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TOP DRUGS DISPENSED IN US

1. HYDROCODONE BITARTRATE / ACETAMINOPHEN
2. TOPROL XL
3. SYNTHROID
4. NEXIUM
5. LIPITOR
TOP DRUG CLASSES DISPENSED IN US
1. CODEINE AND CODEINE ANALOG COMBINATIONS
2. SSRI/SNRI
3. STATINS
4. BETA BLOCKERS
5. ACE INHIBITORS
DRUGS IN THE NEWS
ROFECOXIB (VIOXX™)
VALDECOXIB (BEXTRA™)
MELOXICAM (MOBIC™)
CELECOXIB (CELEBREX™)
OXYCODONE HCL CONTROLLED RELEASE (OXYCONTIN™)
DISEASE STATES IN THE NEWS
MESOTHELIOMA AND ASBESTOSIS
SILICOSIS
ANTHRACOSIS AND BYSSINOSIS
ERECTILE DYSFUNCTION
BI-POLAR, MANIC, AND DEPRESSIVE DISORDERS
MELANOMAS AND SARCOMAS
NAME BRAND DRUGS AND MANUFACTURERS
ALL PHARMACEUTICAL MFGS A TO Z
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

HYDROCODONE BITARTRATE

Hydrocodone is an orally active analgesic and antitussive Schedule II narcotic that is marketed in multi-ingredient Schedule III products. Hydrocodone has an analgesic potency similar to or greater than that of oral morphine. Sales and production of this drug have increased significantly in recent years (a four-fold increase between 1990 and 2000), as have diversion and illicit use. Trade names include Anexsia®, Hycodan®, Hycomine®, Lorcet®, Lortab®, Tussionex®, Tylox®, Vicodin®, and Vicoprofen®. These are available as tablets, capsules, and/or syrups. Generally; this drug is abused by oral rather than intravenous administration. Currently, about 20 tons of hydrocodone products are used annually in the United States.

PAIN MANAGEMENT LINKS

  • American Academy of Pain Medicine

  • http://www.painmed.org/cme

  • American Academy of Physician Assistants

  • http://www.mecgeducation.com/jaapa/pain_management/default.asp

  • American Board of Pain Medicine

  • http://www.abpm.org/index.htm

  • American Headache Society

  • http://www.ahsnet.org

  • American Medical Association

  • http://www.ama-assn.org/ama/pub/category/10171.html

  • American Pain Society

  • http://www.ampainsoc.org

Other common name brands of hydrocodone and their dosage strengths are: Lortab 2.5™, Lortab 5™, Lortab 7.5™, Lortab 10™, Lorcet Plus™, Lorcet 10™, Vicodin™, Vicodin ES™, Norco 7.5™, Norco 10™, Xodol™, Vicoprofen™, and various others (these trade names are all trademarked by their respective manufacturers and are provided for informational purposes only).  Maximum daily doses of hydrocodone may be found on the manufacturers website.  Acetaminophen toxicity is also a great concern with the combination hydrocodone-APAP products.

 

 

HYDROCODONE IN THE NEWS

Pain meds still on top despite addiction, crime concerns
Drug Store News,  by
Michael Johnsen

NEW YORK -- Despite continuing gains in the treatment of other conditions like depression and lipidemia, narcotic analgesics remain the most prescribed class of medicines in the United States, according to new research from IMS Health.

Opioid-based pain medications continue to eclipse both antidepressants and statins, IMS reported, with a total of 154 million prescriptions dispensed over the 12 months ended in June. That equates to a prescription growth rate of 5 percent for that period and compares with 146.4 million prescriptions filled for antidepressants and 132.2 million for statins.

The rise in prescriptions for narcotic analgesics has come despite recent trends that could prompt even higher utilization of statin-based medications. Among them: recent moves by federal health watchdogs to lower recommendations for cholesterol levels among Americans. The change in recommended lipid levels could boost doctors' reliance on statins, including the most prescribed medicine and blockbuster best seller Lipitor.

