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Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by qrbLPHiKpiux on Saturday December 07, 2019 @10:40AM (#21730793)
Doc here.

I was at a continuing education course last year. FDA approved a new narcotic very fast. A non narcotic alternative is taking forever to approve.

Its name is Maxigesic. Tylenol and ibuprofen in one pill.

Why?

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by refurb on Saturday December 07, 2019 @06:42PM (#21733399)
As someone who works in the drug industry, when Maxigesic is approved, please don't prescribe it. Just tell your patients to take one each of the OTC drugs, they are dirt cheap (like $0.02 per pill).

The market is full of drugs that are combinations of OTC medications and usually they are way more expensive. Even if they didn't go nuts with the price, why make a patient pay $0.50 per pill when they could take 2 for $0.04?

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by ensignavenger on Sunday December 08, 2019 @09:56AM (#21736137)
Some patients have a lot of pills to take, and they would rather pay more to take fewer. Maybe they have trouble keeping track of them, maybe it is just pill fatigue. Maybe they have trouble swallowing for one reason or another. Combo pills could be a good thing for a subset of the population. Sure, it requires doctors to be on top of their game and patients to research what they are taking and ask questions, but that doesn't mean it isn't a good idea to have it available as an alternative.

As to the question about why it is taking so long at the FDA, I imagine it isn't a very high priority because there are alternatives.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by refurb on Sunday December 08, 2019 @12:12PM (#21736895)
I don’t disagree that pill burden can be an issue.

The problem is the lack of transparency into cost which results in some drug companies taking advantage.

Combine two pills that cost $0.10 each into one pill that costs $0.15? Reasonable.

Do the same and charge $5 per pill? Ridiculous. Problem is doctors and patients don’t know it costs $5 and insurers can’t be bothered to push back. Suddenly you’ve increased the cost of therapy by 50x.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by qrbLPHiKpiux on Saturday December 07, 2019 @07:32PM (#21733642)
That’s what I do now.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by refurb on Saturday December 07, 2019 @08:08PM (#21733759)
Good stuff. Lots of doctors don’t. Not out of bad will, but they just don’t have the time to dig into it.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by merpnderp on Saturday December 07, 2019 @11:08AM (#21730955)
That’s very strange. People have been alternating/mixing Tylenol and Ibuprofen for nearly 60 years. Don’t we know how they interact?
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by ensignavenger on Sunday December 08, 2019 @09:58AM (#21736149)
I don't know about this drug, but they may be using a different manufacturing process or something else that is undergoing scrutiny.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by Cougher on Sunday December 08, 2019 @05:06AM (#21735173)
Yes we do. People see the equation as drug + drug = relief. Pharmaceutical companies see the equation as drug + drug + patent = $
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by refurb on Saturday December 07, 2019 @12:15PM (#21731337)
What process is Maxigesic being approved under? I assume an aNDA, which is for generic drugs.

The FDA has a massive backlog for generic drugs, while novel drugs (NDA) don’t.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by dickeytk on Saturday December 07, 2019 @11:07AM (#21730952)
What do you think the reason is? I only ask because there are (probably) few Doctors here and it's an interesting question.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by burpsnard on Saturday December 07, 2019 @08:29PM (#21733829)
Yes.. fda approves combination pills seperate to each drug on it's own. While i'm not a pharmacologist, it dies seem odd
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by acd10j on Sunday December 08, 2019 @12:32AM (#21734487)
not a doctor, I for one will prefer a single pill instead of two pills , Swallowing pill is unpleasy for me, if there are too many pills , There is higher chance of mistakes (like forgetting, mixing doses etc) .I will pay a reasonable premium for one combination pill instead of two pills.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by akiselev on Saturday December 07, 2019 @11:32AM (#21731086)
Clinical trials are complicated beasts. The simplest answer is likely that the CRO running the trials - at least I hope its a CRO - isn't set up to target the kind of patients/doctors needed for approval or they don't have funding immediately available to speed that process up at the necessary scale.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by qxnqd on Saturday December 07, 2019 @11:14AM (#21730985)
>Maxigesic. Tylenol and ibuprofen in one pill.

What's the point of this, compared to just having half a pill of tylenol and half a pill of ibuprofen?

