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Sufferers of hay fever and nasal allergies generally reach for anti-histamines to calm their itching, sneezing, congestion and profuse watery nasal discharge. More appropriately however nasal corticosteroid sprays offer superior benefits without some of the unwanted side effects of traditional oral therapies. Recently F.D.A. approved as an over-the-counter option, Flonase Allergy Relief offers 24 hour symptom control both for nasal complaints and itchy, watery eyes as well.
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Wellbutrin, more commonly prescribed as the generic Bupropion, remains a widely prescribed therapy for depression. Popular in part because it may lead to less weight gain and sexual dysfunction compared to other antidepressants, it probably lacks significant major therapeutic advantages versus its competitors. While Bupropion may provide some relief, it neither cures depression nor completely eliminates the symptoms.
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Lowering blood pressure with losartan, the generic form of Cozaar, works as well as more expensive and widely advertised drugs. Many people ultimately need several different drugs to optimize blood pressure control. Generally this is due to inadequate attention to diet and exercise. Success in treating high blood pressure requires a low salt diet, generous servings or fruit, vegetables and nuts with elimination of simple carbohydrates.
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Amlodipine or Norvasc treats high blood pressure. This inexpensive, generically available calcium blocker relaxes smooth muscle cells lining arteries and reduces the force against which the heart must pump. Additionally the drug helps protect against chest pain or angina. It ranks among the World Health Organization List of Essential Medicines.
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Erectile Dysfunction or simply ED affects more than 40% of men beyond age 40. Cialis produces results within 30-45 minutes when combined with sexual stimulation. Alternatively a smaller dose on a daily basis offers advantages for unplanned activities. The drug also may offer minor assistance to men with urinary difficulty due to an enlarged prostate. Cialis neither functions as an aphrodisiac nor as a treatment for premature ejaculation.
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Among the newer injectable “biologics” prescribed to treat severe psoriasis, Taltz and a competitor Cosentyx remain most likely to result in clear skin within 12 weeks. Unfortunately the cash price for one year of these drugs averages in excess of $60,000. While televised ads blanketing the airways claim discount copay cards limit out of pocket expense, insurance companies are not so fortunate. These and similar drugs largely account for the dramatic escalation in yearly drug insurance premiums.
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Trulicity aids in controlling type 2 diabetes with only one shot every 7 days. It simulates the pancreas to release insulin and in addition may assist in weight reduction. Prescribed in addition to other therapies, this GLP-1 stimulator rarely causes hypoglycemia. In the near future, a once weekly form of apparently heart healthy Victoza will probably capture considerable market share from cardiac neutral Trulicity.
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Containing a smaller amount of amino acids than a bite of steak, chicken or salmon, this supposed human growth factor booster makes preposterous appearing claims based on extraordinarily shaky evidence. While using such enticing catch-phrases as anti-aging, breakthrough and fountain of youth, the packaging promotes SeroVital to increase lean muscle mass, reduce wrinkles and more. A $100 investment buys one month of product but at best the “increase” in growth hormone raises it only into the low normal range.
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Also sold as Zestril and Prinivil, the generic ACE inhibitor lisinopril remains a mainstay for treating high blood pressure. This inexpensive and generally safe compound successfully combats hypertension protecting both the heart and brain. Additionally it also reduces the likelihood of death after a heart attack and prevents kidney damage especially in diabetics. However treating high blood pressure requires more than medicine alone. Diet, appropriate weight loss, sodium restriction, exercise, stress reduction and avoidance of cigarettes remain vital issues deserving of attention.
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Lantus Once Daily Insulin
Once the standard, long acting, once daily baseline insulin, Lantus recently encountered significant competition. This opening of the insulin markets may finally bring some pricing relief to this still expensive necessity. For most Type 2 diabetics, the need for insulin marks the failure of diet and exercise to maintain normal body weight. By itself Lantus rarely suffices to control blood sugar.
