Differences in Medications?
Patients have been telling me for years that there's a problem with their medications when they are switched to generics. I've heard this when I worked in psychiatric hospitals and in private practice and, sometimes, on the board. In the hospitals, unfortunately, the patients were often dismissed as being difficult because the physicians believed there was absolutely no difference between the two formulations of the medications.
Unfortunately, many healthcare providers have seen this as an indication of something akin to the placebo effect seen in clinical trials. In other words, they weren't believed.
Well, now mental health professionals are beginning to talk about it openly and do some research in the literature. What it has turned up should be of interest to anyone who has been having problems with their anxiolytic or antidepressant medications.
The journal Clinical Therapy in both 2003 and 2004 noted that there is a difference between brand and generic medications. The journal Hospital Practice also looked at the differences between generics and brand benzodiazepines. The differences can, according to psychiatrists I've heard from, be as much as 20-30% in the bioavailability of the medication.
Simply put. this translates into the percent of a medication that can be absorbed and utilized. Some psychiatrists have noted that they've had to increase the dose of a generic as much as 50% to get the same effect they would get with the brand name.
So, if your med doesn't appear to be giving you the same effect and you've been changed from a brand, perhaps you and your doc might want to research this literature further. I did a quick search on PubMed and found 18 citations talking about this problem. The areas of concern were in transplants, birth control, psychotropics and seizures.
The literature indicates that some medications may dissolve slower and not provide the necessary medication into the blood while others (meds for seizure disorder) resulted in breakthrough seizures. Remember, not all the medications found in this preliminary search were for anxiety or depression, but they provide some needed insights into how medications may differ.
As always, be an informed consumer of any product or service and ask whatever questions you need to in order to come to an informed decision. Caveat emptor is always a good thing.
Related Topics: Cost No. 1 Prescription Issue, Pharmacists Say, The WebMD Rx Guide for Patients
Technorati Tags: medications, generics
Unfortunately, many healthcare providers have seen this as an indication of something akin to the placebo effect seen in clinical trials. In other words, they weren't believed.
Well, now mental health professionals are beginning to talk about it openly and do some research in the literature. What it has turned up should be of interest to anyone who has been having problems with their anxiolytic or antidepressant medications.
The journal Clinical Therapy in both 2003 and 2004 noted that there is a difference between brand and generic medications. The journal Hospital Practice also looked at the differences between generics and brand benzodiazepines. The differences can, according to psychiatrists I've heard from, be as much as 20-30% in the bioavailability of the medication.
Simply put. this translates into the percent of a medication that can be absorbed and utilized. Some psychiatrists have noted that they've had to increase the dose of a generic as much as 50% to get the same effect they would get with the brand name.
So, if your med doesn't appear to be giving you the same effect and you've been changed from a brand, perhaps you and your doc might want to research this literature further. I did a quick search on PubMed and found 18 citations talking about this problem. The areas of concern were in transplants, birth control, psychotropics and seizures.
The literature indicates that some medications may dissolve slower and not provide the necessary medication into the blood while others (meds for seizure disorder) resulted in breakthrough seizures. Remember, not all the medications found in this preliminary search were for anxiety or depression, but they provide some needed insights into how medications may differ.
As always, be an informed consumer of any product or service and ask whatever questions you need to in order to come to an informed decision. Caveat emptor is always a good thing.
Related Topics: Cost No. 1 Prescription Issue, Pharmacists Say, The WebMD Rx Guide for Patients
Technorati Tags: medications, generics
50 Comments:
GREAT blog! I was one who believed that if the generic had the same active ingredient(s) then it would work the same as the brand name drug. Fortunately for me, I have a wonderful Internal Med doctor who does not want me to use generics, although he leaves the decision to me. He did explain seeing a demonstration of 2 drugs (pain meds I believe). One was name brand and the other was its generic. A dose of each was dropped into a glass of water and the water was stirred occasionally, both at the same time intervals. The brand name drug dissolved. Its generic drug never dissolved during the 30 minute demonstration! Which means the drug would have been ingested, passed through the patient's body, and no pain relief would have been provided by taking the drug. Since that demonstration, my doctor has discouraged use of generics. Since his telling me about that demonstration and reading other things about generics, I have stopped using generic whenever possible. Some are unavoidable such as Ibuprofen, but they are some of the ones that do work, fortunately.
