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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Phillipa on October 31, 2013, at 21:08:11
Double Trouble: Seizures and Alzheimer Disease
The URI That Won't Go Away: Case Challenge
Who Are the Primary Care Providers?
Medscape Medical NewsTop 100 Selling Drugs Through September Reported
Robert Lowes
October 31, 2013
The cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca) was the nation's most prescribed drug over the course of last 12 months, through September, whereas the antipsychotic aripiprazole (Abilify, Otsuka Pharmaceutical) racked up the highest sales almost $6.4 billion, according to a new report from research firm IMS Health on the top 100 selling drugs in the United States.New prescriptions and refills of rosuvastatin totalled 23.7 million, edging out the hypothyroid medication levothyroxine (Synthroid, AbbVie) at 23.4 million scripts. Similar to several other drugs in the top 100 list for prescription volume, rosuvastatin also did well in sales, ranking fifth, with $5.3 billion in sales for the 12-month period. In contrast, levothyroxine ranked 52nd in sales despite being heavily prescribed.
The 10 top-selling drugs reflect hardly any change since calendar year 2012, according to IMS Health.
Table 1. Top 100 Drugs by Total Sales
Rank Drug (brand name) Sales from October 1, 2012, through September 30, 2013
1 Abilify $6,391,050,009
2 Nexium $6,086,840,503
3 Cymbalta $5,432,152,672
4 Humira $5,352,226,238
5 Crestor $5,318,542,115
6 Advair Diskus $5,114,309,392
7 Enbrel $4,673,141,322
8 Remicade $4,058,128,532
9 Copaxone $3,788,545,102
10 Neulasta $3,537,574,204
11 Rituxan $3,298,174,917
12 Spiriva Handihaler $3,002,430,799
13 Atripla $2,912,549,658
14 Januvia $2,825,267,039
15 Lantus Solostar $2,778,551,072
16 Avastin $2,690,641,154
17 Oxycontin $2,637,737,756
18 Lantus $2,515,137,058
19 Lyrica $2,324,979,374
20 Truvada $2,278,264,056
21 Epogen $2,214,743,254
22 Celebrex $2,183,115,416
23 Diovan $2,137,198,878
24 Herceptin $1,933,127,070
25 Namenda $1,900,527,136
26 Gleevec $1,874,835,782
27 Lucentis $1,794,896,441
28 Vyvanse $1,709,395,031
29 Zetia $1,652,217,183
30 Suboxone $1,554,971,998
31 Symbicort $1,525,311,056
32 Levemir $1,447,476,053
33 Avonex $1,347,267,771
34 Novolog $1,330,347,675
35 Novolog Flexpen $1,317,460,587
36 Seroquel XR $1,219,959,533
37 Alimta $1,200,106,356
38 Viagra $1,197,351,402
39 Humalog $1,142,653,387
40 Nasonex $1,133,088,155
41 Flovent HFA $1,059,584,589
42 Cialis $1,049,194,980
43 Procrit $1,047,927,348
44 Isentress $1,017,809,988
45 Neupogen $972,494,037
46 Reyataz $968,298,671
47 Janumet $967,434,639
48 Orencia $935,878,810
49 Vesicare $911,521,673
50 Vytorin $891,763,516
51 Aranesp $845,994,421
52 Synthroid $843,417,754
53 Aciphex $830,120,367
54 Benicar $827,715,511
55 Lunesta $822,435,175
56 Evista $822,388,181
57 Xolair $800,269,022
58 Betaseron $799,930,543
59 Sensipar $763,591,668
60 Synagis $763,505,631
61 Xeloda $747,260,480
62 Zyvox $729,817,082
63 Gardasil $707,586,150
64 Sandostatin LAR $696,306,293
65 Combivent $693,216,113
66 Benicar HCT $683,792,459
67 Erbitux $658,837,596
68 Tarceva $651,732,920
69 Velcade $622,009,646
70 Strattera $613,531,907
71 Detrol LA $571,448,481
72 Varivax $566,344,845
73 Lipitor $471,293,545
74 Byetta $400,292,636
