Are those pills you have been taking for years the wrong type?
It’s quite possible, say experts who advise you to be prepared to switch medication just like you would your car insurance
EVERYONE knows that to get the best deal on gas and electricity, credit cards and even travel, it is important to shop around. No point in loyally standing by an energy provider, bank or airline if you could save money – or get a better service – elsewhere.
So why don’t we take this same savvy approach to medication?
The short answer is, many on long-term treatment may not realise that switching to a new or different drug for their condition could reap huge health benefits.
Latest NHS figures show that half of Britons currently have a regular prescription and a quarter of us take at least three different kinds of medicine, long term.
In many cases, they will have been taking the same pills for years, or even decades, often putting up with side effects, or finding the drugs don’t work as well as they used to.
But they may not be on the safest, most appropriate or best drug for their condition, according to Age UK’s health adviser Tom Gentry. ‘Some people are stuck on drugs they have been on for years, even though things have moved on and alternative options could be available,’ he explains.
‘Doctors should be proactive when it comes to reviewing prescriptions but there is a tendency to believe the old adage, if it ain’t broke, don’t fix it.’
Take, for example, cholesterollowering statins taken by six millions Britons – one type, atorvastatin, is the best-selling drugs in history.
This newer version of the drug was made the gold standard by the NHS in 2003, yet thousands of patients may still be on older versions which cause more side effects simply because they’ve not spoken to their doctor about switching, say experts.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, says patients should request regular reviews – and use the opportunity to ask: ‘Is this the best option, or are there alternatives?’
She adds: ‘Mention side effects, as dosage may need to be adjusted. And what are the risks versus benefits: could you stop taking medication altogether?’
Doctors will, of course, consider the cost. ‘A newer more expensive drug might not offer a huge improvement for the patient, so GPs may say switching is unnecessary,’ says the professor.
With this in mind, we spoke to Britain’s leading experts about some of the most commonly taken medications and asked, could it be time for YOU to talk to your doctors about switching, or ditching them altogether?
ARE YOU STILL TAKING YOUR STATIN AT BEDTIME?
STATINS lower the level of ‘bad’ LDL cholesterol in the blood and more than six million people in the UK now take them regularly to ward against heart attack and stroke. Common types are atorvastatin (Lipitor), fluvastatin (Lescol), and simvastatin (Zocor).
SHOULD YOU SWITCH?
UP TO one in ten patients taking statins develop muscle pain and they have also been linked to memory problems and diabetes.
Atorvastatin, a newer type of statin, is one of the best drugs for reducing cholesterol. However, there are patients who are still taking older versions of statin that are less well tolerated, and less effective.
Professor Kausik Ray, an honorary consultant cardiologist at St George’s Hospital, London, says: ‘Older statins are short-acting, becoming less effective within a few hours.
‘As cholesterol production in the body peaks at night during sleep, we used to recommend patients to take their statin before bed.
‘Newer statins like atorvastatin and rosuvastatin are effective for much longer, and can be taken at any time.’
There are newer drugs under development that act in a similar way to statins and can be used alongside them, but they are not currently available to most NHS patients. These include lipoprotein lipase inhibitors, which work by lowering levels of fats in the blood and another class of drug, called PCSK9 antibodies.
Peter Sever, professor of clinical pharmacology at Imperial College, London, says: ‘These are already available to patients who have inherited high cholesterol – and also those who have already had a couple of heart attacks.’
… OR DITCH?
MOST patients prescribed statins will need to keep taking them, says Dr Laura Corr, consultant cardiologist at Guy’s and St Thomas’ Foundation Trust. Doctors look at overall heart-attack risk before offering statins. Cholesterol is one factor, but age, weight, smoking and family history are others.
You can lower cholesterol by up to 20 per cent with a healthy Mediterranean diet, though Dr Corr says: ‘The chances of a heart attack increases with age, and medication will still be the best way to keep risk low as you get older.’
THREE NEW DRUGS TO BEAT TYPE 2 DIABETES
METFORMIN is almost 100 years old but remains the most common drug given to patients with type 2 diabetes, which affects three million Britons. Also known as glucophage, it works by reducing the amount of sugar the liver releases into the blood.
SHOULD YOU SWITCH?
COMMON side effects of taking metformin include nausea and diarrhoea, but this is dose-dependent, says Philip Newland-Jones, consultant pharmacist at University Hospitals Southampton.
‘This affects about 15 per cent of patients but it’s no reason to stop – slightly reducing the dose helps,’ he says.
Very rarely, metformin can alter your taste or cause liver problems.
Newer drugs that increase natural insulin levels can be prescribed when metformin doesn’t properly control blood sugar, or is poorly tolerated. These include popular gliflozins (also known as SGLT-2 inhibitors), incretin mimetics (or GLP-1 agonists) and gliptins, otherwise known as DPP-4 inhibitors.
… OR DITCH?
WEIGHT loss alone may slow the progression of type 2 diabetes, and could even cause remission, meaning metformin is no longer needed – however, dieting is less effective for those with long-term disease.
