The longer I typed on this, the more I RAGED

This combo is so stupid it makes Caduet and Lotrel look logical. It was all I could do not to laugh in the face of the rep when they first brought this to the office. If they ever do a lunch I may fall on the floor in hysterics. It’s sad to me that ANY doctor would EVER write for this

I’m glad the docs can see through this as well. There’s not even a logical mechanism of action for NSAIDs in migraines — that we know of anyway.

I actually went to a GSK sponsored dinner where they paid two local neurologists $1,500 a piece to sing the praises of Trexmiet. They went over the pathophysiology of migraines and stated that there is an inflammatory stage, and this is why Naproxen is important.

The best thing was when they showed a slide for a study (total viewing time of less than 5 seconds) that supposedly showed that taking Treximet (naproxen and sumatriptan in one tablet) is actually more effective than taking them in separate tablets. I almost died laughing.

I gotta hand it to GSK though. The food sure was good even if I wasn’t buying the bullshit they were selling. Hell, if any GSK rep read this, I’d gladly accept an invitation to another dinner so yoou can try to convince me of the benefits of your wonderful new product.

I don’t think the question is “Is it better?” but “Is this necessary?” I’d just as soon buy the generic sumatriptan and naproxen and take two pills. The “inconvenience” is outweighed by the cost savings.

I’m in the hospital so I don’t deal with insurance companies anymore – are they even covering this stuff?

It depends on whether the drug companies are in bed with insurance companies yet…

If they are, then one drug in a class will be covered and the rest will be super high copayment.

I have yet to see an insurance company cover this crap. I’ve seen an handful of scripts for it and every single one of them has ended in a “Drug Not Covered” or “Prior Authorization Required” rejection and a phone call to the MD to get it changed to Imitrex and Naproxen.

Apropos of your poll du jour…this is the same sort of sinister shit that went down when Prilosec went OTC. And even better now one can get house-brand OTC omeprazole – there goes a few dollars of mine that AssyZenica won’t see again.

I foresee a prior-auth headache.

I’ve been arguing with the Treximet rep for almost 3 months now about this. She keeps harassing me to put it in stock because she’s “seeing movement” and all that BS. I say nope I’ll just call the Dr get it changed to Sumatriptan and sell them a 99 cent bottle of naproxen OTC…she’s getting very frustrated with me. That makes me happy.

Ask for copies of her studies, critically review them, then fucking GUT her…If I ever met a Trex-Rep, my wrath will be felt for miles.

I doubt drug reps ever learned the definition for the word CONFOUNDING or EXTERNAL VALIDITY. That’s the problem with the two studies in this post — which freaking ClinPharm uses as sources…how poor!

I’ve had the pleasure of dealing with this crap with insurance. There is one insurance – Coventy/Caremark if i remember correctly – that laughs in its face. Not covered, no PA, no override, no *nothing.* Sumatriptan and Naproxen or nothing. For once, an insurance company doing something logical…

This is where the truth about the drugs keeps getting trumped by glossy literature and the white coat effect (or, the big boob effect?). But, hopefully, TaestP, your white coat can win. Please keep us posted about your proposed followup.

I could probably convince the doctor, but in my time I don’t think I could convince the patient to go for the two separate ingredients and save money without compromising therapy. They were entranced by the “new product” idea that they wouldn’t listen to reason. But, today, consumers are more savvy and just might listen. I feel your rage, and perhaps they would, too.

Even the name Treximet sounds like a parody of the whole situation, i.e., drug going off patent is taken over by a cleverly disguised me-too-er.

Like Stuart said with hypertension meds.

“Oh no, our patent is going to expire.”
What is the next thing they do?
Bitch slap the drug with HCTZ (costs mere pennies by itself) and give it a new f@cking name or add HCT. The objective being to see how much money they can suck out of people.

Why combo?
“Makes it easier for drug compliance in a one tab/cap package.”

Bull-F@cking sh3t.

The cost of the meds will kill the compliance issue faster than the ‘deadly two tabs to swallow’ issue.

Dude…reLAX, man.