It is so hard to keep up with all the new releases, especially when they tend to be contradictory and dependent on who funded the research...
But all we can do is try.
Thanks for keepins us informed!
~Tasker
I was pretty convinced that there might be a difference between the two and then I researched it. One of my own meds was a generic and it wasn't doing the job and now I know why. So, as we say in psychology about students' dissertation topics, this blog was a result of "me-search."
.. this is an old blog... what happened to the more current one?
just wondering..
~Tasker
Hmmm. To which one are you referring? Perhaps the computer gremlins snatched it.
Hmmm. Maybe!
I thought there was a more recent blog. Wishful thinking I guess!
~Tasker
Im glad this has been written about. I am currently on Paxil and it is not being manufactured anymore. I have to switch to something else and my doctor said that generic is different than the regular and the pharmacist says they are the same. Right now I am trying to decide to go to the generic or Paxil CR. Any thoughts?
Sounds like a bunch of BS to me, funded by the drug companies to convince consumers they should pay more for their designer brands. Don't believe everything you read on this site without considering the source and who's bankrolling it.
There is a difference. I have experienced it with 3 different medications. Benadryl & Equate - same exact ingredients listed on the box, same type, but Benadryl puts me to sleep (out cold) and Equate does not put me to sleep. Useful to know if you work inside the gates of a Prison. Fiorinal w/ Codeine, Loratab, Vicodin, Tylenol #3 versus Hydrocodone. Hydrocodone is given as the generic for all the brand name meds listed (matching the strengths). How can 1 generic be the same as 5 different drugs? I have to cut the brand name in half but take the entire dose of the generic to achieve the same results. I personally believe the problem is in the INACTIVE ingredients used in the generic/cheaper medication. The capsule, the coating on the tablet, whatever keeps the pill together - if the INACTIVE ingredients don't have the same release time as what is used in the brand name, then you can't be getting the same dosage.
--An Accountant, not a Drug Rep or Manufacture
So how do we get our health insurance to acknowledge these differences and in some cases such as seizure meds deficiencies. I have had my doctor write no substitution and even write out in longhand on the prescription that I have had breakthrough seizures with generics and still the insurance refuses to pay.
I personally have gone from brand-name Prozac to generic in the last couple of years and have noticed a huge difference. I have doubled the dose of generic Prozac (fluoxetine) and still do not get the same effect.
In talking to my physician, she has also said that many of her patients have complained about this particular generic.
I've experienced the same thing with Percocet. I only get minimal pain relief with the generic, so now buy name brand only. The generic would either take longer to work, or never provide the same level of pain relief. It definitely costs more, but it's worth it.
I have taken Synthroid since 1978 when my thyroid was destroyed. My doctor has always prescribed the brand name only. My pharmacy recently switched my prescription to the brand name after I changed jobs, which meant a change in insurance coverage, and my new insurer would not cover the cost of the brand name. The pharmicist told me there was no difference in the medication. I talked to my internal med MD, who told me that there is a difference, and that this is not the type of medication we want to fool around with. I contacted my insurance company, my doctor wrote a letter giving the reason for his choice of the brand name Synthroid vs. the generic, and I was lucky to receive coverage of the brand name for one year. It will need to be reviewed each year. It is frustrating that this type of battle must be waged with the insurance company! I trust my doctor more than the pharmicist in this situation.
Here's some information that may reassure the generic-brand name equivalency scare:
The Food and Drug Administration (FDA) is legally responsible for approving all brand name drugs prior to their introduction into the market through a multi-faceted, multi-phased drug trial program that requires extensive research as well as funding (via the federal government and pharmaceutical drug companies). When they are approved and introduced into the market, they retain an exclusivity period of time in which they own the patent of the drug formulation, and no other company may make the same drug product (i.e., the drug companies make a LOT of money during this time period).
