Doctor prescribed Valsartan 160mg, but too expensive.

[giddyup]

Just saw the specialist at BKk/Pattaya hospital to have my BP medication reviewed. I was taking Hydrochlorothiazide 25mg and Metroprolol 50mg, both of which only cost me a couple of hundred baht a month. He wanted me to stop with the Hydrochlorothiazide and instead take Valsartan 160mg, which is nearly 1000 baht for 28 tablets. I have had a good look online but I can't see any generics that are any cheaper. Am I stuck with the Valsartan?

 

I see there is a generic called Valatan, but Fascino pharmacy never mentioned that, any idea where it is available.

Edited February 9, 2017 by giddyup

[Sheryl]

No. Ask the doctor if there is any reason why you cannot instead take losaratan, same family and chemically very close, and inexpensive - several local generic brands.

 

 

[giddyup]

22 minutes ago, Sheryl said:

No. Ask the doctor if there is any reason why you cannot instead take losaratan, same family and chemically very close, and inexpensive - several local generic brands.

 

 

Is that Losartan? I just rang the doctor and he said the Losartan isn't as strong as the Valsartan, but I can give it a try.

Edited February 9, 2017 by giddyup

[Sheryl]

Yes, losartan.

 

It is just as "strong".  In fact studies have shown them to be equal in effectiveness and in side effects.

 

"At starting and titrated doses, losartan and valsartan are similarly effective in reducing blood pressure in patients with mild to moderate hypertension"

https://www.ncbi.nlm.nih.gov/pubmed/11558856

In addition, losartan helps slightly reduce uric acids levels, which valsartan does not; may or may not be a benefit.

 

The main difference is that valsartan is a newer preparation still under patent and hence both more expensive and more aggressively pushed by pharm sales reps.

 

You might want to consider a change of doctors.

[giddyup]

7 minutes ago, Sheryl said:

Yes, losartan.

 

It is just as "strong".  In fact studies have shown them to be equal in effectiveness and in side effects.

 

"At starting and titrated doses, losartan and valsartan are similarly effective in reducing blood pressure in patients with mild to moderate hypertension"

https://www.ncbi.nlm.nih.gov/pubmed/11558856

In addition, losartan helps slightly reduce uric acids levels, which valsartan does not; may or may not be a benefit.

 

The main difference is that valsartan is a newer preparation still under patent and hence both more expensive and more aggressively pushed by pharm sales reps.

 

You might want to consider a change of doctors.

Thanks for your reply. The Valsartan dosage he asked me to try is 160mg, but Losartan only comes in a max of 100mg AFAIK. Should I just take the 100mg and see how it goes? I just asked to see a cardiologist at BKK/Pattya hospital, so I saw who they had.

[Upnotover]

Valatan 160 is available in Fascino  (at Numchai).  I was prescribed Diovan 160 which seems to have disappeared from the shelves but this Valatan is a direct replacement (also marked Valsartan on the box).

[giddyup]

Just now, Upnotover said:

Valatan 160 is available in Fascino  (at Numchai).  I was prescribed Diovan 160 which seems to have disappeared from the shelves but this Valatan is a direct replacement (also marked Valsartan on the box).

Thanks, but I think the Valatan is still pricey compared to the Losartan.

[tutsiwarrior]

I presently take Exforge (amlodipine 5mg/valsartan 160mg) and it's pricey, thb840 for a box of 28 at the local clinic...would a straight substitution of losartan 100mg be OK? I can always try it out and monitor the BP to see if any change, I suppose...

[Sheryl]

It is not a direct equivalence of dosage between losartan and valsartan.  160 valsaratan is generally equivalent to 100 mg losartan,

 

Tutsi: your case is more complex than OPS, he was put on only valsartan and from that to losartan is pretty straightfoward, same class of drug: both are what is called Angiotensin Receptor Blockers (ARB) AKA Angiotension II inhibitors.

 

However you are on a combo of an ARB (valsartan)  and amlodipine, the latter is a totally different class of drug and your doctor may have had specific reasons for putting you on it. It is a calcium channel blocker. So do not switch to losartan alone without first discussing with your doctor.

