Generic drugs

[jennisk]

Has anyone had any experience with being switched to a generic version of a medication? Did you notice any changes in the way it acted on you, or any different side effects?
I am asking because I read an article in a magazine (not a medical journal so I'm aware not to take the info as definitive) about gereric drugs. Those at issue were anti-seizure medications, with potency being a problem. I take an anti-seizure medication as a mood stabilzer. It was switched to a different brand of generic recently. I asked the pharmacist if there could be any issues. She did not think so. I would personally think it would be more serious if you were taking it to prevent seizures. Just wondering.

[uni]

Hi Jennisk. I believe there is something to that in certain cases.

My own experience was with the mood stabilizer lamotrigine, also used as anti-seizure medication. It's sold under the brand name Lamictal. I never took Lamictal but for several years I was on the generic one manufactured by a company called Apotex. Then a year or two ago suddenly the pharmacy started giving me a different generic from a company called Mylan. I didn't worry about it, but remember remarking to the pharmacist that the new pills were a lot bigger. After a number of weeks I felt like my mood started going downhill for no external reason that I could think of, so I started wondering about the pills.

I phoned the pharmacy and asked them if it was possible that the 2nd generic wasn't doing the same job for me as the original one. They said it was not common but they'd seen it happen with other sorts of meds with certain people. The national pharmacy chain had switched suppliers for some reason, but the branch I get meds from offered to order in the original kind especially for me (a pleasant surprise) and continue to do so.

Sometime in all this I got on the web (sorry, I forget which sites) and found that other people had run into the exact same problem with the exact same manufacturers of lamotrigine (and some of these people had serious seizure issues). I also found that anti-seizure meds are particularly suceptible to brand switches. It isn't necessarily a switch from Lamictal to generic; it can also happen by switching between two different generics (like in my case). Apparently the issue is not with the drug itself, because that's supposedly regulated, but with the various fillers that are used to make up the pills, which supposedly aren't regulated. Sheesh. I still don't see why it should matter, but I guess it can.

The pharmacy had said nothing about the change until I remarked on the difference in size. They are usually very good about such things, but the old warning of "buyer beware" is still a good one.

I suspect that most people won't run into this, but obviously some do. I'm glad you asked about it. It's something I never thought about until it happened to me. I hope this helps.

P.S. - Since my pdoc hadn't specified which generic on the prescription, just "lamotrigine", the pharmacy used whatever it had. It's best to have the pdoc prescription specify which brand.

[paul m]

Hello Jennisk. Uni's answer is pretty much what I would have said. Generic's have to have the same medical ingrediants and act the same way as brand name meds, but the don't have to be identical in composition. This can lead to some variance from person to person. For example, if the average time of metabolism is 24 hrs for brand abc, the average time for the generic version of abc must also be 24 hrs. The key wording here is average.

People's metabolisms vary, generic's aren't tested very much prior to release and a host of other things can all contribute to a generic not working as well for one person, or conversly working better for another person.

Some group insurance plans (mine) insist on generics unless they recieve letter from my doctor. Others, as Uni has said, will accept the doctors word if he writes no subs on the prescription.

In regards to your pharmacists, they sometimes make more off of generics than they do off of brand name meds. While I trust my own pharmacist, I can only point out that in the last few years Apotex(Cda's largest generic company) voluntarily withdrew at least 4 different generic drugs after an inspection by Health Cda. Exact reasons were not disclosed, but the news release stated that the Health Cda was working with Apotex on Good Mfging Practises. (Source at the end) Take Care. paul m

P.S. the website that I gave has a link to report any adverse reactions that people might have due to prescription medication(near the bottom) they won't have that there, if there wasn't a need.

http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2009/2009_155-eng.php

[astronaut]

I have taken a generic brand of lamictal also. I can't remember which one it was though. I didn't notice any difference but the pills were bigger...

astronaut

[uni]

Great link Paul. I forgot about that Apotex stuff. Also the Mylan people have an advisory. What's a person to do if you need the meds . Sigh.

There are other warnings regarding antipsychotics and anti-seizure meds but I can't figure out how to post the links to those pages. You get there by clicking on warnings and advisories from the linked page you posted.

There are also warnings/advisories on things like acetamenophin and erectile dysfunction aids (FYI to any males here ... just bugging you guys!)

[AJ]

There are some drugs that I wouldn't mess with changing brands, unless closely monitored. People can be very sensitive to a brand change for thyroid medication. It's usually best to stick to the same brand, rather than change and do extra blood tests. I wouldn't recommend switching brands of the blood thinner warfarin without extra blood tests. Anti seizure medication is another tricky one. Carbamazipine levels between brands can vary enough to make a difference, especially for those with epilepsy.

In general brand changes don't make a significant difference in most cases. I would not care what brand of amoxicillin (antibiotic) I got. Having said that, if you're one of those people that notice a difference in tolerance or response to a brand change, ask the pharmacy to order the brand you do better on. Sometimes they will

[paul m]

Hello Uni. At the end of this I will try and put in a link where anyone can type in a product name (or company name) and see if it has been recalled at any time. However before I do that I have copied a couple of sections in regards to lithium. Lithium is an old medication and you think that companies would have figured all the kinks out by now. Here are two advisories regarding it.

" a recall of Apo-Lithium Carbonate SR 300 mg strength tablets was initiated on 20 October 2009 due to stability issues which may have had an impact on the quality of the product"

" Health Canada endorsed important safety information on Carbolith 150 mg capsule from Valeant Canada. Drug stability failure of a few lots of Carbolith 150 mg capsules"

Least anyone think that I am picking on pysch drugs, my arthritis med has 42 advisories, warnings or alerts.

AJ's advice is great as well, pharmacists often have several brands to chose from. Take Care. paul m

http://recherche-search.gc.ca/s_r?t3....s3rv5c3=basic Just click on this link and enter the med name in the search area. Or you can go to this next web page and do it by subject.

http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/alpha-eng.php

[jennisk]

Thank you guys! I will be monitoring my mood closely for the next few days. How long did it take when you noticed a change Uni?

[uni]

Once again, great input from you Paul!

Jennisk, it probably took me maybe two or three weeks to notice the change; it was gradual but enough to get my attention. At first I thought I might be slipping into depression (a reasonable assumption) but once I got back on the original pills I felt ok again. It's so hard to know why our moods fluctuate sometimes, but I won't be taking any chances on this again. Hopefully you will not be affected; most people probably aren't.

I admit to feeling a little foolish when asking the pharmacist about it, like I was being ridiculously picky or paranoid, but they were so good about it that in retrospect I wonder if I wasn't the only one....

[AJ]

You're not the only one Uni.

[uni]

Thanks AJ. That's always good to hear.

[AnneT]

Yes, I've had issues with generic psych meds - "same" dose Effexor caused withdrawal symptoms.