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Advertising suggests the oral anti-coagulant Eliquis offers significant advantages over warfarin in preventing stroke and bleeding. Actually the differences between the two drugs appear rather modest except in cost. The cash price of Eliquis is about $15 a day which translates to more than $5000 a year compared to a paltry $48 a year for warfarin. Additionally bleeding associated with warfarin can be rapidly reversed with vitamin K; bleeding from Eliquis has no antidote.
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Lexapro or escitalopram may treat depression and anxiety. Actually Lexapro contains the same active component as Celexa. Aggressive marketing promoting the drug as superior to other available options succeeded in boosting total sales well in excess of $14 billion. Unfortunately studies fail to show Lexapro offers any unique advantages over other similar SSRIs such as Prozac, Paxil and Zoloft. Recent investigations suggest not only are antidepressants overprescribed but their effectiveness compared to inactive placebo therapy remains subject to debate.
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As men age, the prostate enlarges which creates difficulty urinating. Although the prostate itself does not shrink with Flomax, the smooth muscle component of the gland relaxes. This effect on the involuntary muscle allows easier passage or urine with less hesitation and dribbling. Benefits appear extraordinarily rapidly. Also know as tamsulosin, the drug improves the symptoms of BPH rather than curing the condition. Lightheadedness frequently occurs on arising from a seated position. A recent evaluation of 500,000 men unexpectedly revealed those taking tamsulosin might face an increased risk of dementia. Studies to confirm or refute this possible association must be undertaken.
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While the extraordinarily expensive Repatha dramatically lowers LDL or “Bad Cholesterol” to levels of 30 mg, it fails to reduce the likelihood of death from all causes or even death from cardiovascular disease. Furthermore it barely budges the incidence of stroke or heart attack. Studies suggest a cost well in excess of $2,000,000 to prevent one heart related fatality. Originally thought of as a miracle drug, its lackluster results may lead to a reassessment of the importance of LDL in causing heart disease. As one eminent cardiologist says the drug may just be “performing cosmetic surgery on a laboratory value.”
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Irritable Bowel Syndrome or simply IBS is a condition of unknown cause that manifests as abdominal pain associated with either diarrhea or constipation. A minority of experts believe the diarrhea may result from overgrowth of bacteria in the small intestine. An oral antibiotic Xifaxan remains in the gut and may temporarily improve the condition but at a whopping cost of almost $40 a pill. At best it’s temporarily effective with multiple courses required as the drug fails to cure the condition.
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Beta blockers like Bystolic typically represent second or third tier therapy for high blood pressure. Most drugs in this class share similar features and are available as relatively inexpensive generic versions. Bystolic offers no obvious advantage and remains extraordinarily pricey compared to metoprolol, atenolol or nadolol. Copay assistance cards temporarily shift the financial burden to the insurance company until they next year’s premium increase.
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Heavily promoted as treatment for painful diabetic neuropathy and fibromyalgia, Lyrica advertisements blanket the airways. While some studies demonstrate a small benefit when compared to an inactive placebo, others fail to show any difference. Significant complications include dizziness, sleepiness and weight gain. Suicidal thoughts and altered vision are not infrequent side effects. For cash payers the daily cost may exceed $16.
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The injectable anti-diabetic agent Victoza treats only type 2 or adult onset diabetes – a condition that regularly plagues the overweight and obese. Due to a variety of side effects, Victoza seems best considered for those already on therapy who fail to sufficiently improve on more traditional drugs. Common side effects include abdominal discomfort and headache while less frequent but more severe reactions raise concern. Thyroid tumors including cancer, non-fatal and fatal pancreatitis and kidney failure remain worrisome associations.
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Recently approved Xiidra, a topical eye drop for the Dry Eye Syndrome, appears likely to dethrone Restasis as the treatment of choice for this common malady. Xiidra begins to work more quickly and causes fewer side effects. Unfortunately both of these drugs cost about $5000 each year and fail to eliminate the need for supplements of artificial tears.
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Hydrochlorothiazide (HCTZ)
The diuretic variously referred to as HCT, HCTZ or more properly hydrochlorothiazide remains one of the most popular treatments for high blood pressure. This so-called water pill helps eliminate excess sodium and fluid from the body. In the process, the blood pressure falls. The price is cheap and the side effects few. This drug has rightly remained popular for many decades.