Nsaids are great for migraines, on occasion, just not often enough that you develop rebound. Same for triptans. Of course, different mechanisms. Nsaids treat nerve inflammation and pain, and 4 tabs of generic Advil is my personal drug of choice–along with a tall cup of coffee for vasoconstriction. Like a friggin’ dream, I tell you. I think the naproxen/triptan combo is brilliant, just not worth the brand price. But the solution is simple! Just call for a switch to generic sumatriptan and otc Aleve! Easy.
You can’t blame GSK for trying to protect their profit line, but two can play that game. And this one is so easy–you’ll beat ‘em every time. If you want to make the rep sad, just tell her you’re switching all the prescriptions in the above-mentioned manner as a favor to your patients and the American healthcare system in general. Hahahahhhahah! The more blase, the better.
You want the REAL pisser? Check this sweetie out!
http://online.wsj.com/article/SB122696875770635577.html?mod=googlenews_wsj
Fuckin’ A, man!

Okay, looking for a lesson on this subject.

How long do the patents last on drugs put on the market? 17 years from the time the chemical entity is discovered.

I’m guessing this allows the company to regain in profit, their expenditures to create the drug in the first place. Now, what you’re saying is that when the drug’s patent expires they try to advertise a “new and improved” version of the prescription drug by adding two drugs together and praising it’s own brilliance on a time-saving technique? Does this happen often? Do you think they pay off the research costs before the patent wears off? Happens all the time. See REMOVING THE WOOL — http://www.theangriestpharmacist.com/2008/09/23/removing-the-wool/

Someone mentioned HCTZ. Does this imply that after Lisinopril lost it’s patent (I’m assuming it has a generic, my memory doesn’t recall at the moment), they added Hydrochlorithiazide (sp?) to it so they could incur more profit from patients? Exactly what happened! Diovan did the same thing. I’m betting all of your ARBs will continue to do that.

I’m going off of memory, and my limited knowledge so if anyone can respond and correct any misgivings within my comment, I would appreciate it.

Thanks in Advance.

-Cheers!

Steven

They all play these games. Read the post I linked above — it talks about the games they play with isomers and such.

Yeah, I think I am simply going to get all rx’s switched to generic naproxen and imitrex. Its a win for the patient (lower copay) a win for the pharmacy (2 generic rxs sold vs 1 brand), and a nice middle finger to GSK! I’m sorry but I thought at some point in time drug companies were out to make lives better, but instead they just want to sell shit you don’t need. Its ok though, pts love it when I hook them up with our store brand zyrtec after they find out that Xyzal (which no one should ever get) is a $50 copay.

Finally, I went with omeprazole….even though John Elway takes Prevacid. TAestP, no matter what the haters say, they should be glad to have a pharmacist like yourself that won’t let some douchebag drug company rape them when they are not looking!

When I saw the first box of this show up in my order (auto-drop-ship for new products) I was a bit confused. Why naproxen? I’ve seen a neurologist for migraines and a migraine-variant known as ‘ice-pick headache’, and he gave me indomethacin. Taken regularly for one month, it reduces incidents of headaches – mechanism unknown, but it does work – I haven’t had an ice pick HA in years now. So, why not combine the sumatriptan with indomethacin??? I’d bet that would pan out with improved efficacy even in valid studies…

The issue there is that you used it chronically. This treximet crap is a PRN medicine…

I am not surprised by the tardy pace of R&D in most pharmaceutical industries today.

First of all, most pharmacy students graduate and don’t even think about working for industry,rather everyone signs a five year contract with CVS. So now industry staff consists mostly of businessmen, organic chemistry/science PhD’s, lawyers, other people that have taken less than 2 semesters of clinical and NOT pharmacists.

As a result, nobody can come up with any NOVEL drugs other than COMBINATION drugs.

Second of all, we are sending all our young people to Iraq and Afghanistan to get shot, people who may be potential industrial pharmacists in the future.

Most likely in the future, Treximet fails miserably in sales and Andrew Witty and his army of high profile corporate stakeholders fly to Washington D.C in their $60 million G500 jets to the US Congress or U.K Parliament to ask for a government bailout.

And once again, hard working people inferior to pharmacists like nurses, pharmacy technicians, pharmacy interns, social workers have to pay FOR YOUR MISTAKE with our hard earned salaries.

