![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by yesac on November 12, 2006, at 20:07:20
I've taken many drugs for depression and A.D.D. Most of them haven't worked at all and/or made me feel worse. Anyways, I'm just wondering if anyone knows about or has any experience with generic drugs versus brand names. I'm particularly interested in stimulants like Ritalin and Adderall. I've only taken generics of those two. I'm kind of desperate, so I am hoping that maybe trying the brand names might work. Thanks.
Posted by madeline on November 12, 2006, at 20:28:31
In reply to Brand Name vs. Generic Drugs, posted by yesac on November 12, 2006, at 20:07:20
I'm sure this question will generate a lot of responses.
In theory there should be no difference in the generic preparation and the name brand of the drug.
In the US, the FDA mandates that generics be equivalent to the name brand in dose, pharmacokinetics etc...
However, for drugs that have a very narrow therapeutic window (coumadin, for example) if a patient is started on name brand, they stay on name brand.
Which, to me, suggests that there could be differences between the two, despite what the FDA mandates.
Generic drugs CAN be formulated differently than name brand with different inert compounds, but the drug is supposed to be the same.
Additionally, a lot of insurance companies will not pay for name brand once the generic is available, with exceptions for the drugs I mentioned above.
As far as going back and trying name brand, well, in my opinion, it won't make much difference in your response, but you never know.
I would talk to your doctor.
Posted by Phillipa on November 12, 2006, at 23:21:05
In reply to Re: Brand Name vs. Generic Drugs, posted by madeline on November 12, 2006, at 20:28:31
I know of two that are different one is synthroid, the other is klonopin. Love Phillipa
Posted by valene on November 13, 2006, at 8:19:38
In reply to Brand Name vs. Generic Drugs, posted by yesac on November 12, 2006, at 20:07:20
The FDA does not advertise it, but they allow a whopping 20% -/+ difference in the bioavailability of the active ingredients of all prescription generic drugs.
> I've taken many drugs for depression and A.D.D. Most of them haven't worked at all and/or made me feel worse. Anyways, I'm just wondering if anyone knows about or has any experience with generic drugs versus brand names. I'm particularly interested in stimulants like Ritalin and Adderall. I've only taken generics of those two. I'm kind of desperate, so I am hoping that maybe trying the brand names might work. Thanks.
Posted by yxibow on November 14, 2006, at 3:56:25
In reply to Re: Brand Name vs. Generic Drugs » madeline, posted by Phillipa on November 12, 2006, at 23:21:05
> I know of two that are different one is synthroid, the other is klonopin. Love Phillipa
You are correct about some levothyroxine (Synthroid) preparations. They are rated BX by the 2006 FDA Orange book and require further evaluation. The notation of these acronyms follows in the boring drivel I included at the bottom.There are a few others including Synthroid I believe (not Klonopin) that have designations of "narrow therapeutic indexes" and the generics cannot either be varied at all from their produced milligrams, from what I gather, which includes warfarin (all generic, it is rat poison in a pill after all but the amount is important I know, my father has to take it and it is a blood monitored medication) and a few others.
The Orange Book, if one is really bored, is athttp://www.fda.gov/cder/orange/obannual.pdf
It is a 6+ MB Acrobat file.
We have beaten this with a dead horse and screaming baby seals. There is no reason to buy "brand name" Klonopin at exorbitant prices since it last expired in 1996, for reasons best known to Roche and the FDA since patents were 17 years and are now 20 years and Klonopin was patented in 1975, although a company can withdraw earlier (rarely do.).All the Klonopin generics are AB and are equivalent.
It is entirely possible that some people sensitive enough to a maximum (remember that is an absolute maximum) 20% difference in the AUC curve may experience a difference. The simplest thing is a dosage change. There is also the power of suggestion, that knowing taking a generic after a brand name drug can invoke a placebo effect, since, in the grand scheme of things, especially psychiatric medications, can have up to a 30% placebo effect, generic or not.
