A study published in The Journal of the American Medical Association examined all drugs approved by the US Food and Drug Administration (FDA) from 1975 to 1999. One drug in five was withdrawn from the market or required to have a "black-box" warning put on the package insert about serious risks.
During just one year of the study period, approximately 20 million Americans were given drugs that were later withdrawn.
The most common risks of the drugs were damage to the liver, heart and bone marrow and a variety of problems for pregnant women.
Self-defense: As long as other effective treatments are available, avoid any drug until it has been on the market for at least seven years. Approximately half of all problems with toxicity are discovered within that period.
Here is advice on common drugs to avoid—and better alternatives…
ALLERGY
Desloratadine (Clarinex). Introduced to the market in2002, this antihistamine is essentially the same as the older drug loratadine (Claritin). When you take loratadine, the drug is broken down in the body into desloratadine. The manufacturer simply got a patent for the chemical by-product.
Drawbacks: Not only is there no evidence that desloratadine is clinically different from loratadine, neither drug is a particularly effective antihistamine.
In fact, when the manufacturer submitted four clinical trials to the FDA comparing doses of desloratadine with a placebo, only two of the studies found the drug to be effective.
Better choice: Over-the-counter (OTC) antihistamines, such as chlorpheniramine (Chlor- Trimeton) or diphenhydramine (Benadryl). They are not only less expensive but they are usually more effective.
As an alternative to OTC drugs, ask your doctor about prescription nasal steroids, such flunisolide or beclomethasone. They quickly ease congestion without the grogginess that is sometimes caused by antihistamines.
HEARTBURN
Esomeprazole (Nexium). Introduced in 2001, esomeprazole is the fifth member of the proton pump inhibitor class of drugs used for gastroesophageal reflux disease (heartburn) and for duodenal ulcers that don't respond to antacids or H-2 blockers, such as cimetidine (Tagamet).
Drawbacks: An FDA evaluation suggests that esomeprazole is no better than omeprazole (Prilosec), an older OTC proton pump inhibitor that has a known safety record.
Better choice: People who have heartburn can choose among many drugs—Prilosec, Tagamet, antacids, etc.—that have been on the market for a long time and are known to be safe.
Non-drug treatments, such as not lying down after meals and avoiding chocolate or other foods known to cause heartburn, are often all that's needed.
INSOMNIA
Zaleplon (Sonata). Introduced in t999, zaleplon was designed to help insomnia patients fall asleep without the residual grogginess that is so common with other sleeping pills. Zaleplon is quickly eliminated from the body, so you can potentially take it late at night or early in the morning and still be fully alert when you get up.
Drawbacks: It's less potent than the older benzodiazepine sleeping pills, such as triazolam (Halcion), temazepam (Restoril) and flurazepam (Dalmane).
Compared with a placebo, zaleplon decreases the time it takes to fall asleep by only eight to 20 minutes.
Zaleplon has a high risk for addiction when taken for more than several weeks.
It also has potentially serious interactions, such as excessive drowsiness, when it is taken with other drugs, including antihistamines and anti-ulcer medications.
Better choice: Behavioral and lifestyle adjustments, such as reducing caffeine intake and practicing yoga or other relaxation techniques, are much safer for treating insomnia.
For patients who need extra help for a few nights to two weeks, an older drug, such as oxazepam or zolpidem (Ambien), can be effective.
