In February 1998, we noted that many doctors had prescribed the fen-phen diet drugs to people who weren't truly obese. That overuse had tragic consequences, when researchers discovered that the drugs can damage heart valves. But the "fen-phen" fiasco is just one of many cases of overprescribed medications. Another common instance involves the overuse of nonsteroidal anti-inflammatory drugs, or NSAIDs, also discussed in the February 1998 issue. Here are three other commonly used-and overused-types of medication.
Most doctors start treating hypertensive patients with either ACE inhibitors, such as enalapril (Vasotec) and lisinopril (Prinivil, Zestril), or long-acting calcium-channel blockers, such as diltiazem (Cardizem CD) and verapamil (Calan SR, Isoptin SR). But for most patients, the National Institutes of Health and most blood-pressure researchers recommend the older drugs: diuretics, such as chlorothiazide (Diuril or hydrochlorothiazide (Esidrix, HydroDuiril, and beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), and propranolol (Inderal LA).
Studies have clearly shown that the older drugs reduce the risk of hypertensive complications, including coronary heart disease and stroke; whether the newer drugs cut that risk is less clear. Diuretics and beta-blockers are also less expensive and have a longer safety record.
These drugs work only against infections caused by bacteria, not viruses. However, many doctors appease their patients' demand that they "do something" by prescribing antibiotics for viral infections such as colds, flu, or minor respiratory ailments. Or they may prescribe the drugs for other infections, such as bronchitis or sore throat, that are sometimes caused by bacteria, but without testing for bacteria first.
Even when antibiotics are appropriate, some doctors overuse newer "broad spectrum" antibiotics-notably cephalosporins such as cefaclor (Ceclor) and cefuroxime (Ceftin), and quinolones such as ciprofloxacin (Cipro) and levofloxacin (Levaquin). Those drugs, which typically cost 5 to 10 times as much as the older ones, target many different types of bacteria. But older, narrower-spectrum drugs often work at least as effectively against an infection that's caused by a single microbe, such as strep throat. In general, use the newer drugs only for infections that resist the older drugs, are caused by multiple microbes, or are life threatening and caused by unknown microbes.
The maker of omeprazole (Prilosec) spent $72 million last year on ads telling consumers that they may need the drug if they have frequent heartburn. That investment paid off- Consumers now ask their doctor for Prilosec more often than any other prescription drug.
But for most people with frequent heartburn, the first step is to change their habits, not take drugs. That means losing weight, avoiding a tight waistband, stopping smoking, eating slowly, avoiding or minimizing certain foods and beverages -- alcohol, coffee, carbonated drinks, chocolate, fat, hot spices, and peppermint-and not lying down after eating. For nighttime heartburn, elevate the head of your bed or use a wedge-shaped support to raise the upper half of your body.
Mild antacids like Alka-Seltzer, Rolaids, or Tums can relieve occasional brief heartburn attacks that strike despite those steps. To treat longer episodes or prevent attacks, try cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), or ranitidine (Zantac 75), all sold over the counter. Use stronger, costlier prescription drugs, such as omeprazole and lansoprazole (Nevacid), only in severe cases or if all else fails. And don't take any heartburn drug for more than two weeks unless your doctor has ruled out other causes.
To avoid needless or needlessly expensive drugs:
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*Copyright 1998 by Consumers Union of U.S., Inc., Yonkers, N.Y. 10703. Posted by permission from CONSUMER REPORTS ON HEALTH, March 1998. Downloading, copying, excerpting, redistributing or retransmitting is prohibited without written permission from the publisher. To subscribe, call 1-800-234-1645.