After approximately seventeen years, the patent expires, and the drug product is available to be made by the same brand name company as well as generic manufacturers. The common misconception that many people in the lay public have is that the FDA does not regulate the generic formulations in the same ways that it regulates the brand name formulations. This is not true; the federal government requires the generic drug companies to go through a multi-faceted, multi-phased program as well. The difference is that drug research in vivo (in person) acutely and chronically is not required, for the brand name company has already done so. This accounts for the major difference in price as well. In order for a generic drug formulation to be approved by the FDA, it must meet the following criteria when being compared to the brand name formulation (for example, Prozac and fluoxetine):
(1) the peak concentration curve must stay within the range of + 25% to - 20% at all times
(2) the area under the curve (AUC-- indicative of the amount of drug that is absorbed after bioavailability) must be +/- 3% of the brand name formulation
If the two criteria are met, the two products are termed "bioequivalent" and are AB rated. AB rated generic drugs are then accepted as an appropriate interchange from the much more expensive brand name product. A reference published annually by the FDA, nicknamed "The Orange Book," lists approved AB rated generic formulations.
Because these specific criteria must be met, obviously the AB rated generic formulation must contain the same amount of active drug as the brand name formulation. The main difference lies in the inactive, or inert, materials that are added to the drug formulation. For example, the filler for the capsule may be methylcellulose instead of lactose, or something similar to that. Usually, the generic companies try to adhere to very similar manufacturing techniques, but differences do occur. These slight differences may account for a slight difference in drug absorption or bioavailability, the amount of drug absorbed into the bloodstream following first-pass metabolism (via the hepatic portal vein in the liver). However, these differences in drug formulation should never, ever account for differences that require double-strengthening the dose administered to the patient to receive therapeutic effect. If this is believed to be occurring, I would recommend checking that the generic is indeed AB rated in the Orange Book. If so, keep in mind of a phenomenen similar to the "placebo effect." Individuals who are informed that they are taking generics and that subconsciously believe that generics are second-rate to brand names may feel as though they are not receiving the full drug effect. This has been made a case in many, many trials. I would check that research before I check any research that indicates that generics are not as bioavailable as brand names.
I admit that I am fully supportive of generic substitutions and believe that it is ridiculous to think that generics will not fulfill the same therapeutic effect as brand name formulations. As a side note, I have taken generic drugs for years and have never had any problems, so please do not think that you must take a brand name product to receive the full therapeutic effect.
Hope that this helps any scared consumers!
Sincerely,
Megan Nolan
Fourth year pharmacy school student
In response to other various blogs that were posted previously, I would like to extend some additional information.
Regarding paroxetine (Paxil): the half-life elimination of paroxetine is 21 hours. The purpose of controlled release (CR) formulations is to reduce the number of dosages with drugs that have a short duration of action (metabolized quickly in the body, as indicated by the half-life). Paroxetine is already a once-a-day regimen due to this long half-life....so basically, what is the purpose of Paxil CR? All that you are paying for is a special coating that slowly releases a drug that doesn't need to be released slowly. I'll explain this in a way that may make more sense: the pharmaceutical company, GlaxoSmithKline, who manufactures Paxil, recently had the patent expire...Paxil went generic. Frequently what many drug companies do is create a new formulation that will require a new patent so that they can retain exclusivity of the drug formulation. Paxil CR came out shortly before Paxil went generic for this very purpose. Paxil CR is a complete rip-off in reality. Paroxetine (generic) will accomplish the same task.
Another point in case: I keep reading about all of these individuals that have their doctor tell them all these horror stories about generic drugs. Please keep in the back of your mind this fact: Pharmaceutical representatives (drug reps) are paid by the pharmaceutical companies to represent a particular drug or set of drugs. They not only meet with the doctors (and pharmacists) to inform these individuals of their drug product and the advantages of this drug, but they also have, a'hem, incentives that occur on the sidelines that prompt many doctors to support a particular brand name product by writing scripts for it. So not only are some doctors receiving biased information but also incentives to support their choice. There's much more to the healthcare system than what the public sees or understands....
Ugh...I have been on Celexa for several years, and have had 2 HORRIBLE experiences with the generic version. My reaction to the generic is almost paralyzing (emotionally) in that I just sort of deteriorate (I am not that bad OFF of medication! LOL). Don't want to get up, despairing feelings, etc...I can only liken it to being poisoned. I am presently getting the insurance company to cert. the celexa again by the doc insisting I cannot take the generic. (oh the difference a molecule or two makes) Give it a try, folks...(if your pharmacy says you aren't covered.)
Feeling better now!
