Drugs

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Most common prescribed Classes of Drugs

Nine-out-of-10 senior citizens in the United States and more than half (58 percent) of all non-seniors regularly rely on a prescribed drug, according to the Agency for Healthcare Research and Quality.
In 2016 one in 10 people take five or more drugs - twice the percentage seen in 1994.

Notation: Brand Name (Generic Name)
Only an example of the drugs used in each class are shown. All of the 30 most frequently prescribed drugs are listed.

Rnk Class Use Most
Popular Number of
Prescrip-
tions

1 Lipid Regulators Mainly statin drugs, used to prevent dyslipidemia (high blood cholesterol) Lipitor (Atorvastatin Calcium), Crestor (rosuvastatin calcium), Simvastatin, Pravachol (pravastatin) 255 M

2 Antidepressants - Anxiety
See also tranquilizers below Depression & Anxiety,
(ADHD)
See Anxiety and Depression Medications Selective Serotonin Reuptake Inhibitors (SSRIs): Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline Hcl),Citalopram (Celexa), Luvox
Benzodiazepines Valium, Ativan and Xanax (Alprazolam)
Atypical: Desyrel (Trazodone HCL), Zyban (bupropion)
254 M

3 Narcotic Analgesics Pain (Headache, Musculoskeletal), Chronic pain (arthritis, back pain, COPD) Oxycontin (Oxycodone HCl), Vicodin (Hydrocodone Bitartrate and Acetaminophen) 244 M

4 Beta-Blockers Heart disease (Arrhythmia, ...), particularly high blood pressure (Hypertension), as well as glaucoma, hyperthyroidism and migraines Brevibloc (esmolol HCI), Lopressor (Metoprolol) 191 M

5 ACE Inhibitors High blood pressure, migraines Lisinopril (Prinivil, Zestril), Lotensin (Benazepril), Capoten (captopril) 169 M

6 Antidiabetes Blood Sugar Insulin, Lantus (insulin pen), Glucophage (Metformin) 165 M

7 Respiratory Agents Asthma, COPD Ventolin (Albuterol),
Advair Diskus
Singulair (Montelukast)
see also Corticosteroids 153 M

8 Anti-Ulcerants
Proton Pump Inhibitors Dyspepsia, Gastro-esophageal reflux disease (GERD), Ulsers Nexiam, Pantoprazole, Omeprazole 147 M

9 Diuretics Release water, High blood pressure Hydrochlorothiazide (Microzide) 131 M

10 Anti-Epileptics epilepsy, nerve pain (shingles) gabapentin (Neurontin) 122 M

11 Tranquilizers ADHD, schizophrenia, delusional disorder, mania Vyvanse, Valium (diazepam) 109 M

12 Thyroid Preps Synthroid, Levoxyl, Levothyroxine 107 M

13 Calcium Channel Blockers
Calcium Antagonists Irregular heartbeat (arrhythmia), heart attack Norvasac (Amlodipine Besylate) 98 M

14 Antiemetics Nausea (dopamine & serotonin inhibitors) Compazine, Zofran (ondansetron) 95 M

15 Hormonal Contraceptives Birth Control estrogen and a progestin 92 M

16 Angiotensin receptor antagonist
or blocker High Blood Pressure (Hypertension) Cozaar (losartan potassium), Lasix (furosemide) 84 M

17 Penicillin Antibiotics bacterial infections Amoxil (Amoxicillin), Azithromycins 76 M

...

? Blood Thinners
Anticoagulant
Antiplatelet Atrial fibrillation, stroke, heart attack, Pulmonary Embolism (PE) Coumadin (Warfarin), Xarelto (Rivaroxaban), Plavix (clopidogrel) > 100 M

? Corticosteroids Immunosuppressant, Asthma, allergy, bronchitis, rheumatoid arthritis, poison ivy Delasone, Sterapred (prednisone), Cortef (hydrocortisone), Flonese (Fluticasone)

Source: The Most Prescribed Medications in the U.S. by Drug Class | TheBalance.com, 2016
See also:
10 Most Popular Prescriptions - GoodRx, 2017
Most Common Types of Medications List | MA Pharm.com
Legal Classifications of Drugs | rehabs.com
The 10 Most-Prescribed and Top-Selling Medications
ClinCalc DrugStats Database and the 2017 Top 200 Drugs - ClinCalc.com
Heart Medications

Drug Interactions
Many drugs work fine when taken by themselves, but when taken with another drug, even for a different problem, can result in unwanted side effects, reduce the effectiveness of your medicine or possibly increase the action of a particular medicine.