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Gabapentin: Neurontin
Lyrica and its relative Neurontin or gabapentin are widely overprescribed for pain related disorders. Although approved for treating pain after shingles, evidence for their benefit remains quite sketchy. Gabapentin now ranks as one of the top drugs of abuse with at least 50% or people abusing opioids like hydrocodone and oxycodone simultaneously taking these “johnnies” or “gabbies.” In fatal drug overdoses, gabapentin often appears as a contributing factor.
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Persistent facial redness belonging to the spectrum of rosacea remains difficult to treat. Lasers and light therapy such as IPL and VBeam successfully improve the skin’s color. A new drug, Rhofade, contains the active ingredient in Afrin or oxymetazoline but in a more concentrated form. Topical application twice daily provides minimal improvement at a cost about 200 times greater than the Walmart brand of this long available over-the-counter nasal decongestant.
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Tresiba provides long lasting, once daily baseline insulin coverage for both type 1 and type 2 diabetics. It offers the greatest flexibility of any basal insulin. Tresiba continues providing coverage for more than 40 hours which relieves the burden of adhering to a more precise schedule necessary with shorter acting insulin.
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An array of relatively newly approved, expensive therapies for diabetes complicates decision making with regard to treatment. A drug preventing the body from degrading incretin helps keep levels of insulin high while reducing concentrations of glucagon, a hormone intimately linked to boosting blood sugar. With a daily cash price of about $16, it lowers hemoglobin A1c, HbA1c, by a relatively small amount. Some experts wonder if the hefty price tag of these new therapies can be justified when advantages over traditional options often appear sketchy or non-existent.
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Onexton combines benzoyl peroxide with the antibiotic clindamycin. Although this expensive topical preparation improves moderate acne by only about 50%, whether it offers significant advantage in excess of readily available, over-the-counter 10% benzoyl peroxide remains debatable. The manufacturer Valeant offers a discount card to blunt the more than $500 retail cost of the prescription drug.
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The inexpensive drug generically available as metformin remains the first choice for type 2 diabetics in whom diet and exercise fail to work. Not only does it dramatically improve blood sugar levels and hemoglobin A1c, but unlike other diabetes drugs, its use may lead to weight loss and is rarely associated with hypoglycemia. When necessary it may be combined with additional anti-diabetes medicines. Additionally preliminary reports suggest metformin may act to prevent a variety of tumors and even increase survival in colon cancer.
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PreserVision - Preventing Age Related Macular Degeneration
Vitamins marketed to prevent progression of age-related macular degeneration or AMD combine Vitamins C and E along with zinc, copper and at times carotene family members lutein and zeaxanthin. Although claims suggest major benefits, the evidence favoring their use seems rather meager. At best they may slightly delay progression in those with moderate to advanced disease. They neither prevent AMD nor do they cure the disease. A low fat diet with generous quantities of fruit, vegetables and nuts along with participation in regular exercise and avoidance of tobacco offer more protection than vitamins.
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Constipation as an integral part of the Irritable Bowel Syndrome refers to fewer than 3 weekly bowel movements and may be associated with abdominal pain. A recently approved and of course obscenely expensive drug, Linzess, seems to stimulate the bowels so well that it either causes diarrhea in as many as 1 in 5 people or results in only modest symptom improvement in others. Of course the drug company’s copay card shields the patient, but not the insurance company, until next year’s premium increase.
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Combining an anti-depressant and smoking cessation medicine with a drug for narcotic dependence results in a new pill known as Contrave which supposedly leads to weight loss. Results unfortunately fail to impress. Weight loss averages as little as one pound every month or two with as many as half of individuals prematurely discontinuing therapy often due to troublesome side effects. An FDA mandated black box warns of suicidal thoughts and behavior as well as such neuropsychiatric reactions as depression and mania. Due to some corporate hanky-panky, it is currently unknown whether the drug increases heart related disease or death.
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Basaglar represents the first copycat version of Lantus. These insulin products mimic each other’s actions almost exactly; effectively they function identically within the body. Marketing prowess, insurance coverage and discounting to pharmacy benefit managers more than medical requirements dictate which product a person is likely to receive.
