Paying More for Drugs at TrumpRx

 

TrumpRx: Where to Pay a Lot for Drugs

A recent announcement by the Trump administration promotes a new government website, TrumpRx.gov as a means to lower prescription drug costs for consumers.

As presented in the link, the TrumpRx site lists 43 drugs and details savings. (All 43 drugs are listed at the end of this post). The site connects consumers to where the drugs can be purchased in their brand name form directly from the big pharm companies using coupons and by paying cash out of pocket.

The site is a sham. It will regularly have the consumer paying more for the drugs than when purchased elsewhere, often a lot more.

Update: Journalists are taking note. 

Along with providing examples of the additional costs for many of the drugs at TrumpRx, I will provide advice on getting lower cost drugs. The CBS article that I referenced above does not provide a critical analysis of the increased costs of using the Trump website.

What Determines How Much You Will Pay for Drugs

I have taught medical students about drug prices for over twenty years.

First, a bit of orientation to the subject. The major determinants of how much you are going to pay for a given drug are: 

1. where you live or where you are making the purchase.
2. whether you have insurance, private or government, and whether the drug is partially or fully covered by that insurance.
3. whether the drug is available in a generic form.
4. whether you have coupons or qualify for discounts from the drug manufacturer.
5. whether you can take advantage of such cost-saving strategies as pill-splitting.

I will address each of these.

  1) The TrumpRx website assumes you live in and are purchasing drugs in the United States. Fine, if that is your case. This post is directed to you and your circumstances. 

  2) If you have insurance and the drugs are covered fully or partially by insurance (including Medicare and Medicaid) then the numbers cited as savings by TrumpRx aren't related to your situation. 

  3) The TrumpRx site only directs the consumer to purchase drugs that are brand name and directly from companies that make a big, sometimes huge, mark-up. I will give examples of those mark-ups below. Generic drugs save a lot. 

So are generic drugs equivalent to the brand name drugs? Drugs are three things: they are chemical entities, they are amounts (such as 50 mg), and they are formulations (pill, extended release pill, capsule, injection, etc.). A generic drug that is the same chemical entity, amount, and formulation is equivalent to the brand name. And it is a LOT cheaper.

  4) Drug companies often put out coupons or else have special programs for those who can't pay the full retail price. This is the only savings matter addressed on TrumpRx. TrumpRx links to the big drug manufacturers where individuals can get a direct discount by paying out of pocket.

  5) Finally, there are additional cost-saving measures such as pill-splitting that, if the current administration encouraged, could save the consumer a lot. Rather than go into this matter in detail, I'll present the rationale and how-tos in this link. 

The Non-Savings of TrumpRx

When I went to the site to scan the claimed savings, a number of drugs jumped off the page. 

Let's start with pantoprazole (brand name, Protonix). Pantoprazole is a powerful suppressor of stomach acid production. It belongs to a class called proton pump inhibitors or ppI. It is likely that a patient prescribed this could also be prescribed another ppI, a cheaper drug in this class, or even a drug in a related class that has the same effects. But, for the sake of argument, let's say you need to buy pantoprazole, the only ppI on TrumpRx. If you go through TrumpRx, you will buy it from Wyeth Pharmaceuticals, a subsidiary of Pfizer, and you will be buying the brand name, Protonix. 

This is the information given at the TrumpRx website. 

Protonix: Original price: $457.28. TrumpRx price $200.10. Savings $247.18. These costs are for 30 pills (once a day) and 20 mg.

Two hundred dollars for Protonix (pantoprazole)? Are you freaking kidding me?

The TrumpRx site also gives the same prices for 30 pills and 40 mg, and a slightly different price for packet versus delayed release. 

So, let's say you buy Protonix in its generic formula, pantoprazole. I'm going to choose Walmart prices for comparison, not because they are the absolute cheapest, but because they are representative of providers with lower-end costs, and because Walmart stores are ubiquitous. Other stores may save you more with coupons.

According to GoodRx.com, Walmart charges $14.94 for 30 pantoprazole pills at 20 mg. 

