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inappropriate prescribing


Disease and Drug Family Information
  • Antibiotics [hide all summaries]
    Antibiotics (drugs used to treat bacterial infections) are overwhelmingly misprescribed in the United States. Despite congressional hearings and numerous academic studies on this issue, it has become the general consensus that 40 to 60% of all antibiotics in this country are misprescribed. New studies continue to confirm the fact that a large proportion of antibiotic prescribing for both children and adults continues to be inappropriate.
  • Antipsychotic Drugs: Dangerously Overused [hide all summaries]
    Antipsychotic drugs, also called neuroleptic drugs or major tranquilizers, are properly and successfully used to treat serious psychotic mental disorders, the most common of which is schizophrenia. In younger adults, an alarming number of those with schizophrenia who could and often have previously benefited from antipsychotic drugs are not receiving them. They are seen, among other places, on the streets and in homeless shelters. In older adults, the problem is not underuse but, rather, gross overuse by people who are not psychotic.
  • Depression: When are Drugs Called For And Which Ones Should You Use? [hide all summaries]
    Ironically, one of the kinds of depression that should not be treated with drugs is depression caused by other kinds of drugs. If someone is depressed and the depression started after beginning a new drug, it may well be drug-caused. Commonly used drugs known to cause depression include the following:
  • Diabetes Prevention and Treatment [hide all summaries]
    Diets that are very complicated or very different from what you are used to are hard to follow. The American Diabetes Association (ADA) diet is a highly structured plan based on exchange lists. Although it serves its purpose of regulating calorie and sugar intake quite well, the ADA diet may be difficult for older people to use. Successful use of this diet requires considerable time spent planning meal patterns and food portions. Older people often have trouble with this diet because the food lists are long and complicated and require considerable memorization.
  • Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder [hide all summaries]
    To correctly establish the diagnosis of ADHD requires the use not only of medical but also of special psychological, educational, and social resources. Many children diagnosed with ADHD actually have problems that are primarily caused or worsened by inadequate teachers, unsuitable educational settings, or by problems with their parents. Similarly, many adults diagnosed with ADHD may have interpersonal problems that need to be dealt with by psychotherapy.
  • Fluoroquinolones [hide all summaries]
    One of the biggest-selling and most overprescribed classes of drugs in the United States is the family called fluoroquinolones. One clue that a drug your doctor wants to give you is in this class is the fact that the generic names of all such drugs approved in the United States include the sequence floxacin. These drugs have been alternatives for individuals allergic to, or with infections resistant to, other antibiotics. Some fluoroquinolones are commonly misprescribed for colds, sore throats, bladder infections, or community-acquired (as opposed to hospital-acquired) pneumonia.
  • Misprescribing and Overprescribing of Drugs [hide all summaries]
    The numbers are staggering: in 2003, an estimated 3.4 billion prescriptions were filled in retail drugstores and by mail order in the United States. That averages out to 11.7 prescriptions filled for each of the 290 million people in this country. But many people do not get any prescriptions filled in a given year, so it is also important to find out how many prescriptions are filled by those who fill one or more prescriptions. In a study based on data from 2000, more than twice as many prescriptions were filled for those 65 and older (23.5 prescriptions per year) than for those younger than 65 (10.1 prescriptions per year).
  • Penicillins and Cephalosporins [hide all summaries]
    Penicillins are a group of antibiotics used to kill bacteria or prevent infections. They are probably the least toxic of all the antibiotics. The penicillins are some of the most commonly prescribed antibiotics and are often the drugs of choice for people who are not allergic to them. Cephalosporins are relatives of the penicillins and have a similar, if slightly expanded, range of action. They have a good safety record but certain problems can occur with their use. Diarrhea is the most common adverse effect, and it may become so bad that treatment must be stopped.
  • Sleeping Pills and Tranquilizers [hide all summaries]
    Older adults have a much more difficult time eliminating benzodiazepines and similar drugs from their bloodstreams and these drugs can thus accumulate in their bodies. Also, older adults are more sensitive to the effects of many of these drugs than are younger adults. For older adults the risk of serious adverse drug effects is significantly increased. Serious adverse effects may include: unsteady gait, dizziness, falling (causing an increased risk of hip fractures), increased risk of an auto accident, drug-induced or drug-worsened impairment of thinking, memory loss, and addiction.