Glad there were quite a few vehement responses…somebody related to John Q. Public is looking at this.

But, in Steph’s link the lack of knowledgel started with a response from Louie Ciapolo (sounded like a golden age of the dinosaurs type rationale about ‘always paying for the brand ’cause ya git watcha pay for’). My goodness. Plenty of research goes into companies that produce a generic FDA-approved drug. (Just not as much as the innovatorl product.) My pharmaceutics professor Ray Baweja RPh PhD-who’d worked for FDA and then returned after teaching our class, used to have a saying, ‘So, you think the drug company works to the benefit of patients? And, I suppose you think that the check is in the mail and he’ll still love you in the morning’.

I’m hoping that Mr. Obama gets some good advice, and input from pharmacists on the ‘front line’ and not the paid sycophants–whoever they are!

My link doesn’t work any more.

Try this one?
http://blogs.wsj.com/health/2008/11/18/eyeing-generics-cephalon-hikes-price-on-provigil/

Holy collusion, Batman!

I agree with Steph on this one.

The Pharm Industry also tried the ER/CR/SR (timed release drugs) route to protect its patents for drugs that don’t need it, or they don’t put it on the market till the patent expires. Same crap, different smell.

Similar happening with Lipitor. Ranbaxy wants to sell atorvastatin (generic Lipitor) in the USA. Pfizer gets distressed and offers different countries to sell Ranbaxy’s generics if they leave the USA alone.

http://genericspatent.blogspot.com/2008/06/ranbaxy-and-pfizer-settle-lipitor.html

The release date for generic atorvastatin is pushed back 6 months (from 2010 to 2011) in the USA.

I’m a 1st year pharmacy student and we recently did a case study on migraines and talking to some of my classmates on what they recommended and there were a good number of them who recommended this product to our ‘patient’. It frustrates me to no end how people consistently do not look at all the facts (in the case study the lady was on naproxen and it was decreasing in efficacy) and especially the pricing of these meds when two are wayyy cheaper than the one. I’m curious though why doctors wouldn’t look at the details of this study too and pharmacists are the ones catching it. In school we are taught to think critically, look at the evidence and determine what is best for the patient…wtf are doctors doing then prescribing this shit? Anyone care to enlighten me why doctors are conned into this shit by drug reps? Do they get a bonus cheque in the mail for prescribing it X amount of times?

FrostyPharm
1. Some docs don’t know what’s in Treximet
Oh, BUUUULLL SHIIIIT. Think about shit before you click send from now on. Do you REALLY believe that — or is it just one more weak argument to put in your little ordered list? If you do believe it — do you want someone prescribing medicine for your grandmother that doesn’t know what the fuck is in it? What if I didn’t know? Would you want me filling Rxs with meds that I don’t know what they are or how they work? I think not…

2. Patients ask for it and the doc doesn’t want to argue
Again – you’re full of shit. Patient’s may ask. Some may even pressure, but if a doc buckles because a patient asks, I think we’d be seeing 1000% more Vicodin and Oxycontin scripts. I think most docs would be offended that you would think that — they just give people shit rather than talk to them.

3. Patient has failed everything else so why not try it. I buy this point.

4. Gave the patient samples and now they claim it works better for them than the 2 drugs taken separately.
Patients make wild claims about all kinds of shit…like the Watson brand Vicodin work better than the Mallinkrodt — or that they have to have pink Darvocet cause they are allergic to the other. Do you think I give a shit about that? I would hope most people could understand the concept once explained…

5. Doctor is too busy to think (let alone think critically) or to look at or look for evidence. Which leads to #6
I can understand that they don’t look for the evidence, but this isn’t about scientific evidence. All it would take to unravel this mystery is looking at the drug name (which is under the brand name) on that closet full of samples. Nonetheless, that’s why I’m here — to call the docs and tell them this drug is bullshit, I don’t carry it, and to merely change it to Imitrex and I’ll sell them a bottle of 3-dollar Aleve.

