The Top 10 Generics

Many of the breakthrough drugs of the 1980-1990′s are now available
as generics, and pharmacy competition has led to great bargains for
patients needing these drugs.

The 1980’s and 1990’s were a golden age in the development of great
new drugs to treat many common and uncommon diseases.  Prior to that
time it was very difficult to treat depression, hypertension,
diabetes, and congestive
heart failure
. It was nearly impossible to treat high cholesterol.
Breakthrough drugs like the SSRI
and calcium
channel blockers
for hypertension, metformin
for diabetes, and several drugs in combination for congestive heart
failure came to market, and have revolutionized the care of many of
these chronic diseases. Now the great news it that many of these drugs
are available as generics, and competition between retail pharmacies has
led to incredibly cheap medication.  Here is my top ten list of great
generic medications.

  1. ACE inhibitors. I tend to use lisinopril, but
    several others are also available.  These meds are effective at
    controlling high blood pressure, but have also been shown to prevent
    heart attacks in patients post MI, to prolong life and reduce
    hospitalizations in congestive heart failure, to prevent diabetes
    related kidney failure, and is usually extremely well tolerated.  A
    small percent of patients get a cough, and even smaller percent are
    allergic to these medications.

  2. Statins This class of LDL cholesterol lowering drugs has made effective treatment of high cholesterol practical and simple. Several have gone generic including simvastatin, lovastatin, and pravastatin. Although simvastatin (Zocor) is not on the chain pharmacy $4. drug lists, it is quite inexpensive ($10.90/ 100 40mg doses at Costco) and is effective enough for most patients to achieve goal LDL cholesterol levels.  Many studies have shown statins to be effective at lowering rates of various cardiovascular diseases.

  • SSRI antidepressants: Nearly everyone who can be
    effectively treated with an SSRI can be treated with a generic one now
    as Prozac (fluoxitine), Zoloft (sertraline), Paxil (paroxitine), Celexa
    (Citralopram) and others are available as $4./ month at the chain
  • Metformin: this oral diabetes medication has become
    the standard first line medication for type 2 diabetes, is a $4./ month
    medication, and is now being used for pre-diabetes to prevent
    progression to diabetes, for polycystic ovarian disease, infertility,
    and other off label uses.  It is usually well tolerated, but cannot be
    used in patients with low kidney function.
  • Non-sedating antihistamines: The race by pharma has been to bring
    these nice allergy medications to market as OTC meds (no prescription
    needed)  This is great except most are now not covered by insurance drug
    benefits.  Still they are a huge improvement over the old sedating meds
    that led to accidents and poor school and work performance.

  • Ulcer and Acid Reflux treatments: Both the older
    but still effective ranitidine and the newer proton pump
    (PPI’s) like omeprazole (Prilosec OTC and by Rx) and
    others used to be incredibly expensive, but are now quite affordable.
    They have essentially eliminated surgical peptic ulcer disease, and help
    the suffering of innumerable heartburn sufferers.  There is lots of new
    data linking long term use of PPIs to osteopenia and C. difficiele
    infections, so they are ideally used for limited periods of time, but
    they have made chronic peptic ulcer disease a thing of the past.
  • Topical corticosteroids:   Many excellent topical
    corticosteroids are now available as generics to treat eczema,
    psoriasis, and other skin conditions.  Triamcinolone cream (Kenalog) and
    others are inexpensive and effective.
  • Migraine treatment: Imitrex
    (sumatriptan) lost its patent in the last year, and has become more
    affordable.  Others will follow soon.  These have been miracle
    medications as abortive treatment when used early in the course of
    migraine headaches.

  • Antipsychotics: The treatment of schizophrenia and
    major bipolar disorder has been revolutionized by the development of
    the newer antipsychotics, and the cost has become reasonable with
    risperidol and others now available as generics.
  • Herpes simplex treatment: As genital herpes has
    become incredibly common, treatment costs were exorbitant until
    acyclovir lost its patent.  Now it is much less expensive, and the
    disease that keeps on giving is at least not also unaffordable to treat.
  • Many of these medications cost $100-600. / month as branded
    medications, but most are now either on the $4./ month discount pharmacy
    lists, or otherwise quite affordable.  Ask your doctor about generic
    alternatives to any expensive medications you are taking.  Don’t be
    fooled by the myth that because insurance pays well, the cost is low.
    Prescription medication costs make up about
    of the US health care dollar spent.  You can make a difference.

    Ed Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news and policy from a primary care physician’s perspective at his blog, DrPullen.com.

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