For 30 pills of 40 mg, the price is $15.66. With pill-splitting, this works out to $7.83 for a 30-day supply. 

So, let's compare. 20 mg pantoprazole, 30 days.

Manufacturer's original price (from TrumpRx page): $457.28

TrumpRx price: $200.10

Walmart plus pill-splitting: $7.83. 

TrumpRx represents a 2556% markup.

A typical TrumpRx coupon.

I was thinking of doing this for a bunch of the drugs on the list, but I think that would be beating a dead horse. Instead, I'll do one more. 

When I first looked at the list of drugs, being in alphabetical order, the first ones that jumped out at me were Azulfidine in two formulations. I recognized it as being available generically and it seemed cheating that Trump Rx was claiming the same drug twice just based on whether or not you wanted extended release tablets. 

Azulfidine (brand name) is sulfasalazine (generic name). Sulfasalazine is used for rheumatoid arthritis, Crohn's disease, and ulcerative colitis. Typical dose is 500 mg, 3 to 4 times per day.

TrumpRx says: Original price: $199.20. TrumpRx price $99.60. Savings $99.60. This is for 120 pills (three or four times a day, approximately a one-month supply) and 500 mg.

According to GoodRx.com, Walmart charges $31.94 for 120 pills at 500 mg. 

So, let's compare. 500 mg sulfasalazine, 120.

Manufacturer's original price (as referenced in TrumpRx): $199.20

TrumpRx price: $99.60

Walmart: $31.94.

TrumpRx represents a 212% markup. 

And When it's Brand Name Only, the Savings are also a Lie

For some drugs you have no choice but to go with the brand name and pay the manufacturer prices. Let's look at Wegovy (brand name), an antidiabetic and weight loss drug, for example. With brand name only drugs, the savings can be real. Or not. Manufacturers regularly present discounts all on their own and the numbers presented on TrumpRx are lies. 

This news story is dated 11/17/2025.

"The Danish drugmaker is lowering the price of the drugs for existing cash-paying patients to $349 per month from $499 per month. . . . Also on Monday, Novo Nordisk launched a temporary introductory offer, which will allow new cash-paying patients to access the two lowest doses of Wegovy and Ozempic for $199 per month for the first two months of treatment." 

This is echoed at the TrumpRx website: 

Wegovy, Original Price: $1349.02. (exactly $1000 more than what was mentioned in the November article) TrumpRx Price: $199.00. You have to read the note below the TrumpRx price to get the actual price. "New patients pay $199 for the first two monthly fills of Wegovy® (semaglutide) injection 0.25mg and 0.5mg, then $349/month." 

The $349 price is described in the above news article as something negotiated by Trump back in November. However, if you use the previous price, $499, you have a savings of 30%. The $1349.02 original price is a lie.

Tallying Them Up

So, how many of the drugs on the TrumpRx website are available as generic? This requires judgment calls. For example, Airsupra (brand name) is a combination of two generic drugs. It is only available as a combination in brand name and for a lot more money than taking the two generics individually.

With that in mind, this is my tally from their list, 1 drug was discontinued in 2023, 3 are listed twice in different formulations (so, in actuality, there are 40 different drugs), 12 are not generic in any formulation, 3 more are not generic in the particular presented formulation, 1 is a judgment call to call generic (recombinant FSH), 3 are combinations of 2 generically-available drugs, and 25 are available as generic in the given formulation.

The Drugs.

Abrilada pen. Available generic, but not as a pen administration device.

Airsupra. A combination of two drugs, albuterol and budesonide, both available as generic (and cheap).  

Azulfidine Tabs and Azulfidine En Tabs. Available generic, sulfasalazine. 

Bevespi is not generic.

Cetrotide available as a generic, cetrorelix acetate.

Chantix available as a generic, verinocline.

Cleocin available as a generic, clindamycin.

Colestid available as a generic, colestipol.

Cortef available as a generic, hydrocortisone. (FDA approved in 1952)

Cytomel available as a generic, liothyronine. (we teach this drug as not recommended)

Diflucan available as a generic, fluconazole. 

