America's Most Popular Drugs

For the pharmaceutical industry, last year was historic and grim: it was the first year ever when all of the ten most popular medicines in the U.S. were cheap generics.

Pfizer's best-seller Lipitor, which ranked number 6 last year, fell six places in the ranking to number 12, according to the listing compiled by data provider IMS Health Next year, it will be a cheap generic, too. The first copycat versions, made by companies other than Pfizer, will be launched in November.

Until then, Lipitor will remain the best-selling drug in the country. The number of prescriptions for the drug, used to lower cholesterol, have fallen 38% since 2006. IMS says that sales have fallen 16% in that time, buoyed by increases in the price of the pill.

In the entire listing of the 25 most popular drugs, which I've included below, there are only three branded medicines: Lipitor, Plavix, the blood-thinner made by Sanofi-Aventis and Bristol-Myers Squibb that clocks in at number 23 and Singulair, the asthma and allergy pill from Merck, which ranks number 25. (Click here for The Best-Selling Drugs In America.)

This is a snapshot of the decreasing footprint of the world's largest drug companies. Where once they sold pills to everyone (the list is full of drugs that used to be big moneymakers for Merck and Pfizer and Novartis and Bristol that are now commodities) now they make niche medicines for narrowly defined populations of people. Plavix and Singulair both go off patent over the next couple years, ending the age of mass-market medicines completely.

The most popular drug, as in previous years, is the combination of hydrocodone and acetaminophen -- better known by its old brand name, Vicodin. As I wrote last year, Vicodin's popularity has been constant, even when a panel of advisors to the Food and Drug Administration recommended it should be pulled from the market because of the danger acetaminophen overdose poses to the liver. The FDA has responded to the concerns by asking manufacturers to limit the amount of acetaminophen in these products.

IMS, which tracks data at the pharmacy data for drug companies, also saw other signs that things are getting tougher for drug companies. The overall volume of prescriptions increased at barely more than 1% last year, and the number of visits to health care providers by patients decreased 4%.  Spending on medicines increased 2.3%. In another sign of the times, antipsychotics, which had been the most lucrative medicines in the U.S., lost that title because of the patent expiration of Johnson & Johnson's Risperdal. The new top category? Cancer drugs, which seem to get more expensive every time a new one is approved. (The most recent, Yervoy from Bristol-Myers, costs $120,000 per patient.)

The full list is below. I've bolded the drugs that are currently protected by patents -- that is, not generics. In cases where it looks as if there was absolutely crazy 5-year growth in use, what you're actually seeing is the change from the first year when generics are available. This is an artifact of the IMS data. More data and analysis can be found on the IMS web site.

The Most Popular Drugs
The most prescribed drugs according to IMS Health. Prescriptions in millions. Branded drugs are in bold.
		2010	1-year growth (%)	5-year growth (%)
	Drug (brand name) use	3995.2	1.16%	7.79%
1	hydrocodone/acetaminophen (Vicodin) pain	131.2	2.34%	16.73%
2	simvastatin (Zocor) high cholesterol	94.1	12.29%	553.47%
3	lisinopril high blood pressure	87.4	5.56%	34.05%
4	levothyroxine sodium (Synthroid) hypothyroid	70.5	6.82%	41.57%
5	amlodipine besylate (Norvasc) high blood pressure.	57.2	11.50%	NA
6	omeprazole (Prilosec) acid reflux	53.4	17.62%	196.67%
7	azithromycin (Zithromax) antibiotic	52.6	-2.23%	44.11%
8	amoxicillin antibiotic	52.3	-0.19%	-4.39%
9	metformin HCL (Glucophage) diabetes	48.3	9.03%	25.78%
10	hydrochlorothiazide high blood pressure	47.8	-0.21%	-0.42%
11	alprazolam (Xanax) anxiety	46.3	5.47%	23.14%
12	Lipitor (atorvastatin) high cholesterol	45.3	-12.38%	-38.78%
13	furosemide high blood pressure	43.4	-0.23%	-2.03%
14	metoprolol tartrate (Lopressor) high blood pressure	38.9	-5.35%	33.22%
15	zolpidem tartrate (Ambien) insomnia	38	8.26%	NA
16	atenolol high blood pressure	36.3	-7.63%	-21.26%
17	sertraline HCL (Zoloft) depression	35.7	4.39%	230.56%
18	metoprolol succinate (Toprol) blood pressure	33	22.68%	5400.00%
19	citalopram (Celexa) depression	32.1	18.45%	129.29%
20	warfarin sodium (Coumadin) blood thinner	32	1.27%	19.85%
21	oxycodone/acetaminophen pain	31.9	5.63%	39.91%
22	ibuprofen pain	31.1	2.64%	16.04%
23	Plavix (clopidogrel) heart disease	29.5	-1.34%	60.33%
24	gabapentin (Neurontin)	29.3	15.35%	58.38%
25	Singulair (montelukast) allergies	28.7	0.35%	2.14%