I came across a list of the 50 most prescribed medicines in the U.S. for 2008 and thought it was fascinating. Here is a sampling of the top 20, with discussion to follow:
#1. Hydrocodone (with acetaminophen)
Used to treat pain
121.3 million prescriptions / $5.88 billion retail cost
#2. Lisinopril
Hypertension
69.8 million prescriptions / $686 million retail cost
#3. Simvastatin
High cholesterol
49.0 / $1.45 billion
#4. Levothyroxine
Hypothyroidism
58.6 / $546 million
#5. Amoxicillin
Bacterial infection
52.1 / $439 million
#6. Azithromycin
Bacterial infection
49.3 / $1.28 billion
#7. Lipitor
High cholesterol
49.0 / $5.88 billion
#8. Hydrochlorothiazide
Edema/hypertension
47.1 / $288 million
#9. Alprazolam
Anxiety
43.6 / $468 million
#10. Atenolol
Hypertension
40.9 / $274 million
11. Metformin (diabetes)
12. Metoprolol succinate (hypertension)
13. Furosemide (edema, hypertension)
14. Metoprolol tartrate (hypertension)
(if both formulations of metoprolol are considered, it is the 3rd most prescribed)
15. Sertraline (depression)
16. Omeprazole (ulcers, reflux)
17. Zolpidem/Ambien (insomnia)
18. Nexium (refulx, ulcers)
19. Lexapro (depression)
20. Oxycodone (pain)
21. Singulair (asthman, allergies)
22. Ibuprofen (pain, inflammation)
23. Plavix (blood clotting)
24. Prednisone (allergies, inflammation)
25. Fluoxetine (depression)
26. Synthroid (hypothyroidism)
27. Warfarin (blood clotting)
28. Cephalexin (bacterial infection)
29. Lorazepam (anxiety)
30. Clonazepam (anxiety)
31. Citalopram (depression)
32. Tramadol (pain)
33. Gabapentin (epilepsy, pain)
34. Ciprofloxacin (bacterial infection)
35. Propoxyphene-N (pain)
36. Lisinopril (hypertension)
37. Triamterene (edema, hypertension)
38. Amoxicillin with clavulanic acid (bacterial infection)
39. Cyclobenzaprine (muscle injury, spasm)
40. Prevacid (ulcers, reflux)
41. Advair (asthma)
42. Effexor XR (depression)
43. Trazodone (depression, insomnia)
44. Fexofenadine (allergies)
45. Fluticasone nasal spray (allergies)
46. Diovan (hypertension)
47. Paroxetine (depression, anxiety)
48. Lovastatin (hypertension)
49. Crestor (high cholesterol)
50. Trimethoprim (bacterial infection)
What stands out the most to me about this list is the #1 most prescribed drug – hydrocodone (main ingredient of Vicodin, Lortab, etc). The number of prescriptions was astronomical, enough to average one prescription for every other person in the United States. Of course hydrocodone is very helpful for those suffering pain, but it is also a drug of abuse and addiction that has gained a lot of popular culture attention. Eminem supposedly has a tattoo of Vicodin on his arm. Overdose of the drug has been implicated in many deaths, including celebrities such as Dana Plato and Heath Ledger.
In fact, 9 of the top 50 medicines could be considered addictive, although when used appropriately are helpful in treating pain and anxiety.
Surprisingly, only 3 of the top 20 medicines by prescription volume are name brands, a reflection of insurance company formularies, patient cost-saving choices, and physician recommendations.
Psychiatric disorders account for the primary indications of 11/50 of the top medicines.
Propoxyphene-N (or Darvon-N, Darvocet-N) racked up 20,400,000 prescriptions and $225,000,000 in sales despite this year’s FDA advisory panel vote to recommend it be pulled from the market. Propoxyphene’s potency as a pain reliever is about equal to acetaminophen, with added risks of slowly cleared metabolites and possible increased deaths.
If one considers that hypertension, high cholesterol, and diabetes are at least treatable and often curable with changes in lifestyle, weight loss, and diet, 15 of the top 50 medicines might be reduced with behavioral changes. 2 of the top 3 medicines fall into this category. The Mediterranean diet seems more cost effective.
The above list is ranked by total number of prescriptions written. It includes both generic and name brand drugs. The top ten medicines by total retail dollars spent in 2008 are:
1. Lipitor $5.88 billion
2. Nexium 4.79 billion
3. Plavix 3.79
4. Advair Diskus 3.57
5. Prevacid 3.29
6. Seroquel 2.90
7. Singulair 2.89
8. Effexor XR 2.65
9. OxyContin 2.50
10. Actos 2.44
With all the advertisements and NASCAR sponsorships, one might think Viagra would be in the top ten. Actually it ranked only #38 among the branded meds, with $920 million in sales, just behind a seizure medicine called Keppra.
