Online Pharmacy Medicine Blog

A growing stream of studies and news reports is questioning the effectiveness of Abilify (aripiprazole), the heavily advertised antidepressant.

As the Clinical Psychology and Psychiatry blog reports:

Yet another Abilify for depression study is out in CNS Spectrums and guess what… Still not a significant advantage over placebo according to patients. So in each of three large studies, Abilify has failed to beat a placebo according to patients’ self-report. These three trials are the basis for the massive marketing campaign and an FDA approval.

Abilify started off as an also-ran antipsychotic. But times have changed. Bristol-Myers Squibb’s CEO prophetically stated in 2004 after Abilify’s approval as a treatment for bipolar disorder: “This approval underscores our commitment to delivering innovative solutions that address unmet needs for a broad spectrum of patients with mental illness, as well as their families and health care providers.”

He could as easily have stated: “This approval underscores our commitment to rebranding our unpopular antipsychotic as a Swiss Army Knife/broad spectrum psychotropic that treats everything under the sun. If I can get the FDA and the public to believe that this akathisia-inducing bottom feeder can treat depression, then I’ll be LOADED, BWAAH, HA HA HA HA!!!”

The Los Angeles Times has written of Abilify:

Mounting research has made clear that the atypical antipsychotics [such as Abilify] are not only less safe than originally thought; they are not, on balance, any safer or more effective than older drugs for schizophrenia. And for the population of depressed or anxious patients that some are now proposed to treat, studies suggest the benefits are extremely modest.

Abilify has been specifically advertised as an “add-on” antidepressant for people who are currently taking antidepressants — but who still feel depressed. As such, hordes of patients have gone to their doctors and psychiatrists asking if they should add Abilify to their drug regimen.

As always, consult with your doctor. But it would seem a prudent course to try a number of different conventional antidepressants (Lexapro, Wellbutrin, etc.) before concluding that you need to take not one, but two, drugs for your depression.

Avastin, an anticancer drug by Genentech, costs as much as $55,000 for a single course of therapy. It earns Roche, which recently acquired Genentech, nearly $5 billion annually.

And what do patients get for this extraordinary price tag?

On average, about two months of increased life span, reports MIT’s Technology Review.

Avastin is unique, and fascinating to researchers and doctors, because it “uses a wholly different mechanism than the highly toxic chemotherapies that try to kill tumors.” Avastin is an antibody that attempts to cut off the blood supply to the tumor. It is currently used to treat cancers of the colon, breast, lung and brain.

Avastin is one of most expensive drugs that is widely marketed in the United States. Insurance companies often require patients to pay for a significant percentage of the drug out of pocket, rather than a flat co-pay. Some insurance companies are beginning to balk at paying for the drug at all, citing the low benefit-to-cost ratio.

Meanwhile, in countries like Canada and the U.K., which have national healthcare systems, governments have restricted Avastin’s use.

Researchers and clinicians say that Avastin’s potential to fight cancer is significant, and that through continued use in various treatment combinations with patients, far greater benefits can be achieved over time.

So, is Avastin worth $55,000 for adding two months of life? My guess is your answer depends on whether someone you know needs it — and on who’s paying for it.

Last week, the Japanese drugmaker Daiichi Sankyo Co. received FDA approval to market its anti-blood-clotting drug Effient (prasugrel) in the United States. The thumbs up from the U.S. government has made the drugmaker a rising star in the Japanese stock market.

But the jury is still out on whether Effient will be able to compete with market leader Plavix — particularly given concerns that the Japanese drug causes a high rate of internal bleeding in patients.

Like Plavix (clopidogrel), Effient is a platelet inhibitor. Platelet inhibitors encourage blood flow to the heart, brain, and body. They are prescribed to reduce the risk of heart attack, stroke, and circulation problems in patients with hardening of the arteries or unstable angina, and in those who’ve already suffered a heart attack or stroke.

Studies suggest Effient may be more effective than Plavix in preventing heart attacks and other cardiovascular deaths — but that Effient deaths by internal bleeding basically cancel these advantages out.

A study of more than 13,000 patients with acute coronary syndromes, published in the New England Journal of Medicine, compared prasugrel against clopidogrel, both in combination with aspirin, and found that prasugrel was the more potent anti-platelet agent.

Prasugrel reduced the combined rate of death from cardiovascular causes. The death rate was 9.9 percent for prasugrel, compared to 12.1 percent for clopidogrel.

However, an increased rate of internal bleeding — including fatal bleeding — occurred in the group taking prasugrel. As a result, overall mortality between the two groups was almost identical. The drug has been deemed especially risky for elderly patients.

So pick your poison — a higher risk of death by myocardial infarction with Plavix, or by internal bleeding with Effient. As always, consult with your physician in determining how to treat any condition.

With the FDA raising concerns last week about Extra Strength Tylenol and other acetaminophen products potentially causing liver damage, should you consider switching from Tylenol to aspirin or ibuprofen?

The short answer is “no.” If you are not taking other prescription pain medications (such as Vicodin or Percocet) in addition to Tylenol, and you take Tylenol as directed, you shouldn’t be at risk of hurting your liver.

Remember, virtually all drugs have risks in large doses. Aspirin, for example, carries the risk of stomach ulcer and gastrointestinal bleeding when taken at high doses and/or for extended periods (such as when treating chronic pain).

Here’s a brief overview of the most commonly used over-the-counter pain relievers — acetaminophen, aspirin and ibuprofen — and what you should know about each:

Aspirin. (Popular brands: Bayer, Bufferin) The most common OTC pain reliever, also known as acetylsalicylic acid, reacts with our blood chemistry to inhibit the enzyme cyclooxygenase, which helps to control headaches, minor aches and pain, and inflammation. Aspirin therapy is also being used today in the treatment of heart disease. But as ubiquitious as aspirin appears to be, it’s not without risk — and it’s not for everyone. For those with sensitive digestive systems, it can cause stomach upset, heartburn and even dyspepsia. It’s also an anticoagulant, which makes it bad for hemophiliacs and a bad choice for pain relief after you’ve had surgery. It’s also been linked to Reye’s syndrome, a disease in children, when aspirin is used to relieve discomfort associated with fever.

Acetaminophen. (Popular brands: Tylenol) This pain reliever soothes headaches and lowers fevers, but it is not an anti-inflammatory, so it won’t do much to help with arthritis and other body aches and pains. The biggest benefit of acetaminophen, relative to other headache pills, is that is won’t irritate the lining of your stomach. If you have acid reflux, ulcers or other digestive tract issues, acetaminophen is generally a clear choice over aspirin. Acetaminophen is also considered safer for hemophiliacs and children. However, doctors warn that it’s easier to overdose on acetaminophen than aspirin — a concern underscored by the FDA panel’s ruling. So be sure to take this drug only as directed.

Ibuprofen. (Popular brands: Advil, Motrin) Ibuprofen is chemically similar to aspirin and functions similarly as well, but in lower doses, it tends to be less irritating to the upper digestive system. So if you find aspirin difficult to stomach, but have body aches and pains that acetaminophen can’t treat, ibuprofen is often the best answer for ailments like arthritis, sunburns, sprains and the like.

The FDA is poised to ban prescription painkillers Vicodin and Percocet, which combine acetaminophen with an opiate narcotic. An FDA report says the potential dangers of this combination exceed the benefit to patients.

The report found that severe liver damage, or even death, can result from taking Vicodin or Percocet. They are also highly addictive. According to the FDA, these drugs cause about 400 deaths per year, attributed to either overdoses or liver damage.

Vicodin combines hydrocodone with acetaminophen; Percocet combines oxycodone with acetaminophen. Some of the notable celebrities who have admitted addiction to one or both of these drugs include John McCain’s wife, Cindy; rapper Eminem; and comedian Artie Lange.

The recommended ban will also apply to seven other acetaminophen/narcotic combination drugs.

While alternative painkillers like Percodan, which combine opiate narcotics with aspirin (rather than liver-damaging acetaminophen), are available on the market, they had been largely replaced by Percocet and Vicodin for post-operative pain, because aspirin can interfere with platelet function and lead to excessive bleeding after surgery.

Concerned that Americans are popping too much Extra Strength Tylenol and other over-the-counter acetaminophen products, an FDA panel voted on Tuesday to reduce the maximum dosage on these pain relievers.

The panel recommendation would lower the maximum daily dosage of nonprescription acetaminophen, and limit the maximum single dose of acetaminophen to 650 milligrams. The current maximum single dose of Extra Strength Tylenol is 1,000 milligrams; this would now be available only by prescription.

An FDA report concluded that many people are taking more pills than the box or bottle instructions recommend, and that acetaminophen has crept into many other medicines (such as cold remedies, etc.) that may lead consumers to accidentally take more than they should. Taking too much acetaminophen can lead to serious health problems, including liver damage.

Although the advisory panel’s recommendation has not yet been implemented by the FDA, the agency typically follows its panels’ advice.