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This heavily advertised product supposedly “supports healthy brain function, a sharper mind and clearer thinking.” Surprisingly the “scientific” studies offer little evidence the compound actually provides any benefit. The “active” ingredient appears to be a protein found in jellyfish that does not survive acid and pepsin assault in the stomach and intestine. The FDA has not approved this product and takes issue with promotional claims made by its manufacturer.
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Currently the most popular drug in the family of Invokana and Farxiga, Jardiance stimulates the kidneys to expel glucose from the bloodstream into the urine. As a result patients with type 2 diabetes benefit by losing weight and improving their blood pressure. A relatively large study suggests Jardiance might also slightly reduce the risk of all cause mortality and decrease the likelihood of death from cardiovascular disease. Although these results appear statistically significant, the absolute improvement remains small at less than 3%. No reduction occurs in the incidence of heart attacks or stroke. Blood glucose and hemoglobin A1c fall only modestly.
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The new sleeping pill Belsomra offers a novel action - it reduces the concentration of Orexin – a chemical associated with wakefulness. More traditional sleeping pills typically boost substances involved in generating sleep. Unfortunately Belsomra’s effects are rather disappointing; it’s extremely expensive (around $10 a pill) and people often awaken feeling more drowsy than refreshed.
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Diabetes affects tens of millions of Americans with the number growing alarmingly rapidly. Invokana represents a new concept in therapy. Rather than stimulating the body’s metabolism of sugar, this drug leads to elimination of glucose through the kidneys into the urine. Relatives include Jardiance and Farxiga. Recent concerns suggest some association with kidney failure, bone fractures, ketoacidosis, genital yeast infections and possibly an increased risk of amputations. Cash price may exceed $15 each day.
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The relatively new Vraylar falls into the family of atypical antipsychotics traditionally prescribed for schizophrenia. An advertising campaign seeks to boost its sales for mania associated with bipolar disorder. Whether this drug actually provides benefits commensurate with the $1400 monthly cash price or roughly $45 a pill remains to be determined. Studies leading to FDA approval failed to demonstrate significant difference between it and Abilify or Risperdal both of which are available as relatively inexpensive generics. Lithium offers an inexpensive option for mania and provides the lowest incidence of re-hospitalization for manic attacks. Atypical antipsychotic drugs often cause severe side effects and should be restricted to those truly in need.
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Chronic use of opioids for pain control almost always results in severe constipation often with as few as one bowel movement a week. Relistor prevents binding of the pain medicine to the bowel wall and in the process modestly improves bowel function compared to an inactive placebo. Unfortunately this extremely expensive medicine must be injected just below the surface of the skin on a daily basis. Severe complications may occur. The company behind Relistor, Valeant Pharmaceuticals, gained unwanted notoriety for its business model of buying drug manufacturers and drastically raising prices.
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According to the FDA Cymbalta may treat depression, diabetic related nerve pain, anxiety, fibromyalgia and low back pain. Also known as Duloxetine, the quality of evidence supporting the medicine unfortunately remains of modest to low quality. Actually some studies indicate no benefit when compared to the SSRIs such as Prozac, Zoloft and Lexapro. Similarly effectiveness in fibromyalgia and diabetic neuropathy appears unimpressive. Discontinuing Cymbalta may lead to a peculiar Discontinuation Syndrome associated with headache, dizziness, irritability, sleeplessness, tremor and lack of energy. Some people experience electrical shock like sensations referred to as “brain zaps.”
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Tramadol treats acute or chronic pain and works on the same opioid receptors as hydrocodone, oxycodone and Fentanyl. Additionally Tramadol boasts some of the same activities as the SSRI class of antidepressants including Celexa, Lexapro, Zoloft and Paxil. Initially authorities ignored the potential for abuse and addiction associated with the drug. It seems less toxic when administered as an intramuscular injection than when taken as a pill. The body metabolizes these forms quite differently. Originally not listed as a controlled substance, Tramadol was upgraded to a Schedule IV drug in 2014. Worldwide Tramadol appears to be a major cause of abuse. Widespread addiction exists throughout Africa and the Middle East. Side effects of the drug not only include those customarily associated with opioids, but additionally it may lead to problems associated with the SSRIs. Both an immediate and extended release form are available. The immediate release form is reasonably priced while the cost for the longer acting form varies between $125 and $270 a month for the generic version.
