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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 emme on April 27, 2009, at 20:46:16
Hi All,
Looks like Teva's got competition from a brand called Dr. Reddy. My new lamotrigine tablets are round. I didn't think too much of it at first, but I feel crummy since starting the new bottle and I can't help but wonder....
emme
Posted by Phillipa on April 27, 2009, at 23:41:02
In reply to Anyone having trouble with new generic Lamictal?, posted by emme on April 27, 2009, at 20:46:16
Seems like a lot of folks are having generic problems lately. Sounds like the brand you were on before is the one for you. Phillipa
Posted by yxibow on April 28, 2009, at 2:10:54
In reply to Anyone having trouble with new generic Lamictal?, posted by emme on April 27, 2009, at 20:46:16
> Hi All,
>
> Looks like Teva's got competition from a brand called Dr. Reddy. My new lamotrigine tablets are round. I didn't think too much of it at first, but I feel crummy since starting the new bottle and I can't help but wonder....
>
> emmeDr. Reddy's is a large lab in India, they also make local medictions in India I believe.
Teva (Israel) I think had what it frequently markets for, a 180 day exclusive on it, so now its open to about 14 other companies, not to mention several for the chewables, according to the Orange Book.
So far I have gotten the Teva diamond shaped tablets I believe (100mg).
It is possible that there is a slight variation in strength (and I'm sure there will be lots of arguments about generics and the like....) but its also equally possible and I'm not trying to say this in jest, but that there is some suggestibility and placebo effect in knowing something is or could be different.
The phrase causality is not always causation.
On the other hand I do also sometimes believe things like that about generics and sometimes (not always) its possible to request the same generic company from the pharmacy. They may have to special order it and it may take time. Its usually regulated by the pharmacy by market rates though.One thing to do is to get your medication as soon as the insurance allows (which can be as little as 25 days or so depending on how much they can be pushed) and mix and match until you are on the new generic if they can't get the older one.
-- tidings
-- Jay
Posted by emme on April 28, 2009, at 6:22:48
In reply to Re: Anyone having trouble with new generic Lamictal? » emme, posted by yxibow on April 28, 2009, at 2:10:54
Hi Jay,
> its also equally possible and I'm not trying to say this in jest, but that there is some suggestibility and placebo effect in knowing something is or could be different.
Thanks for your comments. I do feel confident that suggestibility is not the case here. I usually don't have problems with generics and, therefore, was not expecting a problem.
> The phrase causality is not always causation.
I'm certainly aware of that. And I can't prove with 100% certainty that the change in generic is the problem. However, when my condition changes, it's logical to consider whether something in my life has changed and consider it a potential cause. I take a very low dose, and I wonder if variability in the amount of active ingredient may have pushed me below a therapeutic dose. One way to find out...
> One thing to do is to get your medication as soon as the insurance allows (which can be as little as 25 days or so depending on how much they can be pushed) and mix and match until you are on the new generic if they can't get the older one.I'm at the beginning of a 3 month supply, but I got lucky. :) The pharmacy has kindly offered to send enough Teva brand to last till my next refill. It should arrive sometime in the next day or two. Then I'm guessing it will take a week to see if it brings me back to normal. If that doesn't do it, then we start tweaking dosages. This downturn is getting pretty miserable.
ciao,
emme
Posted by zana on April 28, 2009, at 9:59:42
In reply to Re: Anyone having trouble with new generic Lamictal? » yxibow, posted by emme on April 28, 2009, at 6:22:48
I hope you get the Teva soon. I got two different generics of Provigil when I was on an insurance plan that would not approve the brand name and they were definitely not Provigil. Someone may correct me but it is my understanding that generics only have to contain 70% of the same ingredients that are contained in the brand name they are copying.
I do, however, believe in the placebo effect but as my dentist used to say when I'd freak out about lumps or bumps in my mouth, "when you hear hoof beats, look for horses not zebras."
Jeez I do go on.
Hope things get back on track soon.
Zana
Posted by yxibow on April 28, 2009, at 18:36:48
In reply to Re: Anyone having trouble with new generic Lamictal?, posted by zana on April 28, 2009, at 9:59:42
> I hope you get the Teva soon. I got two different generics of Provigil when I was on an insurance plan that would not approve the brand name and they were definitely not Provigil. Someone may correct me but it is my understanding that generics only have to contain 70% of the same ingredients that are contained in the brand name they are copying.
Its a bit more complex than that -- the medication has to be proven to be as effective as the original. That is what is referred to in the Orange Book (FDA) generally as "AB" or similar A acronyms.B compounds may differ and are a different classification under the Orange Book. The generics that are out there in large circulation in general never fall into the B category.
There may be different binding ingredients (e.g. stearates, gelatins, colors, etc.) in one generic or the other, or between thet original.
The general gist is that it has to be between 80% and 125% over the AUC (area under the curve) which is a complex mathematical formula representing bioavailability....
...Wikipediia: "Bioavailability is a measurement of the extent of a therapeutically active drug that reaches the blood and is available at the site of action").
But then it gets more complex, bioequivalence, which is defined to be 90% of an even more complex statistician's delight of a "confidence interval" which separates a sample from the population at large. At that point the theoretical science goes over my head.
