When it comes to the prescription medications people use around the world, patients and their doctors consider a number of factors, such as efficacy in treating a given condition, cost to the patient, and how well known a drug is to prescribers. So how do different drugs stack up? Which ones have the highest sales, and which ones are the most satisfying to patients?

We decided to find out. Using data on U.S. sales figures of major prescription medications as well as 29,672 individual patient ratings of these drugs from the U.S.-focused site, Drugs.com,we examined patterns of patient satisfaction among various categories of the most commonly used drugs. Read on to see rankings of the top medications, which treat everything from ADHD to thyroid conditions and allergies to erectile dysfunction.


Most Sold, Most Liked

We selected the top 50 pharmaceutical drugs by units sold in the U.S. in 2013 and compared their sales with average ratings by patients on Drugs.com. Where these drugs fall in terms of the volume of units sold versus patient satisfaction is fascinating. Overall, patient satisfaction is high: Every one of these top-selling drugs rates a 6.0 or more out of 10, with nearly half ranking at 8.0 or above.

Still, significant variation exists among these drugs. A handful, particularly the diabetes drugs Levemir and NovoLog FlexPen, were among both the most sold and the highest rated. Other popular drugs didn’t fare so well in the ratings: The blood pressure drug metoprolol received an average rating of only 7.0, while the depression medication Abilify rated a mere 6.7.


Best Sellers and Top Categories

Looking at pharmaceutical rankings solely by units sold, we can see which categories of drugs make the most sales. Of the top five medications, four – Levemir, NovoLog FlexPen, NovoLog, and Humalog – were insulin analogues used in the treatment of diabetes, typically requiring frequent injections. And while they're some of the best-known, erectile dysfunction treatments aren't quite the top sellers: out of the bottom 10 in the top 50, two - Viagra and Levitra - were ED drugs.


The Potency of Erectile Dysfunction Drugs

We then focused specifically on ratings and units sold of three major drugs for the treatment of erectile dysfunction, or impotence: Viagra, Cialis, and Levitra. Each one works in the same fashion, acting to increase blood flow to the genitals during sex.

In absolute terms, all three of these drugs were very satisfying to patients, with ratings ranging from 8.4 to 8.9 out of 10. But you might be surprised to learn that Viagra, the first pill for erectile dysfunction, ranked among the last (along with Levitra) for patient satisfaction as well as last place for units sold. The newer Cialis, however, rated an 8.9 and sold more than twice as many units as Viagra.


Comparing Brand-Name and Generic Drugs

We separated the studied medications into several categories based on their medical use and also compared the ratings for brand-name drugs with their generic formulations. Across categories, the highest-rated classes of drugs were those used in cancer treatment, type 1 diabetes, and HIV/AIDS, with HIV/AIDS medications rating around 9.0 out of 10 and cancer medications receiving a solid 10.0 score. On the lower end are medications for asthma, high cholesterol, and oral contraception. High cholesterol drugs ranged from 6.2 to 6.4 in their ratings, while asthma medications received scores of 7.3 to 7.4.

None of the drug categories showed a substantial difference in patient satisfaction of brand-name and generic formulations. The largest difference was 0.45 points in the category of anemia drugs – in favor of the generic versions. Overall, generic drugs scored the same as or better than their brand-name counterparts in five out of 12 categories.


The Shape of Drug Ratings

Expanding on this analysis, we also examined the distribution of patient ratings from 1 to 10 for brand-name and generic medications in each of these categories. The highest proportion of 10/10 ratings was in the category of STD medications, with 60.4% of ratings consisting of a 10 – but only for the brand name. Among generics STD medications, the percentage of 10/10 ratings fell sharply to 44.8%.

However, among the other medication categories with the most 10/10 ratings, brand-name and generic drugs fared about the same: 57.8% and 56.8% of ratings were 10/10 for brand-name and generic HIV medications respectively, along with 56.9% and 56.6% for brand-name and generic erectile dysfunction drugs.

As for the other end of the scale, high cholesterol medications received the highest proportion of 1/10 ratings: 14.1% for brand-name formulations and 16.06% for generics. The runner-up for most 1/10 ratings was asthma medications: Brand names received 1/10 ratings 9.3% of the time and generics drew 8.8%.


Average Ratings For…

Finally, we focused on each drug category and analyzed all the specific medications within it, examining patient satisfaction and comparing brand names to generics. For the following graphs, drugs with fewer than 10 reviews were omitted.

