In this post, I am looking at the most prescribed drugs in the UK. In brief, I review their indicated use and comment on possible causes of drug popularity.
15 most prescribed drugs in the UK are used for the treatment of the following conditions:
- Cholesterol-lowering drugs: Atorvastatin, Simvastatin
- Hypothyroidism: hormone Levothyroxine
- Gastro-oesophageal reflux disease (GORD): Proton Pump Inhibitors (PPIs) including Omeprazole and Lansoprazole
- Cardiovascular drugs:
- High blood pressure drugs: Amlodipine, Ramipril
- Heart failure, angina: Bisoprolol
- Anti-diabetic drugs: Metformin
- Asthma: Salbutamol
- Painkillers: Co-codamol and paracetamol
Most prescribed drugs in the UK
Atorvastatin a cholesterol-lowering drug was the most prescribed drug in the UK with 48.8 mln prescriptions issued (2018). Data available at OpenPrescribing.net shows a sharp increase in prescriptions for this drug in recent years at the expense of Simvastatin drug where a decline in prescribing can be seen. This is mainly due to changes in NICE recommendations on the management of high cholesterol in adults which now recommends atorvastatin as first-line treatment. The overall trend for the use of lipid-lowering drugs is on increase reflecting the problem of obesity and unhealthy lifestyle across the UK population.
Levothyroxine is used in the treatment of hypothyroidism is the second most commonly used drug in the UK. A high number of prescriptions for this item is related to a prevalence of the condition, which is estimated at around 2% in the UK population. Unlike other conditions like high cholesterol or high blood pressure, hypothyroidism is managed almost always with levothyroxine, and rarely with liothyronine, which is very expensive and not commonly prescribed.
Omeprazole belongs to a class of drugs called Proton Pump Inhibitors (PPIs), mainly used in the management of gastro-oesophageal reflux disease (GORD) including heartburn/acid reflux. There is a link between GORD and obesity (Kennedy & Jones, 2010). With 29% of the adult population being obese and 36% being overweight in England (Parliament.uk, 2019) there is a clear contribution to the number of prescriptions produced for this drug.
Amlodipine is used in the treatment of high blood pressure (BP). You can read more about the most popular high blood pressure medication in my separate post. Amlodipine is recommended as first-line drug treatment in high blood pressure in people who are 55 and over or patients who are Caribbean or African origin. Prevalence rate – a proportion of people who have high BP increases with age. Without a doubt, there is a link between the presence of Amlodipine in 15 most prescribed drugs in the UK with the ageing of the UK population and the fact that the population over 65 years of age is the fastest-growing group as compared to other age groups (ONS, 2019). High blood pressure is also linked with being overweight or obese which explains further popularity of BP drugs.
Similarly to Amlodipine, Ramipril is used in the treatment of high blood pressure. Ramipril belongs to a group of drugs called ACE-inhibitors. ACE-inhibitors are recommended as first-line treatment of high blood pressure in individuals below the age of 55.
Like Omeprazole, Lansoprazole is a PPI used in the treatment of GORD and dyspepsia. Both Omeprazole and Lansoprazole are used as first-line treatment in GORD, mostly due to the cost-effectiveness of both drugs (as compared to other PPIs) and lack of superiority of one over the other.
Simvastatin is used to lower cholesterol in the body. As explained in the first paragraph a sharp decrease in prescribing is seen for this drug in favour of Atorvastatin which is more effective in reducing cholesterol than Simvastatin.
This is an interesting drug in the list of 15 most prescribed drugs in the UK. Bisoprolol belongs to a group of drugs called beta-blockers (Beta-adrenoceptor blocking drugs). Although beta-blockers can be used in the treatment of high blood pressure, there are no longer first or even second line of treatment. Other uses of beta-blockers include angina (chest pain experienced by patients due to narrowing of the blood vessels with ‘fats’), myocardial infarction (heart attack), heart failure and arrhythmias. Several indications for this drug reflects a high number of prescriptions produced. In the UK there is about 920000 patients diagnosed with heart failure (NICE, 2018). There are around 1.4mln people who survived a heart attack (BHF, 2019) and who most likely use beta-blockers in the long-term management of their condition.