Duavee is not generic.

Estring. Available as a generic, but not in its "ring" device.

Eucrisa is not generic.

Farxiga available as a generic, dapagliflozin. 

Genotropin. A complex matter, but simplest to say not generic.

Gonal F. A complex matter. It is a recombinant FSH. Other forms of FSH are generic.

Insulin Lispro is actually the generic form!

Levoxyl is available as a generic, levothyroxine.

Lopid is available as a generic, gemfibrozil.

Medrol is available as a generic, medroxyprogesterone.

Ngenla is not generic.

Nicotrol. A discontinued drug (2023). Still, TrumpRx gives a price of $271.16.

Ovidrel is not generic.

Ozempic Pen is not generic.

Premarin is available as generic, conjugated estrogens.

Premarin Vaginal Cream form is not generic.

Prempro is a combination of two generic drugs, conjugated estrogens and medoxyprogesterone, both listed above. There is not a generic form that includes both together.

Pristiq is available as a generic, desvenlafaxine.  

Protonix is available as a generic, pantoprazole. 

Tikosyn is available as a generic, dofetilide.

Toviaz is available as a generic, fesoterodine fumarate.

Vfend is available as a generic, voriconazole.

Viracept is not generic. (surprising. It could be generic.)

Wegovy is not generic.

Wegovy Pill is not generic.

Xeljanz is available as a generic, tolfacitinib. 

Xigduo Xr is available as a generic, a combination of dapagliflozin and metformin.

Zarontin is available as a generic, ethosuximide.

Zavzpret is not generic.

Zepbound is not generic. 

Zyvox is available as a generic, linezolid.

Martin Hill Ortiz is a professor of pharmacology and author of several novels. 

My new novel, In the Shadow of the Tower, the third in the series, The Skyline Murder Mysteries, is now available for pre-order on Kindle. It will be available as a paperback. 

A nation on edge. A city crawling with gangsters. A plot that could change history forever.

Miami, 1933. The nation is in the grip of the Great Depression, and former New York World reporter Alan Priest is struggling to survive as a freelance journalist. His wife, Lorraine, once a sought-after magazine model, is watching her own career fade with the times. Together, they are drawn into a dangerous investigation that reaches far beyond headlines and photographs.

When Alan and Lorraine uncover a mob conspiracy to assassinate President-elect Franklin D. Roosevelt, they find themselves racing against time—and against forces far more powerful than they imagined. To stop the plot, the intrepid pair must navigate a maze of corruption, betrayal, and shifting loyalties, battling ruthless gangsters and questioning even those who claim to be allies.

The first two in the series, Floor 24 and The Missing Floor, are available in multiple formats, including as audiobooks. The audiobook of Floor 24 has quite a complimentary review here.

Available for preorder

Continue reading →

A Mystery Writer's Guide to Drugs and Poisons. Part Two.

Poisons Versus Drugs.

"All happy families are alike. Each unhappy family is unhappy in its own way." Leo Tolstoy.

In order to achieve a therapeutic effect without toxicity, a drug has to work perfectly: not too much effect, not too little. It has to be directed to the cause of the ailment and not act elsewhere. It is hard to get things right.

In contrast, there are many ways to get things wrong.

The Mechanisms by Which Toxins Work.

These are the major ways in which toxins achieve their actions.

• For a drug having a poisoning effect, that effect is an extension of the beneficial effect.

For example, a high blood pressure medicine lowers the blood pressure by too much. A stimulant overstimulates. This can also happen indirectly. As a drug concentration goes up, even an otherwise safe drug begins to activate or deactivate other physiological processes.

• The poison interferes with essential physiological processes.

It prevents red blood cells from carrying oxygen. (Cyanide).
It interferes with cells using oxygen (Arsenic.)
It disrupts the automatic beat of the heart. (Digoxin in higher doses, oleander, which works through the same mechanism as digoxin).
It disrupts nerve transmission (Curare and some snake poisons. Botulinum. Similarly black widow venom overloads nerve transmission).

• The poison is caustic. 

