Sensible Erection | Why no one should take Nexium and it should never have been approved

Monday, 9 January 2012

Why no one should take Nexium and it should never have been approved

quote [ The only active ingredient in Nexium is the exact same thing as the only active ingredient in omeprazole (Prilosec), a (now) generic drug made by the same company, which is over the counter and four to eight times cheaper. AstraZeneca just figured out how to purify out the active component from omeprazole, the S-enantiomer esoomprazole. ]

[sci&tech] [by f00m@nB@r@11:08pmGMT] [+6 Interesting]

Comments

donnie said @ 11:28pm GMT on 9th Jan [Score:5 Informative]
I told this to my mom, who has taken both of these for GERD. What the article does not explain is this :

Losec (aka omeprazole) is a roughly equal mixture of two stereoisomers of the same compound - these are chemical compounds which are identical save for a mirror inversion (think of your left and right hands, for example).

About half of people are capable of metabolizing both isomers (left and rich handed species) of the drug and for those people the full dosage of omeprazole is effective at inhibiting proton pump action. The other half of people are only capable of metabolizing the S-isomer of the drug and for them the equivalent dosage is only half as effective (since only half of the isomers are effectively functional).

For the people in the latter group the same mass-dosage of Nexium would be twice as potent. For those in the former group the effect would be identical. If Nexium has any redeeming quality it is that dosage does not need to be 'felt out' for the patient depending on whether they are a full or only a partial metabolizer. This is perhaps easier for the doctor, but for the patient there is little benefit to paying full price for Nexium.

For the record, donnie again re-iterates his position in opposition of intellectual property laws.

donnie said @ 11:39pm GMT on 9th Jan [Score:4 Informative]
Both enantiomers of omeprazole are equipotent, however, their metabolism is different. (R)-omeprazole is mainly metabolised by the polymorphic CYP2C19 enzyme. There is a 7.5-fold difference in the systemic exposure to (R)-omeprazole in patients who are poor metabolisers compared to extensive metabolisers. With (S)-omeprazole this difference is reduced to about three-fold so it was argued that use of esomeprazole would be associated with less inter-individual variability in efficacy. However, there are few data to support this theoretical advantage3 , especially when only 3% of the Caucasian population are poor metabolisers. There may be a benefit in the Asian population where the incidence of poor metabolisers is about 20%. A rationale for chiral switching to esomeprazole might therefore be based on ethnic differences in metabolism.

LINK

ref : 3. Do single stereoisomer drugs provide value? Therapeutics Letter 2002; 45. http://www.ti.ubc.ca/pages/letter45.htm [cited 2004 March]

donnie said @ 11:41pm GMT on 9th Jan
Links above... I didn't quite get it right from memory - some are fast metabolizers of the R-isomer, others are slow metabolizers. Bioavalability varies, in any case, and the split is more like 3-97% among caucasians, higher among asians, as above.

structured_spirits said @ 11:54pm GMT on 9th Jan
I think the question is more of a legal question as to whether nexium is actually a different chemical than prilosec. As it happened the same company brought both to market, according to the article, with the intention of doing a runaround of an expiring patent to gouge consumers. My question is if nexium had been developed by another company, should they have been allowed to patent it and sell it under a different name from the already-patented prilosec?

donnie said @ 12:04am GMT on 10th Jan
You're barking up the wrong tree. I would scrap the patent system entirely if it were up to me. This is just one example of why.

maryyugo said @ 6:07pm GMT on 10th Jan
Wait... what? What prevents anyone who wishes to from buying the generic? What did I miss here?

donnie said @ 10:49pm GMT on 10th Jan
Nothing... except about 20 years.

lilmookieesquire said @ 11:59pm GMT on 9th Jan [Score:1 Insightful]
JUST MORE LIBERTARIAN PROPAG- oh. No. No wait. That was terribly informative. Never mind. Habits and all. Please carry on.