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Hetlioz - Non 24
Ads blanketing the airways for Non-24 inform the public about sleep deprivation among those who are both totally blind and lack any light perception. Under normal circumstances light rays travel through the retina to the brain and synchronize the sleep-wake cycle. Interruption of this pathway leads to insomnia and daytime sleepiness. The newly FDA approved relative of melatonin marketed as Hetlioz functions modestly better than placebo but costs about $440 a pill or around $160,000 a year. It has not been tested against the inexpensive and formerly recommended melatonin or other much less expensive options. Studies of Hetlioz by Vanda Pharmaceuticals are ongoing for jet lag.
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Advertisements champion Entresto as a phenomenal treatment for heart failure capable of reducing cardiovascular death and heart related hospitalization. Many peculiarities exist in the study leading to FDA approval. It was principally conducted in Eastern European countries, Russia, the Philippines, Venezuela, Brazil, Mexico and India. Only 5% of the patients resided in the United States. Actually Entresto basically combines the anti-hypertensive Diovan with a new compound Sacubirtil. Entresto with the maximum amount of Diovan was evaluated against a modest dose of another drug for high blood pressure rather than Diovan. So all of the benefits might actually stem from the Diovan component. Generic Diovan or valsartan costs less than $25 a month. Entresto’s cash price of $6000 a year or about $16 a day caused insurance companies initial hesitation which led to a lengthy authorization process. Due to the high drop-out rate, the benefits may much less than reported. Additionally it apparently works only in the milder forms of heart failure.
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Diovan or valsartan treats high blood pressure. In the category of ARBs or angiotensin receptor blockers, the drug reduces the likelihood of cough, a major factor associated with the even more popular ACE inhibitors such as lisinopril or enalapril. Controversy surrounds falsified medical investigations in Japanese studies which led to major embarrassment for the Kyoto Heart Study. Worse yet, relatively recent questions exist about ARBs and their potential relation to cancer.
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Prescriptions for Adderall are indicated only for ADHD – attention deficit hyperactivity disorder – and narcolepsy. Looser definitions of ADHD now include adolescents as well as adults. Increasingly abused as a recreational drug, a memory enhancer, an athletic booster and an aphrodisiac, this amphetamine preparation often leads to physical and psychological addiction. Side effects include paranoia, anxiety, palpitations, muscle tremors and even convulsions. Over 100,000 individuals seek emergency care each year related to adverse reactions to Adderall.
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Urinary Tract Infection
Half of all women experience at least one urinary tract infection or UTI by age 35 with recurrences affecting at least 25%. Most episodes begin when a particular strain of E. coli gains entrance to the bladder from the large intestine and attacks the surface of the epithelial cells lining the organ. At times these bacteria enter the interior of the cells and hide for months to years before making their appearance known in the form of a recurrent infection. This roughly parallels the situation with the herpes virus. Symptoms of cystitis include pain while urinating, increased frequency and the urgent need to void. Still mostly treated with a short course of antibiotics, a moderate number of infections spontaneously clear and require only anti-inflammatory therapy.
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Opioid Induced Constipation
Real and imagined pain leads to abuse of opioids including hydrocodone, oxycodone, methadone and fentanyl. Among the most annoying adverse effects are constipation, abdominal discomfort and straining to evacuate the bowels. These adverse effects rarely improve without reducing the opioid dose or discontinuing their use altogether. Recommendations to minimize these symptoms with exercise, increased fluids and fiber supplements typically fail to remedy the situation. Similarly laxatives rarely provide the desired relief.
