Consumer Reports’ best medicines for less

GlaxoSmithKline spent $52 million between 2005 and 2006 advertising the diabetes drug Avandia and increased sales by 20%. But older diabetes drugs that cost much less are equally effective and probably safer.

Alzheimer’s drugs that cost $150 to $200 a month are heavily promoted to doctors and are routinely prescribed, yet studies show they may help only 10 to 20% of patients.

The four prescription drugs that treat heartburn or GERD (gastroesophageal reflux disease) produce about the same benefit. But there’s a nonprescription drug that works just as well and can save users hundreds of dollars a year.

Those are among the highlights from Consumer Reports Best Buy Drugs, a public education project that makes comparative drug information available free of charge here. We have now evaluated drugs for 35 conditions, including attention deficit disorder, heart disease, high blood pressure, high cholesterol, insomnia, menopause, migraine and overactive bladder.

Multiplying medications
With 45% of U.S. adults regularly taking at least one prescription drug and 18% taking three or more, consumers need to know how to get the best value for their health-care dollar.

Consider John and Susannah Dodson, ages 70 and 68, from Shorewood, Minn., who both have high cholesterol, high blood pressure and type 2 diabetes. Between them, the Dodsons take 12 prescription drugs every day, and more when allergies, arthritis, back pain or heartburn flares up. They have struggled for years to keep their drug costs under control. While the new Medicare Part D program helps pay for a good portion of their drug bill, they still face around $260 a month in out-of-pocket drug expenses and were buying some prescriptions by mail from Canada.

Learning from CR Best Buy Drugs how drugs in a class compare was “enormously helpful right away,” Susannah Dodson says. For example, she and her husband had been taking the cholesterol lowering drug Lipitor (atorvastatin). After reading the report on cholesterol drugs, they asked their doctors whether they could safely switch to a new generic, simvastatin. The doctors agreed. “Making the change cut our drugs costs for cholesterol control in half,” Susannah Dodson says.

Our analysis of many classes of prescription drugs showed the following: Older drugs often match newer ones. Skillful marketing by pharmaceutical companies aims to convince doctors and consumers that newer medicines are almost always better. But expert evaluations have concluded that in many cases older drugs available as less expensive generics are as good or even better than newer ones. And because most older drugs have been taken by millions of people for years, experts usually have a better idea of their long-term safety.

Diabetes drugs are a case in point. For most people with type 2 diabetes, the generic drug metformin and a group of older medicines called sulfonylureas — also available as low-cost generics — are just as effective and as safe as a batch of new, highly touted and more expensive medicines, according to the CR Best Buy Drugs findings. Indeed, the diabetes report was released amid a scientific flap over the new diabetes drug Avandia (rosiglitazone), which research has now linked to a possible higher risk of heart attack.

Older, less expensive drugs won’t always meet your needs, though. For example, a newer drug is better for overactive bladder, a condition characterized by the frequent need to urinate that affects some 15 to 20 million people in the U.S. Tolterodine (Detrol), a more expensive brand-name drug, was named a CR Best Buy Drug because it caused fewer side effects than oxybutynin, an older generic.

Drugs within a class aren’t always that different. Drugmakers argue that every drug is unique and that people respond differently to each. Therefore, they contend, more drugs in each class gives doctors and consumers more choice and a better chance of successful treatment.

But this mantra is driven more by a business agenda than a scientific one. To be sure, every drug has a different chemical composition, and studies show that in some classes, such as heart medicines, the effects of individual drugs vary significantly. But in other classes the medicines yield very similar results. When we compared 20 drugs known as NSAIDs (nonsteroidal anti-inflammatory drugs), they all delivered the same amount of pain relief at equivalent doses.

Safety considerations were similar, too. With the possible exception of naproxen (Aleve and generic), all NSAIDs probably pose a small risk of heart attack, especially if taken at high doses for long periods. And they all pose a risk of stomach problems. Our report on this class recommends three low-cost generics: ibuprofen, naproxen and salsalate, a chemical cousin of aspirin. And it warns people against overusing NSAIDs for everyday pain relief.

A similar finding grew out of our analysis of the main class of drugs used to treat children with attention deficit hyperactivity disorder (ADHD). The five drugs in this class yield comparable benefits. Here, too, CR Best Buy Drugs are low-cost generics that could save you hundreds of dollars a year.

By contrast, if you have angina or heart disease, or have suffered a heart attack, you’ll want to pay particular attention to which medicines you are prescribed in the two classes known as beta blockers and ACE inhibitors. The effectiveness of the 14 beta blockers and 10 ACE inhibitors differ markedly depending on your medical circumstances. For example, studies support only the use of particular beta blockers in treating people who have both high blood pressure and angina.

Some drugs are less effective than you might think. While many drugs are highly effective, some widely used ones don’t work as well as their advertising campaigns suggest.

Our review of the five Alzheimer’s drugs, for instance, found that when compared with a placebo (a sugar pill) only 10 to 20 percent of people taking any of the drugs had sustained improvement in their memory or cognitive abilities, or delay in the worsening of those mental functions. The CR Best Buy Drugs Alzheimer’s report notes that the drugs are expensive ($150 to $200 a month) and concludes that they might not be worth it if the patient has to take many other medicines, as do many people with Alzheimer’s.

Despite those results, two of the five Alzheimer’s drugs, Aricept and Namenda, were among the top 100 best-selling brand-name drugs in 2006. Promotions of both drugs to doctors have been extensive. And Aricept’s maker spent almost $60 million in 2005 and 2006 advertising the drug to consumers.

Adverse effects are understudied. For some categories of drugs your choice might well be based more on the side-effect risks than on how well the drug works. But be prepared that your doctor might brush off your concerns. A study in the August 2007 issue of the journal “Drug Safety” found that physicians were more likely to deny than confirm a suspected adverse effect from a statin drug, even when the symptom was well reported in the literature.

CR Best Buy Drugs reports compare drugs on the side effects they can cause. The diabetes report, for example, notes that two subgroups of drugs can trigger substantial weight gain and thus should not be prescribed for people already significantly overweight. And we note that if you have stomach problems, our CR Best Buy Drug metformin might not be for you because it carries a greater chance of nausea and diarrhea.

Other classes of drugs pose such a high risk of adverse effects that their benefit is often overshadowed for some people who might be candidates for treatment. The antipsychotic drugs used to treat people with schizophrenia are an example. Studies indicate that 80 to 90% of people who take an antipsychotic have at least one side effect, such as blurred vision, constipation, muscle weakness, sedation, slurred speech or tremors.

Discussing the risks of adverse effects with your doctor can prepare you for what you might encounter and can improve the chances you’ll stay on a drug you need. Most research focuses on a drug’s benefits rather than on potential problems, so use caution when you are prescribed any new drug. And let your doctor know about any problems and symptoms even if they aren’t listed on the drug’s package insert or in the material from your pharmacist.

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