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by iudqnolq on Saturday December 07, 2019 @11:39AM (#21731124)
If anyone reads this for medical advice (and I really hope they wouldn't be taking advice directly from HN without any filtering), you don't combine them in equal proportions.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by selectodude on Saturday December 07, 2019 @12:01PM (#21731250)
Yes, you combine 500mg of acetaminophen and 150mg of ibuprofen. Ibuprofen only comes in 200mg pills, so if you want to be really spot on, take the liquid stuff for kids.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by StuffedParrot on Saturday December 07, 2019 @12:40PM (#21731475)
That seems pretty high for acetaminophen and low (proportionally) for ibuprofen. Why would you prescribe that?
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by selectodude on Saturday December 07, 2019 @01:33PM (#21731778)
I wouldn't. I take naproxen. That's just whats in the drug if you don't want to wait for the FDA to approve a pill that combines the two.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by iudqnolq on Saturday December 07, 2019 @01:07PM (#21731632)
500mg is the max for ace a doctor is recommended to proscribe (on it's own). 150 is well below the max for ibu. Also I think you may have mixed up the grandparent commentator that stated they were a doctor and the parent that may be a doctor but hasn't made that claim here.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by GoodOldNe on Saturday December 07, 2019 @02:54PM (#21732208)
Am doctor. Routinely prescribe 1000 mg of Acetaminophen.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by iudqnolq on Saturday December 07, 2019 @02:58PM (#21732231)
Thanks for pointing out that I'm wrong. I googled more and realized the numbers I cited were completely wrong.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by connicpu on Saturday December 07, 2019 @06:00PM (#21733185)
500mg is normal for a single extra-strength pill of acetaminophen
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by StuffedParrot on Thursday December 12, 2019 @11:00AM (#21772935)
200mg is normal for ibuprofen, and prescriptions for 800mg versions are not unusual.

Meanwhile 500mg is, I believe, more than they combine with opiates and acetaminophen does lead to death via organ failure on the order of hundreds of people a year. I was curious why they weighted the acetaminophen proportionally so much higher than the ibuprofen.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by tzs on Saturday December 07, 2019 @02:18PM (#21732010)
It still seems odd. Both Tylenol and ibuprofen are good to keep around with your basic home health care supplies. They are available in cheap generics without a prescription. They have different things they are best at, so stocking both is quite reasonable.

Unless they need to be prescribed in ratios that can't be achieved reasonably with the cheap OTC pill dose sizes, it's not clear to my why I'd want a combined bill instead of just taking separate pills.

Taking more than one pill is less convenient, but except for people who have trouble with pills in general I doubt they would want to pay more for that convenience.

Even in the case of fairly high doses, it is not too bad. A few months ago, for example, I somehow managed to get a painful rotator cuff injury while sleeping (no idea how), and my doctor told me to take 1000 mg Tylenol every 8 hours and 800 mg of ibuprofen every 8 hours. At the most common OTC strengths, that would be two Tylenol pills and 4 ibuprofen pills.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by iudqnolq on Saturday December 07, 2019 @02:23PM (#21732038)
If we had decent competition in medicine this wouldn't be an issue. Either people would agree with you and not buy it, or some would buy it, and no one would be worse off.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by qxnqd on Saturday December 07, 2019 @01:46PM (#21731840)
For the record, I didn't pretend to give medical advice at all.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by iudqnolq on Saturday December 07, 2019 @01:51PM (#21731873)
I realize in retrospect my comment might have appeared that way. I meant only that people might (possibly) read your comment and be misinformed. I meant it might be mistakenly read as legal advice, not that it was.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by leakybit on Saturday December 07, 2019 @12:20PM (#21731375)
The point is that you have to pay 20x for the convenience of one pill.
Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by iudqnolq on Saturday December 07, 2019 @12:24PM (#21731399)
*have the option to

It's a damn shame that doctors often fail to tell people about cheaper and more irritating alternatives, but there's nothing wrong with giving people the option to pay more for a better experience.

You often see this in terms of number of times a drug had to be taken per day. There'll be a generic that needs to be taken say three times a day, and a newer drug that only needs to be taken once.

I highly doubt every manufacturer of Ibuprofen or Acetaminophen would decide to throw in the towel if this new drug was released.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by shsidns on Saturday December 07, 2019 @11:14PM (#21734289)
If I had to take a guess it’s because drug A + B != AB

The drugs in question could, combined have deleterious effects (say if their extortion mechanisms are the same).

This shouldn’t be a problem because Tylenol + Advil has been done for decades. However, a beauricracy doesn’t see it as a solved problem to fast track unless there is a specific fast track for this exact scenario.

Re:FDA Approving Drugs at Breakneck Speed, Raising Alarm by wiggles_md on Saturday December 07, 2019 @11:31AM (#21731080)
Might have to do with the claims are they seeking for Maxigesic?