It will damage or kill the exposed tissue. (Many snake venoms, often by constricting blood vessels and cutting off blood supply. Tissue death can lead to gangrene.)

• The compound is made toxic by the body.

Acetaminophen (brand name: Tylenol) is one of the main culprits in drug overdose. The liver transforms it into a toxic compound which, in high concentrations, can destroy the liver.

• The poison causes DNA damage. 

This can result in a very delayed response (as in years or decades) of causing cancer.

• There are drug-drug or drug-toxin interactions. 

There are two main ways by which one drug plus a second chemical can be toxic or fatal.

The first is through their mechanism of action: you add together two chemicals that work hand in hand to increase an effect. A well-known example is barbiturates plus alcohol. Both are CNS depressants: that is, they lower consciousness. Together they can put a victim into a stupor, a coma, or death. Sometimes drugs from different categories have overlapping mechanisms. Many drugs used for migraine headaches act through the neurotransmitter serotonin. Many antidepressants also increase serotonin. Sero (blood) tonin (tone, tension), when it is bumped up in concentration, can cause a spike in blood pressure which can be fatal.

The second major mechanism of toxic interactions is when drug A interferes with the elimination of drug B. In this case the concentration of drug B accumulates in blood to toxic levels.

• Allergies. 

Every drug will have someone allergic to it. Most allergies are not severe. Some drugs (such as penicillin) can trigger potentially fatal reactions in those who are sensitized.

Oleander - a favorite among mystery authors

Things that Authors Get Wrong About Poisons.

1. Death is not instantaneous.

Fast-acting toxins like cyanide or curare are somewhat similar to the victim drowning. In this case, oxygen is cut off. The victim will die over time. Imagine holding your breath until you pass out (three minutes?). Add on to this an additional time in which the irreparable brain damage takes place. Another two to three minutes.

Cyanide was used for gas chamber execution and the victims typically took several minutes before becoming unconscious. Similarly, if the heart stops beating, a patient will continue to live for several minutes. If you want a character to be poisoned and not be able to complete the sentence, "The murderer is. . . ," then you probably need to give a compound that will cause unconsciousness (which can be rapid, several seconds) before death, which will take minutes. 

2. Death is often not certain.

This is a pet peeve of mine. A murderer pushes the victim down the stairs, certain the victim will die. Such an act may cause death, but chances are the victim will come out bruised. Similarly, with poisons, except in cases of overkill (very high doses), death is not assured. Some people (Rasputin) will survive the attempt. Along these lines:

3. The measures of lethality are not exact.

You will find terms related to drug toxicity like "therapeutic index." Therapeutic index is the ratio of the dose that causes lethality in fifty per cent of the population (lethal dose 50, LD50) divided by the dose that provides a positive effect in fifty per cent of the population (effective dose 50). If it takes ten times as much drug to kill fifty percent of people than it does to treat 50 per cent, then the therapeutic index is 10.

To illustrate the uncertainties of the therapeutic index and show how the concept is misused, I provide my students with the following example from the book "Who Killed Kurt Cobain?" Ian Halperin, Max Wallace, 1999, Carroll Publishing Group.

The background: Kurt Cobain, lead singer of the music group Nirvana, died on April 8, 1994. He had a high dose of heroin in his blood and a shotgun wound to his head. His death was ruled a suicide. In "Who Killed Kurt Cobain?" the authors stated it could only be murder. Cobain's blood contained 1.52 ug/mL heroin/morphine. The LD50 is 0.5 ug/mL.

The authors said, "This level [1.52 ug/mL] is widely known to represent three times the lethal dose of heroin. . ." and "a blood morphine level of 0.5ug/mL is . . . the established maximum lethal dose, even for severe addicts." The authors argue that the high dose of heroin would have been nearly instantly fatal or incapacitating and would not have permitted Cobain time to employ a shotgun to kill himself.

