BRAND vs GENERIC - they claim there's no difference...

[realitytest]

This is an expansion on PANZ's thread question about his experience with brand Klonopin compared to (his usual) generic clonazepan.

http://www.crazyboards.org/forums/index.ph...=0entry157440

Begging pardon, for the vanity of self quoting, I'll start with the last line of my post there. IMO this is a super-dooper important topic especially for a site that focuses if unofficially (like the Mother Ship) on people's medication experiences. If it's in the archives here I couldn't find it on search (but didn't wade thru all 23 pages)

****

"We should have a thread about brand generic differences experienced with everything mindly."

What medications do you have experiences with where you noticed a difference between the brand and generic?

Klonopin/clonazepam, Synthroid/levothryroxine and Ritalin/methlyphenidate are the three most commonly prescribed scripts where there is a recognized difference between the response to brand vs. generic. Yes, indeed they are supposedly bioequivalent but somehow they act differently for many (not all). And wouldn'tcha know it, the brand IS more effective ?

Unfortunately for me, I take two of the three (Synthroid and Klonopin) and have a lousy prescription plan, one feature being a formulary. Taking brand (when there's a generic), means you pay cash price. And when my kids took Ritalin we noticed like many parents, that the generic was not only ineffective, it actually made them wilder.

This is a BIG fight for parents of kids with ADD (probably one reason Adderall is more prescribed as that generic is dirt cheap. But it's not as safe! )

In the other thread, Breeze said she noticed a definite difference between brand and generic Neurontin, and I also do between generic and brand Lortab. The generic Lortabs (I've gotten so I can tell the companies apart) are much weaker and have almost no shelf life. Paying full fee for that means it costs me twice all my other copays combined. .

Other experiences?

rt

[ncc1701]

Heya rt,

So it's the case for sure that generics only have to have plus or minus 20% equivalence to the brand.

That's a lot of leeway.

Enough that I (I pay cash for my meds -- I'm on the MasterCard formulary ) only take brand.

B/c if I started on brand I'm staying on it, to be consistent.

And.

There was a release recently by the thyroid drug people (Eltroxin and Synthroid) (yes both together) that the two are *not* interchangeable, and we have to be careful to write the right name on the Rx. And those are two *brands.* FWIW.

For me, the only experience I have had with both brand and generic was Paxil, and it sucked altogether. I have to say that I for sure had less GI s/e with the generic, but whatever.

I've had patients on Prozac whose companies would only cover generic fluoxetine, who for sure noticed a difference, and others on generic alendronate instead of Fosamax who had way more GI s/e. (Let's ignore for the moment the new evidence that's causing most of us to take patients off Fosamax altogether.)

I think if people start on one brand or one generic (Apo or Novo or Ratio or Cheerio or Whatevero), we should stick with the same one. Then at least we know what dose makes sense. But that's me.

--ncc--

[realitytest]

Wow! Interesting stuff. ncc.

How handy there is a doctor in the house.

Do you mean with the +/- 20% bioequivalence that brand and generic are at least 80% the same (I sure hope so)?

Not NOT please God, only 20% the same?!?

And (wholly OT) you say:

.

(Let's ignore for the moment the new evidence that's causing most of us to take patients off Fosamax altogether).

Hmm. Let's NOT ignore this "new evidence". Please (as somebody who takes it) , WHAT IS IT?

(Gee, and my kind neuro just gave me almost a year's supply of Fosamax-D. Pity.

What are they suggesting instead and why? (Probably we should mosey on over to Menopause Corral with this one, but my curisiosity is getting to me)

BTW there MAY be a difference between two thyroid brands but what about levothyroxine/Synthroid?

The makers of Synthroid were successfully sued a few years back for claiming (rightfully) to be more effective than generic substitutes, and had to pay out a tidy sum (almost all of which went to the class action lawyers, of course). . It wasn't a big deal like Phen-Fen or Vioxx where lives were lost so pts had nothing to collect. Abbott Laboratories lost anyhow.

Why? I figured the Insurance Cos lobby was too strong.

OT again.

I'm waiting for the results of my latest thyroid test, seems it's been a bit low - even with supplementation medication, that is. I am wishing very much to persuade my pdoc to give me T3 for depression since I take thyroid anyway, but he refuses saying it's only for augmentation. I take Lamictal but maybe that doesn't count.

I HAVE read it's pretty complicated to come up with a proper dosing of T3 and T4 to bring your TSH up to speed - or down. Not sure my family doc is up to it. At any rate, he refuses to try either. HE claims there's no need, but I think he just doesn't know how. An endocrinologist I saw throughout my first pregnancy (in Israel) said it was MUCH better to take them separately, and in divided doses too - AM and PM.