The price of brand Klonopin rises anywhere from 3-5x to 11x in quantity. Do you really want to support a pharmaceutical line (as genius as Leo Sternbach was, a Jewish scientist who worked at what is now Roche in Switzerland which allowed him to escape the Nazis and come to the US to live to a ripe old age and create Valium) that has had no new benzodiazepines come to market other than a patent extender on the last, Xanax XR?
I don't think I've ever been given a brand name benzodiazepine, but they have a few years on me...
I've always gotten random Mylan (they had a scandal of their own a while back about buying up raw materials and cornering the generic market) and Teva and other scored round random colored pills.
And now follows the boring FDA drivel in section 1.8--------------
The Orange Book says regards to generics:"
1.7 Therapeutic Equivalence Evaluations Codes
The coding system for therapeutic equivalence evaluations is constructedto allow users to determine quickly whether the Agency has evaluated aparticular approved product as therapeutically equivalent to otherpharmaceutically equivalent products (first letter) and to provide additionalinformation on the basis of FDA's evaluations (second letter). With few exceptions, the therapeutic equivalence evaluation date is the same as theapproval date.
The two basic categories into which multisource drugs have been placed areindicated by the first letter as follows:
A Drug products that FDA considers to be therapeutically equivalent to other pharmaceutically equivalent products, i.e., drug products for which:
(1)
there are no known or suspected bioequivalence problems. These are designated AA, AN, AO, AP, or AT, depending on the dosage form; or
(2)
actual or potential bioequivalence problems have been resolved withadequate in vivo and/or in vitro evidence supportingbioequivalence. These are designated AB.
B Drug products that FDA at this time, considers not to be
therapeutically equivalent to other pharmaceutically equivalent products,
i.e.,
drug products for which actual or potential bioequivalence problems
have not been resolved by adequate evidence of bioequivalence. Often
the problem is with specific dosage forms rather than with the active
ingredients. These are designated BC, BD, BE, BN, BP, BR, BS, BT, BX,
or B*."
------------------------
-- Jay
Posted by valene on November 14, 2006, at 9:30:43
In reply to Re: Brand Name vs. Generic Drugs » Phillipa, posted by yxibow on November 14, 2006, at 3:56:25
So Jay, you are saying that all benzodiazepines generic and name brand are equivalent in bioavailability? So I guess I will ask the pharmacy to order me a generic xanax instead of the name brand and save myself $35.00 then! Can't there be a difference in individual metabolism of the drug due to your own metabolic system? I *do* notice a difference in name brand xanax it seems to work quite well but the generic seems to last longer between doses or am I imagining it? Also the name brand stuff breaks apart differently; when you break a xanax it snaps in half; when you break a generic alpraz. it is soft and sort of crumbly (Sandoz brand).
Thanks,
Val
Posted by yxibow on November 14, 2006, at 14:03:58
In reply to Re: Brand Name vs. Generic Drugs » yxibow, posted by valene on November 14, 2006, at 9:30:43
> So Jay, you are saying that all benzodiazepines generic and name brand are equivalent in bioavailability?
I'm not promising that they're all the same in bioavailability, but any given lot will be the same in bioavailability and if one is taking an amount enough to notice any significant difference, a fractional dosage adjustment is possible to be made.
So I guess I will ask the pharmacy to order me a generic xanax instead of the name brand and save myself $35.00 then!
I'm not saying you have to drop it -- if you swear by it, save yourself $35, if you feel its necessary than don't.
Can't there be a difference in individual metabolism of the drug due to your own metabolic system?
There is always a difference individual metabolism of any item put into any person's system. These are all averages taken from studies regardless of generic or non. In general once its in your bloodstream, the active ingredient will break down at the same rate.
I *do* notice a difference in name brand xanax it seems to work quite well but the generic seems to last longer between doses or am I imagining it?That could be due to the inactive ingredients and the binding which are frequently more important in any assessment of strength than the actual ingredients, in general between generic and non. However, that sounds like more the power of persuasion but I'm not you, so I can't say for you.
