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Archive for Drugs by Category

Bupropion

By ProfJameson · Comments (0)
Friday, July 2nd, 2010

Brand Names:

Wellbutrin, Zyban, Wellbutrin(combination), Zyban(combination)

What is it?

If a patient has depression that is not controlled by other medications, or is a smoker and would like assistance in quitting, this drug may be an effective treatment.

What’s In It For Me?

Unlike many drug therapies for depression, Buproprion is not associated with weight gain, drowsiness, or sexual dysfunction.

The Good

High doses of Bupropion (>450mg) may cause seizures in a patient prone to seizures. Also, the medicine may cause mood swings in scizophrenic and bipolar patients.



The Bad

Use of the drug in ADHD showed significant improvements compared to placebo in one study, but has not been evaluated compared to other FDA-approved drug therapies.

The Controversial

Fact Boxes

For The Cynic

Costs can range anywhere from $40-100 a month. While not incredibly cheap, there are other antidepressants that cost more. However if you have insurance, they will likely pay for the non-branded medication


FThe Cost

This drug should be tried in a patient whose depression is not controlled by two or more first-line therapies (such as fluoxetine, citalopram, sertraline). It may be helpful as a stop-smoking aid, but nicotine patches, gum, or lozenges should be tried first.

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Categories : Psychiatric Drugs
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Risperidone

By ProfJameson · Comments (0)
Friday, June 25th, 2010

Brand Names:

Risperdal, Risperdal M-TAB, Risperdal Consta

What is it?

Not exacly known how it works, Risperidone works in the brain. It helps with symptoms of schizophrenia. Doctors are also prescribing it for Bipolar 1 and irritabililty in autism.

What’s In It For Me?

Risperidone decreases symptoms of schizophrenia. It can help decrease hallucinations including those seen and heard, as well as paranoia and delusions (positive symptoms).

The Good

Better than the the older medicines, Risperidone helps relieve schizophrenia symptoms without some of the horrible side effects of the earlier drugs.



The Bad

Even though different than the older drugs that were first used for schizophrenia, Risperidone still has a few side effects that one should know about. Risperidone works in the brain, which means that we could change some of the rest of the things that our brain controls. It doesn’t happen often but breast swelling could be an unwanted effect in women, and really unwanted in men. Taking Risperidone can lead to an increase in blood sugar levels, weight gain and possibly tremors. Risperidone doesn’t help as well with the feelings related to schizophrenia. Signs of schizophrenia that may stick around are the nonsocial behaviors, not being aware of surroundings, and not being able to carry a conversation.

The Controversial

Kids, should they be prescribed a medication that works on their brain? The FDA has approved Risperidone’s use in teenages 13-17 for schizophrenia and to children as young as 5 with irritability autism.

Fact Boxes

For The Cynic


FThe Cost

If you are a veteran, this medication is very inexpensive. For anyone else it is expensive, but not as expensive as some of the newer medications.

Schizophrenia isn’t an easy disease to treat, patients feel like guinea pigs, but in the end it is trial and error. It’s all about being able to live as normal of a life as possible. This medication has worked, and should be given a chance in those adults with schizophrenia. If it doesn’t work for you or the side effects are too much to handle, talk to your doctor about a different one.

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Categories : Psychiatric Drugs
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Pioglitazone

By ProfJameson · Comments (0)
Friday, June 25th, 2010

Brand Names:

Actos, ACTOplus met(combination)

What is it?

This drug works on something called PPAR gamma to turn on a gene that increases the effect of insulin on the cell. This lowers blood sugar for people with Type 2 Diabetes.

What’s In It For Me?

Pioglitazone can lower your blood sugar, which can help with preventing problems with your eyes, kidneys, and heart.

The Good

Unlike it’s cousin rosiglitazone, pioglitazone helps to lower triglycerides and increase your good cholesterol (HDL), while helping to lower your blood sugars.