What’s wrong with this argument? Well, several things.

  a. What the hell is "maximum lethal dose?" You double the maximum lethal dose and you still have a lethal dose.

  b. LD50 says nothing about "instantly fatal or incapacitating" and it wouldn't have been. Fatality through heroin overdose is through suppression of breathing which does not cause instantaneous death. A high dose of heroin may have had Cobain fall asleep in a few seconds.

  c. LD50 says nothing about "even for severe addicts." Severe addicts tend to have tolerance to drug effects.

  d. There is no guarantee that three times LD50 is going to kill 90% of subjects, much less 100%. That's not how the calculations work.

  e. Lethal dose calculations come from animal experiments (they don't run lethality experiments in humans) and the findings may not directly extrapolate.

4. Analyses for Toxins Tend to Look for the Usual Suspects.

Unless the drug or toxin to be found is mentioned in advance, the typical post-mortem forensic analysis is going to miss compounds that are active in small concentrations. It will find toxins that are present at high concentrations and will screen for the most likely poisons.

You can find traces of a poison in blood or in hair using ultra-sensitive techniques: particularly if you know what to look for. Translating this to another use: yes, an ultra-sensitive drug test could find trace THC levels from the marijuana joint you smoked two weeks but that's not the test that people usually run.

5. Getting the Poison This is as Important as Choosing a Poison that Works.

Typically, for a poison to be fatal, it has to achieve a lethal concentration in blood. In other words, it has to get into your system. This detail is overlooked in a lot of thriller/international terrorism poison-the-masses novels. The author imagines that by poisoning a water supply, you will be able to kill off a city.

This scenario doesn't work. First, you go to the city reservoir. Then you have to have enough poison to pour in that would make each glassful lethal. Then, the toxin had better be equally suspended throughout the water volume: it had better not be oily and rise to the surface or else precipitate or else bind to minerals. And it had better be odorless and tasteless. And, if it gets to the person who drinks tap water, it had better not break down in stomach acid or digestive juices.

With gases, there is a huge amount of air in which the compound can dilute. The historical lethal attacks with gas are usually limited to small or enclosed areas. Not a good thing, but not wiping out whole cities.

5a. Getting the Poison Inside the Victim.

On an individual level, the compound must get into the bloodstream. Not many compounds are absorbed through the skin and therefore there are only a few drugs and toxins that could be delivered by skin contact.

The oral route is more likely to be effective. The GI tract is made for absorbing chemicals: nutrients. This absorptive process makes it good for absorbing many, although not all, types of toxins. Large molecules can't be absorbed through the GI tract and if a compound is a protein (as many toxins are), it will be broken down by digestive juices and absorbed as nutrition.

The lung is good for absorbing, but the drug has to be a gas, vaporized (smoke) or else suspended in droplets (spray).  Not much of what you breathe in gets into the blood, but for a toxin that is active in small amounts, that may be enough. The mustard gases (famous from World War I) did not need to get into the blood. They chemically attacked the tissues where they made contact, including the eyes, the throat and the airways.

If you want to be sure a poison gets into the blood, injection is the surest bet. Whether it is subcutaneous (making a blister), IV drip, blow dart, or a full bolus injected into the veins, most any compound, including those that won't be absorbed anywhere else will get into the blood system.

End Note.

With such a large subject to cover this pair of posts may have been too general / or the examples too limited. If someone has a particular question about a toxin feel free to write me.

Never Kill A Friend, Ransom Note Press

Never Kill A Friend is available for purchase in hard cover format and as an ebook.
The story follows Shelley Krieg, an African-American detective for the Washington DC Metro PD as she tries to undo a wrong which sent an innocent teenager to prison.

Hard cover: Amazon US
Kindle: Amazon US
Hard cover: Amazon UK
Kindle: Amazon UK
Barnes and Noble 

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A Mystery Writer's Guide to Drugs and Poisons. Part One.

I have a doctorate in Pharmacology--the science behind drugs--and have taught the subject to medical students for twenty years. I have also taught Toxicology, the science of poisons. The two subjects overlap. As any pharmacologist can tell you, every drug can be a toxin, it just depends on the dose.

Drugs and Poisons.

Drugs and/or poisons take their place in mystery literature as murder weapons, as addictive substances related to character flaws or criminal ventures and, in thrillers, as potential terrorist threats which can wipe out whole cities.