Also the name brand stuff breaks apart differently; when you break a xanax it snaps in half; when you break a generic alpraz. it is soft and sort of crumbly (Sandoz brand).
That I would agree with some generics -- the binding is a bit cheaper. However with some deft work it will snap if done right. I think that depends on the generic. Generally the completely flat ones that rub off with dye I've noticed will break more poorly than the slightly convex made tablets. An investment in a sharp pill splitter usually solves that issue.
All I'm arguing on the subject is that if Generic X vs. Real Drug Y. costs someone a significant amount more on their own plan (but especially if its out of pocket), and we don't have price capping structures in this country like some Commonwealth countries, then its better to go with a generic. In fact its better to start with a generic from the same brand, and insist to continue with the same generic from the same brand unless it falls off the market, if it seems to make a difference.-- Jay
Posted by valene on November 14, 2006, at 18:39:19
In reply to Re: Brand Name vs. Generic Drugs » valene, posted by yxibow on November 14, 2006, at 14:03:58
While searching the web today, I found this weblog from WebMD where a doctor states that generic benzodiazepines and other drugs can be as much as 20% different:
http://blogs.webmd.com/anxiety-and-stress-management/2006/02/differences-in-medications.html
All I know is that after being on generic xanax for so long and then switching, I did notice a marked difference in how I felt. It was almost like having to adjust to a whole new medication. My heart pounded faster at first (never expected that), and the brand name seems to not last as
long. Oh well. I just wish I could be off it entirely but that's another story!
Posted by Phillipa on November 14, 2006, at 18:48:47
In reply to Re: Brand Name vs. Generic Drugs » Phillipa, posted by yxibow on November 14, 2006, at 3:56:25
Jay you don't have to convince me about the klonopin . I don't use it. I'll e-mail you. Love Phillipa
Posted by yxibow on November 15, 2006, at 1:43:14
In reply to Re: Brand Name vs. Generic Drugs, posted by valene on November 14, 2006, at 18:39:19
> While searching the web today, I found this weblog from WebMD where a doctor states that generic benzodiazepines and other drugs can be as much as 20% different:
>
> http://blogs.webmd.com/anxiety-and-stress-management/2006/02/differences-in-medications.html
>
> All I know is that after being on generic xanax for so long and then switching, I did notice a marked difference in how I felt. It was almost like having to adjust to a whole new medication. My heart pounded faster at first (never expected that), and the brand name seems to not last as
> long. Oh well. I just wish I could be off it entirely but that's another story!
This is also a possible scenario -- there's no guarantee that from individual batch to batch of a "brand name" that they also have to be 100% the same -- they ought to be for the money but I believe bioavailability also comes in for original medications, quality control, etc. I don't know the exact FDA regulations for patented medications.And you could have also had what is known as a paradoxical (opposite to expected) reaction to a benzodiazepine in the first place. Heart pounding and non anxiolytic response is not unheard of.
Its about bioavailability -- it won't always be 20% different as an absolute, these things are logarithmic from 80 to 125% under the AUC curve. They could be even more potent than less potent too.The key still is in the binding -- some generics may truly release it at a different rate, I'm not arguing that.
What I'm saying is that if your insurance company is making you pay lots of money for a non generic benzodiazepine or you have to pay out of pocket for it, one might as well start off (when one starts taking it for the first time) with a generic benzodiazepine. Then regardless whether there is a 20% difference between it and a drug, that by the way was mostly invented at least 20-30 years ago, in this class, one will already be used to the generic. And if the pharmacy switches generics, then insist on the other generic or use a different pharmacy if one is really worried about it. I can understand the concern, but the price differences are highway robbery for benzodiazepines (and similarly high produced drugs).
-- Jay
Posted by valene on November 15, 2006, at 9:20:56
In reply to Re: Brand Name vs. Generic Drugs » valene, posted by yxibow on November 15, 2006, at 1:43:14
Thank you, Jay. Are you a psychopharmacology student? You are so well informed about meds.
