BMJ  2003;327:1404-1405 (13 December), doi:10.1136/bmj.327.7428.1404-c

Letter

Drug sales in four European countries still differ

EDITOR—The box shows, by value, the top selling pharmaceutical products that are common to Italy, France, Germany, and the United Kingdom. In 1992,¹ 1996,² and 2001 few products were prescribed in all four countries. Nineteen active substances were common to three countries, 17 to two countries, and 63 were on only one country's list.

Several classes of drugs were represented in all four countries but with different products. For example, angiotensin converting enzyme inhibitors were prescribed as enalapril in Italy, lisinopril in the United Kingdom, and ramipril in Germany and France. Selective serotonin reuptake inhibitors were paroxetine and sertraline in Italy, the United Kingdom, and France; amoxicillin was common in Italy, the United Kingdom, and France, but no antibiotic featured in the top 50 in Germany. The preferred fluoroquinolone was ciprofloxacin everywhere but in France.

In Italy several antibiotics stand out—ceftriaxone, clarithromycin, and azithromycin—as do three benzodiazepines, bicalutamide, tamsulosin, and triptorelin (for prostate cancer). In the United Kingdom the non-steroidal anti-inflammatory drugs were represented by morniflumate; goserelin was the preferred drug for prostate cancer; and the list included two epilepsy drugs (lamotrigine and gabapentin) and the migraine drug sumatriptan.

Popular drugs common to Italy, the United Kingdom, Germany, and France 1992 Omeprazole Simvastatin Ranitidine Nifedipine Enalapril Captopril Aciclovir 1996 Omeprazole Simvastatin Amlodipine Ranitidine Captopril 2001 Omeprazole Simvastatin Atorvastatin Amlodipine Ciclosporin

Germany has a large market for omeprazole, pantoprazole, and esomeprazole; nadroparine; and certoparin. Also included are filgrastim, a granulocyte colony stimulating factor; glimepiride, a hypoglycaemic agent; disodium pamidronate for osteolytic lesions induced by cancer metastases; and mirtazapine, a presynaptic -2 noradrenergic antagonist, for depressive illness.

In France fenofibrate, a hypocholesteraemic agent, competes with the statins. Cefpodoxime and roxythromycin predominate among the antibiotics, buprenorphine was the preferred analgesic, and gliclazide was the bestseller for type 2 diabetes. Donepezil, for Alzheimer's disease, and ribavirin for hepatitis C are other peculiarities of the French market.

Over the past 10 years the quality of drug expenditure has improved because the number of drugs with insufficient evidence of efficacy has dropped in all four countries: from 25 in 1992 to 11 in 1996 and 9 in 2001.^{1 2}

European efforts to establish a centralised procedure and common information on approved drugs in the past 10 years have not unified drug use. Manufacturers' promotional activities and doctors' attitudes, rather than differences in disease, are still the main factors governing the pharmaceutical market.

Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea, 62, I-20157 Milan, Italy garattini{at}marionegri.it

Centro di Economia Sanitaria Angelo e Angela Valenti, Villa Camozzi, Ranica (BG), Italy

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Competing interests: None declared.

References

1. Garattini S, Garattini L. Pharmaceutical prescriptions in four European countries. Lancet 1993;342: 1191-2.[Medline]
2. Garattini S, Garattini L. Discrepancy remains in pharmaceutical prescriptions in four European countries. BMJ 1998;317: 947.[Free Full Text]

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Discrepancy remains in pharmaceutical prescriptions in four European countries

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