75 Lovenox $370,800,431
76 Prograf $369,919,542
77 Zosyn $356,816,770
78 Actonel $349,621,765
79 Lamictal $308,177,881
80 Tricor $299,617,362
81 Zometa $294,538,908
82 Diovan HCT $286,058,196
83 Seroquel $242,498,198
84 Topamax $232,384,993
85 Zyprexa $206,052,247
86 Lexapro $170,313,029
87 Plavix $148,143,566
88 Singulair $142,846,942
89 Effexor XR $133,445,902
90 Actos $129,996,717
91 Geodon $109,697,379
92 Aricept $106,409,356
93 Provigil $102,529,766
94 Valtrex $67,261,819
95 Prevacid $61,444,102
96 Ambien CR $56,255,560
97 Eloxatin $42,499,709
98 Flomax $32,106,042
99 Taxotere $25,615,068
100 Levaquin $13,283,168Source: IMS Health
Table 2. Top 100 Drugs by Prescription Volume
Rank Drug (brand name) Total prescriptions* from October 1, 2012, through September 30, 2013
1 Crestor 23,736,568
2 Synthroid 23,407,581
3 Nexium 20,689,735
4 Cymbalta 19,436,224
5 Ventolin HFA 17,531,384
6 Advair Diskus 16,604,511
7 Diovan 13,101,107
8 Vyvanse 10,409,180
9 Spiriva Handihaler 9,594,938
10 Lantus 9,498,954
11 Lyrica 9,406,166
12 Celebrex 9,288,870
13 Lantus Solostar 9,052,819
14 Abilify 8,922,954
15 Januvia 8,745,980
16 Namenda 8,464,036
17 Nasonex 8,388,973
18 Viagra 7,751,484
19 Zetia 7,714,153
20 Suboxone 7,658,467
21 Cialis 7,469,372
22 Bystolic 6,795,951
23 Tamiflu 6,415,670
24 Flovent HFA 6,154,584
25 Oxycontin 6,005,158
26 Symbicort 5,908,888
27 Dexilant 5,196,874
28 Nuvaring 5,188,089
29 Benicar 5,018,438
30 Levemir 4,749,858
31 Premarin 4,639,414
32 Loestrin 24 FE 4,590,856
33 Proventil HFA 4,402,561
34 Afluria 4,396,084
35 Novolog 4,200,166
36 Thyroid 4,146,906
37 Voltaren Gel 4,087,123
38 Vesicare 4,035,018
39 Benicar HCT 3,961,216
40 Novolog Flexpen 3,796,220
41 Vytorin 3,733,052
42 Lunesta 3,573,075
43 Humalog 3,567,750
44 Focalin XR 3,483,905
45 Toprol-XL 3,426,000
46 Pristiq 3,414,341
47 Ortho-Tri-Cy Lo 28 3,406,933
48 Lumigan 3,265,438
49 Janumet 3,262,008
50 Travatan Z 3,099,633
51 Evista 3,037,813
52 Lo Loestrin FE 2,896,633
53 Xarelto 2,845,724
54 Avodart 2,780,336
55 Pataday 2,747,016
56 Pradaxa 2,688,081
57 Zostavax 2,577,330
58 Combivent 2,564,776
59 Seroquel XR 2,553,562
60 Strattera 2,524,961
61 Detrol LA 2,318,229
62 Trilipix 2,272,817
63 Xopenex HFA 2,249,145
64 Chantix 2,236,551
65 Humalog Kwikpen 2,234,056
66 Lipitor 2,183,138
67 Exforge 2,009,256
68 Exelon 1,893,886
69 Aciphex 1,889,412
70 Welchol 1,849,687
71 Humira 1,840,089
72 Actonel 1,833,889
73 Onglyza 1,780,339
74 Combigan 1,778,837
75 Premarin Vaginal 1,720,394
76 Diovan HCT 1,716,985
77 Victoza 3-Pak 1,684,293
78 Enbrel 1,656,421
79 Truvada 1,608,426
80 Tricor 1,593,716
81 Micardis 1,558,847
82 Azor 1,540,801
83 Alphagan P 1,537,012
84 Patanol 1,482,109
85 Norvir 1,455,910
86 Aggrenox 1,446,475
87 Effient 1,443,887
88 Ranexa 1,421,595
89 Viibryd 1,404,896
90 Dulera 1,381,074
91 Advair HFA 1,332,348
92 Prempro Low Dose 1,314,444
93 Atripla 1,289,014
94 Amitiza 1,287,691
95 Asmanex Twisthaler 1,257,602
96 Levitra 1,257,292
97 Micardis HCT 1,249,265
98 Beyaz-28 1,244,195
99 Ortho Evra 3 1,220,696
100 Humulin N 1,216,524*New prescriptions and refills
Source: IMS Health
Posted by joef on November 2, 2013, at 7:36:12
In reply to Top l00 Med Prescribed Through Sept, posted by Phillipa on October 31, 2013, at 21:08:11
what???? no viibryd or luvox cr....does anyone in this country even use them???????????????
