Last year, we wrote about four prescription drugs people hate. It isn't as easy to find drugs that people love, but we came up with four, each remarkable in its own way. You may be surprised by what made this curious list.
In 2019, I wrote an article called "4 Prescription Drugs People Hate." It was rather popular. Almost 30,000 of you read it, possibly because I included some fairly hilarious patient comments from people who took these drugs. For example, the antibiotic Flagyl (metronidazole) really stirred up some feelings, all of which were negative, perhaps, none more so than:
"OMG, I'd rather swallow vomit."
It was considerably more difficult to find four drugs that people love (1) since many people hate prescription medicines, and those who have a good experience with a given drug are less likely to spend the time and effort to trash it on sites like Ask A Patient or Drugs.com. After all, if you take Pill A and your back hurts a little less you're less likely to want to bother to write a review than if you take Pill B and your spleen comes flying out of your mouth.
I was pleasantly surprised to find four different drugs that are both medically relevant and also received (mostly) good ratings and reviews from a sufficient number of people who had used them. Some of them may surprise you. Here they are, along with patient ratings and reviews.
1. Zofran (ondansetron, antiemetic)
Patient ratings: Ask A Patient: 3.9/5. Drugs.Com user reviews: 8.0/10
There are few bona fide "miracle drugs" out there, but there is little doubt that Zofran (generic name ondansetron) belongs in the category. It's not a new drug – the FDA approved it for chemotherapy-induced nausea and vomiting (CINV) in 1991 – but at that time GlaxoSmith Kline's discovery was transformative, not simply ingenious. The drug was the first member of the 5-HT3 antagonist class, designed to block the action of serotonin (5-hydroxytryptamine, 5-HT) on chemoreceptor trigger zone in the brain and stomach. In addition to CINV, Zofran is FDA approved for nausea and vomiting caused by radiation therapy and general anesthesia, both before and after surgery. It is used off-label for morning sickness and viral gastroenteritis. Pediatricians report that it substantially reduces hospital admissions of children who become dehydrated due to vomiting. Patient Quotes:
"My wife was on chemo and doctor tried several other medicines. None worked. Zofran worked after the first pill. It was expensive but never went to another type of medicine."
"This drug is a life saver. I have had stomach flu bug every year for the past 3 years. Each time this drug keeps me from vomiting."
"Works wonders for morning sickness! I had no appetite and was losing too much weight. This does the trick...I feel human again!"
And from a professional:
"We see hundreds of kids every month at our emergency department. The nurses have the authority to administer Zofran -- one of the safest drugs we have --for vomiting kids as young as 2 months right at the door. By the time I see the kids, they are already feeling fine and sucking on a Popsicle."
ACSH advisor John Dunn, MD, JD. Carl R. Darnall Army Medical Center. 2/18/16
2. Xanax (alprazolam, anti-anxiety)
Patient ratings: Ask A Patient: 3.9/5. Drugs.Com user reviews: 8.8/10
Of all the benzodiazepines (Valium is the best-known member of the class) research Xanax was the most highly-rated by people with anxiety. Many described Xanax as an effective drug with few side effects that could be taken for years at the same dose, but some wrote of the need for escalating doses. While some did fine taking 0.25 mg for years, others needed 1 mg at first but required more than 5 mg per day years later. Tolerance, physical dependence, and addiction are possible but not necessarily problems of the benzo class. Disturbingly (but not surprisingly), it was common to find recent comments from patients who had been taking Xanax successfully for decades but were being forcibly tapered for no other reason than changing US drug policy - an offshoot of the failed attempt to save lives by over-restricting opioid drugs, which not only didn't save lives, it cost plenty more.
"I’ll never forget the first time I actually got the nerve to try it. “This is what normal people feel like???”, was my response."
"The first day I took one I felt like I have missed my life all these years. I looked at my wife and said the following. “Have I been an A-hole for the last 13 years?” She said yes. “You must really love me” She said yes again. For the first time in my life I realized how much anxiety took over my life." (No word on whether the guy is just a calmer A-hole)
"I was prescribed alprazolam 10 years ago. I have bad anxiety, it let me lead a normal fun life, trips etc. My Doctor of 20 years retired recently. Now I have seen two doctors and they will not let me stay on it. Forced taper. Really scared. This med gave me back my life."
