Viagra. Celebrex. Humira. Chances are you've recently seen a TV commercial for at least one of these medications. After all, drugmakers shell out billions of dollars for ads each year to keep them and other prescription drugs fresh in your mind. Over the 12-month period ending in July 2014, in fact, manufacturers spent $1.9 billion on ads for just the top 10 drugs, according to Kantar Media. Experts at Consumer Reports Best Buy Drugs, which reviews research on drug safety and efficacy, looked at each of those top 10 drugs to determine which are worth the hype and which aren't.
Drugmakers know that millions of men are happy to pay for a pill to improve their sex lives, even if insurance doesn't cover the cost—about $70 for 10 5-milligram tablets of Cialis (tadalafil) and $332 for 10 50-milligram tablets of Viagra (sildenafil). That's why Pfizer spent $218 million on Viagra ads, and Eli Lilly $263 million on Cialis ads. The drugs do work as advertised. But they should be used cautiously because they can increase the chance of heart attack and stroke, and can cause other serious side effects, such as vision and hearing loss.
Before you rush to take a pill to treat erectile dysfunction, talk with your doctor to make sure the problem doesn't stem from another concern, such as a medication you already take. Addressing other health problems, too—losing excess weight and managing blood pressure, diabetes, cholesterol, and even depression—can also help restore some lost vim and vigor.
AbbVie, maker of Humira (adalimumab), spent $293 million on ads, more than what was spent for any other drug. Crohn's can be devastating, causing anemia, severe diarrhea, intestinal blockages, and other debilitating symptoms. Research shows that Humira can ease those symptoms and even lead to year-long remission in some people. But it can be very expensive (more than $5,000 per month) and in rare cases can cause deadly complications, including pneumonia and tuberculosis.
If you have mild symptoms, other drugs—notably corticosteroids—should be tried first. But steroids don't always work, and long-term use of them can cause bone loss and infections. Many people need another choice. In that case, Humira can be a good one. It has been available since 2002, so more is known about it than newer drugs. And studies suggest that it might have a lower risk of side effects than related drugs, such as Cimzia (certolizumab) and Remicade (infliximab).
Atrial fibrillation, or Afib, is an irregular heartbeat that can cause blood clots, which in turn can trigger strokes. Afib is usually treated with warfarin, a drug that prevents blood clots. But warfarin requires close monitoring, by you and your doctor, to make sure your blood doesn't clot too slowly, because that makes you prone to bleeding. Eliquis (apixaban) and Xarelto (rivaroxaban) have anti-clotting effects similar to warfarin, but they don't need as much monitoring. However, they can pose a risk of serious internal bleeding, which sometimes may be fatal. The drugs cost about $300 per month.
Warfarin is our CR Best Buy Drugs choice for most people with Afib. It has a long track record and costs less than $20 per month. Warfarin's effects also can be quickly reversed if serious internal bleeding occurs; the newer drugs don't have a proven remedy. But if it's too difficult to get to a doctor's office to regularly monitor warfarin, consider Eliquis because it has been shown to reduce the risk of strokes more than warfarin and poses a lower risk of bleeding.
Read more advice on drug safety, effectiveness, and cost from Consumer Reports Best Buy Drugs.
Fibromyalgia, which can cause widespread pain and tenderness, plus depression, fatigue, and other problems, is notoriously difficult to treat. But studies have found that the benefits of Lyrica (pregabalin), as with other medications used to treat the condition, are small. And the drug can cause blurred vision, confusion, dizziness, liver and kidney problems, suicidal thoughts, and dangerous swelling of the face, mouth, and throat. A month's supply costs around $260.
First try nondrug therapies, such as exercise, counseling, and stress relief. None of the medications used to treat fibromyalgia have been shown to be clearly more effective than the others. Our CR Best Buy Drugs team picked amitriptyline, gabapentin, and paroxetine as initial options. All are available as generics ($106 or less for a month's supply) and are at least as effective and safe as Lyrica.