The Bad

This drug is not as effective as other options at lowering the blood sugar and the A1C. As you might expect, turning on a gene has more than one effect. Rosiglitazone causes fluid to be retained by the body. This can cause annoying swelling in the legs for some people. This fluid retention is an even bigger problem for people with Heart Failure. The other common problem is that it can cause weight gain. This is not just fluid weight, you actually may gain some fat, which is not on most peoples list of things to do.

The Controversial

Pioglitazone’s cousin Rosiglitazone has been accused of increasing heart attacks. Studies so far have not shown that pioglitzone has any risk of heart attacks.

Fact Boxes

Drug

average A1c decrease

average blood sugar decrease

Causes hypoglycemia?

rosiglitazone and

Pioglitazone

 

0.6 to 0.8

 

30 to 50

 

no

metformin

0.8 to 1.5

30 to 50

no

glipizide

1 to 2

50 to 70

yes

sitagliptin

0.6 to 0.8

20 to 30

not much

For The Cynic

Some benefit in decreasing your sugar levels, not the greatest option out there.


The Cost

Looks like Pioglitazone is more expensive than Rosiglitazone now that the news has claimed that Rosiglitazone increases risk of heart attacks.

With the modest benefit, annoying side effects and high cost, pioglitazone is near the bottom of our list for Diabetes drugs.

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Categories : Diabetes Drugs
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alendronate

By admin · Comments (0)
Friday, May 28th, 2010

Brand Names:

Fosamax

What is it?

Alendronate sodium is normally used to treat or prevent osteoporosis (thinning of the bone). The drug binds to the bones in the body and prevents them from breaking down

What’s In It For Me?

Thin bones can easily break or fracture. Alendronate sodium prevents bones from
thinning and strengthens bones that are already weak. This medication is usually
taken only once a week and can reduce your chances of having a bone break or
fracture by about a third..

The Good

This medication is usually taken only once per week. It has been proven to decrease the risk of fractures in women who are at high risk.



The Bad

You must be able to stand or sit upright for 30 minutes after taking alendronate sodium. The tablet needs to be taken with a full glass of water at least a half hour (preferably 2 hours) before the first food of the day. The most common side effects are upset stomach, constipation or diarrhea. Approximately 3% of people taking alendronate sodium experience muscle or bone pain.

The Controversial

Bone strength is often estimated  by measuring a person’s bone mineral density (BMD). This
will determine if you have osteoporosis or not. We believe that alendronate sodium should only be prescribed after a person is diagnosed with osteoporosis and should not be used for prevention of osteoporosis.
In fact, we only recommend alendronate for patients who have a risk of a hip
fracture of 3% in the next 10 years or a risk of any other fracture of 20% in
the next 10 years.  You can calculate your risk by using this FRAX calculator provided by the World Health Organization. Select your country and ethnicity first under calculation tools and then fill out the form.

Fact Boxes

For The Cynic

If you do not have osteoporosis, do not bother with taking alendronate. This medication reduces the risk of clinical fractures in women with osteoporosis but not in women with higher bone mineral density (BMD). Alendronate can decrease the risk of a major fracture by up to 6% in a patient with osteoporosis. This means that if your risk of having a fracture is 20%, alendronate may decrease your risk to 14%. In other words, with alendronate your chances of NOT having a fracture would increase from 80% to 86%.


FThe Cost

Alendronate sodium is $9 for a month supply (4 tablets) or $24 for a 3 month supply (12 tablets) at the pharmacies that have a $4 price list. Fosamax Plus D is not available as a generic and costs about $100 for a one month supply (4 tablets). We recommend taking over the counter vitamin D supplements with generic alendronate sodium.

Alendronate is effective in reducing fractures, but should only be used by those at high risk.

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Categories : Osteoporosis Drugs
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Furosemide

By ProfJameson · Comments (0)
Friday, March 19th, 2010

Brand Names: Lasix

What is it?
Furosemide is a a water pill that helps your body eliminate extra water.

What’s In It For Me?

Too much water in your system can cause swelling (usually in the feet) or it can back up into your lungs and cause shortness of breath. Furosemide is good at helping your body get rid of this extra water by peeing it out.

