuries. You would expect this to be number one.

2. Lipitor lowers cholestoral. With obesity rates where they're at and an aging population this one is a no-brainer also.

3. Premarin treats menopause symtoms.

4. Atenolol treats heart problems and hypertension.

5. Synthroid treats thyroid disease.

Also, we don't know (from this list at least) what % of prescriptions each drug is responsible for making Matt's division an even more meaningless number. A safe assumption would be that senior citizens have a whole lotta scripts.

I'll criticize the drug companies as fast as anyone, but I'm not going to buy into the "we're overmedicating everyone" mentality based on shoddy math and especially in a country without universal healthcare.

One of the biggest beefs I have with drug companies is that they refuse to work on a new malaria treatment because its simply unprofitable. Say what you want about seniors and HMOs but dying young because of a mosquito bite takes the cake. Especially considering if we had a malaria epidemic in the states there would probably be an affordable cure for it in no time.

Again, I don't see this list as a meaningful representation of how much people are taking or which people are taking what. Its simply a best seller list without the hard numbers. Everything else is mostly speculation. If some pill is number 12 what does that mean exactly? Numbers 1-8 could be 99% of the scripts written last year. You just aren't getting any real numbers out of this list to make the assumptions some of you are making.
posted by skallas at 2:59 AM on May 22, 2002

what i find interesting is that we seem to have brand names spelt differently in the uk. i've had clarityn and zirtek prescribed for hay fever here, but they seem to be claritin and zyrtec in the states. i presume it's some kind of trademark issue?
posted by kirsty at 3:02 AM on May 22, 2002

Fluvoxamine (Luvox) isn't on the list. But just so you know that it helped to kill children at Columbine high school, it has also saved my life.

I remember looking at the pill before the first time I took it. I called my dad and said "So this little pill is supposed to help me?" He had no idea. But I had to call him before I took it. I took it and goddammit I'm still here to antagonize y'all. That was 1996. I've tried to wean myself off of it, but even without my conscious "knowing", I begin to drift back into the same OCD scenarios I once did. Much like fluvoxamine "taking awhile to take effect" it takes awhile to realize that weaning yourself off of it also takes awhile to take effect. In other words, it continues to work for me.
posted by crasspastor at 3:53 AM on May 22, 2002

Dreama

Vioxx, is being pushed in their ad campaigns as a revolutionary breakthrough for treating arthritis, is actually just a NSAID -- like Aleve -- analgesic which can also be given for acute pain (hence the tooth-pulling script, I guess) and dysmenorrhea, aka painful cramps. Some breakthrough!

I agree that the marketing of both Vioxx and Celebrex (they're very similar: both COX-2 inhibitors) has been at times misleading, and there is certainly a problem in the US with both drugs having sales lifted by patient recall factors (ie patients ask for it when they don't actually need an NSAID that's 10* the price of generic ibuprofen...) This is almost certainly a bounce from the direct-to-consumer publicity that both brands work with to a large (unprecedented?) extent.

There *is* a breakthrough factor involved with both drugs however: gastrointestinal complications and deaths are extremely common from traditional NSAIDs. Both Vioxx and Celebrex (and the next-generation COX-2s that are in the FDA approval process at the moment) have an ostensibly much better safety profile than older painkillers (note: there *is* some controversy here at the moment however...) The point of this is that if you're a relatively healthy 30 - 40 something female with no history of stomach, liver or kidney complaints then you definitely don't need Vioxx. If, on the other hand, you're elderly or in an otherwise at-risk category (Vioxx & Celebrex are primarily used to treat arthritis - a shared risk demographic) then it's bloody useful to know that you can have pain relief without a significant risk of death.
posted by bifter at 4:08 AM on May 22, 2002

This has turned into a great discussion, and I'm archiving it for reference.

