How to Live to be 100
Generic Drugs
This article was first published in Health View, April 2004.
I recently saw a patient in the emergency room for an acute problem who also had stable chronic medical disorders. She had diabetes, hypertension and elevated cholesterol. I noted she was from California and had been well managed from a medical perspective on just five medications. All five were generic (expired patent, low cost medications.) California has had "managed care" for years and the health plans are tight when it comes to paying for expensive medications.
Her first medication was clonidine, which is a very effective blood pressure medication that has been generic for nearly twenty years. It lost favor over the years due to the side effects of sedation, dry mouth and occasional heart block when mixed with other medications. However, many patients do just fine on it and it is extremely effective and very cheap. It must be taken two to three times a day. The side effect of "heart block" is uncommon and can be diagnosed by placing the stethoscope to the chest and listening to the intensity of the first heart sound at the apex of the heart. It doesn't even require an EKG, so no monitoring costs.
Her second pill was a combination of two generic blood pressure drugs—HCTZ and lisinopril. This is taken once a day and the major side effects usually cancel out: low potassium for HCTZ vs. high potassium for the ACE Inhibitor lisinopril (formerly Prinivil.) HCTZ is a fluid pill, and if the potassium gets low a patient can get leg cramps and muscle weakness. We tell patients to take them with orange juice or a banana since they are both high in potassium. The potassium needs to be checked every 3 to 6 months.
Lovastatin (Mevacor) was her cholesterol medication. This is an effective medication and is the only drug in the statin class that is generic. It must be taken at night to work well (this is the class we recommend taking with CoEnzyme Q-10.) It is recommended that diabetics lower their cholesterol because they are at such high risk of heart attack and stroke. Those that can't do it with diet have been faced with huge costs to afford statin drugs, until now. Others will become generic in the next few years. Anyone with high Cat Scan Cardiac Calcium Scores needs to be on these agents to reverse their heart disease. Those with normal Cardiac Calcium Scores can often be managed well with modest dietary change and glucose control.
Her diabetes was well treated with metformin taken twice a day and with tolbutamide once a day. Metformin is Glucophage. Tolbutamide is Orinase—a real oldie and extremely inexpensive. We usually consider this drug to be unsafe due to its long metabolic half-life in patients with renal failure. However, it is used with abandon in medical cost-conscious California. They get away with it by using electronic medical records to make sure patients have their kidney function checked regularly. Noncompliant patients are identified and then contacted to get the necessary blood work done to monitor for potential adverse reactions.
So our patient from the west coast is on six drugs and has great control of her diseases. She pays only five co-pays since one drug is a combination. She can get a 90 day supply of each for ten dollars, so her total out of pocket costs are 5 X $10 X 4 or $200 a year! Some brand name drugs can cost that much in just one month.
Generic drugs are cheap. To be as safe as newer "branded" medications, they must be monitored by your physician to prevent side effects. Does that add much cost to our friend's care? No. Diabetics should be seen three to four times a year anyway. For diabetics to prevent complications of their disease, they must be monitored to prove that they are controlled. Good control early prevents amputations and dialysis later.
Recent additions to the generic list include: Wellbutrin SR (one twice a day), Paxil, and Prozac for depression. Glucotrol XL and Glucovance for diabetes. Bactroban, the best topical antibiotic on the market . Finally, Ultram, for pain.
Ask your doctor if a generic drug is right for you. There will be no "free" sample, but it will keep you from having to constantly prune the money tree in your back yard to pay for your medications. Diseases can keep us from living to be a hundred, but an affordable medication regime will certainly extend our lives, which is the purpose of this column. Until next month, keep making healthy choices.
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