Posted by Phillipa on November 2, 2013, at 20:50:33
In reply to Re: Top l00 Med Prescribed Through Sept, posted by joef on November 2, 2013, at 7:36:12
I wonder what the total number of medications is? Phillipa
Posted by ed_uk2010 on November 11, 2013, at 16:19:42
In reply to Top l00 Med Prescribed Through Sept, posted by Phillipa on October 31, 2013, at 21:08:11
>The cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca) was the nation's most prescribed drug over the course of last 12 months.
What a shocking and ludicrous waste of money. AstraZeneca will be laughing all the way to the bank. Many millions of $$$ could be saved simply by using generic atorvastatin (Lipitor) or in some cases simvastatin (Zocor). Rosuvastatin is somewhat more potent but atorvastatin is still a highly effective statin. Not all pts require the most potent statin of all!
As for Nexium... don't get me started.
There is no way America could ever have a sustainable socialised health system when such uncontrolled and unnecessary prescribing of the newest and most expensive meds is taking place! This type of prescribing serves the large pharma companies well, and truly reveals that drug reps and advertising have more influence on American doctors than any other information source.
Amazing.
Posted by SLS on November 13, 2013, at 17:13:38
In reply to How ridiculous, posted by ed_uk2010 on November 11, 2013, at 16:19:42
What about HDL/LDL ratio?
What about reversing plaque accumulation?
- Scott
Posted by Phillipa on November 13, 2013, at 21:29:50
In reply to Re: How ridiculous » ed_uk2010, posted by SLS on November 13, 2013, at 17:13:38
Scott just read a newsletter that cholesterol lowering drugs criteria has been changed so less will be prescribed. Later will try to find and post. Phillipa
Posted by herpills on November 14, 2013, at 12:31:16
In reply to Re: How ridiculous » SLS, posted by Phillipa on November 13, 2013, at 21:29:50
Phillipa heard something about this yesterday on NPR but my understanding was now more people will have to take these?
Posted by ed_uk2010 on November 14, 2013, at 13:22:05
In reply to Re: How ridiculous » ed_uk2010, posted by SLS on November 13, 2013, at 17:13:38
> What about HDL/LDL ratio?
>
> What about reversing plaque accumulation?
>
>
> - ScottAt high doses, atorvastatin (Lipitor) is very potent. AstraZeneca will do anything to encourage doctors that Crestor is universally better, but it's not. I stand by what I said, not everyone needs an ultra high potency statin. The relationship between the benefits of statins and increasing HDL are unclear, but anyone who's concerned can try simvastatin 40mg - a very effective dose which costs our health service about £0.40 per box, and also raises HDL.
Posted by SLS on November 14, 2013, at 22:34:07
In reply to Re: How ridiculous » SLS, posted by ed_uk2010 on November 14, 2013, at 13:22:05
> AstraZeneca will do anything to encourage doctors that Crestor is universally better, but it's not.