 

If the issue is just cost, you could probably switch to losartan 100 mg and then a generic brand of amlodipine of which there are several.  This too you should run by your doctor but I can't see any reason why not and will save a lot of $.

 

OP: Private hospitals in Thailand  tend to "push" newer, patented brands of drugs. More profitable, and they also tend to assume more affluent patients want the "newest"and imported  drugs (as well as, want as many different medications as possible)..and of course farang are automatically assumed to be in the affluent category.  Always a good idea to ask specifically if there is an alternative that comes in a  local generic brand.

 

 

[tutsiwarrior]

thanks, Sheryl...

 

the Exforge was prescribed by the doc at the SOS clinic in Hanoi (popular with westerners) after a mild stroke 5 years ago and I've been taking it ever since...now that I'm retired and the bucks are limited need to look into an alternative meds arrangement using generics...

[giddyup]

Bought some Losartan today, 70 baht for 15 capsules, that's only 140 baht a month compared to nearly 1000 baht a month for the Valatan. Thanks Sheryl.

[BEVUP]

Good day all 

Would like to jump on this as well as i am quite interested - maybe one for you Sheryl

 

Have been meds for a few yrs now first prescribed Candestarn also known as Todesaar 16 mg. Doc was going to subscribe another type but was worried i may have a constant dry cough, maybe Cozaar

I am also taking 20 mg Zimmex & 10 mg Ampoline (Caduet 10/20 ) along with 160 mg of fibril (Lipidil )

? I therefore could not see a problem switching to Lostaron but do wonder about the dosage as it would obviously not be 16 mg as above.

History of 160/90 now maybe 130/85

 

[Sheryl]

16 md candesartan is equivalent to 100 mg losartan.

 

But as the candesaratan you are on is already a local brand I don't know how much cost difference there will be.

 

In addition -- and this is important! -- candesartan has additional benefits for patients with a history of, or at unusual risk of, cardiovascular  disease. From the other meds you are on, this might apply to you so best to discuss with your doctor. Losartan and candesaratn are the same in terms of effectiveness in lowering BP, but losartan does have  the extra protective effect candesartan seems to have for CVD.

 

Where you could likely save more money is with the Caduet, which is a mix of amlodipine and atrovastatin and a very expensive imported drug.

 

There are many locally made brands of amlodopine, and one local brand of atorvastatin (Chlorvas) though peopke have reported it is hard to find. Many, many local brands of simvastatin though. Ask you doctor if instead of Caduet you could separately take amplodipine and simvastatin, chances are you can and it will save s lot.

 

 

 

[Oxx]

10 hours ago, Sheryl said:

but losartan does have  the extra protective effect candesartan seems to have for CVD.

 

Did you mean "losartan does NOT have the extra protective effect"?

[Sheryl]

Yes sorry -- does not

[BEVUP]

Thanks Sheryl

Yes i am buying the 2 diff. meds that are in Caduet 

Well i think that sets it straight but would of liked to make a bit of a saving 550 bht (maybe 700 bht) for 30 pills Todesaar 16 mg 

[Sheryl]

Well you can ask your doctor - not knowing your history I cannot say of there is some specific reason to prefer candasartan.

[manarak]

question: is it easy to buy nebivolol and losartan OTC ?

[giddyup]

2 minutes ago, manarak said:

question: is it easy to buy nebivolol and losartan OTC ?

I bought Losartan at my local pharmacy as I mentioned for 70 baht for 15 tablets. So the answer is yes, it's easy.

[manarak]

14 minutes ago, giddyup said:

I bought Losartan at my local pharmacy as I mentioned for 70 baht for 15 tablets. So the answer is yes, it's easy.

thanks - what about nebivolol?

[giddyup]

1 hour ago, manarak said:

thanks - what about nebivolol?

No idea, don't use it.

[davee58]

On 09/02/2017 at 1:06 PM, Sheryl said:

No. Ask the doctor if there is any reason why you cannot instead take losaratan, same family and chemically very close, and inexpensive - several local generic brands.

 

I was originally on Amlodopine / Valsartan 5/160, then my GP in the UK moved me onto Amlodopine / Losartan 5/100 due to a shortage of Valsartan in the UK last September.