Premarin and Prempro, hormone replacement therapies for postmenopausal women, made the list at #69 and #198, respectively. The evidence published in 2002 that it slightly increased cardiovascular, thrombotic, and neoplastic risk among women in the Women’s Health Initiative Study brought Premarin down from its former ranking as the # 2 most prescribed medicine of 2001.
Interesting.
What do you think?
Sources:
October 2009 AARP Bulletin article “The 50 Most Prescribed Drugs.”
SDI/Verispan, VONA
I just saw a patient with 22 daily medications…22!! 18 of them were a mind boggling array of “nerve pills” and pain pills. The patient did not want to even consider discontinuing some of them – although they were prescribed by a primary care doc, which I am not.
I wonder if modern medicine is creating a huge population of pharmacologic addicts.
“I just saw a patient with 22 daily medications…22!! 18 of them were a mind boggling array of “nerve pills” and pain pills. …..”
This finding is not suprising to us who live day to day in the trenches of primary care. We have to trust that the patient is there with a valid complaint, a real concern, a worsening sense of belonging or a longing notion of complete unrest. The history is all that we have (in the beginning) combined with a thorough PE; in just 5 of the alloted 15 minutes per complaint. So, again, we must go into the visit headon with a positive frame of mind- cycle through the diff dx- r/o the ones that just don’t fit and end up treating the most likely set of sx that fit a particular dx. Simple. Flip this on it’s ear, and pull the plug on trust… what’s left?
Why is Lisinopril listed at both #2 and #36? Different formulations?
drc – yes, forgot to write in the full chemical name, sorry.
It might also be worthwhile to separate out those drugs which are commonly prescribed on a long-term basis. My own “hit”, Effexor XR, is one of those — I’ve been taking it for quite a few years now.
What I love about this list is how many very cheap and effective drugs are on it. Pricing for life-saving medications has dramatically improved over the last two years. Being able to rx an ACE, beta blocker, statin, and aspirin for under twenty bucks a month is a real boon to patients.
“Where’s your conspiracy theory now??”
I have a huge file of info regarding prescription Rx’s information, use, and abuse. BELIEVE me when I tell you, THIS is out of control. YES meds are necessary at times, but if ONLY individuals would do research on what they are being prescribed, maybe just MAYBE things would change. Not all docs are incompetent, but when it comes to prescribing drugs many ARE. (Can you say residual income??) Many people also “doctor shop”. I am in the process of starting a support group for young people, to inform them on the issues of prescription drug use. Anti depressants are another issue as well. Again, I realize they are a must at times for a rare few. But often times the REASON an antidepressant is needed is due to pain medication use that has suddenly stopped…. And would soon pass in 10-14 days! FACT! AGAIN I REALIZE THERE ARE TIMES WHEN PRESCRIPTION DRUGS ARE A MUST. BUT NOT as often as they are PRESCRIBED!! If people would only do their research, take a stand, and realize that life is NOT supposed to be happy 100% of the time, that anxiety comes and goes, that depression often times is the cause of some other drug, that sadness is often CAUSED and NEEDS to be felt and dealt with, that the pressures we live under are what is called “life”, that only unbearable pain needs opiates, that being “high” is not how life is supposed to be lived, that students sometimes have late nights of studying and shouldn’t utilize pharmacuticals, etc….I could go on and on. I’m NOT being judgmental—I KNOW….I’ve EXPERIENCED….I’ve SEEN! My prayer is that I can make others, especially the young, aware of this disastrous, debilitating problem!
I have Multiple Sclerosis AND a fractured shoulder. Because apparently just one of those would not have been enough. But I digress…
Add HTN and hypothyroidism and I am one of those people who at times can have up to 22 prescriptions, primarily for MS symptom relief and pain relief for my shoulder. Or when I developed shingles. I am on Tysabri, an immune suppressant, and shingles was a health crisis for me. Upped my usual count by another 3 prescriptions.
While it can be very demoralizing to have more medications than my 76 year old father, I am extremely grateful for the fact that I have these tools at my disposal to help keep me functioning and maintain some quality of life. The pain from my broken shoulder has been relentless and my orthopedic surgeon has never hesitated to attempt to control it. I take the pain relief medication judiciously and can safely say after a year and a half I do not have any dependency issues. I think I am paradoxically lucky in that the medication is not entirely effective, I still have significant pain that I address with relaxation and meditation. So perhaps being spared addiction has less to do with my own personal wonderfulness than with the fact that there’s nothing in it for me. lol
I do not envy the job physicians have in balancing what will relieve a patient’s symptoms without doing more harm in the end. But I am very appreciative of the fact I have the means, through these medications, to keep productive and to keep my symptoms manageable.