Over-the-counter pain relievers ibuprofen (Advil and generic) and naproxen (Aleve and generic) can help ease arthritis pain. But they can also trigger bleeding in the gut. Celebrex (celecoxib), which is related to those drugs, may be easier on the stomach. But it can still cause serious gastrointestinal bleeding, and like ibuprofen, it increases the risk of heart attacks and strokes.
First, try exercise and losing weight. Both could help ease pain enough that a drug may not be needed. For mild pain, consider acetaminophen (Tylenol and generic); it's generally safe when taken as directed. If that doesn't provide enough relief, our Best Buy Drugs recommendation is generic, nonprescription ibuprofen or naproxen. They cost just a few dollars per month, compared with $181 to $282 for Celebrex. But people with a high risk of gastrointestinal bleeding could consider Celebrex.
Rheumatoid arthritis is less common than osteoarthritis but can be debilitating, leading to joint destruction if not adequately treated. Xeljanz (tofacitinib) can ease rheumatoid arthritis pain. But it's not as well-studied as similar drugs, such as Humira, Orencia (abatacept), and Enbrel (etanercept), and it has been linked to perforations in the stomach and intestines. And it's very expensive: $2,380 or more per month.
Other, less costly and safer medications work just as well. Those should be tried first in people who have received a diagnosis of rheumatoid arthritis. Options include sulfasalazine (Azulfidine and generic) and methotrexate (Rheumatrex and generic), often combined with pain relievers and corticosteroids. If those don't work, CR Best Buy Drugs recommends Enbrel, Humira, or Orencia over Xeljanz.
Antidepressants don't always relieve depression. The ad for Abilify (aripiprazole) suggests that the drug might help in those cases. But research shows that it provides little if any additional benefits while increasing the risk of side effects, including heart attack and stroke. Other serious side effects include weight gain, type 2 diabetes, and involuntary movements of the tongue, lips, face, trunk, arms, or legs, which may be permanent. The drug costs about $900 per month.
Don't jump to Abilify. If your symptoms haven't responded to an antidepressant after four weeks, ask your doctor to make sure you don't have another condition that may make your depression difficult to treat. Your doctor may also try increasing the dose of the antidepressant, switching to a different drug, or combining two antidepressants.
Symbicort, a combination of budesonide and formoterol, can help people with chronic bronchitis, emphysema, and other forms of chronic obstructive pulmonary disease (COPD) breathe easier. But formoterol has been linked to a higher risk of death in people with asthma.
Before getting a prescription for Symbicort, make sure you have tried other options. And if you do use it, always have a rescue inhaler with you to treat attacks.
Only the U.S. and New Zealand allow drugmakers to pitch drugs directly to consumers. Consumer Reports has long held that drug ads should be banned here, too. For one, they encourage patients and doctors to turn to medication when nondrug options might work. And when drugs are needed, ads often promote more expensive options, not the best or safest. In addition, a 2014 review in the Journal of General Internal Medicine of 168 drug ads found that 57 percent of claims were potentially misleading and 10 percent were outright false.
Drug ads might make it seem like newer is always better. But new drugs are often no safer or more effective than older ones. And older drugs tend to cost far less because they're usually available as inexpensive generics, as shown in the chart below.
|Asthma||Beclomethasone, 40 mcg inhaler, $142 per month||Pulmicort Respules, 0.25 nebulizer, $330 per month||$188 per month|
|Depression||Fluoxetine, 20 mg, $4 per month*||Cymbalta, 30 mg, $181 per month||$177 per month|
|Diabetes, Type 2||Metformin, 500 mg, $4 per month*||Januvia, 100 mg, $275 per month||$271 per month|
|High cholesterol||Simvastatin, 40 mg, $4 per month*||Crestor, 10 mg, $201 per month||$197 per month|
*Through discount programs at large chain stores such as CVS, Target, Walgreens, and Walmart.
This article also appeared in the February 2015 issue of Consumer Reports On Health. 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).