I thought this might be a fun entry – comparing the most-prescribed medications in America with those at Tansen Hospital.
According to a recent Medscape survey, the top 10 most-prescribed drugs in America, 2013-14 were the…
1. Hypothyroid medicine levothyroxine (Synthroid)
2. Cholesterol-lowering drug rosuvastatin (Crestor)
3. Proton pump inhibitor (PPI) anti-reflux medicine esomeprazole (Nexium)
4. Asthma inhaler albuterol (Ventolin)
5. COPD inhaler fluticasone/salmeterol (Advair)
6. Atypical antidepressant duloxetine (Cymbalta)
7. Angiotensin-receptor blocker (ARB) antihypertensive valsartan (Diovan)
8. ADHD stimulant drug lisdexamfetamine dimesylate (Vyvanse)
9. Long-acting injectible insulin glargine (Lantus)
10. Antiepileptic pregabalin (Lyrica), used off-label for chronic pain/ fibromyalgia
My pharmacist colleague Jackie recently spent an afternoon trawling through several days’ dispensing records for me, and compiled this list of Tansen’s most-prescribed medications.* Interestingly, the two lists are more similar than you might expect:
1. PPI anti-reflux medicine omeprazole (Prilosec)
2. Anti-diabetic drug metformin (Glucophage)
3. Tricyclic antidepressant (TCA) amitriptyline (Elavil)
4. Multivitamin capsules
5. Analgesic paracetamol (Tylenol)
6. Calcium channel blocker (CCB) antihypertensive amlodipine (Norvasc)
7. Antihistamine anti-reflux medicine ranitidine (Zantac)
8. ACE-inhibitor antihypertensive enalapril (Vasotec)
9. Calcium tablets
10. Oral systemic steroid prednisolone (Orapred)
*Even though trade-names are pretty much irrelevant here, I’ve included them in order to help make them more recognizable for my State-side physician friends. It was also a good exercise in reminding ME what those already-forgotten trade names are…!
Neither record review was particularly rigorous, but these lists give at least a sense of what some of the biggest (medically-treated) ailments are in our two countries. Depression, gastric reflux and high blood pressure seem to be quite universal.
Of note, alcoholism is a huge problem across Nepal, although this is not necessarily apparent from our prescribing habits. After all, diuretics and laxatives (spironolactone, furosemide, lactuose) are the only medicines we have here to treat cirrhosis, the final stage of alcohol-related liver disease, and its complications. And I suspect that cirrhosis rates may still increase in the coming years, as the long-term effects of chronic alcohol use manifest in a population that is still, at present, quite young.
Even though we see a huge amount of COPD (chronic obstructive pulmonary disease, or emphysema) here, it is almost always due to archaic open-fire cooking practices that are, thankfully, being made obsolete by the introduction of safer, cleaner-burning fuels. Having spent one afternoon in a friend’s mud hut while she cooked a (fabulous) meal entirely over an open wood-fire pit, it’s easy to see why so many women present with advanced emphysema by the age of fifty. It’s also not uncommon to see an associated end-stage complication here called cor pulmonale, a kind of heart damage caused by COPD that is relatively rare in the West.
And of course, as Nepal continues to develop, infectious diseases like tuberculosis and gastroenteritis will be increasingly replaced by those more “modern” diseases that accompany abundance and an increased life expectancy – diabetes, hypertension, heart disease, stroke and cancer.
It’s honestly hard to say, though, which would be preferable.