On a less dramatic note, characters use drugs for their various ailments and may suffer from their side effects and it is important to get the details right.

Pharmacology and Toxicology are vast subjects with issues related to the thousands of drugs and poisons. In this series I will try to deal with some of the most common situations the mystery writer may encounter. First, however, some basics on how drugs and toxins work.

What Makes Drugs and Toxins Work.

The human body is run by chemicals that it produces. These can be hormones that are released by glands which act elsewhere in the body on organs and tissues or else they can be locally acting substances such as neurotransmitters. What's a neurotransmitter? Nerves, both those that run like wires around the body, and those that comprise the brain, act by releasing stimulants and depressants which affect tissues or act at another nerve. These chemicals are neurotransmitters and run the communication system of the body, giving orders to both the automatic systems that govern functions such as breathing and digestion and the voluntary system that controls movement and willful actions. Neurotransmitters also control the brain functions: consciousness, memory, wakefulness, euphoria, etc.

So, what does a drug do? In most cases* it either acts like the natural chemical or blocks the effect of the natural chemical at its site of action.

Let's have a couple of examples. You are probably familiar with adrenaline (also called epinephrine). It is a chemical released by the body in response to stress or danger. Among other actions, it opens up the lungs for breathing, it makes the heart beat faster, it raises the blood pressure and it directs blood flow to the skeletal muscles. The set of effects from adrenaline are often described as preparing you for "fight or flight."

Adrenaline can be given as a drug. Shock involves a precipitous drop in blood pressure. A doctor may want to raise blood pressure using adrenaline in the case of anaphylactic shock (the type of shock that occurs with a severe allergic reaction such as bee-sting allergies).

Adrenaline was formerly given for asthmatic attacks: it relaxes the bronchiole muscles of the lungs to make breathing easier. In this case, we get to a toxicity: adrenaline not only opens up the bronchioles, it causes the heart to race. It can cause death in those prone to heart attacks. As a general principle of toxicity, some people are more susceptible than others. There are other drugs which can be used for asthma that do not have this effect.

To get back to what I noted above, some drugs mimic while other block the effects of natural compounds. Instead of raising the blood pressure with adrenaline, you might want to lower the blood pressure by providing a drug that blocks the action of circulating adrenaline (and its companion which is released by nerve endings, noradrenaline). Such drugs are often called blockers or inhibitors or else by the more technical term, antagonists.

How Do Drugs Achieve Their Effect?

Drugs, and their natural chemical counterparts, work by binding to receptors which turn on or off cell processes. What is a receptor? The following analogy is over a century old. A drug is the key, the receptor is the lock (or ignition switch). The receptor is typically on the outside of a cell. The drug is carried by blood to the outside of the cells where the drug turns on the cells causing a tissue effect. Why a particular tissue? That's where the receptors are which fit the keys: adrenaline on the heart tissue (and blood vessels and elsewhere where it has its actions).

Let's look at another example. Acetylcholine is a neurotransmitter with many effects throughout the body. Nerves which go to the skin release acetylcholine causing a person to sweat. Nerves which go the salivary glands release acetylcholine causing a person to salivate.

Acetylcholine is also released at the nerves which connect the brain to the skeletal muscles. The skeletal muscles are those that control voluntary movement. Drugs that act like acetylcholine are given to patient with myasthenia gravis. Why? Myasthenia gravis is a disease in which a person's immune system attacks the acetylcholine receptors on the outside of skeletal muscles. The person thereby loses muscle strength. By acting like acetylcholine, a drug can activate some of the remaining receptors.

However, in other circumstances you might want to give a drug that blocks acetylcholine at the skeletal muscles. Why would you want to do that? These drugs (skeletal muscle blockers) are given prior to surgery to prevent the patient from flinching. (General anesthesia does not paralyze the patient, anymore than sleep does not paralyze us.) A good plot device: a murderer substitutes or cuts off the skeletal muscle blocker being infused during a delicate life-or-death surgical procedure.

