Heart Medicine Etc.

[whatchamacallit]

My partner had two stents put in his major left artery (heart) a couple of weeks ago :-) He is recovering well and now on medication (aspirin, Lipitor, Brilinta, and Normetec).

His 40 days supply of the above 4 meds cost him over 14,000 baht :-). So I called Fascino (pattaya) and they carry all but Brilinta. Buying at Fascino would have saved him about 23%.

I assume he will need to take these meds for a long long time (with dosage adjustment in the future).

Questions:

1. Anywhere in Thailand where he can get these meds any cheaper?

2. I have checked online where I can order at least the Lipitor and Brilinta (brand names) for almost over 50% cheaper. In the case of Lipitor - they even have UK made generic for over 80% cheaper. Has anyone ordered online for their meds and have them delivered to Thailand with no problem at all?

Thank you.

[JAS21]

Clopidogrel apparently does a similar thing to Brilinta ... that is easy to get hold of here and is not expensive ( well the generic form isn't). Maybe ask his Dr if he could change ... I'm on it for lifelong. Normally its only for about a year after stents ... which I don't have by the way.

Edited November 17, 2012 by JAS21

[lopburi3]

Normetec seems to by the same hypertension drug I take as Amlodipine so there may be price difference in various brands.

Lipitor is still very high priced although just gone off-patent and believe copy is now available locally. Most people in Thailand are treated with Bestatin which is much cheaper although doctors may have more faith in Lipitor for extreme cases for those that can afford it. Not sure if founded or perception.

As for Brilinta believe I had Plavix after stints but as used non medicated only for about 2 months - believe with the medicated stints it is lifetime.

Asprin is a non factor price wise. And yet likely one of the most important.

[bunnaag]

Normetec seems to by the same hypertension drug I take as Amlodipine so there may be price difference in various brands.

Lipitor is still very high priced although just gone off-patent and believe copy is now available locally. Most people in Thailand are treated with Bestatin which is much cheaper although doctors may have more faith in Lipitor for extreme cases for those that can afford it. Not sure if founded or perception.

As for Brilinta believe I had Plavix after stints but as used non medicated only for about 2 months - believe with the medicated stints it is lifetime.

Asprin is a non factor price wise. And yet likely one of the most important.

Plavix or Chlopidogrel is taken only for one year if medicated stents are used,together with 100 mg Aspirin per day.I am the happy owner of 7 medicated stents.

[Sheryl]

Lipitor is a brand name for atorvastatin. Atorsan is a made generic equivalent.

Normotec is a combination of amliodipine, a calcium antagonist, and olmesartan, an angiotensisn II inhibitor (both are types of antihyertensive medication). As a combination, available only under the imported brand name Normetec. Amliodipine by otself is available as a lcoally made generic under many brand names. Olmesartan is not locally made (still udner patent) but there are a numver of drugs in the same class, with same basic mode of action, which are, for example losartan, which I personally take (brand names include Loranta and Losartan GPO).

Brilinta = ticagrelor, as another poster mentioned it is an anti-platlet agent. It is very new and still under patent, but there are other drugs in the same class that are available as local generics e.g. clopidogrel. In fact, usual practice in the West is toi limit its use to patients found to be resistant to clopidogrel, i.e. as a second line of treatment, not the first.

Sounds like the prescribing doctor went all out on use fo the newest forumlations . Newest is not always better, but it is always more expensive. ...and aggressively promoted by pharm company reps. That influences soem doctors. Also some expect that patients will be impressed by newer, imported drugs. rets assurred that the same doctor if working at a government hospitakl (as many of them do in addition to their private practice) would not have chosen these brands.

Go ahead and switch from lipitor to atorsan (same same), and ask the doctor if:

(1) Instead of normetec, could he separately take amliodipine plus one of the locally made angiotensin II inhibitors such as losartan?

(2) given its cost, woudl there be possible to switch from the Brilinta to clopigrel?

Odds are good answers to both wil be yes, and will save a bundle of $

[meatboy]

having had by-pass and valve surgery i buy amlodipine 5mg at 300bht.per 100,and bestatin 40mg at 150 per 30tabs only need 20mg a day so i cut in half.there should be plenty of generics out there if you look and try and find a wholesale pharmacy.

