The editors of Consumer Reports Health took a very close look at the recently released list of the Top 10 biggest-selling prescription drugs last year. No surprise that most of the drugs to make this list (based on total dollars spent) are expensive and heavily advertised brand name drugs prescribed for common ailments such as heartburn and high cholesterol.

But oddly enough, many would not be the first picks as recommended by the independent medical experts at Consumer Reports Health.  Here’s the list, along with some of their Best Buy Drugs list alternatives: 

1. Pfizer’s Lipitor (for high cholesterol): $7.2 billion in sales last year (that’s over $131 billion in total sales over this drug’s lifetime, with the Sanofi/Bristol-Myers Squibb blood thinner Plavix lagging far behind in second place in lifetime sales with just $60 billion)
2, AstraZeneca’s Nexium (for heartburn, gastroesophageal reflux, and ulcers): $6.3 billion
3. Sanofi Bristol-Myers Squibb’s Plavix (blood thinner for heart attack and stroke prevention): $6.1 billion
4. GlaxoSmithKline’s Advair Diskus (for asthma): $4.7 billion
5. Otsuka’s Abilify (for bipolar disorder, schizophrenia, and severe depression): $4.6 billion
6. AstraZeneca’s Seroquel (for schizophrenia, bipolar disorder, and severe depression): $4.4 billion
7. Merck’s Singulair (for allergies and asthma): $4.1 billion
8. AstraZeneca’s Crestor (for high cholesterol): $3.8 billion
9. Takeda’s Actos (for type 2 diabetes): $3.5 billion
10. Amgen’s Epogen (for people on dialysis with anemia): $3.3 billion

Consumer Reports Health editors warn:

“Not surprisingly – since we tend to recommend low-cost generics with long records for effectiveness and safety – we often recommend different drugs.”

For example:

• Lipitor is their Best Buy Drugs recommendation only for people with a history of heart disease or very high cholesterol levels. In most other cases, they say generic lovastatin, pravastatin, or simvastatin are a better bet.
• The Best Buy Drugs recommendation for type 2 diabetes is metformin, not Actos.
• For heartburn, it’s generic omeprazole, not Nexium.
• For depression, there are five recommendations – but neither Abilify nor Seroquel make their cut.

The Wall Street Journal, however, pointed out this week that, although expensive branded drugs of course lead the way in terms of total dollars spent, non-branded generic drugs now make up 78% of all written prescriptions dispensed.

In fact, there are only three name brand drugs on the entire list of the most commonly prescribed medications:

• Pfizer’s Lipitor, at #12
• Sanofi-Aventis/Bristol-Myers Squibb’s Plavix, at #23
• Merck’s Singulair, at #25.

Bad news for Big Pharma: all three of these drugs are due to lose patent protection this year or next. (The report also says that within six months of “falling off the patent cliff”, generics take over 80% of prescription share.)

The year’s runaway favourite drug on this list was once again  hydrocodone/acetaminophen, the generic form of the painkiller Vicodin. More than 131 million prescriptions for this generic were dispensed last year, about 37 million more than the second-most popular drug, the generic anti-cholesterol drug simvastatin.

For more details, see the Consumer Reports Health Best Buy Drugs reports for common conditions. And to keep up on drug warnings, risks, and recalls, see their news on drug safety.