All I know is I have been on xanax for over 20 years and I used to be able to take 2mg. of the brand Upjohn at bedtime only. Now it does not even last all night. I am feeling hopeless about the awful anxiety and head pressure/heart pounding which seems just like withdrawal. I am planning on asking my pdoc next week for either something to add on to *generic* xanax. She knows I have wanted off this drug. Instead I find myself going up to 2mg. due to the short half-life of the drug. I sure hope this is not tolerance w/d. I have heard people have success using a combo of neurontin/trileptal in discontinuing or reducing xanax. I dread going to bed and keep .125mg. xanax beside me so that when I wake up at 5am or so I can take it.
My pdoc is a Harvard grad and in 2 years got promoted to the director of outpatient psychiatry but when I called her yesterday she said "What do you want me to tell you to do?" What a bizarre question. If I knew I wouldn't be calling her!
Val
> > While searching the web today, I found this weblog from WebMD where a doctor states that generic benzodiazepines and other drugs can be as much as 20% different:
> >
> > http://blogs.webmd.com/anxiety-and-stress-management/2006/02/differences-in-medications.html
> >
> > All I know is that after being on generic xanax for so long and then switching, I did notice a marked difference in how I felt. It was almost like having to adjust to a whole new medication. My heart pounded faster at first (never expected that), and the brand name seems to not last as
> > long. Oh well. I just wish I could be off it entirely but that's another story!
>
>
> This is also a possible scenario -- there's no guarantee that from individual batch to batch of a "brand name" that they also have to be 100% the same -- they ought to be for the money but I believe bioavailability also comes in for original medications, quality control, etc. I don't know the exact FDA regulations for patented medications.
>
> And you could have also had what is known as a paradoxical (opposite to expected) reaction to a benzodiazepine in the first place. Heart pounding and non anxiolytic response is not unheard of.
>
>
> Its about bioavailability -- it won't always be 20% different as an absolute, these things are logarithmic from 80 to 125% under the AUC curve. They could be even more potent than less potent too.
>
> The key still is in the binding -- some generics may truly release it at a different rate, I'm not arguing that.
>
> What I'm saying is that if your insurance company is making you pay lots of money for a non generic benzodiazepine or you have to pay out of pocket for it, one might as well start off (when one starts taking it for the first time) with a generic benzodiazepine. Then regardless whether there is a 20% difference between it and a drug, that by the way was mostly invented at least 20-30 years ago, in this class, one will already be used to the generic. And if the pharmacy switches generics, then insist on the other generic or use a different pharmacy if one is really worried about it. I can understand the concern, but the price differences are highway robbery for benzodiazepines (and similarly high produced drugs).
>
> -- Jay
>
>
>
Posted by Phillipa on November 15, 2006, at 19:02:09
In reply to Re: Brand Name vs. Generic Drugs, posted by valene on November 15, 2006, at 9:20:56
Valene she did what!!!!Love Phillipa
Posted by suneesabrina on November 16, 2006, at 15:17:52
In reply to Re: Brand Name vs. Generic Drugs » valene, posted by yxibow on November 14, 2006, at 14:03:58
> > So Jay, you are saying that all benzodiazepines generic and name brand are equivalent in bioavailability?
>
> I'm not promising that they're all the same in bioavailability, but any given lot will be the same in bioavailability and if one is taking an amount enough to notice any significant difference, a fractional dosage adjustment is possible to be made.
>
> So I guess I will ask the pharmacy to order me a generic xanax instead of the name brand and save myself $35.00 then!
>
> I'm not saying you have to drop it -- if you swear by it, save yourself $35, if you feel its necessary than don't.
>
> Can't there be a difference in individual metabolism of the drug due to your own metabolic system?
>
> There is always a difference individual metabolism of any item put into any person's system. These are all averages taken from studies regardless of generic or non. In general once its in your bloodstream, the active ingredient will break down at the same rate.