The Good
This drug is a very effective water pill. This is very important in patients with heart failure since the heart is already being overworked.

The Bad
Sometimes it works too well and you can get dehydrated. Another sign of losing too much water is getting dizzy when you stand up quickly. You should check your weight and let your doctor know if it decreases by more than 3 pounds.

Furosemide often causes you to lose more electrolytes. Your doctor wll want to check blood levels and you may have to take extra potassium.

The Controversial
It isn’t exactly controversial, but you should know that strong diuretics like furosemide should be used at the lowest dose possible to avoid the problems listed above.

Fact Boxes

For The Cynic
Sometimes leg swelling caused by an accumulation of water can be helped by support stockings. Not all symptoms require medications. Also, there are milder diurectics like chlorthalidone that should be tried first.

For The Cost
Furosemide is available generically and is relatively cheap. It is also available on the $4 dollar list where it is offered.

Furosemide is inexpensive and works very effectively to decrease signs and symptoms of edema. It is our first choice when a strong medication is required to decrease fluid.

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Categories : Blood Pressure Drugs
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losartan

By ProfJameson · Comments (0)
Monday, March 8th, 2010

Brand Names: Cozaar, losartan-hydrocholorthiazide(combination)

What is it?
Losartan is an Angiotensin II Receptor Blocker (ARB). Its primary use is to lower blood pressure.

What’s In It For Me?

Decreasing high blood pressure is helps reduce your risk for stroke and heart attack. Also, Losartan has a protective effect on the kidneys, which is important for patients with Type 2 Diabetes.

The Good
Losartan is an alternative treatment option for patients who cannot tolerate ACE Inhibitors (such as Lisinopril).

The Bad
Losartan can cause in increase in the postassium. It can also worsen kidney function, but that only happens in people at risk, like those who are dehydrated or have very weak hearts. For patients at risk, lower doses should be used. An aallergic type of reaction causing swelling of the tongue, neck, and jaw is less frequent with losasrtan than with ACE inhibitors like lisinopril, but it can still happen (less than 1% of people)

The Controversial
Using ARBs like Losartan as an addition to ACE Inhibitors (like lisinopril) may be only slightly beneficial, if at all.

For The Cynic
One study with Losartan 50mg daily showed no difference in mortality compared to placebo. This finding makes use of the drug at the lower 50 mg dose questionable.

For The Cost
At around $90 per month, Cozaar is the least expensive medication in its class. The good news is that it is scheduled to go generic soon, so the price will be coming down.

Losartan is a great drug that will go generic in the next year. Lisinopril (an ACE inhibitor) is still our first choice because there is more evidence for preventing heart attacks and strokes and it costs less.

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Categories : Blood Pressure Drugs
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Citalopram

By ProfSmith · Comments (0)
Friday, July 10th, 2009

Brand Names:

Celexa

What is it?


Citalopram increases a substance in the brain (serotonin) which improves the symptoms associated with depression.

What’s In It For Me?

A number of symptoms are common in depression, and may include a depressed mood, decreased interest in daily activities, weight loss or gain, sleep problems, fatigue and problems thinking. Depression can also lead to suicide. Citalopram helps to alleviate these symptoms and improve the depressed mood.

The Good


Citalopram is significantly better than a sugar pill at improving symptoms in patients who are depressed. It also has a low incidence of side effects and drug interactions. It is also safe following an overdose.


The Bad


Citalopram, like every antidepressant, takes a significant amount of time to work (4-8 weeks). It is not free of adverse effects and make cause sleepiness, nausea and sexual problems.

The Controversial


Some reports suggest that antidepressants in this class are associated with an increased risk of suicide. Recently, more thorough reviews of this issue have found no greater risk with this class when compared to other antidepressant classes or sugar pills.

Fact Boxes

For The Cynic


Only 60-70% of patients will respond to antidepressants, and only 30-40% will have a complete remission. In clinical studies 25-30% of patients on sugar pills for depression will respond. In fact, antidepressants have their most significant activity in severely depressed patients.

