The Top 20 Selling Drugs in the USA
NB: Data from IMS Health. Figures reported are in $US and collected from 01 October 2012 to 30 September 2013.
Fig 1: Left: The Top 20 US Drugs listed by Total Sales ($) and Right: The Top 20 US Drugs listed by Prescription Volume (units)... I have included the totals, FYI.
Below (Fig 2) are some cheat sheets to view the indications and the drug groupings at a glance. Looking at the drugs listed by total sales in dollars it's certainly understandable that oncology and HIV drugs make up much of the expense for the top 20 due to their high unit price but the antidepressants and statins are included in the top 20 due to their sheer volume.
Fig 2: Left: The Top 20 US Drugs listed by Total Sales ($) and Right: The Top 20 US Drugs listed by Prescription Volume (units) with class of drug and/or indication for use as per the PI (Product Information).
Thorazine, the first real antipsychotic, carried a raft of unwanted side-effects but the drugs available now in the class have fewer neurological side effects such as social withdrawal, apathy and cognitive deficits. Recent large randomized studies (such as The Catie trial) failed to demonstrate that the new antipsychotics were any more effective or better tolerated than the older drugs. Nevertheless, between 2007 and 2011 more that 98% of marketing and advertising spend on atypical antipsychotics can be attributed to just two drugs: Abilify and Seroquel. What was the Seroquel revenue for same period? US$1,219,959,533 (36) and n=2,553,562 (59).
Total = $7,611,009,542 and 11,476,516 units.
The original target population for these drugs, patients with schizophrenia and bipolar disorder, is worth mentioning: the world-wide prevalence of schizophrenia is 1% and bipolar disorder is a little less than 1.5%, yet Abilify ranks 14th in overall unit sales. The drug carries a boxed warning for "an increase in the risk of suicide" and is indicated as "adjunctive treatment of major depressive disorder (MDD)" i.e. not first line treatment.
It is also interesting to read the answer in marketing brochures to the question, "Will Abilify make me gain weight? Patients followed up at 24 weeks, those taking Abilify lost an average of 3.3 pounds compared with patients taking placebo who lost an average of 0.4 pounds". Danger, Will Robinson! One should critically evaluate the efficacy, indications, side effects and adverse events before slapping the drug with the label "the antidepressant that helps patients lose weight."