Aspirin is mainly used and prescribed for secondary prevention of cardiovascular disease, for example in patients who had a heart attack or are at risk of having one. Despite this, widespread availability and affordability (100 tables of Aspirin 75mg cost just over £1), this drug brought the cost to NHS of around £14 mln.
A steady increase of metformin use for the treatment of diabetes is seen with the highest number of prescriptions issued for this drug in 2018 (21.78 mln) Metformin accounts for a net cost of 85.77 mln, highest out of all top 15 most prescribed drugs. However, this is a small proportion of the overall cost of diabetes treatment in the UK. In 2016/2017 a total net ingredient cost for treatment of diabetes was close to £1 billion standing at £983.7 million (NHS Digital, 2017). The prevalence of diabetes again highlights the obesity epidemic in the UK.
Salbutamol is mostly prescribed for the management of asthma. With over 5mln people receiving treatment for asthma in the UK (Asthma UK, 2016), it is understandable why this item made it to the top 15 most prescribed drugs in the UK.
Interestingly paracetamol was widely prescribed in 2018 despite the NHS announcement in 2017 to limit prescribing of items that can be purchased ‘over the counter’, to support cost-saving to NHS as part of NHS Five Year Forward View. Over the counter paracetamol is widely available in most shops and pharmacies. As recommended by Medicines and Healthcare products Regulatory Agency (MHRA) guidelines, customers can buy two packs of paracetamol containing 16 tablets each. The maximum number of paracetamol tablets that can be purchased from a pharmacy is 100. The cost for 100 paracetamol tablets from a pharmacy is just under £2.
Co-codamol contains a combination of paracetamol and codeine and is used in treatment moderate to severe pain. Co-codamol is the most commonly prescribed opioid analgesics. The use of opioids in the management of pain is somehow controversial as there is a lack of evidence on effectiveness in long term use (BMA, 2017). Despite this, in recent years a considerable increase in opioid prescribing for management of non-cancer pain is observed (ibid).
14. and 15. Sertraline and Citalopram
Prescriptions for antidepressant drugs such as sertraline and citalopram are on the rise and close the top 15 of the most commonly prescribed drugs in the UK (see Rise of antidepressant prescribing in the UK). Overall, the number of prescriptions for antidepressants almost doubled from 36mln in 2008 to 70.9mln in 2018. Leading to 2016, antidepressants were the fastest-growing group of drugs in the UK for the fourth successive year. Citalopram and Sertraline belong to a group of antidepressants called Selective Serotonin Reuptake Inhibitors, which are recommended as first-line treatment of depression.
|Drug||Items (mln)||Cost to NHS (mln)||Treatment use|
|4||Amlodipine||29.03||38.61||high blood pressure|
|5||Ramipril||28.58||39.04||high blood pressure|
|8||Bisoprolol||23.58||15.13||heart failure, angina|
Asthma UK (2016). Asthma facts and statistics: Key facts for journalists. Available at: https://www.asthma.org.uk/about/media/facts-and-statistics/ Accessed o 02/12/2019
BHF (2019). British Heart Fundation: Heart Statistics. Available at: https://www.bhf.org.uk/what-we-do/our-research/heart-statistics Accessed on 02/12/2019
BMA (2017). Chronic pain: supporting safer prescribing of analgesics. Available at: https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/analgesics-use Accessed on 02/12/2019
Kennedy T, Jones R. The prevalence of gastro-oesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms. Aliment Pharmacol Ther 2000; 14 (12): 1589–1594. Available at: https://doi.org/10.1046/j.1365-2036.2000.00884.x Accessed on 30/11/2019
NICE (2018). Chronic heart failure in adults: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng106/chapter/Context Accessed on 02/12/2019
ONS, Office for National Statistics (2019). Overview of the UK population: August 2019. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/august2019 01/12/2019