  • Tetracyclines [hide all summaries]
    Tetracyclines are rarely the antibiotics of choice to treat bacterial infections that are common in older adults. In general, tetracyclines are used to treat such infections as urethritis (inflammation of the urinary tract), prostate infections, pelvic inflammatory disease, acne, Rocky Mountain spotted fever, recurrent bronchitis in people with chronic lung disease, walking pneumonia, and other miscellaneous infections.
Additional Information from Public Citizen
Health Letter Articles
  • Proton-Pump Inhibitors: Dangerous and Habit-Forming Heartburn Drugs [hide all summaries]
    (September 2011)
    PPIs are now one of the most widely used classes of prescription drugs, with an estimated one out of every 20 people in the developed world currently taking one of these medications. However, given that recent research shows PPIs may be habit-forming, that the majority of PPI use is probably inappropriate, with minimal or no benefit to the patient, and that new, life-threatening risks with long-term therapy are continually emerging, it is time for the medical community to re-evaluate the role of PPIs in everyday practice.
  • What is Comparative Effectiveness Research, and Why is it Being Badmouthed? [hide all summaries]
    (June 2009)
    Comparative effectiveness research permits comparisons between existing therapies to establish whether they are safer or more effective than one another. The pharmaceutical industry opposes these studies because it doesn't want you to know the truth about these therapies.
  • Fairness Creams in South Asia — A Case of Disease Mongering? [hide all summaries]
    (September 2006)
    Promoting a particular body image or behavior pattern as the preferred one and then selling medicines or products to help people attain the particular ideal may be regarded as disease mongering. Fairness cream manufacturers have exploited the preference for fair skin, portrayed it as a necessary prerequisite for success, and promoted the use of their product to achieve the ideal. Controlled studies on the efficacy and safety of fairness creams are lacking.
Worst Pills, Best Pills Newsletter Articles
  • Testosterone Use Linked to Increased Risk of Heart Attacks [hide all summaries]
    (March 2014)
    There is a growing body of evidence indicating that testosterone treatment exposes men to an increased risk of adverse cardiovascular events, such as heart attack and stroke, as well as death. This article reviews the results of two recently published studies that provide the most compelling evidence yet linking testosterone use to increased cardiovascular risk.
  • How Effective Are Antidepressants for Depression? [hide all summaries]
    (February 2014)
    Some degrees of depression are less likely to respond to treatment with an antidepressant. This article reviews the evidence and evaluates 27 different antidepressants, labeling many as Do Not Use or Limited Use.
  • FDA Restricts, EMA Moves to Ban Ketoconazole Tablets [hide all summaries]
    (January 2014)
    A dangerous and easily substituted antifungal drug presents yet another example of Europeans being more protected from dangerous medicines by their regulatory authorities than Americans.
  • Unproven Laxative Widely Used for Childhood Constipation [hide all summaries]
    (December 2013)
    Learn about the problems of a common over-the-counter laxative, widely used for children but never approved for their use. We discuss the preferable, safer alternatives for treating constipation.
  • FDA Moves to Loosen Restrictions on Diabetes Drug Avandia [hide all summaries]
    (September 2013)
    The FDA is considering relaxing the restrictions on the unacceptably dangerous drug rosiglitazone (AVANDIA) so that more people can access it, even while it remains banned in European countries.
  • “Medicalizing Normality”: Potent Acid Reflux Drugs Overused in Infants [hide all summaries]
    (September 2013)
    The overuse of acid reflux drugs in adults has been well documented. Even worse, there is now evidence of an 11-fold increase in the use of these drugs to treat infants, mostly due to a benign condition for which the risks clearly outweigh any benefit. The article discusses effective, time-honored, nondrug remedies for this benign condition.
  • Overprescribed Antibiotics Hurt One, Hurt All [hide all summaries]
    (June 2013)
    To protect yourself and others, when your doctor pulls out a pen to write a prescription for an antibiotic, you should ask him or her, especially if you are not feeling very sick: Do I really need this? And why?