[Sheryl]

As noted in my prior post, there are no generics of 2 of the drugs he is on, since these are very newly patented, but there are generics of drugs in the same class which he may be able to switch to, should discuss with his doctor.

Only the Lipitor has an exact localy made generic equivalent.

[JAS21]

As noted in my prior post, there are no generics of 2 of the drugs he is on, since these are very newly patented, but there are generics of drugs in the same class which he may be able to switch to, should discuss with his doctor.

Only the Lipitor has an exact localy made generic equivalent.

I am still managing to buy Apolets ... quite a bit cheaper than Plavix.

[whatchamacallit]

Thank you all and Sheryl for your replies. After taking his meds for about 30 days... My partner felt so much pain on his calf to a point walking at the mall was too painful for him. So he called his doctor and was told to take just a quarter of his 40mg Lipitor. Went to see the doctor a couple of weeks ago and the dr. told my partner that his cholesterol and sugar were still too high :-(. So now the dr. is adding Janumet 50/500 mg to his daily drugs regiment even though my partner told him that he has been taking glucono-500. But the dr. told him to take the Janumet instead. I swear this dr. Is working for the drug company! So now his monthly bills for his meds if bought thru the hospital would be over $500.00. I want the best for my partner but I also want to be smart and informed as to what drugs are best or even just the same but cheaper.

I am not very impressed with what he has prescribed so far and only yesterday I found out that the Janumet 50-500 has metformin as the main ingredient which is exactly what my partner has been taking (glucono-500) for a fraction of the price. Janumet only has an additional 50 mg sitagriptin).

Sheryl: the next time we see the dr. We will definitely ask to switch from Brilinta to Clopidogrel !!

Thank you again for all your advise.

Will report back in a week or two with better result... I hope.

[lopburi3]

For myself have been using a combination of Lipitor 40mg and Ezetrol 10mg for the last year and LDL levels have gone from 114 down to below 70 target range (58 last week). But agree not the cheapest medications but Sheryl has provided an alternate for the Lipitor (not nice not to lower retail price after going off-patent). Suspect daily salad eating may also have a positive effect on the number.

[whatchamacallit]

For myself have been using a combination of Lipitor 40mg and Ezetrol 10mg for the last year and LDL levels have gone from 114 down to below 70 target range (58 last week). But agree not the cheapest medications but Sheryl has provided an alternate for the Lipitor (not nice not to lower retail price after going off-patent). Suspect daily salad eating may also have a positive effect on the number.

Oh I forgot to mention that he is also taking 10mg Ezetrol plus the 10mg Lipitor (reduced from 40mg as it was giving him much pain)............. But his last LDL was 203 and glucose 230 !!!!! Not good at all..... Yes the change in diet and exercise is crucial.

We live in Pattaya and will go to Fascino today to check prices :-)

[meatboy]

before my surgery i was on 80mg of simvastatin and i to surfered with bad pain in the calf joints one of the side affects,my dr.put me on ezetrol[ezetimibe] and lipitor they seem to work fine,but after heart surgery i moved to thailand ez.and lip.i found was very expensive so as the warm climate seemed to ease the joint pain i reverted back to statins[bestatin 20mg] colestral is very good the last 3yrs.

[NancyL]

There's much wisdom in Sheryl's post #5. Perhaps it's time to look for another doctor, at least for a second opinion.

I was put on my current drug regime in the U.S. before moving to Thailand and both my internist and cardiologist were sensitive to the fact that we didn't have insurance coverage for drugs. Also, as my internist said, it's usually best to start someone out on the oldest, most proven and cheapest appropriate medication, rather than immediately prescribing the latest, most expensive drugs pushed by the pharma sales reps. His reasoning was that with the older drugs, any side effects would have already been discovered, while with the new drugs the unexpected side effects are discovered with the early consumers.

Now I see a cardiologist at Bumrungrad, who was extensively trained in the west. I explained my internist's and cardiologist's reasoning for their drug selection during my first visit and he agreed entirely. Unlike most Thai doctors, he's used to Americans asking many questions and wanting to do their own research. He's very forthright when we review my medication regime after each year's cardiac physical. He'll say -- this one you can get more cheaply here, this one more cheaply there, stay away from the generic for this, but the generic for that one is OK and so on. He never pushes purchasing from the pharmacy at Bumrungrad unless he knows a drug wasn't easily available elsewhere.

