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PHARM REPORT

BODY WATCH : The Newest Drugs Are Not Always the Best Ones

November 22, 1994|KATHLEEN DOHENY | SPECIAL TO THE TIMES

When a prescription drug is approved by the Food and Drug Administration, manufacturers tout it as the newest and the best medicine. Often, they claim the new treatment has fewer side effects and works better than established medicines. In a random poll, pharmacists tell which drugs are increasingly recommended by physicians--and what they consider to be the pros and cons of each.

Lescol (fluvastatin): This is a treatment for high cholesterol in patients who don't respond to diet changes alone. Approved by the FDA in late 1993, Lescol works by blocking the synthesis of low-density lipoprotein, the so-called bad cholesterol, in the liver, decreasing the concentration of LDLs and total blood cholesterol.

It is prescribed for once-a-day treatment, usually in the evening with a meal or at bedtime, according to a representative for Sandoz Pharmaceuticals Corp., the manufacturer.

"Lescol tends to be less expensive than other cholesterol-lowering drugs," says Philip Towne, a pharmacist and supervisor of the Drug Information Service at Long Beach Memorial Medical Center. "But the maximal cholesterol lowering (effect) tends to be a bit lower." So while it's appropriate for those with mild to moderate cholesterol problems, it's probably not indicated for those with severe cholesterol problems, he says.

Diflucan (fluconazole): Launched in July by Pfizer, Diflucan is promoted as the first oral, one-dose prescription medicine for vaginal yeast infections. (It's also used for other fungal infections.)

When prescribed for vaginal infections, this anti-fungal medicine eliminates the need to use traditional medications inserted vaginally for several days, which women often find messy and inconvenient, says Carl Kildoo, a pharmacist at Long Beach Memorial.

Effexor (venlafaxine): An antidepressant, Effexor works on two neurotransmitters rather than one to improve mood, says a representative for Wyeth-Ayerst Laboratories, the manufacturer, which began marketing the drug in April.

Because Effexor is offered in five strengths, it is easier for a physician to prescribe a more exact dose based on an individual's needs, says Lee Souder, pharmacist-owner of Cal-Med Pharmacy West in La Canada.

The drug might also be a good first-line medicine, Souder says, especially for treating a first bout of depression.

But Towne sees it differently. Until there is more long-term experience with Effexor, Towne recommends it as a treatment for those who have not been treated successfully with other antidepressants. Patients should be aware it can increase blood pressure, he adds.

Costs of Effexor and competitors, such as Zoloft (sertraline), are comparable if Effexor is dosed two times a day and Zoloft once, Towne says. But if Effexor is prescribed at a three-times-a-day dose, it can get more expensive.

Famvir (famciclovir): Prescribed as a treatment for shingles, a painful viral disease caused by varicella zoster virus, Famvir received FDA approval for marketing in late June. It's the first new oral drug in the anti-herpes virus category in several years, says a representative for the manufacturer, SmithKline Beecham.

Famvir interferes with replication of the virus by blocking its DNA synthesis.

It's prescribed three times a day, while another shingles drug, Zovirax (acyclovir), is often prescribed five times daily, Towne says. It's comparable in cost to Zovirax, Towne says, depending on how long a treatment is prescribed. Famvir is usually prescribed three times a day for seven days; Zovirax is recommended five times a day for seven to 10 days.

Caveats: Even though a new treatment might sound like an improvement over existing medicine, some physicians and pharmacists are reluctant to recommend it, they say, due to increased cost over drugs that have been on the market for years.

In other cases, physicians and pharmacists are waiting for longer-term use, to be sure unforeseen side effects don't crop up.

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