Drugs - Most Dispensed Prescription Drugs

In 2001, 3.1 billion prescriptions were dispensed, up from 1.9 billion a decade earlier.²The graphic shows the number of prescriptions dispensed for the top 10 drugs and the percentage that that number represents in terms of all prescriptions dispensed in that year. In 2001, 11.6% of all the prescriptions dispensed were for the top 10 most dispensed drugs. What drugs were dispensed the most? The table beginning on the next page shows the top 10 prescriptions for the years 1995 and 2000. Following the table is a discussion about some of the more noteworthy (and in some cases newsworthy) drugs on the list.

In 1995, Trimox and Amoxil represented 12-14% of all prescribed drugs despite objections to their widespread use, "well demonstrated" lack of effectiveness, and concerns about antibiotic resistance.³ In 2000, not one drug in the top 10 was an antibiotic, suggesting that antibiotic use (or overuse) was down considerably.

Top 10 Prescription Drugs, 1995 and 2000

Rank	1995		2000
	Drug name	Use	Drug name	Use
1	Premarin	Estrogen replacement	Lipitor	Lowers cholesterol
2	Trimox	Antibiotic	Premarin	Estrogen replacement
3	Synthroid	Thyroid hormone replacement	Synthroid	Thyroid hormone replacement
4	Amoxil	Antibiotic	Hydrocodone/APAP	Analgesic
5	Zantac	Acid reflux, ulcers	Prilosec	Acid reflux, ulcers
6	Lanoxin	Digitalis preparation	Norvasc	Antihyperintensive
7	Procardia XL	Antihypertensive	Albuterol	Bronchodilator4
8	Vasotec	Antihypertensive	Glucophage	Diabetes medication
9	Prozac	Antidepressant	Claritin	Antihistimine
10	Proventil-Aerosol5	Bronchodilator	Zoloft	Antidepressant

Lipitor blocks an enzyme in the liver that the body uses to make cholesterol. As a result, the medication begins to work almost immediately. Doctors feel that this immediate positive feedback leads more people to continue taking the medication. The reason for Lipitor's popularity may have as much to do with advertising and increasing consumer awareness of the health benefits of lowered cholesterol as with the drug's effectiveness. In May 2001, the National Cholesterol Education Program (a division of the National Institutes of Health) lowered the total cholesterol level at which drug therapy is recommended. Because of this, Pfizer, the maker of the drug, estimates that the number of patients eligible to take their drug more than tripled. And Pfizer is capitalizing on this. Pfizer has 5,000 sales representatives who promote this drug to doctors. From 1999 to October 2001, Pfizer spent close to $150 million to market this drug to consumers, not only by promoting Lipitor outright but also by educating the consumer about the importance of early diagnosis and treatment for high cholesterol. According to Pfizer's estimates, less than one-third of those who could benefit from cholesterol-lowering drug therapy are actually being treated.⁶

Prilosec replaced Zantac as the medication of choice to treat Gastroesophageal Reflux Disease (GERD) and peptic ulcer disease. Prilosec, according to doctors at Robert Wood Johnson Medical School (RWJMS) in New Jersey, represented a considerable improvement in the treatment of these diseases. It's also considered the most effective drug in its class. But marketing must have played a role in its success as well. Spending on direct-to- consumer marketing more than doubled from 1997 to 2000 ($41.9 million to $107.9 million).

Premarin and Synthroid maintained their status as two of the top 3 prescription drugs. Premarin has been around since 1942. Doctors tend to feel comfortable with its effectiveness. It gained popularity among women in the 1960s who no longer wanted to endure menopausal symptoms. In the 1970s-90s, research showed that hormone replacement therapy (HRT) prevents osteoporosis, cardiovascular disease, and Alzheimer's disease, and lowers the risk of uterine and cervical cancers. Other positive effects were also observed. As a result, the popularity of the drug continued to rise, coinciding with the aging of the Baby-Boomers (5.1 million women become eligible for HRT each year). However, on July 17, 2002, results of long term studies of women on HRT were published in the Journal of the American Medical Association. Researchers found that women on HRT showed increases in breast cancer, heart disease, stroke, blood clots, and ovarian cancer. How this will impact on the drug's prescriptions is yet to be seen. Will more women shun prescription therapies in favor of lifestyle changes and alternative medications? Or will women feel that the benefits of HRT outweigh the risks?

Synthroid's appearance as number three on the list may be surprising, since hyperthyroidism is not very common. This disease is characterized by fatigue, weight gain, hair loss, and sensitivity to cold. Without the proper amount of thyroid hormones, the heart, liver, and kidneys don't work properly. Synthroid is also used in the management of some types of thyroid cancer. According to Marvin Kirschner, chief of endocrinology at the University of Medicine and Dentistry of New Jersey, the reasons for Synthroid's popularity are (1) brand recognition by physicians and (2) the overprescribing of this drug as an obesity treatment. Dr. Kirschner states that Synthroid has been proven as an ineffective treatment for weight loss, but millions of Americans still use that drug for that purpose. Initially, there is a temporary weight loss, but instead of getting rid of extra fat tissue, muscle and bone tissue and lean body mass break down. According to Dr. Kirshner, "overweight patients tell their physicians, 'I don't know why I'm so heavy, I must have a glandular problem.' In response to these pleas, the physician prescribes Synthroid." (Iozzia).

In 2001, the total number of prescriptions dispensed per capita in the United States equaled 10.9 (28 states exceeded this rate). This was up from 9.9 prescriptions per head a year earlier. What is behind the rise in the number of prescriptions dispensed? Part of the rise may be due to the aging of the population. But how much of the rise in prescriptions dispensed is needed and how much is not? Next, we will look at the issue of the overuse of medications in our society.

Sources: IMS Health. "US Top 10 Products by Prescriptions" and "Leading 10 Products by Total U.S. Dispensed Prescriptions, 2001." Retrieved July 16, 2002 from http://www.imshealth.com. Alan Cook, DC. "The Top 10" and "The Top 10 Drugs -- 1997." Retrieved July 16, 2002 from http://www.chiroweb.com/archives. Barbara Iozzia. "Top 10 Prescription Drugs in the U.S." HealthState, Winter/Spring 2001. Retrieved July 17, 2002 from http://www.undnj.edu/umcweb/hstate/winter_spring01/features/feature01_drugs.htm. National Institute for Health Care Management. Prescription Drug Expenditures in 2001: Another Year of Escalating Costs, May 6,
2002. Retrieved July 17, 2002 from http://www.nihcm.org. Frank Scussa. "On its way to $10 billion: LIPITOR." Retrieved July 17, 2002 from http://www.medadnews.com/pharma_month/flash/3011.asp. "Increased Risk of Ovarian Cancer Is Linked to Estrogen Replacement Therapy." ScienceDaily Magazine, July 17, 2002. Retrieved July 17, 2002 from http://www.sciencedaily.com. Richard Frank, et. al. The Henry J. Kaiser Family Foundation. Trends in Direct-to-Consumer Advertising of Prescription Drugs, February2002. The Henry J. Kaiser Family Foundation. State Health Facts Online. Retrieved July 17, 2002 from http://www.state health-facts.kff.org/. Per capita data for 2000 extrapolated using population data from the U.S. Census Bureau. Retrieved July 17, 2002 from http://www.census.gov. Michael Montagne. "Patient Drug Information from Mass Media Sources." Psychiatric Times, May 2002. Retrieved July 18, 2002 from http://www.psychiatrictimes.com/massme-dia.html