Let's look at the skeletal muscle blockers from the point of view of poisons. Tubocurarine (Curare) paralyzes the muscles and was discovered by a researcher who noted South American tribes using poison-tipped blow darts to capture animals. It can be fatal in animals or humans because one set of skeletal muscles helps us to breathe. (During surgery, the patient is placed on mechanical ventilation.)

After curare was discovered, but well before it was purified well enough from its plant source to be used as a drug, it made for a popular poison in mystery stories. No one interested in murder cares whether a poison is pure enough to avoid additional toxic effects.

Another set of toxins work through the acetylcholine system. Popular as the villainous weapons in thrillers and popular with villains in real life (Saddam Hussein, the Tokyo attacks), the nerve gases first overload and then knock out the acetylcholine receptors. The effects are several fold. First you have the twitching and spasms from having the skeletal muscles activated. You have the sweat glands and salivary glands turned on. Then you have the skeletal muscles shut down, including those that help you breathe. The nerve gases make for the more terrifying sort of poisons in part because they are active in small concentrations, they can be absorbed by breathing and through the skin (not many toxins can), and they can be spread in a suspended gaseous form. They also make for great plot devices because they have specific antidotes—and not many poisons do.

The Differences Between Drugs and the Natural Body Chemicals.

Although human-made compounds such as adrenaline can be used as drugs, a general rule is that the body exquisitely regulates its own compounds, producing them as needed and then quickly stopping the effect. One of the main ways in which the body stops the action is by breaking down the chemical into ineffective parts (metabolites). Adrenaline has a half-life of about 2 to 3 minutes. Acetylcholine, at the nerve ending, has a half-life of seconds. One major difference between synthesized drugs and the natural compounds is that the synthesized drugs act for a longer time. For example, an asthmatic patient might be taking a drug that acts like adrenaline in the lungs but has a half-life of hours.

So what is half-life? Unless the drug (or toxin) overwhelms the body's system of elimination, the body will eliminate half of the drug dose in a given period of time. A simple illustration is this:

Digoxin (for heart failure or arrhythmias). Half-life: 40 hours.

• Concentration in blood. (micrograms per milliliter)

• Zero hour. First measure: 8 ug/mL
• 40 hours later: 4 ug/mL
• 40 more hours later: 2 ug/mL
• 40 more hours later: 1 ug/mL

The drug is disappearing by halves, moving like the traveler on Zeno's bridge.

I provide this table to overcome a misconception. Half-life is not how long a drug acts. It may still be acting the level of 1 ug/mL. -- Or else it may not, it may be at a concentration that is no longer causing an effect. Half-life describes the elimination of the drug. The elimination of its effect is determined by the lower threshold of its effective concentration.

Extending This To Other Drugs.

There are thousands of drugs belonging to hundreds of systems. The differences between them is what receptors they act on, individual toxicities, half-lives, and routes of administration. 

For example, morphine-related drugs act through receptors which are naturally activated by the endorphins. These receptors are located in places which cause pain relief, euphoria, depressed breathing (the main fatal effect with an overdose), and constipation (the common problematic side effect). These receptors are present in other places to provide minor effects such as pinpoint pupils.

Morphine-blockers such as naloxone (Narcan) block the receptors. This won't make much of a difference (they are blocking pain-relief rather than causing pain) unless someone has a dose of morphine-related drugs or endorphins present. In such a case the drug wipes out the euphoria, pain-relief, etc. and restores the breathing.


*A final note on this part. Does every drug either mimic or block the action of a natural human substance? No. One alternative mechanism of action comes with the antibiotics which interfere with the chemistry of microorganisms.

Next. Some Differences Between Drugs and Toxins.

Never Kill A Friend, Ransom Note Press

Never Kill A Friend is available for purchase in hard cover format and as an ebook.
The story follows Shelley Krieg, an African-American detective for the Washington DC Metro PD as she tries to undo a wrong which sent an innocent teenager to prison.

Hard cover: Amazon US
Kindle: Amazon US
Hard cover: Amazon UK
Kindle: Amazon UK
Barnes and Noble  

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