The total cost of prescription drugs has fallen for the first time since 2008, despite the number of dispensed drugs rising to record levels.

In 2011, the community pharmacy drugs bill cost the NHS £8.81 billion - £29 million less than the year before - even though the number of prescription items dispensed rose by 35 million from 2010, to 961 million.

Simvastatin retained its crown as the most dispensed item in England in 2011, according to the latest NHS prescription cost analysis for the country, but its popularity could be on the wane.

The cholesterol-fighting drug clocked up 41 million scripts in 2011, but Glasgow community pharmacist Andy Christopherson said: "I don't expect simvastatin to retain the number one spot when Lipitor [atorvastatin] goes generic."

As in 2010, simvastatin was followed in the rankings by aspirin and levothyroxine.

A total of 961 million prescription items were dispensed in 2011, costing the NHS £8.83 billion	Last year's figures Can category M survive the patent cliff? Free at delivery?
	The figures also revealed that fluticasone was the most expensive drug by total cost dispensed in the community last year, costing the NHS £388 million - up from £380 million in 2010. On the whole, there was little change from 2010 to 2011, although a number of products fell out of the top 20 most expensive drugs in England by net ingredient cost, including goserelin and fentanyl.

There were four new entries in the top 20 most costly drugs, with the influenza vaccine charting the highest among them, coming in at number 13 and costing the NHS £72.3 million in 2011.

The vaccine also crept into the top 20 most commonly prescribed drugs, with 11.3 million scripts issued.

Top 20 most dispensed items last year

1. Simvastatin - 41.2m items (last year's position: 1) 2. Aspirin - 32.0m items (last year's position: 2) 3. Levothyroxine - 25.0m items (last year's position: 3) 4. Omeprazole – 23.3m items (last year's position: 5) 4.Ramipril - 22.5m items (last year's position: 4) 6. Paracetamol – 20.9m items (last year's position: 6) 7. Amlodipine – 19.7m items (last year's position: 9) 8. Salbutamol – 19.4m items (last year's position: 7) 9.Bendroflumethiazide – 18.4m items (last year's position: 8) 10. Lansoprazole – 17.3m items (last year's position: 10) 11.Metformin – 15.6m items (last year's position: 12) 12.Co-codamol – 15.1m items (last year's position: 11) 13. Citalopram – 13.4m items (last year's position: 16) 14.Amoxicillin – 13.4m items (last year's position: 13) 15.Egocalciferol – 12.8m items (last year's position: 17) 16. Furosemide – 12.2m items (last year's position: 15) 17. Atenolol – 12.2m items (last year's position: 14) 18. Bisoprolol – 12.0m items (last year's position: 19) 19. Atorvastatin – 11.4m items (last year's position: 18) 20. Influenza – 11.3m items (new entry)

Top 20 most costly drugs in England by net ingredient cost

1.    Fluticasone inhalers - £387.9m (last year's position: 1) 2.    Atorvastatin - £310.9m (last year's position: 2) 3.    Enteral nutrition – £212.8m (last year's position: 3) 4.    Budesonide - £158.8m(last year's position: 5) 5.   Glucose blood testing reagents – £156.6m (last year's position: 4) 6.    Pregabalin - £153.2m (last year's position: 7) 7.   Tiotropium - £149.8m (last year's position: 6) 8.    Olanzapine - £120.8m (last year's position: 8) 9.    Quetiapine - £103.8m (last year's position: 9) 10.    Beclometasone - £90.3m (last year's position: 10) 11.    Candesartan - £86.2m (last year's position: 11) 12.    Insulin glargine - £77.3m (last year's position: 17) 13.    Influenza - £72.3m (new entry) 14.    Donepezil - £72.3m (new entry) 15.    Ezetimibe - £71.5m (last year's position: 14) 16.    Metformin - £71.1m (last year's position: 19) 17.    Co-codamol - £69.0.0m (last year's position: 15) 18.    Pioglitazone - £68.7m (new entry) 19.    Omeprazole - £65.8m (last year's position: 12) 20.    Mesalazine - £64.5m (new entry)

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