In addition, statins were supported with $1.9 billion in direct-to-consumer advertising over the 12-month period ended in June, according to IMS.

Conversely, there are no DTC ad budgets for narcotics and other drugs that are regulated by both the Drug Enforcement Administration and the Food and Drug Administration. And any press reports on that class of medicines typically focus on the negative aspects of narcotic analgesics, namely the serious potential for addiction among users and the rise in robberies and other crimes at pharmacies stocking the drugs.

Despite their drawbacks, narcotic analgesics remain a key element of any pain management regimen when used as directed and monitored by a health care practitioner. The reason is obvious to both patients and their physicians: They provide relief to those who suffer from either chronic or acute pain.

In fact, the category is growing, even though most narcotic analgesics have moved heavily into generic competition--a trend oftentimes responsible for the dampening of a category. According to Express Scripts' 2003 drug trend report, the percent change in the brand/generic mix of narcotic analgesics fell 6.8 percent, indicating greater generic use, even though total utilization within the drug class was up 74 percent.

And given the inclination for managed care organizations to mitigate prescription drug costs as much as possible, the move of so many pain management medications into generic competition is expected to boost prescribing further among physicians. "Physicians are going to be more likely to then learn how to use [pain management medications] more skillfully in conjunction with [other medications]," suggested Rollin Gallagher, president of the American Board of Pain Medicine.

The number of pills prescribed with each prescription is on the rise, as well. According to Express Scripts' drug trend report, narcotic analgesics had the greatest shift upward in units per prescription, climbing 6.2 percent, compared with an overall decline of 0.1 percent across all categories. And that trend is on the rise, Express Scripts reported, from a 4.7 percent gain in 2002 and a 2.7 percent gain in 2001. "This pattern suggests that more members are taking narcotics on a maintenance basis, rather than on an acute basis," the report noted.

The move toward generic competition continues, especially with generic alternatives for Janssen's blockbuster Duragesic pain patch and Purdue Pharma's OxyContin extended release on the cusp of reaching the marketplace. The generic conversion of those medicines, which together accounted for $3.5 billion in 2003 pharmaceutical branded sales, is expected to happen by the end of next year.

That bodes well for the 50 million to 75 million Americans who live with chronic pain daily. According to the Joint Commission on the Accreditation of Healthcare Organizations, nearly one-third of Americans will experience chronic pain at some point in their lives.

And chronic pain does not discriminate by age, noted the American Chronic Pain Association. In its Americans Living with Pain Survey, released earlier this year, the ACPA found that people are experiencing pain at a younger age than what may be commonly perceived or assumed. Proportionally, just as many younger people surveyed experience back pain as do middle-aged and older adults.

Perhaps because of the stigma of abuse associated with the use of opioid treatments, the survey found that 72 percent of chronic pain sufferers have lived with their pain for more than three years, and 34 percent have lived with undertreated pain for more than a decade.

The survey also found that more than half of pain management patients are concerned about the potential side effects of narcotic remedies--50 percent reported being concerned about addiction or the need for higher dosage over time, and 49 percent were worried about having to take narcotics for the rest of their lives. Overall, 44 percent of respondents expressed hesitancy in taking prescription narcotics.

Educating both consumers and health care professionals on the proper use of pare medications could spell opportunity in this category.

"[Pain medicines] are abusable if someone has an addiction problem," Gallagher noted. "But that's only a small percentage of the patients. You have 90 percent of the population who have no problems with addiction, and then you have the 10 percent who have problems with addiction disorders who may have problems with the use of these drugs."

Unfortunately, those 10 percent with addiction problems make for more compelling news stories, which skews public perception on the use of pain management therapies and makes the remaining 90 percent victims of societal attitudes, Gallagher said.

"What you end up having is a person with a serious disease ... and yet they are reluctant to go seek treatment, they don t know how to get to good treatment, and they don't even know what good treatment is," he said.