strangeffect said @ 12:07am GMT on 10th Jan
donnie says vacuum

http://youtu.be/GMpTqa8iICs

sacrelicious said @ 12:55am GMT on 10th Jan
my rich hand is always lording it's vast wealth over my left hand.

structured_spirits said @ 11:29pm GMT on 9th Jan
Wow, they patented the same drug twice. So do they get a fine from the feds or something?

sacrelicious said @ 12:57am GMT on 10th Jan
HAHA, good one!

sythe said @ 11:29pm GMT on 9th Jan [Score:1 Informative]
While I agree it should never have been approved, there is actually a statistically small percent of the population that reacts poorly to the R enantiomer and thus could benefit from esomeprazole. That said, there's a fist full of other PPIs on the market they could use instead.

headlessfriar said @ 11:31pm GMT on 9th Jan
PPIs? Purple Pill Inventions?

sythe said @ 11:36pm GMT on 9th Jan
Proton pump inhibitors, i.e. Nexium, Protonix, Prilosec, Aciphex, etc.

sua_sponte said @ 11:34pm GMT on 9th Jan
This article gives me heartburn.

mechanical contrivance said @ 11:36pm GMT on 9th Jan
Esoomprazole sounds like an Italian dessert.

sanepride said @ 11:44pm GMT on 9th Jan
My wife takes Pantaprazole, which I like to sing opera-style, to the tune of O Sole Mio.

atter_cob said @ 11:49pm GMT on 9th Jan [Score:1 Insightful]
Meh. Compared to other issues in the healthcare industry this is not worth worrying about. Big deal, they got a patent on a minor variation in the drug they already had a patent on. As long as they both are safe and do what they are supposed to do without nasty side effects I don't care much. If Nexium really is identical to Prilosec at 5x the price then I'll just look at it the same way I regard "audiophile" HDMI cables... a scam for the people with more money than brains. If there is a difference for some people, as some people say there is, then clearly having the extra option is a good thing.

	rndmnmbr said @ 11:59pm GMT on 9th Jan Yeah, if your doctor gives you a script for Nexium, go buy Prilosec OTC and pocket the difference. Tell your parents to do the same thing. It's not like this is
	rndmnmbr said @ 12:00am GMT on 10th Jan Whoops.

rndmnmbr said @ 12:01am GMT on 10th Jan
There. Properly closed tags, etc.

It's not like this is the first time drug companies have tried this: http://pipeline.corante.com/archives/2008/03/19/now_your_liver_doesnt_have_to_make_it_for_you.php

sythe said @ 3:04am GMT on 10th Jan
The biggest issue with that thought process is that the insurance companies largely stopped paying for omeprazole, while they'll pay through the teeth for esomeprazole (if you jump through the right hoops).

rndmnmbr said @ 4:42am GMT on 10th Jan
And thus you should take whichever option is cheaper for you in the long run.

Omeprazole over the counter is a godsend for people who need it but can't get it covered by insurance. My grandmother and I sorted through a bunch of Medicare part D plans, looking for one to cover both her sleeping pill and omeprazole/esomeprazole. After coming up bupkis, I told her to get the one that covered everything but omeprazole, and we'd pay for that over the counter.

sacrelicious said @ 12:47am GMT on 10th Jan [Score:2 Insightful]
this is one of many reasons I think it was a fucking catastrophic mistake to allow prescription drug advertisements on television in the 90's.

mechanical contrivance said @ 2:09am GMT on 10th Jan
But then how would people know which prescription drugs they need?

sacrelicious said @ 3:23am GMT on 10th Jan [Score:3 Funny]
good point, that is a flaw in my plan. I'm sure a solution could be found, but it would probably take some kind of PHD to figure it out...

hellboy said @ 3:44am GMT on 10th Jan
True! I mean, their doctors can't be trusted, just look at their pens (and their golf trips).

mrcucumber said @ 1:02pm GMT on 10th Jan
If I remember correctly, you can thank Ronald Reagan for allowing BiGpharma to advertise to people who can't even buy it, only request it. It generates, cash, you know, fuels the economy.

sacrelicious said @ 3:54pm GMT on 10th Jan
I don't think prescription drug TV ads happened that early. maybe it was rooted somehow in Reagan-era policy, but I pretty clearly remember the ads actually hitting the television screen in the late 90's.

mrcucumber said @ 1:54pm GMT on 14th Jan
How Does the Drug Industry Get Away with Broadcasting Those Deceptive Ads?