(I'm wondering even tho my family doc is billed as an "internist", if he really is that well trained. He's a D.O rather than an M.D.)

Erhum, guess I better cut out all these tangential med questions going OT on OT of my own thread.

***

One of the REAL questions underlying all this, is the economic one - how insurance companies in the US anyhow (and looks like Canada's headed toward privatization too) get away with claiming known inferior treatments - not just meds - are "just as good as" the more expensive ones.

At least, let them be honest about it and say "we offer two tiered medical care! Only if you pay higher premiums, do you get the best treatments"

...Just like "Boutique" practitioners vs the garden variety. (And the boutiquers merely offer what used to be considered standard good practice...that is, a doctor who spends enough time the pt. to understand his/her problem and reach a considered dx!)

Rant rant rant. Wishing I could go back to Israel, suicide bombers and all...Of course, medical care has probably changed there too.

rt

[revlow]

There are generics and then there are generics. In other words they are not all *bad*. It depends on the med, what country you are in, and -- in the case of the FDA in the US -- under what application the generic company filed.

For example, in the States the generic version of Lamictal (lamotrigine) is indentical to the brand. Same drug. Exactly. Both manufactured by GSK in the same plant.

There is a lengthy discussion of this here: Generic Lamictal -- Yes, it IS available! Here are the details.... As chinacat and I say here: http://www.crazyboards.org/forums/index.ph...indpost&p=81803

I'm not sure if this answers the question, but I've found a few more pieces to the puzzle. Maybe someone else will know with certainty how to interpret this...

1) Looked again at Lamotrigine at the Complete Product List at Teva USA:

4) Looked up "n/a (2)" at Teva's TEE Ratings page: http://www.tevausa.com/default.aspx?pageid=30 -- according to this, n/a (2) means Therapeutic equivalent, manufactured and distributed under originator's NDA. (NDA = New Drug Application.)

Hey Guys and girls--in my former life, I was a Clinical atudy Coordinator for companies like GSK, and had to be realy familia with the FDA and their rules--

If they are marketing and distributing this under Lamactal's NDA, IT IS LAMACTAL, END OF DISCUSSION. , or it would have to be tested and receive approval on its own. You cannot manufacture a drug under the NDA unless you are the original manufacturer, and it is theraputically the same drug. And thats the truth, as they say. The FDA is incredibly strict about these little details.

Chinacat Ramone, BSN RN, Clinical Study Coordinator

***********************************************

So, again, it all depends.

revlow

[dan]

I took th generic(s) of celexa. Didn't make me happy, but it at least made me not miserable...

[Guest Guest]

I took th generic(s) of celexa. Didn't make me happy, but it at least made me not miserable...

But Dan, did you ever get to compare it to the brand name version to see if they worked the same?

BTW I spoke to Express Scripts today, and the only generic Lamotrogine they have are chewable 25 mg. pills (CHEWABLE? Now I understand why a while back people were complaining about the taste. Couldn't figure it out for a tab you gulp down with water! ). For somebody on 200mg plus like me (could go to 400-500mg) that's a LOT of pills. Generic or not, the brand works out way cheaper.

Or maybe the generic co also makes larger tabs which Express Scripts doesn't carry. (?)

rt

[revlow]

In the U.S. the only generic for Lamictal (lamotrigine) is the 25 mg chewable dispersible tabs. I've read all the legal stuff; that's all that's available at this time. I can't remember when the other amounts will be released, but I remember it's going to be awhile.

How well it pays off financially depends on your insurance. For example, mine is very good -- it's a ten dollar co-pay no matter how many are in the script. (The last time, my refill was for a total of 660 pills. Yup, you read right.) Other people's insurance co's are not so generous, and in the long run there aren't substantial savings btw the brand and the generic. You can read more in the thread I provided above: http://www.crazyboards.org/forums/index.php?showtopic=6810.

I take 550 mg/day, and yes...there are a lot of pills involved. I take 22 tabs a day, divided into 11 in the morning and 11 at night. (They are dinky lil' things; I take 'em in one swallow.)

The taste is horrible. When I first started taking them, I thought for some reason I was supposed to chew them. They tasted like blackcurrant flavored sewage. Then I realized I didn't need to chew them. I just toss them back and swallow some water. No bad taste.

For me, all this is worth it. Can you imagine how much I'd have to pay to get 550 mg/day of the brand?

And again I emphasize that in the States, the generic is the brand.

[Libby]

Yep, there IS a difference. Brand name Klonopin has a lot more clout than generic, and I've noticed that one generic works better than another generic.