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Dry Eye Syndrome manifests as burning, stinging, tenderness and blurred vision along with pain and the sensation of something in your eye. The commonly prescribed medicine to combat this situation, Restasis, often requires months to relieve symptoms. In early studies Restasis drops and its non-medicated vehicle marketed separately as Refresh Endura seemed equally effective although the annual price for Restasis approaches $5000. Uncomfortable adverse reactions routinely prompt many to opt in favor of the newly available competitor Xiidra.
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Ozempic for Type 2 Diabetes
ype 2 diabetes overwhelmingly results from too much of the wrong type of food. The condition places the life in jeopardy for a variety of complications involving the heart, brain, kidneys, eyes and nerves. Type 2 diabetes increases the risk for a variety of cancers as well. While our current medical treatments pay appropriate homage to diet and exercise, they rush to begin with a variety of progressively more unaffordable drugs not capable of significantly reducing the risk of important disease related preventable outcomes. Instead of correcting miseating, habits advertisements abound for expensive drugs like Ozempic, a glucagon like peptide receptor agonist. Although it can mildly lower the glycosylated hemoglobin or so-called A1c, it does not approach the benefits of proper nutrition and exercise. In spite of claims of reduced cardiovascular risk, the advantages are illusory. And the drug may be associated with some worsening of diabetic eye disease or retinopathy. Ozempic claims a minimal amount of weight loss associated with its use; but not sufficient to stanch the disease. For a drug with a cash price of about $800 or $25+ a day one should expect more. Adding further insult, Ozempic merely represents an add-on drug. It must be combined with other expensive anti-diabetic drugs – none of which reverse the disease process. Appropriate diet and exercise remain the best options with success equated with eliminating both disease and need for drug therapy.
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Nuedexta combines the active ingredient in the cough syrup Robitussin with a touch of an old fashioned inexpensive heart drug rarely used anymore due to its side effect profile. Amazingly the cash price for this mixture ranges between $800-$950. Even the Congress investigated this apparent discrepancy. Of course the company offers a co-pay card to limit out of pocket cost while charging the insurance companies an exorbitant amount. Nuedexta treats PBA or Pseudobulbar Affect also known as pathological laughing or crying generally associated with Lou Gehrig’s Disease or Multiple Sclerosis. Unfortunately the results of treatment seem unimpressive.
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Crestor, just recently available as generic rosuvastatin, reduces bad cholesterol or LDL. Available in multiple different strengths, Crestor may prevent heart attacks, stroke and death from cardiovascular related causes. More obvious risk reduction occurs in those already suffering from cardiac disease; use in otherwise healthy individuals provides much less apparent benefit. Increasingly doctors are questioning the role of cholesterol as a risk factor.
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Dupixent treats moderate to severe atopic dermatitis, a common childhood skin rash that regularly persists into the adult years. Also known simply as eczema, the disease causes persistent itching that ultimately results in weepy, crusted, scaly and thickened skin. First line therapy includes minimizing bathing, liberal applications of moisturizer and avoiding irritants known to cause flares. Topical steroid creams of appropriate strength mostly eliminate active disease. Only when these simple measures fail are internal therapies warranted. Unfortunately this expensive drug is often offered in place of these simple, time honored methods. Dupixent injections every other week offer the chance for many but not all affected individuals to minimize their eruption and drastically reduce the associated itch. It achieves this without causing significant adverse reactions, although it may lead to conjunctivitis in up to 1 in 6 individuals. As an additional benefit, Dupixent appears quite effective in treating asthma – a condition often associated with atopic dermatitis. It may also have a role in treating itchy skin not apparently associated with atopic disease, eczema or rash. An aggressive marketing campaign designed to engage both the public and medical profession appears in the face of multiple competing drugs set to enter the market in the near future. The company hopes their first to market status will continue to provide name recognition as other options materialize. The yearly cost for the cash paying consumer is approximately $37,000 or $100 a day.
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Once it appears, Alzheimer’s Disease steadily and progressively interferes with memory, cognitive function and personality. No currently available therapy significantly alters the continuous downward spiral of the disease. Although marketed to favorably improve the course, Namenda seems relatively ineffective. Even when combined with Aricept, another commonly prescribed drug, Namenda regularly fails to alter the prognosis. Side effects and cost remain concerns.
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