Following evanizer's comments: I've been led to believe that doctors in the US are often loathe to suggest alternatives to medication - physiotherapy, counselling etc. - or to take people off pills at certain points in treatment, just because there's so much lobbying pressure. Is that a myth? (I mean, I see branded whatnots at my doctor's whenever I go to the surgery, but I suspect that with flat-rate scrips there's less pressure. At times, in fact, I'd have been prescribed generic painkillers, but the doc told me to buy them OTC...)
posted by riviera at 5:32 AM on May 22, 2002

I'm surprised Sugar Pill isn't on that list. How could that be? Am I spelling it wrong?
posted by ParisParamus at 6:20 AM on May 22, 2002

Claritan is about $1 USD per tablet here in the states. That's without health insurance. If you've got health insurance, depending on how good the prescription plan is, you may find that when Claritan goes over-the-counter, you will actually be paying more.

The reason it's going otc is that a health plan started to balk at having to pay for the prescription. My allergist refuses to prescribe Clarinex as he thinks it's a bogus move by the chem company.
posted by Taken Outtacontext at 6:20 AM on May 22, 2002

Claritin is going generic because its patent ran out, no? FYI: For some reason Claritin only has efficacy in about 50% of the population. They never mention that in the commericals...
posted by ParisParamus at 6:26 AM on May 22, 2002

riviera

Is that a myth? (I mean, I see branded whatnots at my doctor's whenever I go to the surgery, but I suspect that with flat-rate scrips there's less pressure. At times, in fact, I'd have been prescribed generic painkillers, but the doc told me to buy them OTC...)

It's probably true to some extent that there's less pressure in the UK, but that isn't to say that there is no pressure. Personal experience has seen a GP (friend of the family) quit her practice and retire because of her partners' open-handed approach to pharma kickbacks. Similarly, my fiancee has been shunted back and forth between different contraceptive pills (with different side-effects and safety profiles) for no good reason and against generally accepted medical best-practice. The reason? The bad luck to get different doctors with presumably different personal agendas and commercial relationships each time she went to renew her prescription.

I've been interested to see recently that there's a possibility of the trend going the other way in the US - with increased power in the hands of HMOs (healthcare management organisations?) to balance budgets on behalf of insurers by aggressively applying policies opposed to the widespread prescription of expensive and ostensibly unnecessary medication. I'd love to hear more about this, as I'm coming from a pretty external perspective on the debate (UK, informed by pharma trade press only...)
posted by bifter at 6:46 AM on May 22, 2002

An interesting aside...

Ortho Tri-cyclen is the most prescribed birth control pill on the market, and it also has quite a reputation as a libido inhibitor. Couple that with all of the other libido inhibiting drugs out there, and you kinda start to wonder about the intentions of the drug-manufacturers...

I know, I know... Conspiracy theorist..
posted by eas98 at 6:47 AM on May 22, 2002

I've had rheumatoid arthritis (among other things) for eighteen years (I'm a few months shy of twenty-one, now). and for as long as I've been old enough to make my own decisions about medication, I've fought tooth and nail to keep my dosages as low as possible and my medicines as benign as possible, even if it means I have to put up with a bit more physical pain than I would otherwise. still, I have prescriptions for fifteen drugs, thirteen of which I take on a daily basis. and while it's the steroids and the dmards that have kept me alive, it's celebrex that keeps me functioning. the nsaids I was taking (in massive quantities) before celebrex was released made me quite sick -- and, aside from my extensive autoimmune problems, I'm a healthy (and health-conscious), active, athletic young adult. so it really does make a difference.

I do hate the drug industry with a passion but I'm still unfortunately dependent on it. being on a short-term prescription to take care of a short-term problem is one thing, but taking pill after pill every day of your life is another thing. aside from the fact that side effects get worse with extended use, the human body has this amazing adaptability, and tolerance starts to be an issue after too long. that's why it's important, at least to me, to treat and take care of my diseases in as many different ways as possible -- not just because it reduces my need for more drugs, but because it's more effective and less potentially harmful in the long run. I've been lucky and had doctors who've been completely supportive of my attitude, but it's easy to imagine that in a more traditional hmo setting (I've been seeing pediatric specialists in children's hospitals in manhattan and boston for most of my life), I wouldn't have such encouragement. it's a lot more time consuming to sit down with a patient and work out an entire lifestyle than it is to write a bunch of scrips... I can see myself taking the path of least resistance, in other circumstances.
posted by rabi at 7:18 AM on May 22, 2002

