Lipitor remains king of the prescription drugs

This weekend, the U.S. Drug Enforcement Administration, along with local and state authorities, are giving Minnesotans a chance to unload unused or expired prescription drugs. Authorities say the drugs could pose a danger if left unattended.

A new report is out that suggests what types of drugs might be in those medicine cabinets. The consulting firm IMS Health took a look at the year 2010 and offered a snapshot of the nation's top prescribed drugs and the best-selling drugs. And to talk more about those lists, I'm joined now by our regular medical analyst Dr. Jon Hallberg.

Steven John: Let's take a look at the list of the five most prescribed classes of drugs.

Jon Hallberg: Right at the top we have Lipitor cholesterol-lowering medications, then antidepressants, narcotic pain killers, beta-blockers, which are a form of blood pressure medication, and then finally ace-inhibitors, which do the same thing; they work on blood pressure, but really work on the kidneys.

John: These sound like they're lifestyle-related. What does that tell us about the relationship between doctors and their patients when it comes to prescribing drugs?

Hallberg: I think there are two things at play. Lifestyle certainly might play into this. We're seeing so much more diabetes today, which is related to lifestyle. That, in turn, is tied into cholesterol and blood pressure.

I think we're also following guidelines. I know that in primary care there's so much pressure to appropriately diagnose depression, for example, and treat it by using these medications. Same is true with blood pressure and cholesterol. So, I think that it's part of what we're seeing here.

John: As a physician, what is your role in prescribing these medications?

Hallberg: When you look at the top five, you've got pain and depression, and the goal there is simply to alleviate suffering.

The others, though, are sort of silent things. You don't always know that your cholesterol or blood pressure are high. You don't feel it, for the most part. There, we're just trying to change the endpoint; get that blood pressure looking good, get that cholesterol ideally less than 100. The goal is ultimately to buy time. You sort of hope that a person can correct the underlying problems or that the medications do that, and eventually they might not need to be on the meds.

John: So, once a patient is on these medications is it difficult to get them off?

Hallberg: A lot of times it is. That's really the trick.

There are few conditions where a person will be on a medication for life. If a person's pancreas isn't producing insulin, they need to be on insulin. They're a type 1 diabetic. What if they have a thyroid gland that isn't producing thyroid, they need to be on that replacement.

If someone eventually took things to heart, exercised, lost weight and really changed their diet they might not need to be on a cholesterol or blood pressure medication.

John: There was another list that was a part of this report, and that was the top five drugs by sales. What are those?

Hallberg: This is very interesting. These are all name-brand medications that account for the top five sales-spots.

Lipitor is right at the very top, and I think it's synonymous with cholesterol-lowering. You've got Nexium, which is a proton-pump inhibitor (a very potent acid reducing medication that helps heartburn and reflux). There's Plavix, which is for people who can't take aspirin, and we sometimes prescribe it for people in addition to aspirin to help keep the blood from clotting. Advair, which is for asthma and emphysema. At [the fifth spot] is Abilify, which is used for people who have very severe mental disease, which might include schizophrenia or things like bipolar disease.

John: Those brands jump out as ones we've seen widely advertised, so there's no real surprise that they're at the top of sales.

Hallberg: I know. There's no coincidence. When you think of what cholesterol-lowering medication is a person going to be on, you almost immediately think of Lipitor. It's amazing how much it's worked its way into pop culture.

Then there are medications like Abilify, which I just saw as a two-page ad in Entertainment Weekly recently. It just strikes me that they're advertising that drug in that kind of a publication, but it seems to be working.

John: Is there anything else about this survey that surprised you?

Hallberg: I'm a little surprised that Lipitor maintains that top spot because there are other very cheap, very effective generic medications out there. In fact, Lipitor is going generic in the fall. So, it's not going to maintain that spot. Once it's available that way, it will drop [in sales].

It really strikes me that an anti-psychotic medication like Abilify [is on the list]. That is used for very, very severe mental illness is in the top five. It's a somewhat unique medication, so I think that explains part of it, but I also think that there's a very strong advertising component to that.

John: Look into your crystal ball for us, Dr. Hallberg. Do you see either of these lists, the top five most prescribed drugs or the best-sellers, changing much in the next few years?

Hallberg: In terms of the classes, I think that the cholesterol medications, painkillers and blood pressure medications in the broadest sense will maintain those top four or five spots.

We'll see something in that fifth spot changing. I don't know what that will be; it might be a different kind of pulmonary medication to help people with asthma.

I think what we're starting to see are some of the anti-cancer drugs really starting to creep up, and that's something we're going to start seeing more of. We're getting away from broad chemotherapy drugs and going toward very specific that deal with specific kinds of cancers, so that's very interesting and quite exciting.

(Interview edited and transcribed by MPR reporter intern Anissa Stocks)

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