6. (Sadly) I think some docs really believe what the rep tells them is viable, un-biased, science based real information only meant to help the patient. Information from drug reps is their concept of continuing education (albeit with a free meal). If the drug is too expensive for the patient, well that’s their own fault for having lousy insurance.
I agree that Drug Reps actually believe what they are saying to be true — as they are brainwashed in their educational sessions. But, I know that doctors are trained to assess primary literature, the difference between statistical and clinical significance, and even how to ‘tear a study apart.’ So, saying they believe drug reps, is flat out wrong. Most doctors will accept the free shit, but I doubt believe what they say. All this influences their prescribing practices in some cases, but not because they believe in the drug — because they are thanking the drug rep with scripts/volume. I think MDs and drug reps are indifferent to costs as each of them make an exorbitant amount of money — they have no concept of what it’s like to live paycheck to paycheck, and therefore cannot comprehend why someone cannot afford to pay $200 for 9 pills (and why a $25 off coupon really doesn’t do a fucking thing for anyone)

“Treximet is what I believe will help tham and Treximet is what I am prescibing.”
The words of an MD that needs to have his license revoked.

By the amount of samples for everything that we dispose of for the doctor’s offices (in my small county hospital), I’d think that our physicians are just trying to do the patients a favor by giving them a sample i.e. something free.

This area of the country has a strong recent history of MD dispensing. With some drugs MDs may not know what ‘it’s about’ but am under the impression that most docs set aside time very regularly to update themselves, but may in fact, be a little reluctant to go ahead with trying a new drug mechanism until they see the trends.

My impression of why scripts are generated for impossibly expensive meds is that MDs might not know the cost, and also there’s misplaced loyalty or obligation to the reps. I’ll be interested in the impact on the Big Pharma’s self-regulation of the freebies (but, it sounds like they’re already planning ways to get back on unsuspecting American public, like undermining significance of generics to Mr. Obama.)

But, it’s true about varied knowledge base of reps, one would be lucky to meet one that actually knows than what they can parrot about their product–as far as I can tell, reps don’t even have to have a biology background, though I doubt they are hired from the used car lot.

It would be giving docs the benefit of the doubt to suggest that they really don’t know how much drugs cost or the impact of costs on their patients. I would’ve thought their curriculum would be updated from when we new grads (several decades ago) made our mark on the face of pharmacy One of the main thrusts in pharmacy school was goning to be our impact on doctor-prescribing, in curbing the public perception/mantra ‘the doc says you must have this drug, and if you want to get better–that’s the drug you need to take.’

When we filled employee Rxs 17 years ago it would just burn me up when this certain old doc would only write for brand name Lasix for a retired laundry worker whose mentally ill son would come by to pick it up. (I know it’s unChristian, but I felt a certain vindication when the doc’s offspring was arrested for embezzlement a few years later.)

I would say the doctors simply don’t consider cost when making these decisions and give patients samples because they have them lying around. I have experience working in managed care and what I have heard in the past regarding the new drug of week is that the patient was started on samples and now they are working so well (nurse/medical assistant/secretary responds “why would we want to switch back to Sumatriptan when Treximet worked so well?”). Again cost doesnt cross their minds because most insurance plans dont reward doctors for prescribing cheaper drugs (which is difficult because then there are questions of whether that might compromise patient care). Treximet might be an option for that rare patient who has failed every triptan out there, has had neurology consults and is taking migraine prophylaxis but more often than not thats not the case.

I think combining an NSAID with a triptan is a poor choice of therapy regardless of the fact that imitrex will be generic in Feb. Patients that suffer from migraines have an increased risk of CVA’s and such. Because of this most take 81mg aspirin every day.
If they were to get a migraine at night, pop a treximet, and then pop another one two hours later before falling asleep, in the morning the naproxen might still be in their system and would suppress the COX-1 effects of the 81mg aspirin. Giving a long acting NSAID to someone taking aspirin is always a bad idea. Maybe GSK should have used ibuprofen or another shorter acting NSAID.