  • Statins for Primary Prevention: Risks Without Benefits [hide all summaries]
    (June 2013)
    For people who have had heart attacks, strokes and other cardiovascular diseases, statins can prevent further damage. But for primary prevention — in people without such disease — a number of articles raise serious questions about whether the risks of statins outweigh the benefits.
  • Accentuate the Positive, Eliminate the Negative [hide all summaries]
    (May 2013)
    A study documents how little information about important drug risks is disclosed by the drug salespeople who visit so many doctors. Their strategy for increasing sales: Accentuate the positive and almost entirely eliminate the negative about these medicines.
  • New Hypertension Drug Poses Breathing Risks [hide all summaries]
    (May 2013)
    The article discusses possible breathing risks of nebivolol (BYSTOLIC)and how other, older drugs — just as effective as this relatively new high blood pressure drug — are preferred because more is known about their risks.
  • FDA Should Change Labels On Opioid Painkillers to Deter Misprescribing [hide all summaries]
    (September 2012)
    The article reviews a recent petition to the FDA seeking improvements on the labels of prescription opioids (narcotics). The label change would prevent drug companies from promoting these drugs for noncancer pain for dangerously long periods of time, at doses that are too high, and for uses other than severe pain in noncancer patients. The petition was signed by 37 public health experts, including leaders in the fields of pain medicine, addiction and primary care; the health commissioners of New York City and New York state; and Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group.
  • New Advice on Treating Sinus Infections With Antibiotics [hide all summaries]
    (August 2012)
    Learn the details of the large problem of misprescribing antibiotics for sinusitis, symptoms of the condition, limited indications for antibiotic use and alternative treatments for this very common illness.
  • Increased Risk of Cardiovascular Death With Azithromycin and Levofloxacin [hide all summaries]
    (August 2012)
    We review recent evidence that azithromycin (ZITHROMAX, as in Z-PAK) and levofloxacin (LEVAQUIN), used for relatively short periods, significantly increased the risk of cardiovascular risks such as sudden cardiac death in some patients, compared to the risks in people not taking antibiotics. The overprescribing of these drugs is also discussed.
  • Do Not Use: Duloxetine (CYMBALTA) [hide all summaries]
    (June 2012)
    We review the dangers of the extremely popular drug duloxetine (CYMBALTA) and discuss why you should not use it to treat depression, anxiety or pain.
  • Overuse of Antibiotics in Children [hide all summaries]
    (February 2012)
    A very recent study found that each year, children in this country get 10 million antibiotic prescriptions that are clearly unnecessary, creating risks of adverse reactions without any possible benefit.
  • Proton Pump Inhibitors: Dangerous and Habit-Forming Heartburn Drugs [hide all summaries]
    (November 2011)
    PPIs are now one of the most widely used classes of prescription drugs, with an estimated one out of every 20 people in the developed world currently taking one of these medications. However, given that recent research shows PPIs may be habit-forming, that the majority of PPI use is probably inappropriate, with minimal or no benefit to the patient, and that new, life-threatening risks with long-term therapy are continually emerging, it is time for the medical community to re-evaluate the role of PPIs in everyday practice.
  • No. 1 Rule for Safe Drug Use: Have ‘Brown Bag Sessions’ with Your Primary Doctor; Fill Out a Drug Worksheet [hide all summaries]
    (March 2011)
    The article details how you should review all of the medications you are using with your doctor. It also provides a drug worksheet for you to fill out with him or her. The worksheet, when shown to your doctors, may save you from being prescribed drugs that interact with each other or have other side effects that you might not have recognized as being drug-related.
  • Middle Ear Infections and Antibiotic Use in Children [hide all summaries]
    (November 2009)
    The article explaions how parents, in consultation with their doctors, in certain circumstances can safely avoid using antibiotics for treating children's middle ear infections.
  • Are We Now Twice as Sad? The Drug Industry and Doctors Think We Are! [hide all summaries]
    (October 2009)
    The use of anti-depressants in the U.S. nearly doubled in a 10-year period as drugs displaced "talk therapy" and the drugs came to be used for an ever-widening set of disorders.