"Was not diagnosed with anxiety until I was 28. I took valium 5mg for 30 yrs, then became tolerant, changed to alprazolam 1 mg it has now been 40 years and I feel good, unafraid and am social. I also take it responsibly....but now, because of the national drug problems they are trying to take me off, that's causing more anxiety.
3. Viagra (sildenafil, erectile dysfunction)
Patient ratings: Ask A Patient: 3.7/5. Drugs.Com user reviews: 8.5/10
I suppose it was inevitable that Viagra would end up on a list of popular drugs. Levitra and Cialis, the two other common ED drugs were rated similarly, but the newest member (heh heh) of the class Stendra was less popular (but also had very few reviews). Viagra began life as a failed vasodilating heart drug in the 1990s. What followed was nothing short of hilarious. Dr. John Mattina, the former head of R&D at Pfizer noted during 1996 a STAT podcast:
”A very observant nurse reported [that many of the men were lying facedown], saying [they] were embarrassed [because] they were getting erections.”
So, Viagra was, in fact, acting as a vasodilator – just in the "wrong" part of the body. The drug was inhibiting PDE5 (phosphodiesterase 5), an enzyme responsible for breaking down cGMP (cyclic guanosine monophosphate) which regulates blow flow in the corpus cavernosum area of the penis. More cGMP means more vasodilation and blood flow to the penis. By inhibiting PDE5 more cGMP sticks around. You know the rest. Viagra works well for most men.
"Our first session was great, lasting about 30 minutes and lots of “Wow”s. About 20 minutes later, ready to go again for another 30 minutes. And about 30 minutes after the second session, my wife asked if I was ready for another session, which I was." (Damn!)
"I'm 39 and just take 100mg when I really want to have a good time. The 50mg don't do anything for me, but the 100mg is great." (This user has apparently mastered the concept of dose-dependence, but could perhaps use a bit of remedial grammar.)
Speaking of which, my favorite...
"Great tablet my penis like it did when I was 20 - and I'm actually 50, so I'm well pleased." (This guy makes whoever wrote the previous comment sound like Hemingway)
But it doesn't always work:
"I am 86 year old and tried Viagra 100 a few times and it was totally ineffective." (Perhaps this is just asking a tad much).
4. Atripla (HIV infection, efavirenz, emtricitabine, and tenofovir )
Patient Ratings: Ask A Patient: 4.4/5, Drugs.com 9.1/10
Bet you didn't see this one coming. I sure didn't expect it to be so highly praised (2) because it is a three-drug combination, each drug with its own set of side effects and it's expensive. Note that the side effects were mentioned, even by people who gave the drug nearly perfect ratings (3).
"[I sometimes get] severe hallucinations, blur between conscious and non- consciousness. Sometimes nasuea [sic]. (but also) Started 4 months ago with viral load of 500000. I was so worried. Now I am undetectable. I feel so blessed to have Atripla.
First week, I thought I would have to quit, but the effects are wearing off, and I can even make it through the day if I forget at night then take it in the morning, but it requires concentration. Viral load tanked to undetectable and CD4 over 700. Try to stick it out for a few months--it got better for me."
"Summer of 2006, blood work showed low platelets, and high white blood cells, tested 4 HIV came back as positive I felt floored. My CD4 was around 20 and viral load was off the charts. Full blown AIDS. I thought I was going to die. I was 38 then. I was put on Atripla, stabilized in 3 months put on a few pounds, 6 months later my CD4 was around 1200 and I was undetectable. Side effects, vivid dreams, nausea. Found it easier to take it in the A.M. on an empty stomach. Atripla saved my life, for which I am GRATEFUL."
(1) And people hate drug companies too. All four of these drugs were discovered by the pharmaceutical industry.
(2) When writing about unpopular drugs I focused on the reviews that were the most negative (and colorful). Likewise, in this article, I have selected quotes that speak highly of the drugs reviewed. While there were few instances in which unpopular drugs also received high ratings there were more instances where popular drugs received poor reviews.
(3) One of the reasons that Atripla is well-received was the decreased pill burden. In the 1990s, when HIV protease inhibitors were the mainstay of anti-HIV therapy cocktails people had to take 30 or more pills per day at regular intervals, including getting up in the middle of the night. Drugs like Truvada and Atripla changed this radically.
Before and after. Photo: Walgreens