Edited December 27, 2012 by NancyL

[Sheryl]

If he needs sitagliptin in addition to metformin then indeed Janumet is the only preparation available. But doctors were successfulling managing diabetes long before this drug came along. (Though it can be extremely challenging if the patient does nto comply with lifestyle/diet modifications).

A second opinion from a cardiologist AND an endocrinologist would be a good idea. In Bangkok, with doctors traned in the west and thus willing to discuss the pros and cons of different medications. Be upfront about the lack of insurance and the preference for locally made drugs where possible.

[chiang mai]

As noted in my prior post, there are no generics of 2 of the drugs he is on, since these are very newly patented, but there are generics of drugs in the same class which he may be able to switch to, should discuss with his doctor.

Only the Lipitor has an exact localy made generic equivalent.

I am still managing to buy Apolets ... quite a bit cheaper than Plavix.

+1, 600 baht for 30 in CM

[chiang mai]

Normetec seems to by the same hypertension drug I take as Amlodipine so there may be price difference in various brands.

Lipitor is still very high priced although just gone off-patent and believe copy is now available locally. Most people in Thailand are treated with Bestatin which is much cheaper although doctors may have more faith in Lipitor for extreme cases for those that can afford it. Not sure if founded or perception.

As for Brilinta believe I had Plavix after stints but as used non medicated only for about 2 months - believe with the medicated stints it is lifetime.

Asprin is a non factor price wise. And yet likely one of the most important.

The medication attached to medicated stents lasts for not more than 90 days hence it is a short term solution to help get the patient over the initial danger period, thereafter those patients need to an injest oral equivelent such as Plavix, for ever. Studies at the VA have shown that there is no benefit of medicated stents over bare metal ones, where oral Plavis equivelents were used, there is no difference in the mortality rates whilst the stent cost difference is significant..

[bunnaag]

Normetec seems to by the same hypertension drug I take as Amlodipine so there may be price difference in various brands.

Lipitor is still very high priced although just gone off-patent and believe copy is now available locally. Most people in Thailand are treated with Bestatin which is much cheaper although doctors may have more faith in Lipitor for extreme cases for those that can afford it. Not sure if founded or perception.

As for Brilinta believe I had Plavix after stints but as used non medicated only for about 2 months - believe with the medicated stints it is lifetime.

Asprin is a non factor price wise. And yet likely one of the most important.

The medication attached to medicated stents lasts for not more than 90 days hence it is a short term solution to help get the patient over the initial danger period, thereafter those patients need to an injest oral equivelent such as Plavix, for ever. Studies at the VA have shown that there is no benefit of medicated stents over bare metal ones, where oral Plavis equivelents were used, there is no difference in the mortality rates whilst the stent cost difference is significant..

where did you get the information that you have to take plavix for ever if medicated stents were installed.The cardiologists at the German heart center in Munich have a different opinion.I was the receiver of 7 medicated stents and was told clopidogrel(Plavix) has to be taken for only one year.

[lopburi3]

Believe that used to be the recommendation but current thinking seems to be forever from my reading but you will get different opinions from different doctors. Also current thinking seems to favor a more conservative approach in stent usage than in the past.

Below is current Mayo Clinic write up:

• Take aspirin. If you have a stent, you'll have to take aspirin daily and indefinitely to reduce the risk of clotting. Follow your doctor's instructions on how much and what type of aspirin to take.
  
• Take anti-clotting medication. People with stents are given prescription anti-clotting medications, such as clopidogrel (Plavix). The American Heart Association and Food and Drug Administration recommend that people who have had drug-eluting stents inserted should continue to take medications, such as clopidogrel, to reduce the risk of stent clotting for at least one year after the stent is inserted. In some high-risk situations, your cardiologist may recommend taking clopidogrel indefinitely.
  
• Listen to your cardiologist. Always talk with your cardiologist about how long you should take anti-clotting and other medications because the answer will vary depending on the nature of your blockage and your risk of bleeding. The most important thing to remember is to take all your medications exactly as your doctor prescribes.
  