  • Prescribing “Easy Fix” Placebo is Common [hide all summaries]
    (January 2009)
    In a recent survey of U.S. doctors, 55 percent of those responding stated that, in the past year, they had used a placebo, defined as “a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.” However, the prescribing of these "placebos" was not limited to the traditional inert "sugar pill" but also included actual drugs such as over-the-counter analgesics,sedatives and antibiotics, products that can have serious side effects even though, for the illnesses they were being used to treat, they would not be expected to have benefits beyond the patient expectation level. The article concludes with a discussion of the basis of our opposition to the use of placebos.
  • Massive Misprescribing of Inappropriate Drugs to Hospitalized Elderly Patients [hide all summaries]
    (September 2008)
    A nationwide study published in spring 2008 in the Journal of Hospital Medicine showed that nearly half (49 percent) of almost 500,000 hospital patients older than 65 have been prescribed one or more of 92 drugs known to be unnecessarily unsafe for older patients. 10,000 of these patients had four or more of these inappropriate medicines prescribed during their hospitalization. Among the most common categories of adverse drug reactions these inappropriately prescribed drugs can cause are excessive sedation, abnormally low blood pressure and bleeding. We list the 92 drugs in the article and give further details about the kinds of side effects these drugs can cause.
  • Avoiding Overuse of Proton Pump Inhibitors (PPIs) [hide all summaries]
    (March 2008)
    This article reviews evidence for the international epidemic of overuse of proton pump inhibitors (PPI), drugs used to treat ulcers and gastroesophageal reflux disease (GERD). There were 70 million prescriptions filled in U.S. pharmacies in 2006 for the four leading PPI drugs: esomeprazole (NEXIUM), lansoprazole (PREVACID), pantoprazole (PROTONIX) and rabeprazole (ACIPHIX). Find out about several serious side effects of these drugs such as increased community-acquired pneumonia, increased hip fractures and acute kidney inflammation. Learn about alternatives to using PPIs.
  • Improper Antibiotic Treatment for Bladder Infections [hide all summaries]
    (June 2004)
    In a recent study of more than 13,000 women going to a doctor because of a bladder infection, more than 95% of whom had an acute bladder infection (not a recurrent one), only 37% were prescribed the preferred treatment for this condition:
  • Serious and Growing Problem of Antibiotic Resistance [hide all summaries]
    (June 2004)
    In a current campaign to educate doctors and the public about the seriousness of the problem of antibacterial resistance, the Federal Centers for Disease Control, part of the Department of Health and Human Services, has published these worrisome statistics: Each year nearly 2 million patients in the United States get an infection in a hospital. Of those patients, about 90,000 die as a result of their infection. They recommend avoiding unnecessary use of antibiotics or the wrong antibiotic and list, for patients, principles to follow.
  • Direct-to-Consumer Advertising: Bad News for Most Patients and Doctors [hide all summaries]
    (April 2004)
    A recent study of patients and doctors has found that most people in both groups have very negative views about the impact of prescription drug direct-to-consumer (DTC) advertising campaigns, now costing the public — which ultimately pays for the campaigns — about $3 billion a year. The study, published in the Archives of Internal Medicine in February, examined the attitudes of 784 doctors, in Colorado and nationally, and 500 Colorado households about many issues concerning DTC advertising.
  • Prescription Drug Ads and High Drug Prices: A Relationship? [hide all summaries]
    (April 2004)
    According to a supplement put out by Advertising Age in March entitled Fact Pack 2004 Edition, with additional information taken from Ad Age’s web site, the pharmaceutical industry continues to be quite adept at maintaining its place among the leading advertisers. Four of the top 25 U.S. advertisers, in terms of spending in this country during 2002, were drug companies. The article urges that you do not waste your time looking at or listening to prescription (or over-the-counter) drug ads.
  • Dangerous, Inappropriate Prescribing Of Diabetes Drugs Metformin (GLUCOPHAGE), Rosiglitazone (AVANDIA), And Pioglitazone (ACTOS) To Patients With Heart Failure [hide all summaries]
    (September 2003)
    Government-sponsored research published in the July 2, 2003 Journal of the American Medical Association found that the diabetes drugs metformin (GLUCOPHAGE), rosiglitazone (AVANDIA), and pioglitazone (ACTOS) were being prescribed inappropriately to patients with heart failure and that the inappropriate prescribing of these drugs has been increasing over time.