 

Losartan was the correct replacement, there should have been no problems, and when I saw my GP again after the first four weeks I reported that all was well, but already I sensed weight gain, bloating, and a hard swollen stomach at night, even after drinking just a couple of beers.  I did not immediately link it to my medication.

 

After that my symptoms got progressively worse, I felt bad, and drinking beer no longer seemed like a good idea, though I did have a few.

 

I was in Cambodia at the time.  I replaced the Losartan with some over the counter Valsartan and within a few days felt much improved.

 

 

Edited February 18, 2017 by davee58

[giddyup]

13 minutes ago, davee58 said:

I was originally on Amlodopine / Valsartan 5/160, then my GP in the UK moved me onto Amlodopine / Losartan 5/100 due to a shortage of Valsartan in the UK last September.

 

Losartan was the correct replacement, there should have been no problems, and when I saw my GP again after the first four weeks I reported that all was well, but already I sensed weight gain, bloating, and a hard swollen stomach at night, even after drinking just a couple of beers.  I did not immediately link it to my medication.

 

After that my symptoms got progressively worse, I felt bad, and drinking beer no longer seemed like a good idea, though I did have a few.

 

I was in Cambodia at the time.  I replaced the Losartan with some over the counter Valsartan and within a few days felt much improved.

 

 

I am only taking half of a 50mg Losartan (25mg) and 1/4 of a Metroprolol 100mg (25mg) and so far have suffered no side effects, and my BP is averaging out at around 135/75 and a pulse of 65, so I'm happy with that.

[Sheryl]

I take losartan myself, have for years and no problems at all, but with any drug a small percentage of people will have side effects so the experience of one person -- or even of many people - does not necessarily predict that of another person.

 

That said, valsartan and losartan are so chemically similiar that it is very, very surprising that someone would have problems on one but not on the other. Studies have not found any difference in their side effect profiles. One wonders if the timing might have been coincidental.

 

 

[manarak]

36 minutes ago, Sheryl said:

I take losartan myself, have for years and no problems at all, but with any drug a small percentage of people will have side effects so the experience of one person -- or even of many people - does not necessarily predict that of another person.

 

That said, valsartan and losartan are so chemically similiar that it is very, very surprising that someone would have problems on one but not on the other. Studies have not found any difference in their side effect profiles. One wonders if the timing might have been coincidental.

 

Sheryl, what's your opinion on the availability of nebivolol?

I would prefer OTC of course, because as I got it prescribed to me in Switzerland already, I consider an additional visit to a doc to be useless.

[Sheryl]

56 minutes ago, manarak said:

Sheryl, what's your opinion on the availability of nebivolol?

I would prefer OTC of course, because as I got it prescribed to me in Switzerland already, I consider an additional visit to a doc to be useless.

 

It does not require a prescription in Thailand. But it may take some going around to find; it is not widely used here as it is an expensive import and there are many less expensive drugs in the same class. Nebilet is brand name.

[manarak]

4 minutes ago, Sheryl said:

 

It does not require a prescription in Thailand. But it may take some going around to find; it is not widely used here as it is an expensive import and there are many less expensive drugs in the same class. Nebilet is brand name.

hmm.. ok... then I might look for another molecule that is cheap in Thailand. do you know a good substitute?

[smedly]

anyone found valatan cheaper than 700baht 

[Sheryl]

Losartan is an inexpensive alternative antihypertensive in same family as valsartan, same mode of action and similar but not identical molecular structure. Suggest you ask your doctor if you can switch to it. I pay under 100 baht for month supply.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[smedly]

1 hour ago, Sheryl said:

Losartan is an inexpensive alternative antihypertensive in same family as valsartan, same mode of action and similar but not identical molecular structure. Suggest you ask your doctor if you can switch to it. I pay under 100 baht for month supply.

Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

Thx Sheryl, I already take Losartan and pay more than you for it here in Pattaya, they seem to just make the price up here, 100mg losartan is 350baht

 

I am trying to lock down a source for Valatan but so far only found one and they want 750baht for 160mg x28, not even sure it would be a steady supply

 

I know it can be obtained cheaper than that at around 400baht