Peter Rost further stirs the pot on Pfizer promoting the off-label use of Mirapex for restless leg syndrome (RLS). The thing is, Mirapex really is recommended as first-line treatment for RLS (via UptoDate):
Begin with pramipexole [Mirapex] (0.125 mg) or ropinirole (1.0 mg) approximately one hour before the usual time of symptom onset; the dose is titrated upward according to response. These drugs are effective and well tolerated by most patients
Off-topic, I like how the Pfizer drug rep described Neurontin:
Neurontin – Christ! Pick a disease. Any disease! Although, much of this off-label use was physician-driven. I recall one of my Neurologists describing Neurontin as the’Swiss Army Knife’ of pharmaceuticals.
Related posts:
- Restless legs syndrome
- I do NOT think that Restless Legs Syndrome is "bogus"
- PharmedOut.org a subsidiary of Pfizer?
- Medicare covers more cancer drugs, did they cave in to the pharmaceutical lobby?
- RIP Torcetrapib
- The persecution of "off-label"
- Pfizer: Going to the dogs
KevinMD.com on Facebook
{ 3 comments }
Correct, Mirapex got the RLS approval in 2006, the story deals with the time period before this happened, when a rep alleges they were encouraged to do off-label promotion to meet forecasts.
What I see now is RLS being overdiagnosed and overtreated. I have seen a number of psychiatric hospitalisations precipitated by the use of dopaminergic drugs for this condition with little consideration of the downside risks or workup–or the actual relative seriousness of the symptoms. I have diagnosed and treated RLS for 20 years–long before most docs recognized it.
What is different now? There is a patented product to use and money to be made.
Meanwhile, the “experts” funded by the drug company go about telling people how many people “need” to be treated and that older meds, like clonazepam, are contraindicated. (It works fine for most of my patients and never ever put one of my bipolars in the hospital with a psychotic decompensation). The big problem is that they don’t make money off clonazepam.
This is why I find “expert panels” and guidelines an unscientific and therefore unprofessional basis for practice decisions as it is clear that they are highly influenced by pharma industry and other “stakeholders”.
It was frankly better when RLS was off the public and most doctors radar and people had to beat the doctor over the head to get treated. At least then you didn’t have tons of people with minor and easily tolerated symptoms getting treatments with risks and costs out of proportion to the benefit.
I don’t have RLS, but I do have PLMD (confirmed by a sleep study). From my research, I blame the seven years of being on maximum doses of anti-epileptics to control pain. Now that the pain’s under control, I spent a year getting off those drugs and I suddenly develop PLMD.
I’ve tried both Mirapex and Lyrica for it. Mirapex made my mind race a million thoughts a minute and kept me up. I wasn’t about to add a sleep medicine to go with it.
Lyrica worked for a while, then needed a higher dose for the same results. Eventually quit it all together for six months, then even the low dose did nothing.
So I live with it. I wish there were more options, and I get sick of hearing of RLS and how quite a few people I know think they have it.
Comments on this entry are closed.