  • Inappropriate Prescribing Of Fluoroquinolone Antibiotics, Ciprofloxacin (CIPRO), Gatifloxacin (TEQUIN), And Others [hide all summaries]
    (July 2003)
    In this study, the researchers evaluated 100 consecutive patients who went to the emergency room and received a prescription for a fluoroquinolone antibiotic. Of the 100 patients, 81 (81%) received a fluoroquinolone antibiotic for an inappropriate use. In 43 (53%) of these patients, a fluoroquinolone was found inappropriate because another antibiotic was considered first-line treatment, and in 27 (33%) patients there was no evidence of an infection and therefore no indication for the use of any antibiotic.
  • Long Term Hormone Replacement Therapy (HRT): The Demise of a Standard of Practice [hide all summaries]
    (September 2002)
    We hope that by now women have heard that one part of a large, long term, government sponsored clinical trial, the Women’s Health Initiative, evaluating hormone replacement therapy (HRT) was halted prematurely. The bottom line from this trial is that long term HRT’s risks outweigh its benefits. You should not be using hormone replacement therapy for any reason other than its very short term use to control the symptoms of menopause.
  • Neurontin (GABAPENTIN) - The Illegal Corporate Creation of a Blockbuster Drug [hide all summaries]
    (May 2002)
    A March 14, 2002, New York Times article revealed that the manufacturer of the seizure medication gabapentin (NEURONTIN) illegally promoted the drug to prescribing physicians for at least 11 “off-label” (unapproved) medical conditions, using their own employees, euphemistically called “medical liaisons.” Many of the bases for the safety and effectiveness of gabapentin for these 11 unapproved uses appears to have been fabrications by the corporation.
  • The Same Old Sad Story - Inappropriate Prescribing to the Elderly [hide all summaries]
    (February 2002)
    “Inappropriate medication use is a major patient safety concern, especially for the elderly population.” This is the first sentence of a study published in the December 12, 2001 issue of the Journal of the American Medical Association. The majority of the 33 drugs in this study have been on the market for years........
  • Do Not Use! Life-threatening Liver Toxicity with the Antidepressant Nefazadone (SERZONE) [hide all summaries]
    (February 2002)
    The Food and Drug Administration (FDA) informed pharmaceutical giant Bristol-Myers Squibb Co. on December 10, 2001 that it must add a black box warning to the professional product label, or “package insert,” for the antidepressant nefazodone (SERZONE), informing doctors and pharmacists that life-threatening liver damage can occur with this drug.
  • No Evidence to Support the Use of Progesterone in the Management of Premenstrual Syndrome (PMS) [hide all summaries]
    (February 2002)
    Researchers from the United Kingdom reported in the October 6, 2001 issue of the British Medical Journal that published medical evidence does not support the use of progesterone in the treatment of premenstrual syndrome (PMS) and that it is unlikely that progestogens are effective in this disorder.
  • Preventable Drug-Induced Injury: What is the Last Line of Defense? [hide all summaries]
    (December 2001)
    A study published in the October 3, 2001, Journal of the American Medical Association reveals the extent of inappropriate prescribing by physicians and the equally inappropriate dispensing by pharmacists of cisapride (PROPULSID), a dangerous nighttime heartburn drug that was removed from the market in March 2000 because of fatal heart rhythm disturbances (see the March 2000 issue of Worst Pills, Best Pills News). Before using a new prescription drug, ask your pharmacist for the drug’s professional product labeling or “package insert.” This is not the same as the automatically-dispensed, information-deficient sheet you usually get.
  • Serious Vision Disorder With Topiramate (TOPAMAX) [hide all summaries]
    (November 2001)
    Health care professionals were notified on September 26, 2001 about an eye disorder in some patients taking the seizure drug topiramate (TOPAMAX). This condition is characterized by acute myopia (nearsightedness) and secondary-angle closure glaucoma.
Drug and Dietary Supplement Profiles - Each profile is a comprehensive review of the safety and effectiveness of this drug. If drug is not a Do Not Use product, information on adverse effects, drug interactions and how to use the medication are included.
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