[chiang mai]

Normetec seems to by the same hypertension drug I take as Amlodipine so there may be price difference in various brands.

Lipitor is still very high priced although just gone off-patent and believe copy is now available locally. Most people in Thailand are treated with Bestatin which is much cheaper although doctors may have more faith in Lipitor for extreme cases for those that can afford it. Not sure if founded or perception.

As for Brilinta believe I had Plavix after stints but as used non medicated only for about 2 months - believe with the medicated stints it is lifetime.

Asprin is a non factor price wise. And yet likely one of the most important.

The medication attached to medicated stents lasts for not more than 90 days hence it is a short term solution to help get the patient over the initial danger period, thereafter those patients need to an injest oral equivelent such as Plavix, for ever. Studies at the VA have shown that there is no benefit of medicated stents over bare metal ones, where oral Plavis equivelents were used, there is no difference in the mortality rates whilst the stent cost difference is significant..

where did you get the information that you have to take plavix for ever if medicated stents were installed.The cardiologists at the German heart center in Munich have a different opinion.I was the receiver of 7 medicated stents and was told clopidogrel(Plavix) has to be taken for only one year.

That is the opinion of every cardiologist I have ever met, three in Thailand at Bumrungrad and CM RAM plus two in Singapore at National University Hospital, Also, every piece on this subject that I have ever read have all reported the same, if you can find a link, in English and from a reputable source, I will be pleased to see it.

[chiang mai]

Believe that used to be the recommendation but current thinking seems to be forever from my reading but you will get different opinions from different doctors. Also current thinking seems to favor a more conservative approach in stent usage than in the past.

Below is current Mayo Clinic write up:

• Take aspirin. If you have a stent, you'll have to take aspirin daily and indefinitely to reduce the risk of clotting. Follow your doctor's instructions on how much and what type of aspirin to take.
  
• Take anti-clotting medication. People with stents are given prescription anti-clotting medications, such as clopidogrel (Plavix). The American Heart Association and Food and Drug Administration recommend that people who have had drug-eluting stents inserted should continue to take medications, such as clopidogrel, to reduce the risk of stent clotting for at least one year after the stent is inserted. In some high-risk situations, your cardiologist may recommend taking clopidogrel indefinitely.
  
• Listen to your cardiologist. Always talk with your cardiologist about how long you should take anti-clotting and other medications because the answer will vary depending on the nature of your blockage and your risk of bleeding. The most important thing to remember is to take all your medications exactly as your doctor prescribes.
  

It's probably worth pointing out here that Asprin and Plavix both come from the same family of drugs, for that reason cardiologists often give patients a choice of whether to take one or the other, beyond the one year mark. So in order to be more accurate, the requirement is for stent patients to take an anticoagulant for ever, whether they take asprin or Plavix is frequently their choice.

[JAS21]

Believe that used to be the recommendation but current thinking seems to be forever from my reading but you will get different opinions from different doctors. Also current thinking seems to favor a more conservative approach in stent usage than in the past.

Below is current Mayo Clinic write up:

• Take aspirin. If you have a stent, you'll have to take aspirin daily and indefinitely to reduce the risk of clotting. Follow your doctor's instructions on how much and what type of aspirin to take.
  
• Take anti-clotting medication. People with stents are given prescription anti-clotting medications, such as clopidogrel (Plavix). The American Heart Association and Food and Drug Administration recommend that people who have had drug-eluting stents inserted should continue to take medications, such as clopidogrel, to reduce the risk of stent clotting for at least one year after the stent is inserted. In some high-risk situations, your cardiologist may recommend taking clopidogrel indefinitely.
  
• Listen to your cardiologist. Always talk with your cardiologist about how long you should take anti-clotting and other medications because the answer will vary depending on the nature of your blockage and your risk of bleeding. The most important thing to remember is to take all your medications exactly as your doctor prescribes.
  

It's probably worth pointing out here that Asprin and Plavix both come from the same family of drugs, for that reason cardiologists often give patients a choice of whether to take one or the other, beyond the one year mark. So in order to be more accurate, the requirement is for stent patients to take an anticoagulant for ever, whether they take asprin or Plavix is frequently their choice.

That's as maybe but they work differently.