>
>
> I *do* notice a difference in name brand xanax it seems to work quite well but the generic seems to last longer between doses or am I imagining it?
>
> That could be due to the inactive ingredients and the binding which are frequently more important in any assessment of strength than the actual ingredients, in general between generic and non. However, that sounds like more the power of persuasion but I'm not you, so I can't say for you.
>
> Also the name brand stuff breaks apart differently; when you break a xanax it snaps in half; when you break a generic alpraz. it is soft and sort of crumbly (Sandoz brand).
>
> That I would agree with some generics -- the binding is a bit cheaper. However with some deft work it will snap if done right. I think that depends on the generic. Generally the completely flat ones that rub off with dye I've noticed will break more poorly than the slightly convex made tablets. An investment in a sharp pill splitter usually solves that issue.
>
>
> All I'm arguing on the subject is that if Generic X vs. Real Drug Y. costs someone a significant amount more on their own plan (but especially if its out of pocket), and we don't have price capping structures in this country like some Commonwealth countries, then its better to go with a generic. In fact its better to start with a generic from the same brand, and insist to continue with the same generic from the same brand unless it falls off the market, if it seems to make a difference.
>
> -- Jay
Dude - You're smart!! : )
Posted by valene on November 16, 2006, at 16:29:11
In reply to Re: Brand Name vs. Generic Drugs, posted by suneesabrina on November 16, 2006, at 15:17:52
> Dude - You're smart!! : )No argument here!
Val
Posted by yxibow on November 17, 2006, at 3:23:53
In reply to Re: Brand Name vs. Generic Drugs, posted by valene on November 15, 2006, at 9:20:56
> Thank you, Jay. Are you a psychopharmacology student? You are so well informed about meds.
I'd like to consider myself one :) I've thought of going into medicine but the years of studying.... No... though.. I just have been through a lot of them and different disorders and I tend to research the prescribing information a bit too much <g> ? :)
I don't profess to be the be all to end all. In the end, we all have "case studies" on here. What I mean by that, is that everyone is different and their reactions to medications are different, and a bizarre enough reaction sometimes gets written up in journals as a "case study", involving a doctor referring to one or a couple of patients but not a full double blind study.
Enough of them, and I begin to glean some certain generalizations, like a certain number, but not everyone seems to be more depressed if they have an anxiety disorder and are taking Klonopin, etc.
> All I know is I have been on xanax for over 20 years and I used to be able to take 2mg. of the brand Upjohn at bedtime only. Now it does not even last all night.It is conceivable that you are developing tolerance, although the 20 year length does seem to outweigh that argument... I can't say...
I am feeling hopeless about the awful anxiety and head pressure/heart pounding which seems just like withdrawal.Its possible it is interdosal withdrawal -- that is you're running out too quickly for some reason, perhaps breakthrough anxiety, and thus your heart rate increases because the Xanax wears off between doses.
I am planning on asking my pdoc next week for either something to add on to *generic* xanax. She knows I have wanted off this drug. Instead I find myself going up to 2mg. due to the short half-life of the drug.
That is one of the pitfalls of Xanax, it can be necessary to take it up to 4+ times a day.
I sure hope this is not tolerance w/d. I have heard people have success using a combo of neurontin/trileptal in discontinuing or reducing xanax.
In the short run, Neurontin may provide a sedative effect that would help you (as I recall when I first started) -- in the long run, I still take it but I think it only augments the benzodiazepine I take. But as they say, your miles may vary.
I dread going to bed and keep .125mg. xanax beside me so that when I wake up at 5am or so I can take it.
>
> My pdoc is a Harvard grad and in 2 years got promoted to the director of outpatient psychiatry but when I called her yesterday she said "What do you want me to tell you to do?" What a bizarre question. If I knew I wouldn't be calling her!I guess I could say "??" I can't comment there, only you know what the two of you discuss.
-- best wishesJay
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.