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10 Drugs you should avoid

The risks of these meds just aren't worth it

Published: March 2014

Those drug ads really try hard to reel you in—and they work! Who wouldn’t want to be relaxing in a bathtub as the sun sets or riding a horse on a gorgeous fall day without a health worry in the world? The way we see it, when it comes to choosing safe, effective drugs, most of us are at a huge disadvantage. Lots of the info out there is not intended to fully inform you; it’s simply trying to persuade you that what the drug companies are selling is what you need. What’s more, you may not feel well—that’s why you need the drug, right?

Of course, it’s your doctor’s job to help you sort all that out. But keep in mind that health care providers are the targets of a whole different set of promotions. Drug companies spend billions each year pushing prescription drugs to the medical community. They advertise in medical journals and sponsor continuing-ed programs. Pharmaceutical reps call on doctors in person, with drug samples and other freebies. And some doctors are paid huge fees to act as representatives of drug companies at conferences.

So how are you supposed to know which drugs to take?

 

That’s where we come in. For a decade now, Consumer Reports Best Buy Drugs, has been cutting through the noise of drug promotions with its unbiased evaluations of medications. We don’t take advertising or answer to special-interest groups. As a result, we can give you straight facts on the safest, most effective drugs that provide the best value for your health care dollar. Sometimes that means telling you which drugs you shouldn’t take. Our Best Buy Drugs team, which includes doctors and expert medical researchers, put together a list of 10 drugs that aren’t a good idea for anyone. (They are listed by brand names; their generic names are in parentheses.)

What should you do if you’re taking one of these?

 

Explore the alternatives; some are listed here. Also see the free reports at BestBuyDrugs.org, which tell you everything you need to know about specific drug categories—say, antidepressants or cholesterol-lowering meds. The reports give you the evidence-based information you need to start a conversation with your doctor about which meds are right for you.

1. Alli and Xenical (orlistat)

 

2. Belviq (lorcaserin)

 

3. Qsymia (phentermine and topiramate)

 

What they’re for: Helping overweight and obese people lose weight.

 

Why skip them: Clinical trials show slim benefits, and side effects range from embarrassing to scary. Orlistat has the longest track record of the three. The prescription version, Xenical, was approved in 1999; the lower-dose, over-the-counter version, Alli, in 2007. That’s long enough for some serious side effects to come to light. Turns out the drug not only blocks enzymes that allow you to digest and absorb dietary fat but also might interfere with an enzyme that helps remove toxins from your liver and gastrointestinal tract, according to research supported by the National Institutes of Health.

 

On rare occasions, the drug has been linked to severe liver damage, liver failure (resulting in transplant), and even death. Less serious but far more common is the fallout from undigested fat, including gas and involuntary discharge of stool. Orlistat can also hinder absorption of beta-carotene and vitamins A, D, E, and K.

 

Belviq and Qsymia, both approved in the last two years, are also problematic. In addition to headaches, dizziness, nausea, fatigue, and constipation, Belviq occasionally causes leaky heart valves, and memory and attention problems. Qsymia combines two prescription drugs, the stimulant phentermine and antiseizure drug topiramate. It increases the risk of glaucoma, kidney stones, mood disorders, and birth defects. Also, the drug can increase heart rate and shouldn’t be used by people who have heart disease or a history of stroke.

 

And the benefits? Not so great. Studies show that, on average, orlistat, Belviq, and Qsymia users who make nutritional changes and exercise lose only a bit more weight than those who just modify their lifestyle.

 

What to try instead: We get it—losing weight is hard. Unfortunately, weight-loss drugs and supplements typically don’t make it much easier. In the long run, you are far better off focusing on what has been shown to work without the risks: exercising regularly, eating fewer calories, and sticking with both.

4. Sarafem (fluoxetine)

 

What it’s for: Treating premenstrual dysphoric disorder (PDD), a severe form of PMS.

