[e-drug] 14th Model List of Essential Drugs (2)

["Anders Hernborg" <Anders.Hernborg@telia.com>]

E-DRUG: 14th Model List of Essential Drugs (2)
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  Hi
   I am a Swedish GP who worked with Essential Drugs ('Medicamentos Essenciais') in Angola a long time ago in the 80´s. Today I work as an "academic detailer" with pharmacotherapeutical issues among my GP collegues in my county.
   
I checked the new 14th Model List and have not gone through it very much in detail but still found some things that puzzled me:

   Enalapril for hypertension we most often recommend in dose of 10 or 20 mg. Does the list only recommend tablets of 2,5 mg?  8 tablets per day?
  
 On lipid-lowering agents, 12.6, is said:
   "The  WHO  Expert  Committee  on  the  Selection  and Use of Essential Medicines  recognizes  the  value  of lipid-lowering drugs in treating patients  with  hyperlipidaemia.  HMG-CoA  reductase inhibitors, often referred  to  as  "statins",  are  a  family  of  potent and effective lipid-lowering  drugs  with  a  good  tolerability profile. Several of these  drugs  have  been  shown  to  reduce the incidence of fatal and non-fatal myocardial infarction, stroke and mortality (all causes), as well  as the need for coronary by-pass surgery. All remain very costly but  may  be cost effective for secondary prevention of cardiovascular disease  as  well  as  for  primary  prevention in some very high-risk patients. Since no single drug has been shown to be significantly more effective or less expensive than others in the group, none is included in  the  Model List; the choice of drug for use in patients at highest risk should be decided at the national level. EML14 13"
   
First I think lipid-lowering drugs is not to treat mostly patient with hypertlipidemia in the first place but  patients  with  a  high risk of  cardiovascular events, even with normal values of LDL or total  cholesterol.  "Since  no  single  drug  has  been  shown  to be significantly more effective or less expensive than others in the group, none is included "   ??????
   
Simvastatin  is  now since 2 yrs generic and cost in Sweden almost one tenth of the
   price for atorvastatin. No one less exensive????
   
Amlodipine (Norvasc) is on the list. In European countries it is still under patent. I  think  it will be generic on the earliest within 6 months or so. It  is already a  generic internationally? In Sweden felodipine, similar to amlodipin  is already a generic drug.
   
The  only antidepressive drug on the list is amitriptyline. SSRI-drugs may not be  more  effective  but  at  least  less cardiotoxic than tricyklics.  Citalopram is a cheap generic SSRI drug.

Any comments?
   
Anders Hernborg
   Swedish GP
Anders Hernborg <Anders.Hernborg@telia.com>