[e-drug] Abandoned essential medicines (7)

["Peter Mansfield" <peter.mansfield@adelaide.edu.au>]

E-DRUG: Abandoned essential medicines (7)
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Wilbert and Joel are right to mention hydrocholorothiazide in response to my post about chlorthalidone as an example ofmarket failure because whilst it is available it is not available in an optimal dose.

We don't know which is best for hypertension because there are no large head to head trials. I mentioned chlorthalidone because it was the "diuretic" used in the ALLHAT trial and found to be slightly better than the more expensive alternatives. 

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002 Dec 18;288(23):2981-97.

In Australia both drugs are only available alone in 25mg tablets. They are equally effective with less adverse effects including little or no diuretic effect at half that dose. However hydrochlorothiazide is available as 12.5mg in combination with other drugs (ACE inhibitors). 

I ask my patients on chlorthalidone alone to buy a tablet cutter and cut the tablets in half. 

regards,

Peter

Dr Peter Mansfield
GP
Director, Healthy Skepticism Inc
Countering misleading drug promotion.
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"Peter Mansfield" <peter.mansfield@adelaide.edu.au>

Research Fellow, Discipline of General Practice, University of Adelaide
peter.mansfield@adelaide.edu.au
See publication list at:
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