1) Penicillin and amoxicillin for bacterial infections
Penicillin and amoxicillin are age-old antibiotics that are still first-line therapies for strep throat in adults today. Additionally, we use the intramuscular injection (IM) form of penicillin for first-line treatment of syphilis. Amoxicillin, used regularly since the 80’s, has broader coverage than penicillin (meaning that it fights more types of bacteria) and is used to treat ear infections, bronchitis and sinusitis. Still effective.
2) Nitrofurantoin for urinary tract infections
Nitrofurantoin (Macrodantin, Macrobid) is another oral antibiotic. It has been used over 40 years to treat urinary tract infections (UTIs), and can be used right after intercourse to prevent UTIs in women who get UTIs often.
How does it work? An enzyme in the bacteria breaks down nitrofurantoin to an active chemical that damages the bacterial cell. Macrobid, approved in the 90’s, now has a generic. It results in less stomach upset than Macrodantin.
3) Nitroglycerin for chest pain
Nitroglycerin tablets that you place under the tongue (sublingually) has an interesting backstory. This drug has been used for many many years—interestingly, without FDA approval—to treat chest pain caused by angina (or reduced blood flow to the heart). That is, until Nitrostat was approved in 2000.
Now, nitroglycerin 0.4 mg sublingual tablets come as generic nitroglycerin or brand-name drugs, Nitrostat and Nitrolingual. After so many years, nitroglycerin still works and is the first thing an ER doctor will give you if you show up with chest pain.
4) Hydrochlorothiazide and chlorthalidone for high blood pressure
Used for over 40 years, hydrochlorothiazide (HCTZ) and chlorthalidone are still recommended by American Heart Association and American College of Cardiology as first-line therapies to treat high blood pressure. Studies show that these thiazide diuretics are superior to newer medications in preventing heart attack and stroke—and they’re cheaper.
That’s why they should be the drugs of choice for initial treatment of hypertension in most patients who need drug therapy. Actually, chlorthalidone is turning out to be more effective than HCTZ and may become the new OG winner.
5) Amlodipine for high blood pressure
Amlodipine was approved as brand-name Norvasc in 1992—26 years ago—and is used to lower blood pressure. Calcium channel blockers like amlodipine are, in fact, considered the first-choice drug for blood pressure control specifically in African Americans.
6) Lisinopril for hypertension and heart failure
Lisinopril was approved as brand-name Zestril in 1987 and is another old-school medication recommended as first-line therapy for blood pressure and heart failure. Though dry cough is a well-known side effect occurring in about 5% of folks who take it, lisinopril is a cheap, effective medication.
7) Allopurinol for gout
Ever since the early 80’s, patients have been taking allopurinol once a day to prevent gout attacks. Despite our recent newcomer, Uloric (febuxostat), allopurinol is still recommended as first-line therapy for gout—because it’s safe, it works and it’s cheap.
8) Methotrexate for arthritis, psoriasis and some cancers
Methotrexate has been around since the 70’s and is still prescribed for rheumatoid arthritis, psoriasis and some cancers, including leukemias and lymphomas. Surprisingly, after almost 50 years since methotrexate was approved, we still don’t really know how it works to treat rheumatoid arthritis. Some say it’s by affecting immune function. In psoriasis, methotrexate is believed to target skin cells that quickly replicate. Yup, methotrexate is still used.
9) Trazodone for insomnia and depression
Trazodone is an antidepressant that was initially approved in the early 80’s (40 years ago!). It enhances serotonin levels in the brain by blocking the neurotransmitter from being reabsorbed. Trazodone is still widely prescribed for folks who have trouble sleeping and struggle with depression. Because it really works for insomnia, it has stayed popular.
10) Prednisone for inflammation-related diseases
Prednisone is an oral steroid approved in the 50’s. It’s still commonly prescribed for dozens of medical conditions, including asthma exacerbations, autoimmune hepatitis, multiple sclerosis and various skin conditions. A newer, sustained formulation of prednisone called Rayos was approved by the FDA in 2012, but it never really caught on because it’s so expensive. Prednisone is a powerful anti-inflammatory steroid that has never been replaced.
11) Plaquenil for autoimmune diseases
Plaquenil (hydroxychloroquine sulfate) has been around forever and yet, has never been knocked from its seat as a first-line therapy choice for autoimmune conditions like rheumatoid arthritis, lupus and Sjogren’s syndrome. It improves long-term functionality in patients with rheumatoid arthritis by blocking the activity of the immune system. Still great.
Dr O.
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