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Executive Summary

HOECHST-ROUSSEL's LASIX WAS THE MOST COMMONLY PRESCRIBED drug in 1986 for patients at least 65 years of age, according to survey data compiled by the National Disease and Therapeutic Index (NDTI) and included in FDA's eighth annual review of drug utilization in the United States. The generic version of the diuretic did not show up on NDTI's top 25 drugs "as specified by the prescribing physician." The survey found that Lanoxin, Burroughs Wellcome's brand of digoxin, was the second most commonly prescribed drug for the elderly, while digoxin generic versions ranked fourth in prescribing frequency. Of the top five most widely used prescription drugs among the elderly, two are digitalis products and three are diuretics. SmithKline's Dyazide (hydrochlorothiazide and triamterene) ranked third among drug "mentions" with hydrochlorothiazide ranking fifth (see chart below for 25 most commonly prescribed drugs for the elderly). The report notes that cardiovascular agents and diuretics, "the classes used most frequently by the elderly," account for 16 of the top 25 drugs. Cardiovascular agents, the report notes, "were the most frequently used class of drugs in the elderly, accounting for 25% of all mentions." Among the cardiovasculars, coronary vasodilators, antihypertensives and digitalis preparations were the most commonly cited agents, accounting for 5.4%, 5.3% and 5.2% of all mentions, respectively. "Mentions," the report explains, "reflect drugs prescribed, recommended, or given in any medical setting by private physicians in office-based practice." NDTI's data were obtained from a panel of over 2,000 physicians who report case history information on each private patient seen or contacted. Overall, cardiovasculars accounted for "327 mentions per 100 population in the elderly compared to 31 mentions per 100 population in younger people," the report states. In the under 65 group, the cardiovascular class ranked third, accounting "for 8% of all drug mentions." Diuretics ranked second among major drug classes used by the elderly with 10.7% of all drug mentions. Analgesics ranked fourth with 6.6% of all mentions, followed by diabetes agents (fifth with 4.7% of mentions), and psychotherapeutics, ophthalmics and antiarthritics, each with roughly 4.5% of mentions. The NDTI data shows that the elderly, representing 12.1% of the U.S. population, accounted for 25% of all visits to physicians and 32% of all drug mentions. Anti-infectives, ranked third among the elderly with almost 9% of all drug mentions, were the most frequently used class in people under 65, with 20% of all drug mentions. In the younger group, amoxicillin was the most frequently used with 4.5% of mentions, followed by erythromycin (3.1%), cephalosporins (2.8%) and penicillins (0.3%). The report points out that "although anti-infectives ranked third in the elderly compared to first in the younger group, the rate of use was higher in the elderly with 117 mentions per 100 population compared to 74 mentions per 100 population in people less than 65 years old." TOP 25 DRUGS PRESCRIBED FOR ELDERLY 1) Lasix 2) Lanoxin 3) Dyazide 4) Digoxin 5) Hydrochlorothiazide 6) Inderal 7) Aspirin 8) Persantine 9) Theo-Dur 10) Nitroglycerin 11) Insulin nph 12) Coumadin 13) Prednisone 14) Aldomet 15) Procardia 16) Isordil 17) Motrin 18) Tylenol with codeine 19 Tagamet 20) Cardizem 21) Capoten 22) Tenormin 23) Lopressor 24) Timoptic 25) Zantac

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