Well, it is better if you are looking to reduce LDL/HDL ratio. Do you have any data to support your opinion?
http://www.ncbi.nlm.nih.gov/pubmed/22360820
Of course, side effects are a consideration. Crestor (rosuvastatin) isn't always the easiest drug in the world to tolerate, but lots of people have no side effects at all.
If I were in the position of needing a statin, I would try rosuvastatin 40 mg/day first and atorvastatin 80 mg/day second. At these dosages, both drugs will facilitate the reversal of arterial plaques. Rosuvastatin is somewhat better for this, though.
I know you really like the idea of taking generic drugs. I do, too. The idea is idyllic, but not always realized. I have had bad experiences with two generics of lamotrigine. Lamictal is the only version of lamotrigine that treats me properly. Of the 7 psychotropic drugs I take, 5 of them are generics. My guess is that they are working as well as the brand name drugs.
Why do we have multiple SSRI drugs or TCA drugs?
- Scott
Posted by Phillipa on November 15, 2013, at 8:48:22
In reply to Re: How ridiculous » ed_uk2010, posted by SLS on November 14, 2013, at 22:34:07
Scott when I got my lab results back my HDL was extremely high. My cholesterol was 236 I think and LDL was a bit high. But it gave a cholesterol ratio reading of total cholesterol to I think HDL which put me at an extremely low risk level? I don't have a copy of labs available. It seems that the new guidelines are hard at least for me to interpret also. As they are for risk of stroke and heart disease. Phillipa
Posted by ed_uk2010 on November 24, 2013, at 5:46:37
In reply to Re: How ridiculous » ed_uk2010, posted by SLS on November 14, 2013, at 22:34:07
Hi Scott,
>If I were in the position of needing a statin, I would try rosuvastatin 40 mg/day first and atorvastatin 80 mg/day second.
Unless I'd just had an ACS/MI, I wouldn't want to initiate with high doses. Not everyone needs maximum intensity statin therapy.
>I know you really like the idea of taking generic drugs.
Where appropriate, but this isn't a brand-generic issue. Rosuvastatin is very potent and yet a lot of people who take it only take 5-10mg. Many of them could quite probably be treated with other statins, especially atorvastatin. If treatment is initiated with rosuvastatin, which seems to be happening very often in the US, there may be slightly less need to switch drugs due to lack of efficacy (which is rarely difficult with statins), but at a very high financial cost. For patients whose lipids are excellent on atorvastatin, I find it hard to see why rosuvastatin would be better. Atorvastatin has a particularly large body of outcome data showing its real world as well as laboratory efficacy. Rosuvastatin might look slightly better on paper in terms of lab stats but it's so easy to switch to rosuvastatin if atorvastatin proves inadequate that I don't think this is relevant in terms of the initial drug chosen.
Also, a high-proportion of statin users are primary prevention pts. Unless their lipids are through the roof, maximum intensity statin treatment is rarely needed, haemorrhagic stroke risk may be increased with little in terms of benefit over standard intensity statins. It seems that their doctors agree (you see low doses of rosuvastatin 5-10mg). So why did the prescriber choose to initiate Crestor first-line at all? ....I suggest it is because they just saw the rep, who has played a far greater role in prescribing than they ought. The attractive and enticing graphs came out and it suddenly looked as if rosuvastatin was the answer to everyone's cholesterol woes. For sure, a 1st line rosuvastatin strategy is very easy for the prescriber, which must account for a lot of its popularity. But is it necessary? I don't think so. Not when so many people achieve stability + excellent labs results on other statins. And yes, cost is very relevant so that fact that generic atorvastatin is available is important. I have little doubt that AstraZeneca are offering seemingly excellent 'patient support' to pay for their expensive drug, but the high cost is always transmitted back to the consumer in one way or another. Be it in insurance costs or whatever ;) which may be difficult to afford.
Low intensity statins: fluvastatin (lowest), pravastatin.
Moderate intesity statins: simvastatin.
High intensity statins: Atorvastatin, rosuvastatin.
