The widely prescribed beta-blocker atenolol is in short supply around the country.
an atenolol shortage on July 26. According to the FDA website, three companies that manufacture generic atenolol -- Mylan, Sandoz, and Teva -- say that the cause is a shortage of an active ingredient. A fourth manufacturer, Zydus, said that it "is able to supply its current customer demand and has increased capacity to support additional demand starting in August."
, a website that provides information about drugs to consumers, said that the brand name version of atenolol, Tenormin, costs $400, compared with $4 for the generic versions. The site recommends to people who have trouble filling their prescription that "it might be a good idea to talk to your physician about switching to another beta blocker in the meantime." Possible alternatives are metoprolol tartrate, metoprolol succinate, and bisoprolol, according to the site.
Cardiologists contacted for this article agreed with that advice.
Scott Ratner, MD, a cardiologist in private practice in New York on Long Island, said "don't panic." He rarely uses atenolol these days. It is indicated only for hypertension and not heart failure and there are "at least 8 other beta blockers available for hypertension, all just as good." He noted that atenolol was still available at Walmart for $4.
Ethan Weiss, MD, (UCSF) said he was surprised that anyone was still taking atenolol. He now uses metoprolol almost exclusively, "especially in older people who have renal dysfunction."
Hypertension expert Franz Messerli (Mt. Sinai) said that patients and physicians should take advantage of the shortage to switch drugs:
“Atenolol for the treatment of hypertension is a very, very old hat. In fact it simply is obsolete. So what you want to do, whether or not the atenolol shortage strikes, is ask your doctor why you are still taking atenolol. Yes, atenolol does lower blood pressure (as do leeches), but no, it has never been shown to prevent heart attacks, stroke or death better than placebo. We should remember that blood pressure is a surrogate endpoint, not everything that lowers it will automatically translate into cardiovascular benefits. However, the principle reason for treating high blood pressure remains prevention of its devastating complication and atenolol falls miserably short in this task. In fact it provides a sense of false security, blood pressure is down but the risk of stroke and MI remains unchanged. If you have been on atenolol for years and decades, this shortage should be a good opportunity to revise your antihypertensive regimen. But by all means do not discontinue the drug abruptly because this could trigger a rebound effect.â€
Turmoil in Generics
The atenolol news comes at a time when there have been increasing reports of confusion and problems in the marketplace for generic drugs:
- Cardiologists at the Cleveland Clinic reported in the that dramatic price increases in nitroprusside and isoproterenol resulted in a significant reduction in usage of the drugs at 47 hospitals.
- exposed a highly unusual situation in which consumers filling prescriptions are being forced by their insurance companies to purchase expensive brand name versions of drugs instead of less expensive generic versions. "Out of public view, corporations are cutting deals that give consumers little choice but to buy brand-name drugs -- and sometimes pay more at the pharmacy counter than they would for generics," the Times and ProPublica write.
- As a result of the business practices cited by the Times and ProPublica, reported that "CVS, the largest pharmacy chain in America," is being sued "for allegedly charging more to customers who use insurance to pay for certain generic prescriptions." According to Business Insider, "The suit claims that the pharmacy agrees with pharmacy benefit managers, or PBMs -- the middlemen of the industry that manage the list of what drugs an insurer will and will not pay for -- to sell certain drugs at a higher price if a customer is paying with insurance."