I found cheaper and safer drugs

by Willie T. Ong, MD

Last July 24, 2007, I wrote an article entitled, “Where in heaven’s name are the cheaper drugs?” Less than 24 hours later, my e-mail inbox was swamped with 47 desperate messages coming from as far as Saudi Arabia and Canada.

Because of space constraints, I’m reprinting only four of the e-mail questions I received. Our STAR readers’ letters are really the answers to two sticky questions: 1) Do we need to bring down the cost of drugs? and 2) Should doctors prescribe cheaper medicines?

“My father and I are regular readers of your column in The Philippine STAR. My father, who is 70 years old, suffers from hypertension and asthma. His weekly medicine bill is P2,000. As he is no longer employed and only depends on his SSS pension, that isn’t enough to buy all his medicines. We hope that you can help us reduce his medicine bills.” — Edeliza Rosario-Marino of Cavite.

“I just came across your column in the STAR and I was delighted to know that there is a cardiologist out there who empathizes with patients who have to shell out so much money for expensive medicines. The cost of medicines for high blood pressure and cholesterol is really very prohibitive. (She lists five drugs.) It is a welcome relief for us to know that there are still practical doctors like you.” — Cathy Garcia

“Your column brought joy and some appreciation that you recognize the pains of buying very expensive medicines. I go to Mercury every five days for my parents and uncle. I need P1,500 every time. (Here she lists six drugs) We need doctors like you in times like these.” — Nolita Miras

“I read your article in The Philippine STAR and found it very educational. It is very gratifying to know that there are doctors who care for poor patients who can’t afford the foreign branded medicines. I am a senior citizen who is on maintenance medicines due to my heart. I cannot afford the price, with only a P5,000 monthly pension from SSS. (Here he lists four drugs.)” — Edmar

A few good meds

To facilitate answering so many STAR readers, I have listed down the cheaper and safer drugs available for the most common diseases afflicting our countrymen. These should be affordable by the middle class. Remember, having a senior citizen card can get you a 20-percent discount.

Ask your primary doctor gently about these cheaper alternatives. Let me state clearly that only your doctor can change your medications.

Drugs for high blood pressure (afflicts 15 million Filipinos)

1. Calcium channel blockers reign supreme for those with very high blood pressure. The generic names of these drugs end with the syllable “pine.” As I’ve mentioned before, the very best, the most powerful and my number one drug is Amlodipine, 5 mg at P17.50 per tablet (brand name Amvasc from Therapharma, hotline 637-4890). My 97-year-old Lola will attest to it. In second place (because of its shorter duration of action) is Felodipine, 5 mg (brand name Versant-XR from L.R. Imperial) at P20 per tablet.

2. Diuretics are effective drugs for people with a salty diet and for elderly individuals. The best diuretic is hydrocholorothiazide, 12.5 mg (brand name Hytaz), taken once a day. It costs P4.85 per tablet. One strategy for patients is to buy Hytaz 25 mg (at P6 a tablet), then halve it, so it will cost you only P3 a day! Hurray for Hytaz. The lower 12.5 mg dose lessens the need to monitor the patient’s potassium levels. It’s also the perfect add-on drug if your blood pressure is still flaring away even after Amlodipine.

3. Ace-inhibitors and Angiotensin II antagonists are first-line drugs for high blood patients who also have enlarged hearts or diabetes. Losartan 50 mg alone (brand name Lifezar), or Losartan 50 mg plus hydrochlorothiazide 12.5 mg (brand name Combizar), both from Therapharma, costs P24 per tablet, 50 percent less than foreign brands.

4. Beta-blockers are excellent for patients with heart palpitations or heart disease. However, they can only lower the blood pressure slightly. The tried and tested beta-blocker is Metoprolol, 50 mg (brand name Neobloc from Gx International) given twice a day. It costs P4.30 per tablet.

Drugs for Stroke and Heart Attack Prevention

Aspirin at 80-100 mg is the first drug I consider in patients with stroke, heart attack or heart disease. The cheapest I could find is Bayer Aspirin, which costs only P1.25 per tablet. Just take it after meals to minimize stomach upset.

If the patient feels a burning sensation in the stomach with aspirin, I usually try the lower dose of aspirin at 30 mg (brand name Cor 30). Studies show that the lower dose already has some health benefits.

