Consumer Reports recently published a list of drugs that have heightened risks for older adults, due to the fact that as kidneys age, they lose some ability to process drugs. Consumer Reports compiled a “list of medications that are best avoided by those 65 and older, as well as a list of alternative medications.” See below:

Medicines Older Adults May Want to Avoid

Adverse drug reactions that result in emergency room visits affect older Americans nearly twice as often as young people. One reason is that as the body ages, the kidneys’ ability to process medications declines. As a result, some drugs stick around longer in the body, and others can build up to unhealthy levels if multiple doses per day are required.

At the same time, millions of older Americans take five or more medications a day, which multiplies the risk of experiencing an adverse drug event.

Consumer Reports Health has published new information to help guide people in their drug selections. A list of medications that are best avoided by those 65 and older, as well as a list of alternative medications, is included.

For example, antihistamines Chlor-Trimeton (chlorpheniramine) and Benadryl (diphenhydramine) can cause confusion, sedation and the inability to fully empty the bladder (urine retention) in people over 65. Generic cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin) are generally safer bets.

Another example is pain relievers. Aleve and Naprosyn (naproxen), Daypro (oxaprozin) and Feldene (piroxicam) can cause gastrointestinal bleeding and kidney damage. Demerol (meperidine) can cause confusion and falls. Better and safer choices include Tylenol (acetaminophen), Advil (ibuprofen), Zostrix (capsaicin cream) and for severe pain, morphine.

Click here for a complete list of drugs to avoid for older individuals.

Find more information at Consumer Report’s Best Buy Drugs about comparative effectiveness
and comparative cost for many of these medicines.

The Los Angeles Times ran an article today by Fran Kritz, Heading to the drugstore? Clip a coupon — but read the fine print. The article talks about the growing use of retail “coupons” by drug companies anxious to stave off competition, from cheaper generics or other drugs. Coupons are better suited to regular consumer products like shampoo, fabric softener and breakfast cereal than to medical treatment. This is why we here at Prescription Access Litigation oppose the use of coupons for prescription drugs, and why last year we called on the FDA to ban them.

PAL’s director is quoted in the article:

Last year, the FDA posted a federal register notice asking for public comments on the proposed study. The agency has since pulled the notice, spokesman Sandy Walsh said, in order to refine the parameters of the study, but in the meantime, comments voicing opposition to coupons came into the agency. The Prescription Access Litigation Project, for example, a group devoted to lowering the cost of prescription drugs, filed comments representing 23 consumer groups calling for an outright ban on prescription drug coupons. Among the complaints: that coupons interfere with a doctor/patient relationship by leading consumers to ask their doctor for a drug for which they’ve seen or received a coupon, and that they deceive consumers into using high-priced brand names over generics.

“A $10 coupon is nothing compared [to] the long-term savings from using a cheaper generic drug, particularly for long-term maintenance drugs,” says Alex Sugarman-Brozan, the group’s director.

The prices of brand-name drugs that don’t face competition from less expensive generics are completely arbitrary — the manufacturer just sets a price that it thinks the market will bear. So what does a coupon mean in that kind of situation? We compare it to a store that one night raises its prices, and then the next morning announces a sale. How do you know how much you’re really saving? How do you know if you’re getting a good deal? The answer is — you don’t. And brand-name drug companies count on that. They also count on the fact that people think they’re getting a better deal when they get some kind of discount (sale price, coupon, etc.) than when the base price of a product is just lowered. So drug coupons create a false sense of savings.

Drug coupons are also intended to do an “end-run” around health plans’ efforts to steer their members to less expensive but equally effective generic drugs. Let’s say your health plan charges a $10 co-pay for a generic heartburn drug, and a $20 co-pay for an expensive brand-name heartburn drug. The difference to you, the patient, is $10. If you get a $10 coupon for the brand-name drug, you don’t pay any more for the brand-name than the generic. But the generic usually will work just as well as the brand-name. So what’s wrong with that, people may ask.