See Drug Interaction Checkers (web sites and apps) below

Dangerous drug combinations are a major public health problem, hospitalizing tens of thousands of people each year. Pharmacists are the last line of defense, and their role is growing as Americans use more prescription drugs than ever. One in 10 people take five or more drugs - twice the percentage seen in 1994.

Your doctor and pharmacy should warn you about these interactions and not prescribe or give you drugs which in combination will adversely effect your health or possibly kill you.

Two years ago, at the age of 70, I had a heart problem that required a stent. My cardiologist put me on a cholesterol drug and a blood thinner. I went off the blood thinner after 6 months with a normal ekg.
However a followup check a year later with a 24 hour Holter Monitor revealed an heart arrhythmia.
I was put back on the blood thinner and given a drug for the arrhythmia.
Another arrhythmia drug, amiodarone, was prescribed shortly thereafter when I had a TIA (Transient Ischemic Attack) in my eye.

After looking thru 7 pages of documentation provided by the pharmacy (Wallmart) with the amiodarone that had statements like "This drug will be started in a hospital where you will be closely watched", I decided to hold off taking it until I could talk to my cousin, a physician.
The documentation said nothing about interactions.

It's a good thing I held off. A couple of drug interaction checkers (see below) found several serious interactions.

Pharmacies miss half of dangerous drug combinations
How the pharmacies performed.

In December 2016, the Tribune tested Chicago-area pharmacy chains as well as independent drugstores. The test was recorded as a fail if the store did not warn about the drug interaction and did not try to discuss it with the prescribing physician.

See Pharmacies miss half of dangerous drug combinations - Chicago Tribune.

In 2011 a study conducted at the University of Arizona College of Pharmacy found that only 28 percent of pharmacies' clinical decision support software systems – the computer programs that are in place to alert pharmacists to possible medication problems - correctly identified potentially dangerous drug-drug interactions.
See Study shows pharmacies' software systems miss potentially dangerous drug-drug interactions | College of Pharmacy - University of Arizona

Drug naming Examples:
There is online software and smart phone apps you can use to check yourself.
I had several problems with these, some because of drug naming.
Some required a brand name (e.g. Lipitor) but the pill bottle only had the generic name (Atorvastatin).

Drugs have several names. Some examples:

Chemical Name¹ Generic Name Class Brand or Trade
Name Use

N-(4-hydroxyphenyl) acetamide Acetaminophen nonopioid Analgesics Tylenol pain, fever

ACETYLSALICYLIC ACID Aspirin nonopioid Analgesics Bayer Aspirin, Bufferin, ... pain, fever

2-(4-isobutylphenyl)propanoic acid Ibuprofen Nonsteroidal Anti-inflammatory drug (NSAID) Advil, Motrin, Aleve anti-inflamatory, pain

Dihydrocodeinone oxycodone Opioid OxyContin Pain Relief

Diacetylmorphine Heroin Opiate dope, H, smack, junk Pain Relief

dl-threo-2-(methylamino)-1-phenylpropan-1-ol Pseudoephedrine Decongestant Sudafed colds, sinusitis, and hay fever

bis[(E)-7-[4-(4-fluorophenyl)-6-isopropyl-2- [methyl(methylsulfonyl)amino] pyrimidin-5-yl](3R,5S)-3,5-dihydroxyhept-6-enoic acid] Rosuvastatin calcium Lipid Reguator
Statin Crestor LDL cholesterol lowering

