Counterfeit Drugs

7 Scariest Counterfeit Drugs
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When we pick up a prescription at the pharmacy or open a mail-order package, few of us question whether what's in the bottle is what we ordered. But according to government reports, marketing counterfeit drugs is one of the world's fastest-growing industries. And although the problem is most acute in the developing world -- where fake vaccines, antimalarials, and antiretrovirals for controlling AIDS threaten whole populations -- it's a growing threat here too. Of the 4 billion prescriptions filled in the United States each year, as many as 40 million may be filled with fake drugs, according to the World Health Organization's most conservative estimates. (That's just one percent of all prescriptions; in countries with weaker oversight it can be as high as 25 percent of all prescriptions.) The U.S. is becoming a favorite market for counterfeiters, because annually Americans buy 40 percent of the world's prescription drugs.

Why are counterfeit drugs so dangerous? Many contain only inactive ingredients, so your health condition goes untreated. In the worst cases, counterfeit drugs contain ingredients that can be dangerous, even poisonous. According to the Partnership for Safe Medicines, examples of fillers found in tested drugs include powdered drywall, antifreeze, and yellow highway paint. It's also impossible to properly regulate dosages with counterfeit drugs; they're often found to be "up-labeled," a process by which legitimate capsules of a low-dose drug are sold in packages labeled with a higher dosage. Perhaps worse, other seized counterfeits have been found to have as much as three times the active ingredient, which could cause serious side effects.

Here are the seven types of drugs most likely to be counterfeit, and how to avoid them:

Counterfeit drug type #1: Erectile dysfunction medications

There's no question about it, expensive so-called "lifestyle" drugs like Viagra, used to treat erectile dysfunction (ED), are the most likely to be counterfeited, perhaps because they're extremely popular and not so easy to bring up with the doctor. In fact, the Pharmaceutical Security Institute reports that 37 percent of all drugs seized are in the category dominated by ED drugs. One problem is that men are avoiding their doctors and buying these medications without a prescription -- unaware that it can be risky for people with heart disease and other conditions. Because sildenafil, the active ingredient in Viagra, works by dilating blood vessels, doctors don't consider it safe to take without a health exam. (To add to the confusion, Cialis, another drug for ED, is also frequently counterfeited but has a different set of potentially dangerous side effects.) Counterfeit Viagra has also been found to contain toxic ingredients including amphetamine or speed, blue printer ink, boric acid, paint, and brick dust -- and too much of the active ingredient, carrying the risk of overdose.

Drugs to watch out for:

  • Viagra
  • Cialis

How to protect yourself:

No matter how tempting it is to purchase ED drugs anonymously online, save yourself the risk of serious side effects by asking your doctor for the appropriate prescription. Not only that, but erectile dysfunction can be an important clue to other serious health problems such as heart disease, so a full exam could be lifesaving.

Counterfeit drug type #2: Antibiotics and antivirals

Because antibiotics and antiviral agents can be the last defense of the deathly ill, the risk of counterfeit substitutes is particularly scary. In November 2011, representatives of Pfizer testified that Zithromax, a popular and potent antibiotic, was one of the company's drugs particularly prone to counterfeit. Another bit of scary news in the battle to fight serious infectious disease is that Prevnar, one of the pneumococcal vaccines, has also been found to be counterfeited frequently.

Drugs to watch out for:

  • Zithromax (azithromycin), an antibiotic
  • Tamiflu, an antiviral
  • Prevnar, a vaccine against pneumococcal bacteria

How to protect yourself:

Get prescriptions filled at an authorized pharmacy. And don't be tempted to buy antibiotics over the counter in Mexico or other countries where they're sold without a prescription.

Counterfeit drug type #3: Cardiovascular medications

When it comes to prevention of coronary artery disease (CAD), heart attack, and stroke, regular use of medications to control blood pressure, lower cholesterol, and thin the blood is key. So it's no wonder that cardiologists and other doctors have viewed with alarm reports that fake -- and ineffective -- versions of these often-expensive drugs are circulating in the U.S.

Drugs to watch out for:

  • Lipitor, the most common cholesterol-lowering medication
  • Norvasc (amlodipine), a calcium channel blocker used to treat high blood pressure
  • Plavix (clopidogrel), a blood thinner

How to protect yourself:

Don't be tempted to purchase drugs online in an attempt to save money. Use the pharmacy your doctor recommends or ask for a recommendation to a reputable online pharmacy. Read labels carefully, checking the name of the drug and the place and date of manufacture. If anything seems off, discuss it with your doctor.

