Q. Good day, Doc. I’m 42 and into legal practice. Last October, my cardiologist changed the Lipitor I’m taking and instead prescribed Vytorin 10/10 for my cholesterol. I’ve been on Vytorin for three months now. My question is: In your personal and honest belief, will you prescribe this to your patients? Lately, I’ve learned from a US channel that Vytorin is being doubted and has adverse effects. Is this true? — R.
Thanks R. Your question opened my eyes. I need a quick prayer before I confess to you the issue about three famous drugs (or group of drugs):
1. I have never prescribed Vytorin or Ezetrol.
Vytorin is a combination of two drugs: Simvastatin and Ezetimibe. The Ezetimibe is new and has not been proven to be better than the ordinary statins. I have never prescribed Vytorin, for which I was finally proven right.
A big controversy just erupted when the US House of Representatives Energy and Commerce Committee wrote the drug company to reveal the results of the ENHANCE study, which was completed way back in April 2006. For two years, no report came out about Vytorin, and in that span of time, an estimated $5 billion of this drug were sold.
American Dr. Richard N. Fogoros asked why the results were delayed. The suspicion is that the results were pushed back (or manipulated) to gain as much profit before the failed study comes out.
Luckily, the results were finally disclosed to the public: Vytorin is not better than Simvastatin alone (like your Zocor or Vidastat). In fact, the results show a trend of worse outcome (but not statistically significant) with Vytorin rather than with Simvastatin alone. The arterial wall thickness increased by 0.0111 mm for Vytorin (which is bad), compared to only by 0.0058 mm for Simvastatin alone. If you are still taking these drugs, go back to your doctor ASAP.
Safe alternatives: Choose the statins alone, like Simvastatin, Atorvastatin or Rosuvastatin.
2. I have never prescribed the coxib pain relievers. Popular brands (still being marketed) are celecoxib (brand name Celebrex) and etoricoxib (Arcoxia) for pain.
Despite their immense popularity with rheumatologists and surgeons, I have never prescribed the coxib pain relievers. Why? Because two of their sister drugs (belonging to the same class as the coxibs) have been withdrawn from the market because of serious side effects. What’s the side effect? Well, they can kill you.
First strike: A very popular and notorious coxib was Rofecoxib (brand name Vioxx) which was hastily withdrawn from the market because it caused heart attacks.
Second strike: Recently, another sister coxib named lumiracoxib (brand name Prexige) was withdrawn by the company because of serious liver side effects.
So what about the other remaining coxibs still standing in the market? In the US, public citizen groups have filed a petitioned to their FDA to withdraw most, if not all, of the remaining coxibs. Personally, I will never prescribe them. Just use common sense, it’s two strikes already for the coxibs. What more evidence do we need?
Safer alternatives: For mild pain, I first give the affordable paracetamol tablet. For moderate pain, I prescribe ibuprofen 400 mg or mefenamic acid 500 mg to be taken on a full stomach. I’d rather have my patients take a drug which might cause gastritis rather than a drug that may kill.
3. I have never prescribed the glitazones.
Five years ago, I already read the disturbing report that rosiglitazone (brand names Avandia and Avandamet) may cause heart failure. Right now, the evidence is steadily building against it. My guess is that the drug will soon be withdrawn. It’s just a guess.
Why do I think so? First, some drug companies have set up an admirable safety rule that the glitazones should only be prescribed by cardiologists and endocrinologists. The reason: because these doctors can detect if the patient is at risk for heart failure, which is a problem for the glitazones. Second, the US FDA recently required a black box warning for Avandia stating that this drug may cause heart failure. It’s like telling the patient, “You’ve been warned, so take it at your own risk.”
Another popular glitazone is pioglitazone. According to some studies, pioglitazone is less prone to causing heart failure (around 20 times lower risk) as compared to rosiglitazone. But nonetheless, the risk is still there.
Safer alternatives: There are a lot of proven drugs for diabetes like gliclazide, glipizide, and metformin.
Final Thoughts
My experience with withdrawn drugs is not new. In the past, I have followed closely the sad demise of popular drugs like Adifax (for weight reduction) and Posicor (for high blood pressure). Now, we add Vioxx and Prexige to the growing list, but not after being taken by millions of suffering patients and prescribed by thousands of unsuspecting doctors.
The only lesson for doctors and patients is to follow the medical adage: “Don’t be the first to prescribe a new drug. And don’t be the last to discard an old drug.” I have followed this rule in my practice. That is why I have never prescribed any drug, which hasn’t been on the market for at least three to five years. In fact, I have not yet prescribed Januvia (a popular drug for diabetes). I’m really tempted, but not yet.
To be honest and fair, the drug manufacturers of these said products have, for the most part, brought wonderful and lifesaving drugs to the public. It just so happens that one of their products has been tainted with controversy. But that’s how science works. I’m sure, given the right data, the companies will voluntarily withdraw the drug.
For my part, I cannot in conscience prescribe expensive and potentially dangerous medicines to patients who are suffering already. And when these patients (and readers) trust you with their lives, who are we not to give them the safest treatment we can find?
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For your questions, e-mail drwillieong@gmail.com.