When I switched to the generic of my antidepressant med, I developed an allergic skin reaction. Not possible said my MD. I stopped the med. and waited for the sx to stop. After a week or so, I tried again. Same itchy sunburn-like rash. I went back to the branded med. and was fine. My pharmacist said he had 2 or 3 other patients who had reported similar reactions to the generic.
I switched from Bentyl to generic, and I know the generic did not work as well as the brand. To anyone who chooses to believe this could not possibly be true, I say "whatever".
As a former FDA inspector AND patient--the inactive ingrediants, binders, etc have EVERYTHING to do with bioavailability. Unfortunately, "formulary book people" like insurance people, don't have this physiological understanding so natureally the choose the cheapest. Its NOT a placebo effect but only double blind studies will prove it beyond a reasonable doubt. DR S
Until now, when meds have insisted that chloroquine nolonger cures malaria, it's what I use. I buy chloroquine from Europe rather than India, Pakistan et al. The latter for sure don't work. This extends to all other medicines. The generics are full of fillers/ exipients.
Those generics are, in the long run going to cause very serious health consequences. The manufacturers must be very closely monitored.
Obet're Charles,
kampala, Uganda.
As a prescriber in a public clinic, in 2004 I had 12 patients stable on Celexa. In early 2005, several months after it went generic, 10 of the 12 had odd side effects and/or worsening depression & anxiety. I called the pharmacy of the two who continued to do well (the were the only ones using a certain small town druggist) to suss out possible reasons. He'd found out who Forrest (Celexa "maker") used as a supplier and bought that brand of citalopram for his customers. Clever & thoughtful. It's really a case by case issue. In this case, given that a number of the 10 clients had mental retardation & were brought in by staff unaware of the changeover but very aware of the change in mental wellness, placebo/suggestibility wasn't the reason for the difference.
For the sake of balance, I'm also willing to bet that there are generics out there which actually outperform the brand name. If I can find/think of one, would that cause a generalized backlash against brand name medications? I don't think so. Several brand names have had recalls in recent times for manufacturing defects, and any manufacturing site may vary in quality of output from month to month and year to year, brand name or generic. Do you wax nostalgic for that October 2004 Geneva fluoxetine?
I have tried generic estrogen vs.brand and there is a difference. The brand works better. The drug store gave me generic without asking me and I caught it a couple refills later....so always make sure you tell the pharmacist BRAND NAME ONLY, PLEASE.....
In response to what Megan said. Whether Paxil and PaxilCR is the same or not. I have noticed a difference. I do not get hardly any side effects from the CR as I did with regular Paxil. So there has to be a differnce in at least how it releases in my body.
Everyone here has some great insight to what my husband may be experiencing. I grew up believing the generic is the same and there is no difference. Since switching over to the generic Zoloft, we have noticed his mood changing to barely better than no anti-depressant at all. I mentioned it to the pharmacist who looked puzzled and said it must be some other factor as the generic is THE SAME THING AS THE NAME BRAND. After reading this I think it's time for a trip to the doc for the real stuff.
OK, I have a question. I have tried so many antidrepressants and I just keep gaining weight. I tried the generic form of celexa which is citalopram and it seemed to help me lose weight. Has anyone else experienced this? Any suggestions on anti's that do not put the weight on....thanks!!!
Been on 40mg (generic) paxil for a couple of weeks and now have an itchy rash on my arm. Wondering it anyone else has experience this?
I've been on the brand Zoloft and when it became available in generic I started that. I have increased from 25 mg. to 50 mg. and I have been getting some vivid dreams. I always had them even in the lower dosage. Is that one of the side affects?
to whom can answer my question...
i have been put on a new birth control, sesoquin. it allows me to only have a period every 3 months or 4 times a year. i get a 3 month supply each time
my question is..i know my body needs time to adjust to this new medication and there may be spoting in the first pack of pills, but i am in my 2nd month of pills and i have had my period for the past 12 days now. its not a regular period like i use to get, but it is the ending of what would have been of my reguarly monthly period. its hard to explain. its not heavy at all, but enough to use a tampon each day pretty much.
i wanted to know if this was normal and to be expected or should i call my doctor and get it checked out. please write me back at blueeyes8787@yahoo.com i would greatly appricate it.