For pts who do not achieve targets on high dose atorvastatin, rosuvastatin can be tried. Ezetimibe can be added instead but it is also expensive and not supported by outcome data. Nevertheless, adding ezetimibe appears to have a greater effect on lipids than switching statins.At 80mg/day in particular, the potency of atorvastatin is such that it seems highly sensible to try it before considering rosuvastatin. Whether it is initiated at this dose (as in ACS) or titrated as in primary prevention depends on the circumstances.
The number of patients receiving statin therapy is so immense that the costs of comparable doses must be compared. For example, at current prices to the UK National Health Service, atorvastatin 80mg/day is a massive 10 times less expensive than rosuvastatin 40mg. In practice, few pts receive the 40mg rosuva dose here, the standard maximum dose is 20mg. Atorvastatin 80mg, on the other hand, is very widely used.
Overall, I don't want anyone to be undertreated, but the use of more potent drugs than is necessary for the situation won't benefit anyone.
Posted by sigismund on December 1, 2013, at 22:28:37
In reply to Re: How ridiculous » SLS, posted by Phillipa on November 15, 2013, at 8:48:22
One way I have seen it done is to divide the HDL level by the LDL level (or vice versa).
Posted by ed_uk2010 on December 2, 2013, at 11:27:34
In reply to Re: How ridiculous » Phillipa, posted by sigismund on December 1, 2013, at 22:28:37
> One way I have seen it done is to divide the HDL level by the LDL level (or vice versa).
It can all get a bit theoretical. As far as I know, the correlation between drug-induced HDL increases and the risk of heart disease is not at all clear. Interestingly, HDL seems to (presumably usefully?) rise in people who live a healthy active lifestyle.
Most LDL cholesterol is made in the liver, which is where statins come in... many people have high LDL even on balanced low saturated fat diets. Reducing LDL with statins is more effective than other lipid-modulating drugs, and there's far more evidence that statins actually reduce cardiovascular events and deaths. Take fibrates and ezetimibe, they sure modulate your lipids but whether they save lives is not at all clear.
I generally rate atorvastatin (generic Lipitor) highly because it has so many useful characteristics:
1. Very effective at reducing LDL.
2. Lots of outcome data showings reduced cardiovascular events and deaths.
3. Normally well tolerated.
4. Wide range of doses available if adjustment is needed.
5. Possible to safely initiate at high doses post-MI or ACS.
6. Not expensive.
7. Not as many drugs interactions as older statins.
8. Overall, excellent first choice statin. If it's not effective or tolerable, by all means try another eg. rosuvastatin, or one of the older statins.
9. For pts who have excellent lipid control on atorvastatin, I do not 'buy' the idea than rosuvastatin is magically better. It smells of BS to me. Almost like suggesting that everyone needs the maximum dose of their antidepressant because the overall response rate is marginally better.
10. :)
Posted by ed_uk2010 on December 2, 2013, at 11:35:15
In reply to Re: How ridiculous » SLS, posted by Phillipa on November 15, 2013, at 8:48:22
Hi Phillipa,
Unless your lipids are grossly abnormal (which they are not), using lipids in isolation is not a good predictor of cardiovascular risk. All major risk factors need to be taken into account...
1. Weight/BMI.
2. Smoking.
3. Exercise habits.
4. Diet
5. Diabetes (or not)
6. Male or female (pre- or post-menopausal)
7. Blood pressure.
8. Family history.
9. Personal history eg. prior cardiovascular event.Statins can be useful for pts who have marginally high LDL cholesterol only if other risk factors are high. Statins are not useful for pts whose risk factors are very low apart from mildly elevated cholesterol. Obviously, if LDL is grossly high (often genetic), statins are Rxed even in the absence of other risk factors.
Basically, statins are useful for most pts at high cardiovascular risk, regardless of their precise cholesterol level (unless it is actually low, which it rarely is in high risk pts)!