[R-(R*, R*)]-2-(4-fluorophenyl)-β, δ-dihydroxy-5-(1-methylethyl)-3-phenyl-4- [(phenylamino)carbonyl]-1H-pyrrole-1-heptanoic acid, calcium salt (2:1) trihydrate Atorvastatin Lipid Reguator
Statin Lipitor, Atorva LDL cholesterol lowering

Amoxicillin Penicillins, antibiotic Amoxicillin, Augmentin² bacterial infections

Warfarin sodium Warfarin Blood Thinner, Antiplatelet agent³ Coumadin atrial fibrillation, stroke, heart attack⁴

(S)-Clopidogrel; Clopidogrel [INN:BAN] Clopidogrel Blood Thinner, Antiplatelet agent³ Plavix atrial fibrillation, stroke, heart attack⁴

(S)-5-Chloro-N-({(5S)-2-oxo-3-[4-(3-oxo-4-morpholinyl)phenyl]-1,3-oxazolidin-5-yl}methyl)-2-thiophenecarboxamide Rivaroxaban Blood Thinner, Anticoagulant³ Xarelto atrial fibrillation, stroke, heart attack⁴

N1-(5-chloro-2-pyridinyl)-N2-((1S,2R,4S)-4- ((dimethylamino)carbonyl)- 2-(((4,5,6,7-tetrahydro-5-methylthiazolo(5,4-C)pyridin-2-yl)carbonyl)amino)cyclohexyl) Edoxaban Blood Thinner, Anticoagulant³ Savaysa atrial fibrillation, stroke, heart attack⁴

Metoprolol succinate; Selozok; Spesicor Dos; Seloken ZOC Metoprolol Beta Blocker Loprestor, Toprol-XL, Atenolol (Tenormin) heart attack, ventricular tachycardia, hypertension

1. Drugs also have a chemical formula or structure. e.g. Tylanol is C₈H₉NO₂
Some drugs have several chemical names.
Some are listed Medical Subject Headings (MeSH) National Library of Medicine (NLM)
Many have CAS (Chemical Abstracts Service) numbers assigned to them. 2. Amoxicillin is both a Generic and Brand name.
Augmentin is Amoxicillin and clavulanate potassium.
3. Blood Thinners work in different ways. See blood thinners.
4. Blood thinners can also be used after knee or hip surgery, PTE and DVT.

Drug Interaction Checkers:
Multi-Drug Interaction Checker | Medscape.com
Required brand name (e.g. Lipitor) for some, but my pill bottle only had the generic name (Atorvastatin)
Includes supplements.

Drug Interactions Checker - For Drugs, Food & Alcohol | Drugs.com
Includes supplements.

Interaction Checker | WebMD

Drug Interactions Checker - Check Your Brand and Generic Drugs - RxList

My case study:
I checked interactions with 4 drugs prescribed by my cardiologist.
Lipitor (Atorvastatin) a cholesterol drug, Savaysa (Edoxaban) a blood thinner, Lopressor (Metoprolol) a drug to control ventricular tachycardia, and Amiodarone a drug to control A-fib.
Multi-Drug Interaction Checker | Medscape.com

Gave me 2 "Serious - Use Alternative" interactions:
amiodarone + edoxaban and atorvastatin + edoxaban
atorvastatin and amiodarone will increase the level or effect of edoxaban. and 3 "Monitor Closely" Interactions
amiodarone + metoprolol, amiodarone + atorvastatin, amiodarone + metoprolol

Drug Interactions Checker - For Drugs, Food & Alcohol | Drugs.com

Gave me 1 Major interaction :
amiodarone < > edoxaban
Amiodarone may increase the blood levels of edoxaban. This can increase the risk of serious or life-threatening bleeding complications.
Gave me 2 Moderate Interactions:
amiodarone < > metoprolol and amiodarone < > atorvastatin

My cardiologist and GP both said amiodarone (A-fib med) may increase the effect of the Savaysa (Edoxaban) (blood thinner), but unless I have symptoms of excessive bleeding, e.g. blood in bowl movements, they are OK together.
I took amiodarone and Savaysa (Edoxaban) for a month with no problem.

