E-DRUG: Norwegian GPs protest withdrawal of cheap antihypertensive HCT
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[Low-dose thiazide diuretics are still the best 1st line antihypertensives,
but
drug companies are not very interested to produce them any more...
An example from the developed world; copied as fair use; from WONCA.
http://www.globalfamilydoctor.com/publications/woncaNews/
WB]
NORWEGIAN GP'S PROTEST WITHDRAWAL OF CHEAP ANTIHYPERTENSIVES
Low dose thiazides are generally recommended as first-line treatment for
hypertension. They are cheap, effective, and the low doses now
recommended (25 mg hydrochlorothiazide or less) carry little risk of
side effects. The British Hypertension Society has given this
recommendation highest strength (A): "Use a low dose thiazide as
first-line treatment unless there is a contraindication or a compelling
indication for another drug class."
Drug companies make little profit from selling thiazides, and therefore
prefer to market newer, patent-protected, and expensive
antihypertensives. In Norway thiazides have gradually been withdrawn
from the market, and for the last couple of years Dichlotride from Merck
& Co has been the only pure hydrochlorotiazide (HCTZ) available. No
generic HCTZ has been on the market.
Recently Dichlotride was also withdrawn. The company claims that this is
due to problems with production and delivery, but admits that
Dichlotride will probably be withdrawn permanently.
As major prescribers of antihypertensive drugs Norwegian general
practitioners were deeply troubled by this development. The subject was
lively discussed on Eyr, the Norwegian mailing list for general
practitioners, and many critical messages were also sent directly to the
drug company. It was suspected that Merck & Co were using their market
position to enforce an increased use of more expensive patent-protected
drugs at the expense of cheap HCTZ.
The discussion was then taken up by other Norwegian media. A major
national newspaper carried the story at the top of its front page. Many
other newspapers also brought the news, and there were comprehensive
debates on national radio. "It is unacceptable that we loose valuable
drugs due to market forces," said the President of the Norwegian Medical
Association. The secretary of the Minister of Health admitted that this
story probably illustrates that Norway lacks proper legal measures to
secure adequate supply of cheap and well documented drugs.
The issue was also brought up on the international mailing list
GP-WONCA. It seems that some other European countries may be facing
similar problems with limited supply of HCTZ. In most countries,
however, generics are widely distributed. So far, Norway is the only
country where HCTZ is not marketed at all. Norwegian general
practitioners, supported by the Norwegian Medical Association, have
challenged the government to come up with a solution to this problem.
Hogne Sandvik
General Practitioner, Norway
Hogne.Sandvik@isf.uib.no
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