What are common prescription drugs used in general practice?

Common Prescription Drugs in General Practice

The most common prescription medications in general practice include metformin for diabetes, lisinopril and amlodipine for hypertension, atorvastatin for hyperlipidemia, and GLP-1 receptor agonists for weight management and diabetes, all of which have demonstrated significant benefits for morbidity and mortality outcomes. 1, 2

Diabetes Medications

First-Line Therapy

• Metformin: The cornerstone first-line therapy for type 2 diabetes 3, 4
  • Mechanism: Decreases hepatic glucose output and enhances insulin sensitivity
  • Benefits: Lowers HbA1c by ~1.5%, doesn't cause weight gain, reduces cardiovascular events (36% reduction in all-cause mortality) 3
  • Dosing: Usually started at lower doses and titrated up
  • Contraindications: eGFR <30 mL/min/1.73 m² 1
  • Side effects: Primarily gastrointestinal, rarely lactic acidosis

Additional Diabetes Medications

• GLP-1 Receptor Agonists (semaglutide, liraglutide, tirzepatide)

  • Strong cardiovascular and weight benefits 1
  • Primary side effects: Transient gastrointestinal symptoms

• SGLT2 Inhibitors

  • Benefits: Cardiovascular and renal protection 1
  • Contraindicated in dialysis patients
  • Side effects: Genital mycotic infections

• DPP-4 Inhibitors

  • Modest efficacy, weight neutral
  • Caution: Possible increased heart failure hospitalizations with saxagliptin and alogliptin 1

• Sulfonylureas

  • Inexpensive but associated with hypoglycemia risk and weight gain 1, 5

Cardiovascular Medications

Antihypertensives

• ACE Inhibitors (lisinopril, ramipril, enalapril)

  • First-line for non-Black patients and those with diabetes or CKD 2
  • Dosing: Start 2.5-10mg daily, target 20-40mg daily
  • Monitoring: Renal function and potassium within 1-2 weeks of initiation

• ARBs (losartan, candesartan, valsartan)

  • Alternative when ACE inhibitors cause cough 2
  • First-line for Black patients (with calcium channel blocker)

• Calcium Channel Blockers (amlodipine, diltiazem, nifedipine)

  • Among top prescribed medications globally 1
  • Amlodipine typically started at 2.5-5mg daily

• Beta-Blockers (metoprolol, bisoprolol, carvedilol)

  • Particularly useful in patients with heart failure or post-MI 2
  • Metoprolol is among the top 3 most prescribed medications in the US 1

• Thiazide Diuretics (hydrochlorothiazide, chlorthalidone)

  • Common first-line or add-on therapy 2
  • Usually dosed at 12.5-25mg daily

Lipid-Lowering Medications

• Statins (atorvastatin, simvastatin)
  • First-line for hypercholesterolemia 1
  • Benefits: Reduce cardiovascular morbidity and mortality
  • Side effects: Myopathy (5-10% of patients), rarely rhabdomyolysis
  • Drug interactions: Multiple, including macrolides, antifungals, and certain calcium channel blockers 6

Pain and Neuropathy Medications

• Gabapentin: 300-1200mg three times daily for diabetic peripheral neuropathy 1
• Pregabalin: 100mg three times daily for neuropathic pain 1
• Duloxetine: 60-120mg daily for diabetic neuropathy 1
• Tricyclic Antidepressants (amitriptyline, nortriptyline): 10-75mg at bedtime for neuropathic pain 1

Weight Management Medications

• GLP-1 Receptor Agonists (semaglutide, liraglutide, tirzepatide)

  • Most effective for weight reduction 1
  • Demonstrated cardiovascular benefits beyond weight loss

• Phentermine/Topiramate

  • Less robust weight reduction than GLP-1 RAs
  • Side effects: Increased heart rate, mood disorders, cognitive effects 1

Practical Prescribing Considerations

Medication Selection Algorithm

1. Identify primary condition requiring treatment
2. Consider comorbidities that may influence medication choice:
   • Diabetes + hypertension → ACE inhibitor/ARB
   • Obesity + diabetes → GLP-1 RA
   • Heart failure + hypertension → ACE inhibitor + beta-blocker
3. Check for contraindications:
   • Renal function (metformin, SGLT2i)
   • History of angioedema (ACE inhibitors)
   • Heart failure status (certain DPP-4 inhibitors)
4. Start low, go slow with dosing, especially in elderly patients
5. Monitor appropriately for side effects and efficacy

Common Pitfalls to Avoid

• Failure to check drug interactions - especially with statins and multiple antihypertensives
• Inadequate monitoring of renal function with ACE/ARBs and metformin
• Not considering weight effects when selecting medications
• Overlooking cardiovascular benefits beyond the primary indication (e.g., SGLT2i, GLP-1 RA)
• Polypharmacy without regular medication reconciliation

By understanding these common prescription medications, their benefits, risks, and appropriate patient selection, clinicians can optimize therapy to improve morbidity and mortality outcomes in general practice.