Medication tracking apps:
CareZone | Easily organize health information in one place.
Medisafe - Solutions: Android | iPhone
Round Health - A better way to remember your medicine

Food, Herbal and Dietary Supplement-Drug Interactions
About one in four persons taking prescription medication also take a dietary supplement.1,2 According to the National Center for Complimentary and Alternative Medicine (NCCAM), a dietary supplement can be a vitamin, a mineral, an herb or other botanical, an amino acid, or other such substances or their constituents.

For example:
Grapefruit interacts with Statins.
Cranberry juice, Fish Oil, Garlic, Ginko, Ginseng, Vitamin E and St. Johns Wart interact with Warfarin (Antiplatelet)

Read the documentation that comes with your prescription.

I need to do more checking for sources on this.
See:
Herbal and Dietary Supplement-Drug Interactions in Patients with Chronic Illnesses - American Family Physician

Glossary:

Types:
Classes:
Depressants - alcohol, Valium, Xanax, Librium, and barbiturates.
Hallucinogens - Hallucinogens have powerful mind-altering effects and can change
how the brain perceives time, everyday reality, and the surrounding environment.
LSD, PCP, MDMA (Ecstasy), marijuana, mescaline, and psilocybin.
Opiates - Derived from popy plant. See below
Stimulants - A class of drugs that elevate mood, increase feelings of well-being,
and increase energy and alertness.
Cocaine, methamphetamine, amphetamine, MDMA (Ecstasy), nicotine, and caffeine.
See Drug Classifications | Villanova

Analgesics - Pain Killers
Barbiturates - A central nervous system depressant. e.g. phenobarbital
largely replaced by benzodiazepines.
Benzodiazepine - Minor tranquilizers. benzodiazepine diazepam (Valium)
Opiates - Opiates are alkaloid compounds naturally found in the opium poppy plant
Morphine, codeine, and thebaine.
Opioids - A more modern term for Opiates
Narcotics - Addictive drugs that reduce the user's perception of pain and induce euphoria
(a feeling of exaggerated and unrealistic well-being)
Natural derivatives of opium: morphine and codeine
Partially synthetic drugs from morphine: oxycodone (OxyContin), Dilaudid), Numorphan
Synthetic compounds that resemble morphine. Fentanyl (Duragesic) levorphanol
(Levo-Dromoran), meperidine (Demerol), methadone, and propoxyphene (Darvon).
Vicodin contains an opioid pain reliever (hydrocodone) and
acetaminophen
Can be swallowed, smoked, sniffed, or injected
See The Big List of Narcotic Drugs | American Addiction Centers

Terminology:
Acetaminophen (Tylenol)
ADHD - Attention Deficit Hyperactivity Disorder
AHFS - American Hospital Formulary Service®
ANDA Number - Abbreviated New Drug Application
ATC code - Anatomical Therapeutic Chemical Classification System

Blood Thinners
CAS Number - Chemical Abstracts Service Number
ECHA - European Chemicals Agency -
EPC - Established Pharmacologic Class
GABA - Gamma-Aminobutyric acid a depressant.
GAD - generalized anxiety disorder
HF - Heart Failure
IMS - Intercontinental Marketing Services - Now known as QuintilesIMS.com.
MDMA - 3,4-Methylenedioxymethamphetamine, commonly known as ecstasy
MeSH - Medical Subject Headings
MEPS - Medical Expenditure Panel Survey
MI - Myocardial Infarction
NLM - U.S. National Library of Medicine
NDAIS - Nonsteroidal anti-inflammatory drugs Aspirin, naproxen (Aleve),
and ibuprofen (Advil, Motrin) are examples of OTC NSAIDs.
SCA - Sudden Cardiac Arrest
Therapeutic Index (TI) (also referred to as therapeutic ratio)
The ratio of amount of a therapeutic agent that causes the therapeutic effect
to the amount that causes toxicity.

Illegal & Addictive Drugs