By Jonathan D. Rockoff And Tess Stynes 

Johnson & Johnson reported fourth-quarter sales slipped 0.6% despite surging prescription-drug sales, in a sign of what the stronger dollar will mean for U.S. companies counting on overseas markets.

Like many health-product companies, J&J, New Brunswick, N.J., has expanded its businesses overseas, especially in fast-growing emerging markets like China. The moves have helped companies increase sales in health-care markets that are expanding much more than cost-conscious U.S. and European markets.

Yet it has also left them more vulnerable to fluctuations in the various economies as well as currency shifts like the recent rising dollar.

Now, 53% of J&J's sales of drugs, medical devices and consumer products like Band-Aids come from outside the U.S. Chief Executive Alex Gorsky said in a conference call that problems in Russia and Venezuela were challenging the businesses in those countries. J&J's $18.3 billion in fourth-quarter sales were up 3.9% operationally but suffered a 4.5% currency hit.

"Currency headwinds have increased quite substantially," Chief Financial Officer Dominic Caruso said in a conference call. Last year, he said, the dollar grew stronger "to a greater extent than we had anticipated." He said the company expects another 3.5% to 4.5% of negative foreign-exchange impact this year if the dollar remains at its current high levels.

Overall, J&J reported a profit of $2.52 billion, or 89 cents a share, in the quarter, compared with $3.52 billion, or $1.23 a share a year earlier. Excluding an increase in litigation-related items, integration costs and other items, per-share earnings rose to $1.27 from $1.24 and above the average analyst estimate of $1.26 a share.

Shares of J&J dropped 3% on the New York Stock Exchange.

J&J's financial performance is considered a bellwether for the various health-products markets because the company's portfolio spreads so broadly. Mr. Gorsky said the U.S. health-care market seemed to be reviving, with hospital admissions and surgical procedures growing, though doctor's visits are still in negative territory.

He said China's health-care market was also in good shape but described Europe, Russia and Venezuela as challenging, while saying Brazil was "mixed."

The dollar's strengthening blunted another strong quarter for J&J's prescription-drugs business, which reported its sales grew 9.6%, propelled by such new drugs as diabetes treatment Invokana, blood-thinner Xarelto and prostate-cancer therapy Zytiga.

The pharmaceuticals business is primed for further growth, Mr. Gorsky said, with promising drugs for depression, multiple myeloma and prostate cancer in development. Yet low-price competition looms for some of J&J's top-selling drugs, including for the antipsychotics Invega and Risperdal, the latter of which the company expects to face generic competition in Europe this year.

A big, surprising sales driver for J&J last year was the hepatitis C drug Olysio, but the company expects the drug's sales to drop off as the result of growing competition. In the latest period, Olysio sales reached $256 million in the U.S., above analysts's expectations, but below the $671 million in the third quarter.

J&J improved its operating margins by 190 basis points, excluding the impact of special items. The company is planning to wrest another $1 billion in savings out of its IT, finance and human-resources operations, Mr. Caruso said.

Mr. Gorsky said J&J's consumer-health business was "on track" to fixing the manufacturing problems that led to recalls of children's Tylenol and other popular over-the-counter medicines. He said that 80% of the McNeil over-the-counter medicines unit's SKUs had returned to shelves, and sales of children's Tylenol were growing four times the market rate.

J&J's medical-device business is finishing up the integration of Synthes's surgical-parts business, which J&J bought for $21.3 billion in 2012. J&J ended last year with $14.3 billion in net cash. Mr. Gorsky indicated the company was interested in deals to further bolster its medical-device business.

"We continue to look for new options," Mr. Gorsky said.

Write to Jonathan D. Rockoff at Jonathan.Rockoff@wsj.com and Tess Stynes at tess.stynes@wsj.com

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