 

U.S. Is Working to Make Painkillers Harder to Obtain
Patients May Suffer as DEA Battles Abuse
By Marc Kaufman
Washington Post Staff Writer
Sunday, February 15, 2004; Page A03
 
Drug Enforcement Administration is working to make one of the nation's most widely prescribed medications more difficult for patients to obtain as part of its stepped-up offensive against the diversion and abuse of prescription painkillers.

Top DEA officials confirm that the agency is eager to change the official listing of the narcotic hydrocodone -- which was prescribed more than 100 million times last year -- to the highly restricted Schedule II category of the Controlled Substances Act. A painkiller and cough suppressant sold as Lortab, Vicodin and 200 generic brands, hydrocodone combined with other medications has long been available under the less stringent rules of Schedule III.

The DEA effort is part of a broad campaign to address the problem of prescription drug abuse, which the agency says is growing quickly around the nation. But the initiative has repeatedly pitted the agency against doctors, pharmacists and pain sufferers, and it is doing so again with the hydrocodone proposal.

Pain specialists and pharmacy representatives say that the new restrictions would be a burden on the millions of Americans who need the drug to treat serious pain from arthritis, AIDS, cancer and chronic injuries, and that many sufferers are likely to be prescribed other, less effective drugs as a result.

If the change is made, millions of patients, doctors and pharmacists will be affected, some substantially. Patients, for instance, would have to visit their doctors more often for hydrocodone prescriptions, because they could not be refilled; doctors could no longer phone in prescriptions; and pharmacists would have to fill out significantly more paperwork and keep the drugs in a safe. Improper prescribing would carry potentially greater penalties.

The DEA says the change is necessary because hydrocodone is being widely misused -- with a 48 percent increase in emergency room reports of hydrocodone abuse from 1998 to 2001. The drug, a semisynthetic chemical cousin of opium, produces a morphine-like euphoria if taken without a medical purpose but generally does not produce a similar "high" in patients with severe or chronic pain. Hydrocodone was one of several prescription painkillers that radio talk show host Rush Limbaugh acknowledged last year that he was addicted to.

"Hydrocodone is one of the most abused drugs in the nation," said Christine Sannerud, deputy chief of the drug and chemical evaluation section of the DEA. "The agency thinks it would be wise to move it to Schedule II, because that would help a lot in terms of reducing abuse and trafficking."

DEA officials would not say when they might begin the process of changing the schedule, but other federal officials said they understand that the DEA wants to act soon.

Under the federal Controlled Substances Act of 1970, the DEA places all narcotic or mind-altering drugs into one of five "schedules," and the medications are more or less available based on the potential dangers they pose and benefits they provide. Morphine-based hydrocodone, when combined with aspirin, acetaminophen or other common analgesics, has been a Schedule III drug since the act went into effect.

The DEA effort comes as the agency is already embroiled in a dispute with many pain specialists over the use -- and alleged overprescribing -- of another powerful painkiller, OxyContin. Scores of doctors have been arrested on felony charges of conspiracy, drug trafficking and even murder in connection with their prescribing.

Although the agency says the prosecutions are needed to shut down "pill mills" and stop unscrupulous doctors, many pain specialists say that the agency has become overzealous and that some doctors are refusing to prescribe needed painkillers because they fear DEA investigation.

"Rescheduling the drug will bring more hoops and barriers to getting access to the drugs, and it may prevent some minimal amount of abuse," said Richard Payne, president of the American Pain Society. "But my concern is that it will come at the cost of denying access to thousands of patients."

Susan Winkler of the American Pharmacists Association said her organization is concerned that the "ripple effects" would be substantial and negative.

"Our members and doctors would have increased liability if [hydrocodones] are rescheduled, and that will inevitably reduce prescribing," she said. "We urge the DEA to make sure their decision is based on science and will make the situation better, not worse."

 
  
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