Diclofenac has less COX-1 affects and could be safe — at least it wouldn’t interfere with the ‘blood thinning’ effects of ASA. Of course, it’s more likely to give you an ulcer though…right?

sumatriptan is on our pharmaceutical benefits scheme in Australia for the treatment of migraine. Cost to patient for 50mgx4 tabs no more than $29.74 with a dispensing fee and 10% markup to the pharmacy.
capitalism is great except for affordable healthcare.

go to http://www.pbs.gov.au and have a peek at some prices

I looked at the package when we received it last week of the Dr. Reddy branded Sumatriptan – it was nice to note that it was manufactured by Penn Labs – maybe it was Penn Pharmaceuticals, but it was Penn – which was followed by “(a GlaxoSmithKline company)” , for Dr. Reddy’s. So GSK is still going to be making tons of money from it until somebody challenges Dr. Reddy’s.

Yeah, once the exclusivity period expires, the generic is immediately available — but it is still a product of the original brand manufacturer. For instance, when Lotrel went generic we received generic Amlodipine/Benazepril — and of course, the capsules still said LOTREL on them…plain as day…

I filled my first Treximet RX this weekend. I did my best to talk the customer out of it. Not covered by insurance, the customer paid the full cash price. The customer told me they needed it because Imitrex didn’t work on their migraines (they hadn’t tried any other triptan.) I told them that if Imitrex worked it was pretty unlikely that Treximet would work. I explained that Treximet was nothing more than Imitrex with an ibuprofen-similar drug. The customer didn’t care, said she “had to have something”, and didn’t have time to wait for us to call the doctor. What can I do, I figure if people have nothing better to do with their money, not to mention I work for a chian and we had the Treximet autoshipped and this might be our only chance to sell it before it expires.

And what about that Soma 250 crap? How is that better than the generic 350 mg, which is much much cheaper?

I realize I’m a little late to the rant on this one but I feel compelled to weigh in. Treximet, contrary to some of the insightful appearing commentary in this thread, is NOT the same thing as Imitrex and Aleve.

It’s a fast-release form of Imitrex combined with a slow release of Naproxen. Stop reading your own rants and read the actual studies! It has been clinically shown to stop migranes faster and for longer, period! It took Pozen a long time to get through the trials but in the end prevailed.

Yes, GSK stands to improve their revenue stream because of it. Pozen is not a puppet of GSK but rather an innovator of novel combinations. Anyone who thinks different should join the investors of POZN on Yahoo!.

And before you rant on about how it’s just the same as Imitrex and Aleve, why don’t you do some real research and show us how they compare rather than all this bullshit commentary. You complain about the drug companies making grandiose claims based on real clinical research and yet sit here making damning claims based upon opinion. Gee, I’d be inclided to trust research over opinion. Which is exactly why the FDA doesn’t approve drugs based upon opinion…

Yes, because there are tons of people out there wasting their time on comparing Sumatriptan versus Sumatriptan/Naproxen. You’re a fucking pawn and an idiot if you actually believe that.

As I always say, send me the Pubmed ID and I’ll upgrade you from “Entirely Braindead” to “High Functioning Retard.”

my question is this – why don’t more dr’s dispense drugs that in many cases prevent migraine more often? at one point, i was having 2 ass-kicking migraines a week, and am unable to take imitrex (because of a major head injury suffered years ago). my dr put me on 20 mg of propranolol (and yes she wrote the scrip for that, not inderal. weird!) bid. i’ve been on this therapy for a year and a half and i have sufficient digits on one hand to count the migraines i’ve had in all that time… the only downside to it is postural hypotension (my bp before therapy was 100/70 or in the ballpark).

propranolol is too cheap. that’s why!

Propranolol is an AB-rated generic of Inderal…that’s why!

Here’s your PMID for Treximet. Here’s a tip for you, try google some time, it’s a neat tool to help you search the internet for more things to bitch about…

http://www.sedolor.es/noticia.php?id=1385

Yeah, thanks for sharing the SPANISH press release about Treximet. You’re a fucking idiot.

If you post this type of nonsense again, I’m going to mushroom stamp you with my e-penis so hard your mother’s forehead will hurt…

^^^^^^

BAHAHAHAHAHAHAHAHA!!! Holy shit, the last line was classic. New site logo? lmao.

Ha. That is funny right thar’! I came up with and typed that at work with an 80 year old woman crying at my cash register. She wasn’t sad or hurt. She had money to pay for her drugs. She just started crying for no reason and left.