Healthy Skepticism Library item: 1685

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Sandvik H.
Norwegian GPs Protest Withdrawal of Cheap Antihypertensives
Wonca News 2002 Feb
http://www.globalfamilydoctor.com/publications/woncaNews

Full text:

Low dose thiazides are generally recommended as first-line treatment for hypertension. They are cheap, effective, and the low doses now recommended (25 mg hydrochlorothiazide or less) carry little risk of side effects. The British Hypertension Society has given this recommendation highest strength (A): “Use a low dose thiazide as first-line treatment unless there is a contraindication or a compelling indication for another drug class.” Drug companies make little profit from selling thiazides, and therefore prefer to market newer, patent-protected, and expensive antihypertensives. In Norway thiazides have gradually been withdrawn from the market, and for the last couple of years Dichlotride from Merck & Co has been the only pure hydrochlorotiazide (HCTZ) available. No generic HCTZ has been on the market.

Recently Dichlotride was also withdrawn. The company claims that this is due to problems with production and delivery, but admits that Dichlotride will probably be withdrawn permanently. As major prescribers of antihypertensive drugs Norwegian general practitioners were deeply troubled by this development. The subject was lively discussed on Eyr, the Norwegian mailing list for general practitioners, and many critical messages were also sent directly to the drug company. It was suspected that Merck & Co were using their market position to enforce an increased use of more expensive patent-protected drugs at the expense of cheap HCTZ. The discussion was then taken up by other Norwegian media. A major national newspaper carried the story at the top of its front page. Many other newspapers also brought the news, and there were comprehensive debates on national radio. “It is unacceptable that we loose valuable drugs due to market forces,” said the President of the Norwegian Medical Association. The secretary of the Minister of Health admitted that this story probably illustrates that Norway lacks proper legal measures to secure adequate supply of cheap and well documented drugs. The issue was also brought up on the international mailing list GP-WONCA. It seems that some other European countries may be facing similar problems with limited supply of HCTZ. In most countries, however, generics are widely distributed. So far, Norway is the only country where HCTZ is not marketed at all. Norwegian general practitioners, supported by the Norwegian Medical Association, have challenged the government to come up with a solution to this problem.