There *is* a breakthrough factor involved with both drugs however: gastrointestinal complications and deaths are extremely common from traditional NSAIDs. Both Vioxx and Celebrex (and the next-generation COX-2s that are in the FDA approval process at the moment) have an ostensibly much better safety profile than older painkillers

I stand corrected. Though I was not diminishing the effectiveness of these drugs for those who have taken them. I too have a mild collagen disorder which manifests itself with arthritis-like symptoms, but since I've spent the last several years pregnant and/or nursing, I've been holding out on managing the pain pharmaceutically as much as possible. Like Rabi, though, I've had good doctors who've worked with me to manage my disease in a proactive manner, and support my wish to avoid meds. But if I should I get to a point where that choice is no longer feasible, I will be glad for innovative drugs that ease pain more safely than the old guard.
posted by Dreama at 7:53 AM on May 22, 2002

Hmm. Glucotrol XL (the stuff I got put on) has been in decline in the last few years, while Amaryl (same class of drug) has been climbing slowly. That bugs me.
posted by Foosnark at 7:57 AM on May 22, 2002

I found the comments about Vioxx particularly interesting, because I began taking it several months ago for chronic back/neck/shoulder pain. I knew it was a Cox-2 inhibitor (although I know nothing about Cox-2 enzymes) but it never occurred to me it could be used for post-dentistry pain, etc.

It's currently over $80 for 30 pills, but it works much better for me than the old standby Non-Steroidal Anti-Inflammatory Drug known as ibuprofen; I had been taking as much of that stuff as I dared and not getting any relief. Vioxx to me falls a little short of its slogan, "For Everyday Miracles," but "Your results may vary."
posted by StOne at 8:05 AM on May 22, 2002

StOne

I knew it was a Cox-2 inhibitor (although I know nothing about Cox-2 enzymes) but it never occurred to me it could be used for post-dentistry pain, etc.

First of all, the way you should view Vioxx is as a strong NSAID with a premium-priced safety profile (I'm not knocking it btw, but it really isn't anything more than this).

It's a patent issue: Vioxx and Celebrex were the first COX-2s to market, and managed to essentially corner the market on next-generation serious pain relief, for which the most frequent application is arthritis. Next-next-generation arthritis painkillers were already in the pipeline when they came to market however (and are currently jumping through FDA approval hoops). The classification of what are essentially general purpose painkillers/anti-inflammatories for a single high-value disease (ie arthritis) area lets the pharma companies get maximum loot for the period that they hold patent, while the research into other more mundane applications (for which approval can take a while) lets them squeeze the last few drops out when the patent expires and the competitors arrive on the scene.

Out of interest, both drugs have also been tested for efficacy in cancer treatment...
posted by bifter at 8:20 AM on May 22, 2002

ParisParamus, here's an article that details the reasons Claritin is becoming OTC.

While Schering's decision to do so was voluntary (their patent actually runs out this coming December) it was also influenced by the WellPoint Health Networks's, a petitioner to the FDA, desire to see lower pharmacutical prices.
posted by Taken Outtacontext at 8:56 AM on May 22, 2002

If the pharmacist offers you a generic, think twice.

My drug was about 144 on the list (too bad they didn't number them). I've been taking dilantin to control seizures for more than 15 years.

I'm very fortunate that the I've been virtually unaffected by any of the nasty side effects associated with this drug. However, I found out the hard way that Mylan, the generic phenytoin equivalent is not the same. It's absorbed at a different rate, and I was beginning to have mild partial seizures because the stuff wasn't staying in my bloodstream.