However, for those with allergy to aspirin, then we’re trapped because our only alternative is the excellent but super-expensive drug named Clopidogrel (brand name Plavix). Each 75 mg tablet costs P110. You won’t get an ulcer from drug irritation, but your wallet will develop a hole. There’s no cheaper alternative yet, but I heard Clopidogrel will become off patent soon and the price may drop by 50 percent.

Drugs for high cholesterol (affects four million Filipinos)

Treating high cholesterol is quite simple for me. It’s either heads or tails — simvastatin or atorvastatin. A majority of my patients get well with simvastatin (generic name Vidastat from Therapharma) at 40 mg, which costs P38 per tablet. I divide the tablet so my patient ends up taking 20 mg daily for only P19. The price is still a bit steep, if you ask me.

Unfortunately, there are some patients with very high cholesterol levels, say above 300 mg/dl. The most powerful Statin drug is atorvastatin at 20 mg to 80 mg (brand name Lipitor from Pfizer). This is an excellent but expensive drug at P70 to P90 per tablet. Sorry, there’s no cheaper alternative yet. Eat less lechon and diet more, guys… or pay the 55.

Drugs for diabetes (affects four million Filipinos)

I am not an endocrinologist but I believe that the older and cheaper drugs for diabetes are excellent drugs for majority of Filipinos. These drugs have become off-patent already (anyone can sell them) that is why no one is talking about them anymore. Marketing budget is zero.

But if we think of what’s best for our patients, doctors should still prescribe these effective, high-quality and cheaper drugs for diabetes, such as the following:

(1) Generic name Gliclazide 80 mg, brand name Glubitor (from L.R.I.) at P7.50 each.

(2) Glibenclamide, brand name Gluban (from Metro Drug) at P6.80 each.

(3) Metformin 500 mg, brand name Glumet (from L.R.I.) at P7 each.

(4) Combination of Glipizide 5 mg and Metformin 500 mg, brand name Norsulin (from L.R.I.) is a fantastic bargain at only P11 per tablet. Wow, what a find!

Rosiglitazone controversy

What about the Glitazones, especially the controversial rosiglitazone (brand name Avandia and Avandamet) in the news? I’ll tell you a mini-story. Four years ago, I already read the disturbing report that rosiglitazone may cause heart failure. Alarmed, I sent the report to my endocrinologist-friends to warn them. Sadly, I didn’t get any feedback.

In my practice, I have never ever prescribed the Glitazones despite their immense popularity. It’s super-expensive and there are safer and cheaper alternatives available.

Cheaper treatment for pain

For mild pain, I first give the affordable paracetamol tablet. For moderate pain, I prescribe ibuprofen 400 mg or mefenamic acid 500 mg to be taken on a full stomach. These drugs may cause some gastric irritation but as long as you take them sparingly, the side effects are minimal. For severe pain, I give tramadol, a powerful drug to relieve pain.

Vioxx controversy

The above listed pain relievers are cheaper, and in my opinion safer than the expensive and popular Coxibs. I have never ever prescribed Coxibs. A very popular and notorious Coxib was Rofecoxib (brand name Vioxx), which has been hastily withdrawn from the market because it has caused heart attacks. And to think that these drugs cost over P100 each!

Regarding other Coxibs, I am not 100-percent sure if they are safe or not. For my conscience and peace of mind, I would not prescribe them yet until long-term studies prove they’re safe. I don’t want to gamble with my patient’s life. I’d rather have my patients take an occasional mefenamic acid, which might cause gastritis rather than a drug that might cause a heart attack.

Disclaimer:

These are just my own honest opinions. Patients should consult their primary doctor and ask which drugs are best suited for them. Only your doctor can change your drugs for you. Find a doctor who will work for you and help you with your budget.

It pains me to write this article but…

After you’ve read our readers’ sentiments, you understand why I finally decided to write this article. I believe these insider’s secrets will not only help our readers save money, but it may even save lives. I only pray and hope that my friends in the pharmaceutical industry and the profession will understand.

As a doctor, I cannot in conscience prescribe expensive medicines to patients who are stressed and suffering already. After all, a doctor’s sworn duty is to give comfort and to put the patient’s interests above all other considerations. Take care, everyone, and be well!

Source: Philippine Star