Counterfeit drug type #4: Alzheimer's and AIDS drugs

Particularly hard to detect are problems with counterfeit drugs for conditions such as Alzheimer's and AIDS, because the drugs are used as maintenance therapy to prevent disease progression. Since they're not controlling acute symptoms, you might not know for a long time -- if ever -- whether or not they're working.

Drugs to watch out for:

  • Antiretroviral combinations used to treat AIDS
  • Aricept (donepezil hydrochloride)
  • Namenda (memantine hydrochloride)
  • Other medications used to treat Alzheimer's

How to protect yourself:

Get prescriptions filled at an authorized pharmacy. Look for savings by asking the doctor to order in larger quantities or to substitute a generic, rather than buying them yourself online or from Canada or Mexico.

Counterfeit drug type #5: Cancer drugs

As if those fighting cancer don't have it hard enough, now comes the worry that lifesaving anticancer agents could be fake. Recent headlines concern Avastin (bevacizumab), a pricey drug used to treat colorectal, lung, kidney, and brain cancer. (Avastin was used to treat breast cancer, but the FDA recently rescinded approval for that purpose.)

Fake Avastin has surfaced several times recently. In each episode, batches of fake Avastin were intercepted entering the U.S. or during the distribution process and found to contain no active ingredient. The fake Avastin is manufactured in Turkey (usually under the Turkish brand name Altuzan), then makes its way to the U.S. via a network of distributors in the U.K., Denmark, and Switzerland. Only real Avastin, which is made solely by Roche subsidiary Genentech in the U.S., is approved by the FDA, but doctors may be tempted to purchase Altuzan to save money. It's frightening to learn that as many as 19 oncology clinics in Illinois, California, and Texas were found to have purchased the bogus medication.

Drugs to watch out for:

  • Avastin (bevacizumab), called Altuzan in Turkey, where the counterfeit version originated
  • Casodex (bicalutamide), used to treat prostate cancer
  • Sutent (sunitinib), used to treat pancreatic, esophageal, bowel, and advanced kidney cancer
  • Taxol (paclitaxel), used to treat numerous cancers

How to protect yourself:

If you're being treated at a reputable hospital or cancer treatment facility, it's likely you don't need to worry. However, to be safe, ask your oncologist or other staff where the clinic purchases medications and if the provider is licensed. Experts say that the risk of purchasing unapproved cancer medications is much higher from unlicensed sources.

Counterfeit drug type #6: Painkillers and allergy drugs

Since they're relatively easy to obtain, you wouldn't think there'd be a big market in counterfeit versions of over-the-counter drugs. But the Partnership for Safe Medicines warns against fake generics and common OTC medications. One of the biggest fake drug busts of 2007, in fact, involved Claritin, a popular antihistamine. Another drug frequently counterfeited is the painkiller Celebrex (an NSAID). Less surprisingly, Vicodin, a prescription painkiller that's a combination of codeine and acetaminophen, is a popular online purchase and therefore subject to counterfeit.

Drugs to watch out for:

  • Celebrex (celecoxib)
  • Claritin (loratadine)
  • Vicodin (hydrocodone and acetaminophen)

How to protect yourself:

In the case of over-the-counter medications, packaging is key. Become familiar with the typical labeling and packaging of any medication you regularly take and watch carefully for anything out of order. Vicodin is rightly a controlled substance, so obtain it only from your doctor and only in the dosage prescribed.

Counterfeit drug type #7: Antidepressants, antianxiety drugs, and antipsychotics

Zoloft, one of the most popular of the antidepressants known as SSRIs, has turned up on a number of lists of the top counterfeit drugs. So have Ativan and Xanax, used by many people with anxiety disorders to calm the central nervous system. And Zyprexa, one of the newer "atypical" antipsychotics also used to treat Tourette's syndrome, was discovered among the counterfeit drugs in a major bust.

Drugs to watch out for:

  • Zyprexa (olanzapine)
  • Zoloft (sertraline)
  • Xanax (alprazolam)
  • Ativan (lorazepam)
  • Other drugs in these classes

How to protect yourself:

Fill prescriptions at a legitimate pharmacy or an online pharmacy recommended by your doctor. And never buy Xanax or Ativan from an unauthorized seller; you don't know what you're really getting.

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Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio