Best Buy Drugs

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They’ve become household names: Celebrex, Lipitor, Pristiq, Toviaz. You’ve probably seen the ads on television, and strained to hear long and frightening lists of warnings about side effects.

Drug makers shell out billions of dollars each year to target consumers with those ads ($4.3 billion in 2009) and even more for promotions aimed at doctors ($6.6 billion in 2009), according to IMS Health, an industry group that monitors drug sales and marketing.

The trouble is that the ads work. Our research shows about one of every five people who take a prescription medication said they’ve asked their doctor to prescribe a drug they’ve seen advertised; of those, 59 percent said the doctors complied, according to a survey in May 2010 by the Consumer Reports National Research Center. But what the ads won’t tell you is that those newer drugs are often no safer or more effective than older medications that cost a fraction of the price.

A look at the evidence

That’s where Consumer Reports Best Buy Drugs comes in. We don’t test drugs the way we test cars or refrigerators; we use research from experts at the Drug Effectiveness Review Project, based at Oregon Health & Science University. The DERP analyzes hundreds of studies on a given class of drugs to treat a condition. Prices of brand-name drugs are provided by Wolters Kluwer Pharma Solutions.

CR Best Buy Drugs and the DERP are part of a movement called evidence-based medicine. The goal is to help doctors and patients base treatment decisions on independent and unbiased scientific evidence, not on a pitch from a drug sales rep.

Our free reports, available at www.ConsumerReportsHealth.org/BestBuyDrugs, cover 25 classes of drugs for more than 35 conditions, including allergies, diabetes, high blood pressure, high cholesterol, and muscle pain. The good news: The CR Best Buy picks for most of those chronic conditions could save you hundreds to thousands of dollars a year.

To earn a Best Buy designation, a drug must be at least as effective and safe as other medications in its class and less expensive. But if an analysis of studies shows that a brand-name drug is notably safer or works better than a lower-cost medicine, it will be deemed a CR Best Buy, regardless of its price.

Here’s even better news: Many of the CR Best Buys cited in this article cost just $4 for a 30-day supply (or $10 for a 90-day supply) at Kroger, Target, and Walmart.

Don’t fear generic drugs

Most of the CR Best Buy picks are generics. That might give you pause. Our own surveys from 2009 and 2010 found that more than 40 percent of people said they had concerns about generic drugs, fearing that they weren’t as safe or as effective as brand-name medications, had different side effects, or came under different federal standards.

To get approval from the Food and Drug Administration, a generic-drug maker must prove that its product contains the identical active ingredient as its brand-name counterpart and that the drug is “bioequivalent,” meaning that as much active ingredient enters and leaves the blood-stream as fast or as slowly. Generics that meet those criteria should have the same therapeutic effect as brand-name drugs.

The FDA regulates generics just as it does brand-name drugs and monitors them once they’re on the market. To date, the FDA has found no difference in the rate of adverse reactions between generic and brand-name drugs.

“Seventy percent of all prescriptions are for generic drugs,” says John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. “Generics look different from brands because of trademark issues, but they’re equivalent in efficacy and safety and can save up to 80 percent off the retail price.”

DIABETES

If you’re one of the 24 million people in the U.S. with type 2 diabetes, exercise, a healthful diet, and weight loss (if needed) are essential to help keep your blood-sugar levels in check. If medication is required, three older, inexpensive drugs are your best first options. They’re just as effective as newer, high-priced medications and in some cases are better and safer.

The best first option is generic metformin. If that doesn’t drop your blood-sugar levels enough, you might need to add glimepiride or glipizide. (If you also have heart failure or kidney disease, your doctor might start with one of those drugs instead.)

If the older drugs still don’t do the trick, a newer medication called Actos (pioglitazone) might make sense. But it can be expensive. It’s also linked to a higher risk of heart failure, so we advise that you consider it only if other medications have not been effective or if you can’t tolerate them.

CR Best Buys

• Metformin
• Glimepiride
• Glipizide and Glipizide Sustained Release (They are available as low-cost generics.)

Less impressive

• Rosiglitazone (Avandia). Linked to a higher risk of heart attack and stroke. Last year, the FDA restricted use of this drug to people for whom other drugs were ineffective.
• Pioglitazone (Actos). Linked to a higher risk of heart failure. Only consider if other treatments have not worked.
• Sitagliptin (Januvia). Expensive brand-name drug that’s no more effective than metformin and might induce hypoglycemia (low blood sugar) when used with other drugs.

Actos vs. Metformin

Older drugs work just as well as newer drugs and are safer in some cases. They could also save you a lot of money.

DEPRESSION

An estimated 14 percent of Americans will experience a serious bout of depression during their lifetime. Contrary to most ads that suggest medication is the only answer, the first step is to see your doctor and then a therapist. Talk therapy might be all you need to feel better. (It worked for our readers: According to our 2009 Annual Questionnaire, those who had at least seven counseling sessions reported just as much relief as those who only took medication. Those who did both fared even better.)

If an antidepressant is recommended, our Best Buy Drugs analysis finds that all are equally effective at relieving depression, so your choice might come down to safety, cost, and whether you have other medical conditions.

Our five CR Best Buy picks are inexpensive generic drugs with well-established safety profiles that will save you big bucks over brand-name drugs. Some are more likely to cause certain side effects than others, so make sure your doctor is aware of the side effects you especially want to avoid.

For example, paroxetine is associated with a higher risk of sexual problems; sertraline is associated with a higher rate of diarrhea. People respond differently to those medications, so you might have to try several before you find one that works. And even then, up to 40 percent of people who try antidepressants will not experience any relief.

But if you already take an antidepressant and it is working well for you, we do not recommend switching to another one.

CR Best Buys

• Generic bupropion
• Generic citalopram
• Generic fluoxetine
• Generic paroxetine
• Generic sertraline

These medicines are substantially less expensive than brand-name antidepressants and are equally effective. They are good options to try first.

Less impressive

• Desvenlafaxine (Pristiq). Available only since 2008, it does not have the long track record of other antidepressants.
• Duloxetine (Cymbalta)
• Venlafaxine (Effexor)

They are all expensive, brand-name drugs that are no more effective than the generic Best Buys.

Cymbalta vs. Fluoxetine

Antidepressants can help some people, but they aren’t always necessary. If you need one, the five inexpensive generics we recommend are good first options.

HEARTBURN

When heartburn flares up, many people turn too quickly to powerful drugs called proton pump inhibitors when lifestyle changes or antacids might do the trick. Studies show that up to 69 percent of people who are prescribed a PPI don’t actually need it. Not only can that be a waste of money, but it can also expose you to potentially serious side effects, including an increased risk of pneumonia and hip and other bone fractures.

For relief of mild or infrequent heartburn, cut back on alcohol and caffeine, quit smoking, eat smaller meals, don’t lie down for 2 hours after eating, and lose weight (if needed). If those changes don’t bring relief, try an inexpensive over-the-counter antacid, such as Maalox, Mylanta, Rolaids, Tums, or their generic equivalents, or other drugs called H2 blockers, such as Pepcid AC, Zantac 150, or their generic equivalents.

If heartburn strikes twice a week or more for several weeks, see a physician. You might have a serious condition called GERD (gastroesophageal reflux disease), and you might need a PPI.

CR Best Buys

• Generic omeprazole
• Prevacid 24HR
• Prilosec OTC

All are available without a prescription for $19 to $24 for a month’s supply and work as well as the more expensive medications.

Less impressive

• Dexilant (dexlansoprazole). It was approved in 2009, so it has a limited track record. We recommend waiting until more is known about its effectiveness and safety.
• Zegerid OTC (omeprazole/sodium bicarbonate). It costs about the same as the other over-the-counter PPIs, but it has not been well established how the bicarbonate ingredient affects it, so skip it for now.
• Nexium (esomeprazole), Prilosec (omeprazole), Prevacid (lansoprazole), AcipHex (rabeprazole). These branded prescription medications are much more expensive and not much more effective than generics in this class. Aciphex and Nexium are not available as generics.

Nexium vs. Omeprazole

Make sure you really need a prescription medication; many people don’t. If you do, pick the least expensive option because no one drug is clearly better than another.

About CR Best Buy Drugs

For more information on these and other conditions, click here.

The Best Buy Drug reports are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant program. The grant is funded by a multistate settlement of consumer-fraud claims over the marketing of the prescription drug Neurontin (gabapentin).

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