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Monday, July 13, 2009


So what would you say is the best drug out there now?

What should the criteria be? Low cost. Effective. Easily dosed at once a day. Curative. Likely to be reimbursed by one's insurance, that is, it won't require prior authorization.

Hard to beat Penicillin VK. Inexpensive and curative. But wait. There are so many bugs out there resistant to it that curative is now iffy. And it is dosed at one tablet every six hours. How many times do you remember to take those things every six hours? Thought so.

Prilosec OTC? Often reimbursable by insurance, it is powerful enough to be considered curative. Even if you don't have an insurance that will pay for it it isn't terribly expensive and you can pick it up right off the shelf. Once daily dose, too.

Steering away from strictly OTC drugs though (like Zantac, Pepcid, etc. which are all quite good), what else? Generic Fosamax is a good one: cheap and effective for osteoporosis, the drug is dosed once a week. Curative, though? Well, I wouldn't go that far.

Carvedilol? Generic and inexpensive (Wal*Mart has it on their $4 list), it is dosed at twice a day--not the once a day that the CR has but still respectable. A member of the beta-blocker class for heart problems and lowering blood pressure, carvedilol (brand name Coreg) has recently had a run of great press in the clinical literature, to the point that if you just had a doctor give you a prescription for a beta-blocker other than carvedilol then you should make a point of having it rewritten. It seems to be that good. Beware of prescriptions written for Coreg CR though: this is merely an attempt by its manufacturer, GlaxoSmithKline, to lengthen it patent rights by altering slightly—and not significantly affecting its effectiveness—the dose form into a controlled release form. The price of the CR form is high and will often require a prior authorization from your insurance. Get the generic.

So for my money, I would be hard pressed to come up with a better drug than carvedilol. For those on the drug, I say, "Well done, and bon appetit!"

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