The difference to the health plan is usually much more. The health plan might be paying $40 or $50 more for the brand-name drug than the generic. So what, you might say. That’s their problem, not mine. That $40 or $50 more the health plan pays doesn’t come out of nowhere — it comes out of your premiums. So next year, your premiums might go up that much more. In prescription drugs, as in life, there’s no such thing as a free lunch.

The article also points out that the savings with a coupon often still don’t match the savings on a generic:

Synthroid, for example, a brand-name drug from Abbott Laboratories that treats thyroid hormone insufficiency, costs $13.99 per month at drugstore .com, versus $8.99 for the generic. But the coupon Abbott is now promoting only takes $3 off of each prescription, making the generic cheaper by $24 per year.

So, next time you see a coupon for a prescription drug, be wary. Ask your doctor if there are generic or even Over-the-Counter options that work as well as the brand-name drug. If you have health insurance, see if your insurance (if you’re insured) has lower co-payments for generics — some insurers are even starting to charge zero co-payments for generics. If you don’t have health insurance, check out RxOutreach.org, a Patient Assistance Program offering deeply discounted generic drugs. And whether you have insurance or not, check out Consumer Reports Best Buy Drugs to see what drugs are the “best buy” for the condition you have.

To read our comments to the FDA, calling on them to ban drug coupons, go here.

Consumer Reports, long a critic of drug advertising, recently introduced a new feature on its website: AdWatch. In the first episode, an Associate Editor picks apart the claims made in an ad for GlaxoSmithKline’s (NYSE:GSK) drug, Requip. The ad pitches Requip as a treatment for “Restless Legs Syndrome,” or RLS. RLS, while a real condition, has been massively overhyped by ads for drugs such as Requip. (For an excellent discussion of this, see “Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick” in the free journal Public Library of Science – Medicine) Requip is a drug that was originally used for Parkinson’s Disease.

Here’s Consumer Report’s very clever and thorough deconstruction of the ad:

John Mack reports on the Pharmaceutical Marketing Blog that this critique angered folks at the Restless Legs Syndrome Foundation. Guess who’s a major sponsor of this alleged consumer group? Why, GlaxoSmithKline, of course, the maker of Requip! Here’s what John Mack wrote about this today:

However, CR does have a HUGE readership that I can only dream of! As a result, its attack on Requip drew the attention of the Restless Leg Syndrome Foundation, the supposedly grassroots patient advocacy group with suspicious monetary and corporate ties to GlaxoSmithKline (GSK), the marketer of Requip (see posts cited above).

The RLS Foundation issued this clarion call to its “members”:

“We wanted to apprise everyone on our mailing list of some bad press for RLS. We want to encourage you to ‘fight back’.

“A video on consumerreports.org promises ‘relief from restless legs hype.’ The RLS Foundation is taking a tough stand against this type of bad press for RLS.

“Click here to watch this extremely sarcastic and insulting video for yourself. Then, click here to read the RLS Foundation’s response to this video.

“The RLS Foundation is calling for drastic measures to respond to this video. We aren’t concerned that they are reporting on a drug. We are concerned that they are mocking a condition that so many people live with everyday. We encourage you to respond to this advertisement immediately. If you are a subscriber of Consumer Reports, we encourage you to cancel your subscription….”

Here’s a link to the copy of the RLS Foundation’s letter to Consumer Reports.

We applaud Consumer Reports for its new AdWatch feature and for examining the Requip ad. While RLS is a real condition and some people will get relief from drugs such as Requip, the shameless overmarketing of it through ads like this is enormously harmful. The purpose of drug ads is to expand the market for the advertised drug, to convince as many people as possible that they need a particular drug, even if they don’t actually need it. Since 2005, we have been calling attention to and critiquing particularly troublesome drug ads through our Bitter Pill Awards: Exposing Drug Company Manipulation of Consumers. We’re glad to be in the company of Consumer Reports in our efforts.