 

Why skip it: You can get the same drug as an inexpensive generic. But there has been a big push behind the brand name. Faced with steep declines in sales of the antidepressant Prozac when the generic hit the market, Eli Lilly rebranded it with a feminine name and a slick ad campaign—and slapped on a high, brand-name price. Although Sarafem’s website points out that the drug is not for depression, the active ingredient is an antidepressant: fluoxetine, or generic Prozac. But that costs $30 monthly; Sarafem is about $330.

 

What to try instead: Talk to your doctor about other ways to manage your symptoms. Exercise and a diet rich in complex carbs and low in salt have been shown to help with some. So have some supplements, including calcium (1,200 milligrams daily) and magnesium (200 to 400 milligrams daily), and the herb chaste tree (vitex agnus castus). If your symptoms are crippling enough to warrant the diagnosis of PDD, then it may make sense to consider fluoxetine.

5. Liptruzet (atorvastatin and ezetimibe)

 

6. Vytorin (simvastatin and ezetimibe)

 

What they’re for: Treating high LDL (bad) cholesterol. Both of these prescription drugs combine a cholesterol-lowering statin with a different type of cholesterol drug, Zetia (ezetimibe).

 

Why skip them: These combination pills have not been shown to prevent heart disease or premature death better than a statin alone, plus they are riskier and far more expensive. Statins’ side effects can include an increased risk of type 2 diabetes, memory problems, muscle soreness, and in rare cases a condition that can lead to kidney failure and even death.

 

Adding ezetimibe to the mix tacks on the risk of diarrhea, fatigue, muscle problems, and joint pain. But does it boost the heart-protective effect? The Food and Drug Administration just approved Liptruzet last year, but Vytorin has been around longer and has more research behind it, and the answer is a resounding “no.” In a two-year study, Vytorin was no better than simvastatin alone in reducing plaque buildup in arteries. In a second, five-year study, Vytorin worked no better than a placebo at reducing heart attacks or strokes.

 

In fact, the only real beneficiaries of these combo meds are the companies that make them. “Combining two drugs to produce a new patentable product is a pharmaceutical company ploy that should have been transparent to the FDA,” said Marvin Lipman, M.D., Consumer Reports’ chief medical adviser. “That’s especially true in light of the lack of evidence of long-term benefits with these products.”

 

Drug companies profit far more from patented name-brand drugs than from generics. For example, a single Liptruzet pill runs about $5.50—more than a whole month’s supply of some generic statins.

 

What to try instead: First talk to your doctor about lifestyle changes that can reduce or even eliminate your need to take a drug. If you need medication to reduce LDL (bad) cholesterol, first try a statin alone. Our Best Buy picks include several generic statins—atorvastatin, lovastatin, pravastatin, and simvastatin—depending on your health needs.

7. Nefazodone (generic only)

 

What it’s for: Treating depression.

 

Why skip it: Nefazodone can damage your liver, and there are several safer alternatives. After receiving numerous reports of liver damage and even death associated with nefazodone, the FDA branded it with a black-box warning (the strongest type). In 2004 its manufacturer, Bristol-Myers Squibb, stopped making the brand-name version of the drug, Serzone. But a decade later, generic nefazodone is still widely used in this country. Health care providers wrote more than 200,000 prescriptions for the drug in 2013. That’s more than the number written for the branded antidepressant drugs Celexa or Prozac.

 

What to try instead: It’s normal to feel down sometimes. If you are functioning OK and have no history of depression, it’s likely that you can make it through a rough patch with the support of friends and family and, if necessary, professional counseling. If the cloud doesn’t lift and you’re having trouble functioning, you and your doctor may decide it’s time to try an antidepressant. According to Consumer Reports Best Buy Drugs, there are several good generic choices available: bupropion, citalopram, escitalopram, fluoxetine, and sertraline. But before you try any of those, be aware that people tend to respond to the drugs very differently. Some people with depression have to try two or three medications before they find the one that works for them.

8. Soma (carisoprodol)

 

What it’s for: Relaxing the muscle spasms associated with backaches, headaches, and fibromyalgia.

