medications, pharmaceutical companies, primary care

How many ways can the same thing be repackaged?

I hate “me-too drugs.”

What is a “me-too drug,”, anyway?  It’s a new drug that is very structurally similar to already existing drugs.  For example: Prilosec, Protonix, Nexium, Aciphex, Prevacid, and Dexilant.  All of these are proton-pump inhibitors and work basically exactly the same way.  One is not superior to the other.  And yet, pharmaceutical companies keep coming out with new ones.  Why?  I can give you 12 billion reasons.  They all have to do with dollars.

Anyway, here is another one that sticks in my craw, and has for a while.

Sleeping pills are big business in the USA.  In 2008, 56 million prescriptions for sleep medications were written.  According to the National Sleep Foundation, Americans pay $14 billion a year for sleep aids.  Ambien (zolpidem) is the most widely prescribed sleep aid.  I’m not really going to discuss the safety issues associated with sleep aids- that’s a post for another day.  This is a different rant.

One of the big selling points of zolpidem is that it, in general, does not leave people with a hung-over feeling the next day.  This is due to its short half-life (the amount of time it takes for half the drug to leave your system).  In a few hours, the drug has all but cleared out of your bloodstream.  Of course, for many people this means that they take the pill around 10 PM, fall asleep, and then are wide awake at 2:30 AM.

Ambien went generic in 2007.  Coincidentally (yeah, right), Sanofi-Aventis released Ambien CR a couple of months before Ambien went off patent.  Ambien CR is the same drug as plain old Ambien.  It’s in a special formulation that supposedly releases more slowly into your stomach, and this supposedly gets around that little problem of waking up after a few hours of sleep.  The data presented by drug reps showed that there were slightly higher levels of the drug in the blood for longer in patients who took the CR versions.  However, higher blood levels doesn’t necessarily correspond to any clinical difference.  I have not been able to find one single head-to-head study of the clinical effectiveness of Ambien vs. Ambien CR.  Not one.  If any reader out there can point me towards one, I’d appreciate it.  Until then, I’ll continue to suspect that Ambien CR is nothing but a patent-extender, designed to keep people on a more expensive version of a now generic drug.  Which is why I never prescribe it.

Now Purdue has joined the party by releasing Intermezzo.  In addition to having a ridiculous name, it’s a ridiculous drug.  It is plain old zolpidem once again, this time repackaged in a teeny-tiny dose (1.75 mg).  It is meant to be taken in the middle of the night- when your Ambien or Ambien CR wears off and you’re up at 2:30 in the morning, take one of these and get back to sleep.  An intermezzo is a musical interlude in between two other pieces, usually in an opera.   And you take this drug in the interlude that you are awake.  Get it???

I have no idea what the price of this wonder drug will be.  However, I can virtually guarantee that it will be far, far more expensive than what people have already been doing for years- taking half of a 5 mg zolpidem in the middle of the night- with exactly the same effect.  Voila!  A perfect example of a me-too drug.

I can guarantee two more things. First- an advertising onslaught.  I’m guessing opera will feature heavily in the ad campaign.  Second- people actually will ask me to prescribe this drug.  Yes, the advertising actually works.  Sad, but true.  I’ll spend lots of time explaining why this new drug is no better than what’s already out there, but some people can’t be persuaded.  And health care costs continue to rise…

1 thought on “How many ways can the same thing be repackaged?”

  1. The reason why the advertising works is because we as patients only hear of the ones On television. Imagine if you had to list and explain every medicine/ drug that's at our disposal? We wouldn't be able to fit that into our 15 minute appointment.


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