{"id":1002,"date":"2015-03-08T15:33:40","date_gmt":"2015-03-08T22:33:40","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1002"},"modified":"2015-03-23T07:18:07","modified_gmt":"2015-03-23T14:18:07","slug":"americas-top-selling-drug-is-an-antipsychotic","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1002","title":{"rendered":"America’s top selling drug is an antipsychotic"},"content":{"rendered":"

\"Abilify\"<\/a>I learned recently\u00a0that the antipsychotic\u00a0Abilify is the biggest selling prescription drug in the U.S.<\/strong>\u00a0 (I try to stay calm and collected here, but that’s a fact worth\u00a0boldface.) \u00a0To be a top seller, a drug has to be expensive and also widely used. \u00a0Abilify is both. \u00a0It’s the 14th most prescribed<\/a>\u00a0brand-name medication, and it retails for about $30 a pill<\/a>. \u00a0Annual sales are over $7 billion<\/a>, nearly a billion more than the next runner-up.<\/p>\n

Yes, you read that right: $30 a pill. \u00a0A little more for the higher dosages. \u00a0There’s no generic equivalent\u00a0in the U.S. as yet; Canadian and other foreign pharmacies stock the active ingredient, generic aripiprazole, for a fraction of what we pay in the states. \u00a0However, Abilify’s U.S. patent protection expires next month, and aripiprazole may soon be available here at lower cost.<\/p>\n

Abilify is an “atypical” antipsychotic. \u00a0This is\u00a0a confusing term, as these are now the drugs typically prescribed for schizophrenia and other psychotic conditions. \u00a0The name comes from their atypical mechanism of action, as compared to the prior generation of antipsychotics. \u00a0“Atypicals” also play\u00a0a useful role\u00a0in the treatment of bipolar disorder, where traditional\u00a0medications such as lithium require blood level monitoring, and often multiple doses\u00a0per day.<\/p>\n

Antipsychotics are powerful drugs\u00a0with\u00a0considerable risks and side-effects. \u00a0But psychosis and mania are powerful too. \u00a0As with cancer chemotherapy and narcotic painkillers, a risky\u00a0and\/or\u00a0toxic treatment can be justified in dire circumstances. \u00a0It’s also true that one\u00a0crisis\u00a0visit to an emergency room, not to mention a psychiatric admission, may\u00a0cost more than months of Abilify, and can itself be emotionally traumatic. \u00a0If Abilify keeps psychosis at bay and prevents hospitalization,\u00a0the risks are worth it. \u00a0The cost\u00a0is worth it too\u00a0\u2014 if a less expensive generic atypical won’t do. \u00a0Several are now available.<\/p>\n

As I wrote<\/a> in 2009, the manufacturer Otsuka tapped\u00a0a much larger market for Abilify as an add-on treatment\u00a0for\u00a0depression. \u00a0I objected to the consumer ad campaign that trumpeted\u00a0this expensive, dangerous niche product for common\u00a0depression. \u00a0While there’s a role for\u00a0Abilify\u00a0in unusually severe, unresponsive depression,\u00a0advertising it widely as a benign “boost” for one’s\u00a0antidepressant was, and is, irresponsible<\/a>. \u00a0By analogy, the makers of the narcotics\u00a0OxyContin\u00a0and Percocet could run ads showing people with bad headaches, and urging\u00a0fellow headache sufferers to ask their doctors “if Percocet is right for you.”<\/p>\n

And these are merely\u00a0the FDA-approved uses of Abilify. \u00a0Atypicals are also widely prescribed off-label for use as non-addictive tranquilizers and sleeping pills, and to treat other psychiatric conditions. \u00a0There’s no advertising\u00a0for\u00a0off-label use, so the onus falls squarely on prescribers who balance the risks and benefits of these drugs in a manner that research tends not to support<\/a>. \u00a0In short, a costly, risk-laden\u00a0medication\u00a0created to ease\u00a0the awful\u00a0but relatively\u00a0uncommon tragedy of schizophrenia is now the top selling prescription drug in America\u00a0owing to its widespread use in garden variety depression, anxiety, and insomnia.<\/p>\n

It’s been said that the top selling drug in any era is a comment on\u00a0society at that point in time. \u00a0Valium held the\u00a0lead during\u00a0the 1960s and 70s, suggesting an age of uncertainty<\/a> and anxiety<\/a>. \u00a0The top spot was taken over by the\u00a0heartburn and ulcer\u00a0medication Tagamet<\/a> in 1979. \u00a0Tagamet was the first “blockbuster” drug with more than $1 billion in annual sales. Cholesterol-lowering\u00a0Lipitor<\/a>\u00a0was the biggest seller for nearly a decade after it was released in 1997, the same year the FDA\u00a0first allowed drug ads targeting consumers. \u00a0Pfizer spent tens of millions on such ads\u00a0\u2014\u00a0and sold over $125 billion of Lipitor over the years. \u00a0The stomach medicine Nexium took over after that. \u00a0Without covering all the top sellers, it’s fair to say that Americans spend a great deal on prescriptions to deal with emotional distress\u00a0and unhealthy lifestyles. \u00a0The blockbusters\u00a0also show\u00a0how\u00a0mass-marketing brand name drugs\u00a0has becomes a huge and highly profitable business.<\/p>\n

What does it say about us that Abilify holds the top spot now? \u00a0What does it mean to live in the Age of Abilify? \u00a0First, that we’re still looking for happiness and peace in a bottle of pills, costs and risks be damned. \u00a0Second, that there’s nearly no end to the money the U.S. health care system will spend on problems that can be addressed more economically. \u00a0And third, it’s a stark reminder\u00a0that\u00a0commercial interests seek\u00a0to expand sales and profits whenever possible. \u00a0They find (or create) new markets, promote products by showcasing benefits and concealing\u00a0drawbacks, appeal to our emotions instead of our rationality<\/a>.\u00a0\u00a0This is simply how business works. \u00a0We should not be surprised, yet\u00a0we ignore this reality\u00a0at our peril, particularly when it comes to our health.<\/p>\n","protected":false},"excerpt":{"rendered":"

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. (I try to stay calm and collected here, but that’s a fact worth boldface.) To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[16],"class_list":["post-1002","post","type-post","status-publish","format-standard","hentry","category-medication","tag-pharmaceutical-marketing","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1002","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1002"}],"version-history":[{"count":9,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1002\/revisions"}],"predecessor-version":[{"id":1013,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1002\/revisions\/1013"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1002"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1002"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1002"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}