The Cost


Citalopram is available as a generic drug, so if you have a generic/brand copay, it will be cheaper.  It is on the $4 list for the pharmacies that have a $4 list. Citalopram gets a 4 star rating because it is as effective as other antidepressants and inexpensive.

Citalopram is a good choice for patients starting on an antidepressant.

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Categories : Depression Drugs
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Omeprazole

By admin · Comments (0)
Tuesday, July 7th, 2009

Brand Names:

Prilosec

What is it?
Omeprazole turns off the acid producing cells in your stomach

What’s In It For Me?

This drug can prevent heartburn (acid reflux). It can also be used to cure or prevent an ulcer.

The Good

Omeprazole and other drugs like it are the most effective way to treat problems related to stomach acid. Note, however, that it must be taken regularly to work. It is not useful on an as neeed basis.



The Bad

Omeprazole does not provide quick relief, it takes over 24 hours to work. Also, stomach acid is beneficial in some ways, so decreasing stomach acid can lead to poor absorption of vitamins and minerals and possibly even bacterial growth in the stomach.
Diarrhea occurs in about 8% of people taking this drug.

The Controversial

Omeprazole and other drugs like it are sometimes used to prevent ulcers from drugs like Motrin. It is difficult to decide which patients should get such preventative treatment.

For The Cynic

Many times heartburn can be treated with non-drug lifestyle changes. However, if you have serious acid reflux and your esophagus is being damaged, you probably need more than lifestyle changes.


The Cost

Omeprazole is the least expensive drug in it’s class (called PPI’s) It is available without a prescription. The 20 mg strength is equal to prescription strenth.

Omeprazole is an inexpensive and highly effective treatment for acid reflux and for ulcers.
It is our first choice drug in this class.

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Categories : Stomach Drugs
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Glipizide

By admin · Comments (0)
Thursday, July 2nd, 2009

Brand Names:

Glucotrol, Glucotrol XL, Metaglip(combination)

What is it?

Glipizide stimulates the pancrease to secrete more insulin. This helps lower blood sugar in Type 2 Diabetes

What’s In It For Me?

Lowering blood sugar with glipizide will help prevent all the bad things you have heard that diabetes does to you.

The Good

Glipizide and drugs like it are the most effective oral medications for lowering blood sugar.



The Bad

Glipizide can cause low blood sugars. It also can cause weight gain, like most other diabetes treatments. Some people develop an allergic rash with glipizide.

The Controversial

It seems logical that stimulating the pancrease to secrete more insulin might cause it to “burn out” quicker. This has never been studied. You have to balance this theoretical risk with the effectiveness of the drug. However, we do recommend metformin as the first line drug for this reason

Fact Box – Oral Diabetes Drugs

Drug

average A1c decrease

average blood sugar decrease

Causes hypoglycemia?

metformin

0.8 to 1.5

30 to 50

no

glipizide

1 to 2

50 to 70

yes

sitagliptin

0.6 to 0.8

20 to 30

not much

For The Cynic

People with diabetes will often end up on 3 oral medications and still have poor blood sugar control because they want to stay off insulin. It is better to simply stop all of these drugs and start insulin when this happens.


For The Cost

Glipizide is very inexpensive. Generic glipizide is on the $4 list at many pharmacies. It often must be take twice a day. Glucotrol XL is a once a day medicine that is moderately priced around $30/month

The Bottom Line

Glipizide is a very effective oral agent. Metformin is still preferred as a first line drug in patients with good kidney function.

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Categories : Diabetes Drugs
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Fluvastatin

By ProfJameson · Comments (0)
Wednesday, July 1st, 2009

Brand Names:

Lescol
Fluvastatin is a much weaker cousin to Simvastatin. It significantly less effective at lowering cholesterol, and there is no cost advantage. We believe there is no good reason to use this drug. The general information about fluvastatin, is pretty much the same as simvastatin. Just remember it has not been studied very much and we give it a 2 star rating for effectiveness.

Please Click Here for the Simvastatin page.

Bottom Line:

We recommend other drugs over fluvastatin.

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Categories : Cholesterol Drugs
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