Bottom line: don't assume your pharmacist knows everything about every drug.
posted by groundhog at 10:51 AM on May 22, 2002

Thanks, bifter, for the clarification and the link.
In regard to patents and generics, CBS News recently did a report about Claritin coming out with Clarinex and Prilosec pushing Nexium--mostly the same drugs, but "new and improved" and under patent.
That was the one week I didn't see Nexium commercials on the CBS News. But they're back.
posted by StOne at 12:38 PM on May 22, 2002

Taken Outtacontext: I would love to know more about the FDA's ability to subvert the limitations on patent protection. Has anyone sought to challenge this? Sounds dubious to me.
posted by ParisParamus at 1:03 PM on May 22, 2002

Does anyone have any experience buying prescriptions on the cheap in Canada? Will a pharmacy there honor a US rx?
posted by ParisParamus at 1:47 PM on May 22, 2002

And is it considered illegal to import on this basis (for oneself)?
posted by ParisParamus at 1:47 PM on May 22, 2002

Will an anthrax-related drug make it into the top 200 in 2002? Hope not.
posted by ParisParamus at 3:17 PM on May 22, 2002

Well, since there seems to be an interest here in Vioxx, and since some here maintain that your humble poster has some, uh, annoying familiarity with "inflammation", here's the oversimplified deal with Vioxx and other COX-2 inhibitors:

NSAIDS like Vioxx and aspirin and ibuprofen work by diminishing the activity of an enzyme called cyclooxygenase, normally abbreviated COX. Think of enzymes like COX as little machines that greatly increase specific chemical reactions.

One of the specific reactions COX boosts is the creation of another class of chemicals called prostaglandins, which are produced in minute quantities by virtually all the tissues in our body. Prostaglandins serve in part as a kind of signal to crank up things like inflammation, and a particular kind of prostaglandin (E2) can even sensitize nerve endings to inflammation.

Scenario: as a righteous bleeding-heart liberal, you're routinely kicking poor conservatives around, but sprain your ankle in the process (God works in mysterious ways...). The tissue becomes inflamed and hurts like hell, so you pop a couple of aspirin...COX gets blocked, prostaglandins get blocked...and voila...you have less pain, less inflammation.

Which is only just, considering that you injured yourself in the line of duty, so to speak.

Problem: the presence of those cute little prostaglandins normally also helps create gobs of slimy but oh so protective mucus in your GI tract. This mucus protects against the acid secreted in your gut...acid that helps sterilize and digest the greasy cheeseburger (damn you to hell) you had for lunch. But being a limp-wristed liberal who can't bear pain, you took the aspirin, which blocked your COX and blocked your prosta-glandies, and now that lovely acid is eating holes in the mucus-deficient vascular richness of your GI tract, giving you a bleeding gut to go along with your black AND bleeding heart.

Solution: there are actually two cyclooxygenase inhibitors (creatively called COX-1 and COX-2). It's actually COX-1 that is more important in GI mucus production, so in theory the selective blocking of COX-2 gives good pain and inflammation relief without the bleeding gut problems. Enter Vioxx and the other COX-2 inhibitors (Celebrex is the other biggie...more are in the drug company pipeline).

Not sure what to do about your bleeding hearts, though. Can't really attribute it to COX-(inhibitor)-sucking, so I guess it must be genetic.
posted by fold_and_mutilate at 3:40 PM on May 22, 2002

fold_and_mutilate: mate, that was priceless. Still roaring with laughter here (and couldn't have explained it better myself... considered a career in teaching?)
posted by bifter at 1:26 AM on May 23, 2002

Ever thought of whoring yourself out for mastercard f&m?

Now. What kind of drug can we get you on to make you more straight-laced and malleable?
posted by crasspastor at 2:45 AM on May 23, 2002

Pity you found a way to turn what was an otherwise excellent series of informative posts into partisan point-scoring.
posted by darukaru at 5:10 PM on May 24, 2002

Pity you found a way to turn what was an otherwise excellent series of informative posts into partisan point-scoring.

Gosh, was that meant for lil' ol' me?

If so, may I congratulate you on a particularly astute comment within the thread. My reference to liberals as "limp-wristed" and "black-hearted" is no doubt extraordinarily hurtful to those I habitually bait in my usual partisan manner.
posted by fold_and_mutilate at 12:16 AM on June 7, 2002