However, things began to change in the 1980s. In 1981, Merck published the first DTC ad for a prescription drug, Pneumovax, in Reader’s Digest. It was followed by numerous print ads, and in 1983, the first television prescription drug ad for Boots Pharmaceutical’s Rufen, prescription strength ibuprofen.

Over the next decade-plus, the pharmaceutical industry, emboldened by the Reagan-era belief in “limited government,” steadily pushed to deregulate DTC ads.

follywaggle said @ 12:58pm GMT on 10th Jan [Score:1 Underrated]
Here's my experience. Probably TMI.

I have Barrett’s esophagus and a hiatal hernia and have been on PPI's since 2006. My doc started me on Nexium which my insurance covered so it was no big deal to me. Since my teens I would have heartburn and reflux for weeks at a time no matter what I did and now the Barrett's made it potentially life threatening. The Nexium helped greatly. Still had occasional episodes but they were short lived.

In October of 2009 my insurance stopped covering Nexium. I tried a few weeks of Prilosec and it wasn't working at all. It felt as if I wasn't taking anything. I then paid for Nexium out of pocket both to relieve my symptoms and in fear of having the Barrett's turn in to esophageal cancer.

It was in 2010 that I started having other issues/pains (arthritis was setting in but I didn't know it at the time) mostly in my feet at the time so I sought out other remedies for those issues. The podiatrist prescribed Celebrex but I wasn't comfortable taking it for long and it wasn't working consistently anyway. What sort of worked was taking Curcumin, Ginger, and Omega 3 supplements daily. It didn't completely get rid of the pain but it helped greatly. After taking these for a while I also noticed my stomach issues completely subsided. This continued for a while where my heartburn/GERD was all but gone but the pains in my feet and now back/hips/chest were getting much worse. I also started changing my diet, basically anything to alleviate the pain.

My podiatrist referred me to a rheumatologist who diagnosed me with spondyloarthropathy and put me on humira. This made all the difference in the world for the arthritis pain. I went from barely making it from one room to another because it hurt so much to move moving around pain free. A week after being on humira I kicked a soccer ball to my son. My wife broke down into tears. I looked at her and she said it's the first time she saw me do that in a few years. I didn't realize it had been so long.

Anyway, after being symptom free and talking to my gastro doc early in 2011 I tried Prilosec again and this time it worked fine. I have been on Prilosec for months now without issues. I still take Curcumin and Ginger a few times a week and eat more fish for the Omega 3.

Rojo^ said @ 4:09pm GMT on 10th Jan
I've also noticed that the more weight I put on, the less effective Prilosec is. If I get over 260, I pretty much have to take omeprazole every day. It only lasts for 18 hours or so, and I have to munch on antacids before bed.

When I'm 250 or below, I have much fewer problems while on omeprazole, and I never even think about my Rolaids. Maybe once every two weeks I'll get a small smoldering reminder that it's time to start another three or four days of omeprazole, and I'm good the rest of the time.

So maybe it's your curcumin and ginger that's helping, or maybe you're simply in better health after changing your diet and so forth. In any case, I'm glad the Prilosec is working well for you now.

follywaggle said @ 12:35pm GMT on 11th Jan [Score:1 Interesting]
YMMV but I'd give curcumin a try. No negative side affects from what I read and have experienced. I first tried it because of the claimed benefits for arthritis and supposed cancer fighting abilities. Then found it settled my stomach issues as well. When my older brother tried it he said he has had the first nights of sleep without waking up from gastro issues in a long time.