Thank you
I currently take synthroid and zoloft. If you speak to any endocrinologist they will tell you to stay away from generics. It does make a difference. Name brand synthroid is $14 without insurance. Zoloft is $90 for name brand and $70 for generic. However, with a Pfizer discount card that is not income based you can get the "real deal" for cheaper.
Answer to the birth control question. Breakthrough bleeding is a common occurrence when going to a 3-month regimen. It took my aunt about a year for her body to adjust and me about 6 months. I will take time, but it is very worth it. Particularly for me because I have endometriosis.
right now I'm taking the genaric brand of Klonopin Clonazepam and, I know there is a significant diverence I'm given 2 2mg tabs twice a day. since swicthing not only do i have more panic attacks at about 4pm every day the genaric wears off were as the brand name would last all day plus had minumal panic attacks.Im forced to take the genarics because there
's about a $100 difference. looking for some feed back or suggestions. Thanks
I am currantly in a study group trying citalopram 10mg. for hot flashes--and I love it. I HAVE LOST 7 #'S,I have been trying to lose this weight for 8 years. I hate the forty's. But now sinse Citalopram I don't have as many hot flashes and I've lost weight so I'm extreamly happy, so I hope to continue on Citalopram after the study.
Personally I have taken prozac for many years and when my Dr. said the insurance said I had to try 2 months on the generic, I can tell you there was a significant difference. I was nearly suicidal by the time I was back on the real prozac. I also was told to lower the doesage at one time and due the fact that I have 33 inches of working intestine after by-pass surgery not the usual 35 feet that is normal I ended up in the hospital with nearly no medication in my bloodstream from the lack of absorption. Once I was on my higher dose I was ok again. But 2 close calls that were not even from my depression makes one very guarded about generics and the education and coning of Drs. and now I am in a severe depression after 12 yrs free except shorter depressive times We think it may really be bipolar disorder as my med do not seem to be working at all and I think I was originally misdiagnosed as the recall of my life seems to show. I thought "manic" was normal and just not being depressed but I think I was manic more than depressed, so now we start from scratch 30yrs later. Please pray that we can find the real problem and I can get out of this black hole.
Thanks in advance
Charlie Marie
I am posting in regards to the Annonymous posting at 1:17pm about the switch from Prozac to generic Prozac. Could you please share with me what the generic brand was? I have been on a generic form for years and my pharmacy recently switched to a different generic and I feel like I am going into a downward spiral. I'm interested to know if there is a difference between generics.
Thank-you. srk
In response to the post about Paxil and skin irritation, I just switched from Zoloft generic to Paxil generic. I've been taking the Paroxetine for about a week and a half, and my scalp is very itchy, and I have red splotches on my face that are bumpy and itch like crazy! I called the Dr. about this issue, but haven't heard back yet. Anyone else experience this?
Is there anyone who is currently on Armour Thyroid who has formerly taken Synthroid or its generics?
I am interested in knowing if there is hair loss with Armour Synthroid as I have been gradually losing my hair ever since my surgery. They said it would be a short term situation. It is not.
Thank you.
I've been taking an anti-depressant (Effexor) which I was given to help with hot flashes.....and it does, a lot, and I am considerably much better when taking this med, however, a side effect is my hair in the front, is thinning.....talk about needing an anti-depressant. I feel I've traded one problem for another. If my hair continues to thin like this I'll really get depressed! I've been doing internet research and have found this to be a documented problem with Effexor. Is there an anti-depressant that does not have this side effect?
I AM INTERESTED TO KNOW IF ANYONE ELSE WHO HAS HAD THEIR THYROID REMOVED IF THEY EXPIERENCE ALL THE SAME SYMTOMS OF TIREDNESS, THINNING HAIR, WEIGHT GAIN, AND DEPRESSION?
if you believe anything that the FDA says or any of the other branches of government...please watch the news, read the papers. they do not have our best interests at heart, it's all about money, etc. wait until CODEX gets here in the united states.
GENERICS ARE NOT THE SAME AS BRAND AND ANY GOOD DOCTOR WILL TELL YOU THAT, AND MAYBE A FEW PHARMACISTS.