As noted in the previous article though, many organic situations affect this as well, including food.Thus while it is possible for there to be a lower amount in the plasma, it is entirely possible also for a generic to exceed the original.
-- Jay
Posted by Phillipa on April 28, 2009, at 20:18:16
In reply to Re: Anyone having trouble with new generic Lamictal? » zana, posted by yxibow on April 28, 2009, at 18:36:48
I still like if it ain't broke don't need fixing so try to get the med you did well on. As greenstone was proven by other babblers to be superior to other brands of xanax the real deal per the pharmacist who wondered why I'd spend all that money on brand???? Just an example. Love Phillipa
Posted by bleauberry on April 29, 2009, at 5:39:37
In reply to Anyone having trouble with new generic Lamictal?, posted by emme on April 27, 2009, at 20:46:16
My doctor has had enough disappointments with generics that he won't even prescribe them anymore. The primary complication potentials he has seen involve prozac, celexa, zoloft, xanax, klonopin, lamictal, and neurontin. He insists on brand for those meds.
Basically what happens is a patient who has been stable begins to deteriorate. Everyone is puzzled why this is happening. With some investigation, it turns out the pharmacy substituted generic, without the patient or the doctor knowing about it. When switched back to brand, the patient restabilizes. It has happened hundreds of times, more than enough to not be a fluke or a coincidence.
Posted by SLS on April 29, 2009, at 6:20:13
In reply to Re: Anyone having trouble with new generic Lamictal?, posted by bleauberry on April 29, 2009, at 5:39:37
My doctor has experienced the same thing with quite a few of his patients. He often sees problems with generic versions of lamotrigine (Lamictal) and paroxetine (Paxil, Seroxat).
The active ingredient in a generic drug is the same as in the branded version, but it might not be absorbed as readily. Who knows in what ways the differences in excipients and manufacturing techniques affect the delivery of the drug to the brain. One way or another, it seems to happen often enough that a brand name drug and a generic version of that same drug are not bioequivalent as is observed consistently by practicing clinicians.
- Scott************************************************
> My doctor has had enough disappointments with generics that he won't even prescribe them anymore. The primary complication potentials he has seen involve prozac, celexa, zoloft, xanax, klonopin, lamictal, and neurontin. He insists on brand for those meds.
>
> Basically what happens is a patient who has been stable begins to deteriorate. Everyone is puzzled why this is happening. With some investigation, it turns out the pharmacy substituted generic, without the patient or the doctor knowing about it. When switched back to brand, the patient restabilizes. It has happened hundreds of times, more than enough to not be a fluke or a coincidence.
Posted by Phil on April 29, 2009, at 9:52:38
In reply to Re: Anyone having trouble with new generic Lamictal?, posted by SLS on April 29, 2009, at 6:20:13
My insurance only pays for generics, if available.
Even if the pdoc writes dispense as directed.
So, I have to live with it.
Posted by bleauberry on April 30, 2009, at 17:00:00
In reply to Re: Anyone having trouble with new generic Lamictal?, posted by Phil on April 29, 2009, at 9:52:38
> My insurance only pays for generics, if available.
> Even if the pdoc writes dispense as directed.
> So, I have to live with it.This is not true with most insurance companies. They will pay a portion of the cost of the brand drug. But your copay instead of being for example $4.00 might be $50.00. They will pay some of it, but you end up paying a large chunk.
The cost is worth it. Without the real stuff, there is no way to know what you missed out on. Wasted time, wasted copays, prolonged suffering. A good strategy is to put health priority above money priority, as it should be, pay the price for the real stuff with a little assistance from insurance, and if it works good then try to switch to generic later down the road and see if it holds. It might and it might not. But starting out on generic without ever trying the real stuff doesn't make sense to me.
Posted by Phil on May 1, 2009, at 8:32:01
In reply to Re: Anyone having trouble with new generic Lamictal?, posted by bleauberry on April 30, 2009, at 17:00:00
I work for the state of Texas--they made the deal. When it went thru I raised hell for 3 days.
Trust me, since I've been on meds 25 years, they will not pay for brand or any part thereof, period.
ps I was on Lamictal till the generic came out. I didn't feel a difference.
I guess I'm just Mr. Lucky.
Posted by emme on May 1, 2009, at 16:20:51
In reply to Anyone having trouble with new generic Lamictal?, posted by emme on April 27, 2009, at 20:46:16
The replacement Teva lamotrigine has arrived. I imagine I will know in several days if it will make a difference. Must...have...patience....
Posted by emme on May 8, 2009, at 6:32:48
In reply to Got the Teva - now I see what happens, posted by emme on May 1, 2009, at 16:20:51
After a few days back on the Teva, my mood was improving, the terrible depression easing. It's about a week now and my motivation is coming back. I suspect there's a cause and effect relationship here. It angers me that pharmacies play with people's well being by swapping brands without permission. My advice is that if you get a batch of Dr. Reddy's and find you are not doing well, get on the Teva or the GSK and see how it goes.
Posted by SLS on May 8, 2009, at 7:22:49
In reply to One week later. It's better, posted by emme on May 8, 2009, at 6:32:48
> After a few days back on the Teva, my mood was improving, the terrible depression easing. It's about a week now and my motivation is coming back.
Woohoo!
- Scott
This is the end of the thread.
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