 

Why skip it: Soma has not been proved to work better than other muscle relaxants, and it carries a serious risk. It’s one of top-selling muscle-relaxing drugs, but its dark secret is this: Almost all of the reports of addiction and abuse associated with muscle relaxants are linked to carisoprodol. That may be because the drug breaks down in the body to form meprobamate, a medication controlled by the Drug Enforcement Administration because of its addiction potential. And there’s no need to take the risk, says our medical adviser John Santa, M.D., who points out that good studies on Soma have failed to show that it works well. Other, better-studied alternatives are much safer.

 

What to try instead: Start with nondrug remedies such as rest and heating pads. If they aren’t doing any good, your best bet is to try an over-the-counter pain reliever such as acetaminophen (Tylenol and generic) or an NSAID (aspirin, ibuprofen, naproxen). Studies have not shown that muscle relaxants provide more relief than those garden-variety painkillers. If you and your doctor decide to try a muscle relaxant, we recommend generic cyclobenzaprine, which is relatively inexpensive and supported by the most evidence.

9. Fleet Enema (sodium phosphate)

 

What it’s for: Relieving constipation.

 

Why skip it: When used incorrectly, Fleet and generic OTC laxatives containing sodium phosphate can lead to dehydration and disrupt your body’s balance of key minerals, which can harm your kidneys and heart. Other laxatives work as well and are safer. Reports of serious incidents, including 13 deaths, prompted the FDA to issue a warning on the drugs, which work by drawing water into the stool to make it soft and easy to pass. The most serious harm occurred in people who took more than the recommended dose or used it more than once in 24 hours.

 

What to try instead: If you are constipated, the first thing to try is eating more fiber-rich foods such as fruits, vegetables, whole grains, and legumes, and drinking more water. If that doesn’t work, try a fiber supplement with psyllium. If your constipation bout lasts longer than two weeks, talk to your doctor about whether you need a drug to get things moving along. Our experts’ top pick: polyethylene glycol (MiraLax).

10. Latisse (bimatoprost)

 

What it’s for: Treating sparse eyelashes, a condition called hypotrichosis.

 

Why skip it: The side effects include changes in your eye color. The ads with Claire Danes and Brooke Shields and their lush eyelashes may make it sound more like makeup than a powerful prescription drug. Its downsides are many and include itching and redness, and if you’re not careful you could end up with hair growth elsewhere on your face. But the biggest bummer is that Latisse can permanently darken your eyelids and eyes. (Latisse originated as the glaucoma drug, Lumigan; the eyelash growth was a side effect seen in clinical trials.)

 

Our consultants are concerned that the drug will lower eye pressure, potentially masking glaucoma and delaying treatment. And you have to keep using Latisse to maintain the effect—at a cost of $140 per bottle. Insurance might not pick up the tab.

 

What to try instead: People who have lost their eyelashes from, say, chemotherapy may find the benefits of Latisse worth the risks. Otherwise, use mascara. It’s convenient, it’s cheap, and it doesn’t cause side effects.

Beware of combo meds, too…


Colds make you miserable in many ways, so it’s tempting to grab a drug that’s claimed to treat every symptom. Don’t! Multisymptom remedies might not do all they’re claimed to do, and they can contain stuff you don’t need.


Example: Drugs such as Dayquil that are claimed to relieve cough and stuffiness may contain the cough suppressant dextromethorphan and the decongestant phenylephrine, neither of which works very well.


And they can make you feel nervous or dizzy. Aside from those ingredients, all that’s left is a pain reliever. So if you have body aches or a fever, you might as well just take acetaminophen (Tylenol and generic), which is cheaper and less likely to cause side effects.


And if you have a runny nose, the antihistamine in combo products such as Alka Seltzer Plus Cold and Cough may help. But you may wind up with dry eyes and mouth, and fluid retention.


So next time you get slammed by a cold, stick to drugs that target specific symptoms. And follow Mom’s advice to rest, drink fluids, and eat some chicken soup!


Editor's Note:

This article also appeared in the April 2014 issue of ShopSmart magazine. This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).



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