Posted by Phillipa on December 2, 2013, at 20:04:11
In reply to Risk » Phillipa, posted by ed_uk2010 on December 2, 2013, at 11:35:15
Doc said no meds as not much I can change via exercise, weight, etc. I have borderline cholesterol but the HDL's are extremely high so when the division of cholesterol is done I come out as low risk. I think my HDL's were double the good range. PJ
Posted by ed_uk2010 on December 3, 2013, at 3:31:57
In reply to Re: Risk » ed_uk2010, posted by Phillipa on December 2, 2013, at 20:04:11
> Doc said no meds as not much I can change via exercise, weight, etc. I have borderline cholesterol but the HDL's are extremely high so when the division of cholesterol is done I come out as low risk. I think my HDL's were double the good range. PJ
Very good news PJ. As for LDL cholesterol, given the new 'targets', pretty much the entire population has borderline or high cholesterol so I wouldn't be the slightest bit concerned given your otherwise good physical fitness.
Posted by Phillipa on December 3, 2013, at 19:15:52
In reply to Re: Risk » Phillipa, posted by ed_uk2010 on December 3, 2013, at 3:31:57
Ed seriously think it's cause they want people to spend money on meds? How brilliant is this!!! And then there is the new guidelines for normal thyroid, and blood sugar also. I think you just solved what most likely isn't a mystery but how to recreate revenue for the drug companies. PJ
Posted by ed_uk2010 on December 4, 2013, at 3:07:11
In reply to Re: Risk » ed_uk2010, posted by Phillipa on December 3, 2013, at 19:15:52
> Ed seriously think it's cause they want people to spend money on meds? How brilliant is this!!! And then there is the new guidelines for normal thyroid, and blood sugar also. I think you just solved what most likely isn't a mystery but how to recreate revenue for the drug companies. PJ
Drug companies are very good at selling, a do have an influence on guidelines due to their massive influence on the medical profession as a whole. Their influence in the US is probably greater than in most countries, particularly due to direct-to-consumer advertising of Rx drugs, and 'samples', which are banned in most countries. Samples are an excellent way for drug companies to get pts on the most expensive drugs possible and make it seem like a great deal. In the long run, it is far from it. Of course, lots of pts do need expensive drugs, just not half the population ;)
For sure, low cholesterol targets are an excellent idea for pts with established heart disease or multiple risk factors, but not entirely necessary for every member of the general population, who would be better off eating well and riding their bike... now who does that remind me of? :)
On the other hand, statins do have many virtues... so long as people don't use them as an 'excuse' to keep eating McDonalds for breakfast.
Posted by Phillipa on December 4, 2013, at 20:37:32
In reply to Re: Risk » Phillipa, posted by ed_uk2010 on December 4, 2013, at 3:07:11
Ed you are still cute as ever!!!! So glad you are back. PJxxxx
Posted by ed_uk2010 on December 8, 2013, at 3:05:30
In reply to Re: Risk » ed_uk2010, posted by Phillipa on December 4, 2013, at 20:37:32
> Ed you are still cute as ever!!!! So glad you are back. PJxxxx
Thanks PJ, it's got a bit busier too.
Posted by joe schmoe on December 22, 2013, at 11:11:02
In reply to Re: Risk » Phillipa, posted by ed_uk2010 on December 4, 2013, at 3:07:11
The whole statin cholesterol thing is a crock.
I'm surprised that people who research psychiatric meds so heavily, don't look into the science supporting the diet heart hypothesis. There is no evidence supporting it whatsoever.
If you like books, read these:
If you like web pages, read these:
http://www.cholesterol-and-health.com/
http://www.cholesterol-and-health.com/Does-Cholesterol-Cause-Heart-Disease-Myth.html
http://wholehealthsource.blogspot.com/2009/12/dirty-little-secret-of-diet-heart.html
http://wholehealthsource.blogspot.com/2011/01/does-dietary-saturated-fat-increase.html
http://wholehealthsource.blogspot.com/2009/07/diet-heart-hypothesis-stuck-at-starting.html
It goes on and on. Look into it. It really is an amazing swindle.
I am re-reading the Kendrick book (one of the "Great Cholesterol Con" books in the Amazon list) right now. It is an excellent primer on CHD and its real causes. I think PUFA consumption does play a role though - avoid vegetable oils at all costs. It causes easily oxidized LDL, which is bad news.
This is the end of the thread.
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