CONSUMER REPORTS BEST BUY DRUGS: When Headaches Beget Headaches; Plus, "Best Buy" for Treating Migraines Could Save Consumers Hundreds of Dollars a Year

Money Saving Strategies for Prescription Drugs

YONKERS, N.Y., May 6 /PRNewswire-USNewswire/ -- People suffering from chronic headaches can easily fall prey to "rebound headaches," overdoing it with non-prescription pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, and generics), and naproxen (Aleve and generics), in addition to certain prescription pain medications, including drugs to treat migraines.  Current estimates indicate that one in four adults exceeds the recommended dosage on nonprescription pain medications and, according to a recent Consumer Reports online survey of 47,283 subscribers, even more people (31 percent) fess up to not carefully following the directions on the label.  

"It's not uncommon for people to experience medication-overuse headaches," said Orly Avitzur, M.D., medical adviser, Consumer Reports Health, and a practicing neurologist.   The same online survey by Consumer Reports suggests that people don't consider nonprescription pain medication to be as "serious" as prescription drugs.  "It often comes as a surprise to my patients when I tell them that overuse of an over-the-counter medication such as ibuprofen or aspirin may be causing their headaches.  We all keep these OTCs in our medicine cabinets and I think many of us are so accustomed to them that we may underestimate the risk of overmedicating," added Dr. Avitzur.  

According to another recent Consumer Reports survey of more than 6,000 subscribers, 73 percent said they kept acetaminophen (Tylenol and generics) in their medicine cabinets, and the same percent kept ibuprofen on hand, while 69 percent had aspirin in their medicine cabinets.

A new Consumer Reports Best Buy Drugs report recommends seeing a doctor if you suffer from chronic headaches or migraines, which afflict nearly 20 percent of women and 6 percent of men.   The report, available for free online at www.ConsumerReportsHealth.org/BestBuyDrugs, helps consumers differentiate between the most common tension-type headache and the less common cluster headaches and migraines, which can be incapacitating. Migraines are a leading cause of absenteeism and decreased work productivity, exacting a higher price to society than other chronic conditions including asthma, depression, diabetes, and heart disease.  

The report provides a detailed evaluation of a group of drugs called the triptans, which have become the most commonly prescribed remedy for migraine patients when an attack occurs.  While doctors are unclear how they work, the drugs are known to affect how the nervous system handles serotonin, which is involved in pain processing.  Consumer Reports Best Buy Drugs, a public information project, uses comparative effectiveness research to compare the safety, effectiveness and cost of drugs for more than 20 common medical conditions.  For this report, Consumer Reports BBD looked at more than 1,600 peer-reviewed studies and from there focused on 98 studies that directly compared one triptan with another or with other migraine medications or a placebo.  

"Before considering a prescription medication, such as a triptan, I advise patients to remove as many offending triggers as possible to manage or prevent migraines.  Typical triggers include certain foods like chocolate and cheese; red wine; dehydration; getting too little sleep; and skipping meals," said    Dr. Avitzur, who recommends keeping a daily diary to help track down triggers over time.

When that doesn't work, and when over-the-counter pain remedies haven't helped sufficiently, some people find relief with prescription medications.  As a class, triptans can be expensive: a single dose ranges in cost from $21 to $157, depending on the dosage and the form the medication comes in (tablets, nasal spray, or injection).  For people with frequent migraines, the cost of multiple doses of a triptan drug can add up and may even pose a barrier to treatment.   The generic version of sumatriptan, a Consumer Reports Best Buy Drug, can save migraine sufferers hundreds of dollars annually if their migraines are serious enough to warrant the use of a triptan.  Sumatriptan is currently the only triptan available as a generic, making it the least expensive in the category.  Because it is the oldest triptan on the market, sumatriptan has a long established safety profile.

A month's supply of sumatriptan (assuming a 25 mg dose taken two times a month) can cost  $48, whereas the same dosage of the branded version, Imitrex, can cost $78.  For consumers, switching to generic sumatriptan could represent a savings of $360 over the course of a year. Triptans are generally safe medications when used appropriately and prescribed for the correct patients, but they should not be taken by people with certain conditions and risk factors for heart disease and stroke.   Triptans have several significant limitations, including side effects such as dizziness, fatigue, and, sleepiness. And, like many headache drugs, they can cause "rebound headaches" -- migraines that are brought on by repeated use or overuse of the drug itself.

Triptans are just one of several classes of drugs with an unusually high price tag.  Consumer Reports BBD helps consumers get the best value for their health care dollars by identifying "Best Buys" based on safety, efficacy, and cost.  Consider the following cost saving tips:

MONEY SAVING STRATEGIES FOR PRESCRIPTION DRUGS

• First check our free CR Best Buy Drug reports to find out whether generics are more cost-effective for treating your condition than drugs available as brand name only. Then ask your physician or pharmacist about switching to those or other generic versions of the drugs you need.
• Let your doctor know that cost is an issue for you.  Many people are reluctant to discuss the cost of their medicine with their doctor, and studies have found that doctors do not routinely take the price of medication into consideration when they prescribe.  Also, discuss the option of pill splitting, an effective cost saving measure for some types of medications.  
• Ask for the cheapest form. We have found that prices of the same drug might vary substantially depending on whether it's a capsule or tablet.
• Keep in mind that older drugs are often just as good.  The evidence is now convincing that many older drugs available as low cost generics are as good as, or better than, the pricey new ones coming on the market.
• Know that drugs within a class or group aren't always different.  Drug makers argue that each drug is unique and that each person may respond differently to it.  That's true, but it's also true that in some classes of medicines, there are several drugs that achieve pretty much the same results for most people. In other words, your doctor can substitute one for another.
• If you have health insurance, you can find out which drugs are covered by your pharmacy benefits manager (PFB). The PFB determines which drugs that are covered and may have a special relationship with a given pharmacy.
• Consider a loyalty card.  Whether you're insured or not, look into a pharmacy discount card which can save you as much as 10 to 20 percent.  
• Shop around. A recent report about drugstore savings by Consumer Reports found that large discount stores like Costco and Walmart are now competing for your prescription business.  Prices can vary so it's best to shop around.
• Ask your pharmacist to match lower prices. Many independent pharmacies will match prices found at the large, big-box retail stores. It makes sense, too, if you want to stick with one pharmacy, which can reduce the chance of taking incompatible drugs. Wherever you buy drugs, note all the medications and supplements you take so that the pharmacist can check for potential interactions.

MAY 2010

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SOURCE Consumer Reports