Here's an article on it from the Mayo Clinic.

Another from the American Cancer Society

maryyugo said @ 6:11pm GMT on 10th Jan
Caution with Humira:

"Because adalimumab suppresses TNF, which is part of the immune system, latent infections, such as tuberculosis, can be reactivated, and the immune system may be unable to fight new infections. This has led to fatal infections.[19]

According to the product labeling, after a number of studies and reports of adverse events in patients receiving adalimumab, including serious and sometimes fatal blood disorders, serious infections including TB (tuberculosis) and infections caused by viruses, fungi, or bacteria, rare reports of lymphoma[20] and solid tissue cancers, rare reports of serious liver injury, and rare reports of demyelinating central nervous system disorders, rare reports of cardiac failure, the U.S. Food and Drug Administration issued a black box warning to doctors which appears in the product labeling of adalimumab and the other TNF drugs instructing them to screen and monitor potential patients more carefully.[21]"

From the wiki

follywaggle said @ 2:37am GMT on 11th Jan
Blood screenings every 3 months will keep an eye on things.

From the doctor.

Unless you count surfing to consumptionjunction a decade or so ago.

pishiver said @ 1:24pm GMT on 10th Jan
Meh, I take nexium for my acid-reflux..it's prescribed to me & I get it free through my health plan...the article headline is misleading as it makes it seem as though there is something dangerous about the drug...

And I've seen a few people on that page in the comments section saying crap like "just take tums instead!"...they have no idea what the fuck they are talking about. If I were to go on tums only, I'd be popping them every half-hour(I know this because this is what happens if I forget to refill my Rx before a long weekend). That is just WAY too much fucking calcium.

Rojo^ said @ 3:56pm GMT on 10th Jan
For me, generic OTC omeprazole is usually cheaper than my insurance co-pay would be for Nexium, plus I don't have to keep going to the doctor or calling to have my prescription renewed. One 42-count box of omeprazole is usually around $20, and sometimes comes with a $3 or $5 register reward if I'm lucky. $15 for 3 months' worth of heartburn meds = win.

Omeprazole works much better for me than Zantac, Pepcid, Tagamet, or whatever else I've tried. I actually asked my doctor for a prescription for Nexium because all the OTC stuff I'd tried was so fail. She turned me on to Prilosec, telling me it was basically the same thing as Nexium, just with an expired patent.

That new drug Zegerid has the same 20mg dosage of omeprazole, but includes sodium bicarbonate as well. For some reason the sodium bicarbonate seems to dull the effectiveness of omeprazole for me. Plus, the bigass horse pills are unpleasant. I got it on sale and with register rewards this time; but when I run out, I'm going back to the generic stuff.

iosef said @ 5:08pm GMT on 10th Jan
this is a pretty common scam by the pharma cos. patent on your cash cow pills running out? no problem, patent some minor variation that may or may not be more or less effective for some fuzzy proportion of patients. market the shit out of the new variation, and wham. continued monopoly pricing.

the minor variation doesn't even have to be chemically any different. It can be as simple as an 'extended release' formula. usually any other pharma co could have produced the same thing with minimal R&D. are the lapdogs at the FDA going to stop you? no.

The real tragedy here is that people who do get some benefit from enantiomerically pure esomeprazole aren't going to have access to it for cheap, because spineless regulators have awarded the patent to AstraZeneca.

rndmnmbr said @ 5:15pm GMT on 10th Jan [Score:1 Insightful]
The important part is, the patent on the original formulation still runs out, and generic companies can then produce it for a tenth of the price.

If your doctor insists on only prescribing the expensive stuff, and won't work with you to find a cheaper option with generic drugs, then you need to find another doctor.

maryyugo said @ 6:12pm GMT on 10th Jan
Eggzacktlee