FDA wants to sell Rx diet pill OTC

[disneysteve]

All that is true with countless other OTC medications. If we take off every medication that could be bad for somebody who doesn't read the label warnings all that would be left is aspirin... oh wait, that would be gone too.

I think you missed my point. I'm suggesting that patients shouldn't take Xenical without a medical evaluation first because something potentially serious might be missed/ignored.

For the record, I do prescribe Xenical and other weight loss meds, but only along with proper evaluation, monitoring and appropriate educational efforts.

 

[cardaway]

I think you missed my point. I'm suggesting that patients shouldn't take Xenical without a medical evaluation first because something potentially serious might be missed/ignored.

And I guess you missed mine. How is this different than many other OTC's with serious side effects and issues with other conditions?

To be blunt, everytime doctors complain about this stuff it reads a lot like them being ticked they are getting cut out. Sure there are concerns, but there's concerns with almost every OTC.

 

[Blondie]

Sorry, but "oily leakage" isn't on my list of things to do today!

If those people out there who desire the extra push can handle wearing a pad/diaper or whatever to collect the um...leakage, then go for it.

There has to be a better alternative than this particular diet pill!

 

[disneysteve]

And I guess you missed mine. How is this different than many other OTC's with serious side effects and issues with other conditions?

To be blunt, everytime doctors complain about this stuff it reads a lot like them being ticked they are getting cut out. Sure there are concerns, but there's concerns with almost every OTC.

I think that many Americans have grown to see doctors as nothing more than pill prescribers. Thanks to direct to consumer marketing and the Internet, too many patients think they already know what's wrong with them and what they need to treat it. They see the doctor only as an obstacle to getting what they want. From that point of view, having more meds sold OTC sounds great.

The problem is it doesn't work that way. If a patient wants a diet pill but I find their BP is 220/110, I'm going to get their BP under control along with giving them Xenical. If I find that their blood sugar is 250, I'm going to put them on diabetes meds along with their Xenical.

Are there issues with other OTC drugs? Absolutely. I just don't think we should compound those problems by moving more drugs OTC. Why take a bad problem and make it worse? That just doesn't make sense to me.

Also consider that putting Xenical OTC doesn't really benefit the patient. Xenical is covered by many prescription plans in my area. OTC the patient will have to pay for it himself. As a prescription, the patient gets a medical evaluation that may uncover previously unknown problems. With it OTC, that won't happen. OTC they can just take the pill and not change anything. With it a prescription, they get ongoing counseling on diet and exercise issues. I just don't see how it is better for anyone to sell it OTC.

So yes, I am upset that they are cutting the doctor out of the process. But the reason I'm upset is because the patients are the ones who will suffer.

 

[kpm76]

Well, I don't know enough about Xenical specifically to make any intelligent comments but in a general sense I am highly opposed to any kind of diet pill being made available OTC. It's so important to be monitored by a Dr. for many of the reasons disneysteve outlined. In addition, Drs can help patients modify their diet and develop an exercise routine which ultimately will lead to long term weightloss and maintanence as well as an overall healthy lifestyle. IMHO, OTC diet pills are a quick fix to appeal to the needs of our instant gratification-type lifestyle.

 

[RitaZ.]

I'm not familiar with the drug, but I can see the potential for its misuse, especially among girls that suffer from eating disorders.

I'm not even going to ask you to explain what that "oily leakage" is all about, I've got an idea.

 

[disneysteve]

I can see the potential for its misuse, especially among girls that suffer from eating disorders.

Actually, the advisory panel addressed this. They felt that those with eating disorders wouldn't be likely to abuse this med because it doesn't result in quick weight loss. Without that instant gratification, they didn't feel folks would abuse it.

 

[Toby'sFriend]

It's so important to be monitored by a Dr. for many of the reasons disneysteve outlined. In addition, Drs can help patients modify their diet and develop an exercise routine which ultimately will lead to long term weightloss and maintanence as well as an overall healthy lifestyle. IMHO, OTC diet pills are a quick fix to appeal to the needs of our instant gratification-type lifestyle.

I think that if a patient wants to choose to go to a Doctor for those reasons, that is wonderful and the option of going to a Doctor certainly shouldn't be taken away.

But I don't agree with having the choice made from them.

 

[RitaZ.]

Actually, the advisory panel addressed this. They felt that those with eating disorders wouldn't be likely to abuse this med because it doesn't result in quick weight loss. Without that instant gratification, they didn't feel folks would abuse it.

Really? That's a frightening thought, desperate people usually aren't that rational/logical. I'd say keep it as it is right now, just my opinion.

 

[CathrynRose]

IMO we should get more drugs OTC.

2nd this - bigtime!

Too many time Ive had to pay for a DR visit, knowing exactly what RX I needed, but the DR wouldnt refil without a visit (my albuterol inhaler, for one)

 

[kpm76]

I think that if a patient wants to choose to go to a Doctor for those reasons, that is wonderful and the option of going to a Doctor certainly shouldn't be taken away.

But I don't agree with having the choice made from them.

