Medications are, in a way, reflections of our society as a whole - both in the diseases from which we suffer; and the worries, fears, and concerns that plague the health-conscious. This list of the top fifty medications prescibed in the United States is broken down into groups of ten for better analysis.

The top ten
The number one medication of the list is Vicodin. Vicodin is a Class II narcotic (moderate potantial for addiction), and in my experience on of the most abused non-controlled medications on the market. There are certainly legitimate uses for this drug, but also a vast grey market for it - often commanding five to ten dollars a pill on the streets. Its top position speaks to its addictive potential. Lipitor is number two - it is a very potent cholesterol-lowering agent, and has strong antioxidant properties as well. Mysteriously, overall death rates drop in people on this medicine, not only stroke and heart attack deaths, but also deaths from accidents, violence, and other seemingly unconnected causes. Its potency wins out over cost considerations - it is rather expensive. Number three, Premarin, will drop more as better agents to prevent osteoporosis come on the market. Fears about estrogen replacement therapy are on the rise.

Numbers four, seven, and nine are inexpensive medicines for treating blood pressure, which is a very common condition. Number five, Synthroid, is a thyroid hormone replacement. Hypothyroidism is a condition that is common yet seemingly exists under the radar so to speak. Patients and doctors alike would do well to pay more attention to symptoms of chronic fatigue. Six and eight are antibiotics - the first very convenient, and the second very cheap - ideas which often compete bitterly when treatments are being determined. Number ten is Xanax - the successful grandchild of Valium and panacea for the anxious, elderly, and insomniacs of the world.

11 - 20
The next ten medications delve into more of the common ills people suffer from. Proventil is the most common inhaled medicine used in treating asthma. Clariten treats allergies - a closely related condition. Microzide and Maxzide, like Lasix above, are mild diuretics used to treat blood pressure and mild edema. Prilosec and Prevacid block acid production in the stomach, helping with reflux and ulcer treatment. They overturned medicines like Tagamet and Zantac as soon as they were relesed due to their effectiveness. Also in the top twenty we begin to see antidepressants. Zoloft and Paxil are temporary winners in the perpetual game of pharmaceutical king of the mountain, defeating Prozac years ago. Generic Prozac may soon threaten their regency however. Motrin and Celebrex both treat pain and arthritis. In this case cost narrowly wins out over convenience. The gap is wider if you add in the over the counter forms of Ibuprofen.

21 - 30
The third group starts with an established cholesterol medicine and a cheap antibiotic, then introduces another scourge of society - diabetes. Glucophage actually adjusts the metabolism of the liver and muscle tissues to improve glucose metabolism in the body. An amazing but expensive medicine. Vioxx, another stomach-friendly anti-inflammatory similar to Celebrex continues to lose ground due to fears of potential adverse cardiac and circulatory effects. A cheap anti-hypertensive] and an expensive but powerful antibiotic are followed by a hormone combination for menopause, PremPro. This will drop precipitously in 2002 because of results showing increased risks of morbidity in women taking this medicine. Prednisone is a multipurpose medicine for things from poison ivy to arthritis and asthma flares to sunburn. It's also cheap as dirt. Number thirty introduces us to our first birth control pill.

31 - 40
The fourth quintile begins with another narcotic. Codeine is much less addictive than Hydrocodone, so it is also much less sought after despite the fact that pain control is almost identical. Zyrtec and Allegra fight a horrendously expensive battle to treat your allergies, and one or both may well overtake Claritin in 2002 - which is why Claritin's makers have released a new form called Clarinex. Marketing battles also explain the relatively poor showing of Levoxyl versus Synthroid although it works just as well for replacing thyroid hormone deficiencies. Trimox, Lopressor, and Ativan are a cheap antibiotic, blood pressure medicine, and nerve pill respectively. Toprol-XL got a late start in the antihypertensive market and should move up well in 2002. Prozac comes in a distant thirty-ninth, but its maker has pulled some tricks out of its sleeves in 2002 by releasing Sarafem - a treatment for PMS which is just Prozac in a fancy pink and purple pill; and Prozac weekly - the first and only once a week treatment for clinical depression. Prozac itself has since gone generic. Zantac comes in at fortieth only because it's really cheap. It will lose to its over-the-counter form as time goes by.

41 - 50
The last group finishes our examination. A medicine for insomnia leads the pack. Ambien helps you go to sleep, but wears off in about two hours so you wake up without a medicine hangover - great stuff, but pricey. Celexa is a relative antidepressant newcomer whose lack of side-effects should propel it up the list soon. Elavil is a much older and cheaper antidepressant, but has more side-effects to counteract the cost savings. Fosamax in the first of a new class of medicines which treat osteoporosis. These medicines should overturn the popularity of the prescription estrogens in the coming years. They basically act similar to fluoride by becoming incorporated into the actual structure of the bones, strengthening them. Next, another cheap blood pressure medicine, and then the little blue pill - Viagra - Vitamin V. "The Problem" isn't quite as common as Bob Dole seems to think - although it could be the ten bucks a pop they charge too. Pravachol - a cheap cholesterol pill, and Naprosyn, a cheap arthritis pill come next; then Neurontin - another multipurpose medicine which began life as a seizure medication, and is now used for migraines and neuralgias. Nobody really knows exactly what it does, but nobody much cares either if it works. Number fifty is Coumadin, an anticoagulant used to prevent recurrence of strokes and heart attacks, and also other blood clotting disorders.

Overall, the buzz of Vicodin wins out overall. Pleasure wins over effectiveness, effectiveness and convenience usually beat price, and marketing always wins all else being equal. Common problems remain common, and hypothyroidism continues to be underdiagnosed. My prescription? Change Vicodin to a Class II drug. It won't solve everything, but it'll make doctors', pharmacists', and ultimately addicts' lives much better.


Author's note - if you node any of the unlinked medications listed above, or those with only rudimentary nodes, /msg me and I'll link them. Take a look at E2 FAQ: Prescription medications too - it may be helpful to you.

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