I just recieved a generic pecsription of VICODIN,can't stop scatching, itch all over, I've been taken the REAL stuff off & on for years with no problem. Anybody else have this problem?
wtgeiekPaxil CR is great and it works !!!!
cc
It's 1/21/08. Was on Paxil for 11 years, great time. Stopped working, very anxious/depressed. Put on many things Cymbalta, Lexapro and different amts. No help. Went on Zoloft, now 250mg and main problem is severe scalp itching, to a point I draw blood. It's like an addiction. Anyone having these probs??? Thanks
I just recently had my thyroid removed, have lost weight since the surgery because I don't feel like eating, it has been a month and I am just now able to drink without coughing and chokeing. I have been on Synthroid 110mcg, then 112mcg, now on 88mcg, I also take the generic Paxil and have been itching like crazy for the past few days, could this be medication related?
CAN ANYONE HELP? I'M ON GENERIC SYNTHROID-LEVOTHYROXINE?? DON'T KNOW HOW TO SPELL IT, JUST KNOW ITS GENERIC. IF "ANYONE" KNOWS, I WOULD LIKE TO KNOW THE INGREDIENCE IN ARMOUR THYROID AND SYNTHROID. ONE DR. PUT ME ON THE GENERIC THROID AND ANOTHER WANTER TO PUT ME ON ARMOUR THYROID.
DOES ANYONE KNOW WHATS BEST? I'M PRESENTLY ON THE GENERIC; I AM TIRED A WHOLE LOT OF TIME;
THANKS
ANONYMOUS
I was using Brand Zoloft for two years when the generic brand was put on the market. I was given three different colors of shapes and sizes of generic Zoloft over a three month period. The big blue gen zoloft dissolved in my mouth before I could drink. I was going down in a depression hole when I realized I needed to get back on name brand. Told my dr. who said tell pharmacy and switch. Pharmacy said get dr to check brand name box. All this done, the ins. co now is objecting to the switch to brand name and is costing $94 a month for me. The difference is unbelievable. I am functioning much better on brand name Zoloft. I and my dr. are fighting the ins. co to cover the brand name w/co-pay of $25.
can i take ciprimil and effexor together? will it harm me
While it is true that there can be differences between brand and generic meds, no study or experiment will prove anything. Let me explain. For instance the drug dissolving in water, that is water, not your stomach. Also, one persons stomach is not the same as another. Therefore, each individual is going to have a possible different response to any drug brand or generic. Also, may times now brand companies are making the generic also. I have seen brand lotrel in a generic makers bottle. Also, Pfizer has a generic company that makes many of their brand drugs once their patents expire and they are not the only company that owns a generic company too. Furthermore, I would like to see these brand vs generic drugs used in the same person and blood levels drawn to determine if there is that much of a difference. The fact is that many brand companies do not want people to use generics, it costs them money. Now, there are a few drugs that I would suggest a patient to stay with brand once started, but for the most part millions of dollars can be saved by using generics. Remember, saving money on prescriptions saves your employer money and should keep your premiums/copays from rising further. Of course this is just one person's opinion.
To anonymous, thanks 4 showing how 2 test a drug's effectivness with the water in a glass, 30 min. dissolvment trial. Another problem with the generic brands, aside from their 50/50 dependability rate is that some insurance companies are forcing the consumer's hand into getting the generic brand or not covering the cost of the name brand altogether. This can lead 2 the obvious problems, all the way up to possible deaths, which is probably what the insur.com's want anyway.
Carolyn: I am currently taking Paxil CR 37.5mg once a day. I have heard my next refill will be generic as my insurance requires any drug that goes generic I must take. Do you think I will realize a difference in the way I feel? If so, I will need my doctor to write a letter of medical neccessity to my insurance and they will probably charge me the non-formulary price. Any answers will be appreciated.
I took Lexapro for a couple of years and loved it, however it is rather expensive - so I ask my Dr if there was anything available that would give the same results - less expensive. He suggested the generic of Celexa (citalopram). For the first couple of weeks I didn't see a difference, as time goes on (around a month now) I "feel" a big difference. I am itchy, my thoughts are more racy, in a nutshell it has worsened the anxiety end of things. I am going back to Lexapro - sometimes you get what you pay for.
Just heard from my HR department that there is a difference in the effectiveness rate of generic VS brand name oral contraceptives. I was on Yasmin and last week received the generic...should I be worried- - happy with the current size of my family!
MSB
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