Mr Newland Jones says: ‘Many people have had the condition for a long time when they are diagnosed.
It is important not to ignore symptoms and take advantage of free screening checks at pharmacies and surgeries.’ For more information, visit diabetes.org.uk.
ARE YOU SURE IT’S WARFARIN YOU SHOULD BE ON?
NOT long ago, anyone who needed a blood thinner to prevent stroke, heart attack or deep vein thrombosis was prescribed warfarin. Many of the estimated 1.4million Britons with atrial fibrillation or other heart-rhythm problems take the drug daily to prevent blood clots. It works by reducing the liver’s ability to make blood-clotting proteins.
SHOULD YOU SWITCH?
WARFARIN is effective but taking it isn’t straightforward, explains Dr Matt Fay, a Bradford-based GP specialising in heart health.
‘What you eat and other medication affects absorption of the drug, so warfarin levels in the blood may vary. Too much can cause serious complications, including bruising and bleeding. Patients need monthly blood tests to check that their levels of the drug are stable.
‘Newer anticoagulants [drugs that stop blood clots] have recently been developed that are more stable, meaning blood tests are not needed.’
These newer types of anticoagulants, collectively known as NOACs, may be safer and more effective than warfarin.
Aspirin is also a blood-thinner, stopping platelets clumping together to form clots, but it is an ineffective treatment for atrial fibrillation patients, according to Dr Fay. Any patient on aspirin for this condition should switch to warfarin or a NOAC.
… OR DITCH?
FOR most people prescribed anticoagulants, the benefits outweigh the risks, which include severe bruising, prolonged nose bleeds and passing blood in urine or stools. People should not stop taking anticoagulants before seeing their GP, says Dr Fay. Thanks to a recent ruling, patients with atrial fibrillation can be taken off medications if deemed at low risk of stroke.
DON’T GET HOOKED ON POWERFUL PAIN PILLS
LAST year, 23.8million prescriptions for opioid-based painkillers, such as codeine, Oxycontin and tramadol, were issued by GPs in England – a rise of ten million in a decade. An ageing population and greater demand for stronger pain relief are thought to be to blame.
SHOULD YOU SWITCH?
OPIOIDS trigger production of the feelgood brain chemical dopamine, explains Nottingham University Professor Roger Knaggs, spokesman for the British Pain Society. However, they can be addictive, depending on the dose and how long they are taken for.
‘Opioids work best for people suffering from serious injury or disease like cancer. But it should only be a short-term solution,’ he says.
Itchy skin, nausea, confusion, loss of libido and mood changes are all side effects.
Buprenorphine, given via a stickon skin patch, is a newer opioid drug that has fewer side effects and is less addictive.
‘Another option may be gabapentin, a non-morphine medicine which was developed to treat seizures and can also be used to treat nerve pain,’ says Prof Knaggs. ‘But it may cause drowsiness.’
Antidepressants including amitriptyline are used to treat pain caused by nerve damage, but may work for only a few patients.
… OR DITCH?
DR ANTHONY Ordman, consultant in pain medicine and president of pain medicine at the Royal Society of Medicine, says patients should be referred to specialist pain clinics when their GP is out of options. ‘We use the skills of doctors, nurses, physiotherapists as well as psychologists to try to reduce symptoms of chronic pain,’ he adds. Non-drug methods such as psychotherapy, or non-invasive transcutaneous electrical nerve stimulation machines, may be used in a bid to reduce medications.
ANTIDEPRESSANTS
ONE in six British adults takes antidepressant medication to treat depression, anxiety and other mental health disorders. According to NHS guidelines, a course of treatment should last at least six months but reports suggest some patients are advised to take them indefinitely. Most commonly prescribed are selective serotonin reuptake inhibitors (SSRIs) including fluoxetine, sertraline and citalopram, which increase levels of neurotransmitters including serotonin, linked to mood. Tricylic antidepressants, including amitriptyline, are often prescribed when other anti-depressants don’t work.
SHOULD YOU SWITCH?
LONG-TERM antidepressant use can cause low libido and trigger anxiety, insomnia and headaches. Tricyclics can cause constipation, dry mouth and fatigue, low blood pressure and irregular heart rate.
If you are suffering side effects, mirtazapine (Zispin) causes fewer sexual and sleep problems.
One of the newest drugs available is vortioxetine (Brintellix), which is an SSRI and also seems to improve memory and cognition. However, it is currently only recommended by NICE as a third-line treatment when other treatments don’t work because it is patented and expensive. Another drug, agomelatine, has had good results and seems to cause few side effects.
… OR DITCH?
‘IF YOU have been taking antidepressants for more than a year, you may well be able to come off them,’ says Professor David Taylor, spokesman for the Royal Pharmaceutical Society. ‘Your GP will be able to advise on gradually decreasing the dose.’
Waiting times for psychotherapy can be six months or longer, although it is still worth asking to be referred as soon as possible.