While I agree whole-heartedly that we should have the right to make personal choices, one thing to keep in mind is the potential effect misuse of OTC drugs may have on the health care system as a whole. Increased trips to the ER and/or more extensive medical care needed as a result of illnesses brought on by using meds without proper observation will result in higher cost of health care for all of us.

 

[disneysteve]

2nd this - bigtime!

Too many time Ive had to pay for a DR visit, knowing exactly what RX I needed, but the DR wouldnt refil without an RX (my albuterol inhaler, for one)

There's a perfect example of the problem with OTC meds. For those who don't know, albuterol is a medication for asthma. It is what we call a "rescue" medication, meaning it should only be used on an as-needed basis. When a patient calls my office to refill their albuterol, I check and see when they last refilled it. By doing so, I'm able to judge how frequently they are needing to take it. One inhaler should last about 6 months. If the patient is using it more than about 3 times per week, something is wrong and their asthma is not under control. In that case, there are other medications that are more appropriate for them to be using to better control their disease.

If the patient could just buy the stuff OTC, they could be taking it 3 or 4 times a day with no medical intervention. Who does that benefit?

 

[Maleficent13]

There's a perfect example of the problem with OTC meds. For those who don't know, albuterol is a medication for asthma. It is what we call a "rescue" medication, meaning it should only be used on an as-needed basis. When a patient calls my office to refill their albuterol, I check and see when they last refilled it. By doing so, I'm able to judge how frequently they are needing to take it. One inhaler should last about 6 months. If the patient is using it more than about 3 times per week, something is wrong and their asthma is not under control. In that case, there are other medications that are more appropriate for them to be using to better control their disease.

If the patient could just buy the stuff OTC, they could be taking it 3 or 4 times a day with no medical intervention. Who does that benefit?

Couldn't you just TELL the patient that one inhaler should last about 6 months and if they are going through them more frequently they should see the doctor? Rather than babysitting their inhaler use?

 

[disneysteve]

Couldn't you just TELL the patient that one inhaler should last about 6 months and if they are going through them more frequently they should see the doctor?

Sure, I could tell them that IF I'm involved in the patient's care. But if the patient doesn't need to see a doctor to get the medication in the first place, I never have that opportunity.

And, of course, just because I tell a patient that doesn't mean they listen. If I have no way to track their usage, I can't help them. If they need to contact me for their refills, that gives me the opportunity to reassess their condition and make adjustments to their treatment if needed.

I don't consider it to be "babysitting" to make sure that my patients are taking the proper medicine for their condition, taking the proper dosage and getting the desired response.

 

[Cindy's Mom]

Couldn't you just TELL the patient that one inhaler should last about 6 months and if they are going through them more frequently they should see the doctor? Rather than babysitting their inhaler use?

Would that be the same as TELLING people that illegal drugs and cigarettes are bad for you.....

I'm with you Dr. Steve

 

[ead79]

I can see both sides of this issue. I am a supporter of making certain types of medications available OTC. In my mind things with low risks of non-serious side effects could and should be made available OTC (e.g. allergy medications like Zyrtec, Allegra, etc.). I don’t believe that this type of weight loss pill should be made available OTC since it has potentially harmful side effects, and, as Steve mentioned, obesity often goes hand in hand with other health problems that need to be monitored. If the person doesn’t see a doctor to get the medication, then a doctor can’t help them with their obesity or monitor their other health problems.

 

[caitycaity]

To be blunt, everytime doctors complain about this stuff it reads a lot like them being ticked they are getting cut out. Sure there are concerns, but there's concerns with almost every OTC.

ita with this.

 

[cardaway]

While I agree whole-heartedly that we should have the right to make personal choices, one thing to keep in mind is the potential effect misuse of OTC drugs may have on the health care system as a whole. Increased trips to the ER and/or more extensive medical care needed as a result of illnesses brought on by using meds without proper observation will result in higher cost of health care for all of us.

Which would be offset by the majority of people who follow directions and are no longer draining the system with unnecessary doctor visits.

 

[cardaway]

Also consider that putting Xenical OTC doesn't really benefit the patient. Xenical is covered by many prescription plans in my area. OTC the patient will have to pay for it himself.

That's pretty short sighted IMO. Since I don't take it I can't say for sure, but it's likley that the co-pay for a drug like this is quite high. So high that the OTC cost will not be that much higher when weighed against the previous co-pays for both the pills and doctor visits.

So yes, I am upset that they are cutting the doctor out of the process. But the reason I'm upset is because the patients are the ones who will suffer.

I can't remember the last time I went to any medical treatment and they didn't ask for a list of what I'm taking, including OTC's. I think you're exegerating the "cutting the doctor out" part and it's reading a lot like the scenario I posted about earlier.

 

[Miss Jasmine]

One other point worth mentioning...the OTC version will be half the dosage of the prescription version. The prescription version will still be available by prescription. Also, cost could be an inhibiting factor. Even OTC it will still cost about $12 to $25 per week. In addition, studies have shown the drug helps only with 5 to 6 pounds.

I don't see anything to get excited over. Personally, I do not like to take pills, prescription or OTC, I hate putting unnatural things in my body. But if someone thinks it will help them or give them the motiviation for a healthier lifestyle, then I am all for it.