ADHD Medications

Among medications for attention deficit hyperactivity disorder, the highest-scoring drug was Desoxyn, followed by its generic form, methamphetamine hydrochloride, with both rating more than 9.3 out of 10. Of the top five drugs in this category rated highest by patients, all of them were amphetamine stimulants. Meanwhile, all the ADHD medications that scored below 7.0 were non-stimulants, such as Intuniv (guanfacine) and Strattera (atomoxetine).


Asthma Medications

Differences can also be seen in the patient ratings of various types of asthma drugs. Steroid medications such as prednisone and both generic and brand-name Dulera rated higher than 7.6 out of 10, with prednisone reaching 7.9. However, the non-steroid drug Singulair (montelukast sodium) received only 6.5 to 6.7.


Contraception

When it comes to contraceptives, two of the three highest rated weren’t pills at all. ParaGard, a copper IUD, rated highest at 8.9 out of 10, whereas the Skyla hormonal IUD received an 8.7. Brand-name Ortho-Cyclen was the only oral contraceptive to score above an 8. Meanwhile, of the three lowest-rated medications, two – Camrese and LoSeasonique – were extended-cycle contraceptives that allow women to have only four periods per year.


Erectile Dysfunction Drugs

One thing is clear: Nearly all erectile dysfunction medications are highly satisfying to patients. All the drugs in this category rated higher than 8.4 out of 10, with two reaching 9.0 or above. Interestingly, Staxyn rated 9.3, while Levitra rated only 8.5, even though both are formulations of vardenafil. This may be because Staxyn is designed to dissolve orally, which affects the drug’s bioavailability.


Cholesterol Medications

Cholesterol-lowering medications display a wide range of patient ratings. One fibrate drug, gemfibrozil, came in first with an average rating of 8.0 out of 10. Another, Trilipix (fenofibric acid), was nearly last with only a 5.1. And while Zocor (simvastatin) ranged from 5.0 to 5.9 and Zetia (ezetimibe) ranged from 6.3 to 6.8, the combination drug Vytorin (ezetimibe/simvastatin) was rated 7.6, higher than either of these.


HIV/AIDS Medications

Medications for HIV/AIDS also showed extremely high patient ratings, ranging from 8.7 to 9.5 out of 10. Many of these medications are actually a “cocktail” of several drugs working together to inhibit HIV in the body. Stribild, a combination of four drugs, rated highest at 9.5, along with its generic formulation. Raltegravir placed last with 8.7, although its brand name, Isentress, rose to 9.0.


STD Medications

Medications for sexually transmitted diseases fall into a number of categories, such as antibacterials and antivirals, and they’re used to treat many different conditions. Abreva – and its generic form docosanol – is a topical antiviral treatment for cold sores caused by the herpes virus, and both drugs rated 9.0 out of 10. On the lower end, azithromycin, prescribed to treat chlamydia and chancroid, rated 8.3 out of 10. Overall, each of these medications showed high levels of patient satisfaction.


Antidepressant, Antipsychotic, and Mood Stabilizing Medications

Antidepressant, antipsychotic, and mood stabilizing medications can function in a variety of different ways, and the medications we studied show a diverse range of patient ratings. Serzone and its generic form nefazodone were among the highest rated, coming in at 9.7 and 9.3 respectively. For comparison, the well-known SSRI Prozac (fluoxetine) rated an average of 7.8 to 7.9, whereas combination olanzapine/fluoxetine for treatment-resistant depression rose to 9.2. At the lower end, Fetzima (levomilnacipran) ranked a mere 4.7 out of 10, making it one of the few drugs rated below 5.0 by patients.


Finding the Medication That’s Right for You

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Methodology

The data were collected from IMS Health by way of Drugs.com on the top 50 best selling prescription drugs in the U.S. and their generic equivalents in 2013 by units sold that year, with the exception of Levitra (vardenafil), for which data was only available from 2010. Average patient ratings of these drugs on a scale of 1 to 10 were also acquired from Drugs.com as well as 29,672 individual patient ratings of all drugs falling within eight major categories and the distribution of each rating from one to 10. Drugs with fewer than 10 ratings by patients were excluded from the analysis.

Sources

  • http://www.drugs.com/
  • http://www.theatlantic.com/health/archive/2015/03/generic-drugs-the-same-but-not/388592/
  • http://www.npr.org/sections/health-shots/2013/04/03/176145911/side-effects-prompt-patients-to-stop-statins-cholesterol

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