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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by ricker on May 27, 2009, at 18:57:48
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
Hi Scott,
I will be anxiously awaiting the generic name your pharmacist had bottles of!! I'm currently taking Apo-Lamotrogine.... hope that wasn't in his (no-good) bag??
I also hope you begin to see a rapid improvement in your mood!Take care, Rick
Posted by Phillipa on May 27, 2009, at 19:23:38
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
Scott oh wow this could put a new slant on the generic issue as far as I'm concerned could be why valium no longer works as generic? Phillipa also will be awaiting. And hope to see you quickly improve.
Posted by SLS on May 27, 2009, at 19:55:03
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by ricker on May 27, 2009, at 18:57:48
Hi Rick.
> I will be anxiously awaiting the generic name your pharmacist had bottles of!! I'm currently taking Apo-Lamotrogine.... hope that wasn't in his (no-good) bag??
No need to worry. It wasn't Apo-.
:-)
> I also hope you begin to see a rapid improvement in your mood!
Thanks. I "popped" an extra dose of brand name Lamictal earlier today. I am feeling better already. Of course, this could be a coincidence, as my mood has been quite labile throughout the day over these past few weeks.
What good is having the exact same drug combined with different excipients if you don't digest and absorb it the same way?
- Scott
Posted by ricker on May 27, 2009, at 23:44:23
In reply to Re: Generic Lamictal - lamotrigine » ricker, posted by SLS on May 27, 2009, at 19:55:03
> What good is having the exact same drug combined with different excipients if you don't digest and absorb it the same way?
Very good question!? I don't understand why the FDA does not regulate generic meds so they're 100% exact... meaning generic excipients "must" be that of brand? Is it production costs, patent infringement or other?
I would think there's enough data out there to indicate therapeutic decline, at least for psychiatric generic meds.
Maybe somebody can chime in on this for me.Rick
Posted by yxibow on May 28, 2009, at 2:34:28
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
> I was dispensed a generic version of Lamictal for the first time this past month. My doctor thinks it is possible that this change is what has allowed for my recent deterioration. I had my pharmacy special order another brand of generic. I don't want to mention any names just yet. I have some old Lamictal laying around that I will take for the next week to see if it makes a difference. My doctor showed me the pill bottles that people brought in to him that had been filled with a generic. All of these people had relapsed on this one particular brand.
I just can't see this, but I suppose if the Lamictal is working especially well and there is low tolerance for any mg change, then maybe something could happen.Oh, there's no reason to be secretive, its in the Orange Book. I think there's a handful of generic companies for lamotrigine.
There is also, as you know, a placebo factor.
Also psychological reasons may place a "decline", and although admittedly the rule is the last medication change, there are other things involved in conditions.
Causality is not always causation, though there can be suspicions.
> I now have to reevaluate my recent negative experiences while taking Namenda (memantine). I tried it while taking the generic lamotrigine. It might make sense to restart it, especially if I feel better after switching brands of lamotrigine.
I know your medication combination is probably as complicated as mine -- but I have seen no difference with generic Lamictal (Teva). Of course, whether it is doing anything important at one point or another is another story.Fewer medications are always better than more, but that's just a side comment.
Namenda was horrible for me at 20mg, unfortunately, but I hope you have luck with it.
-- tidings
Jay
Posted by SLS on May 28, 2009, at 5:28:33
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by yxibow on May 28, 2009, at 2:34:28
> > I was dispensed a generic version of Lamictal for the first time this past month. My doctor thinks it is possible that this change is what has allowed for my recent deterioration. I had my pharmacy special order another brand of generic. I don't want to mention any names just yet. I have some old Lamictal laying around that I will take for the next week to see if it makes a difference. My doctor showed me the pill bottles that people brought in to him that had been filled with a generic. All of these people had relapsed on this one particular brand.
> I just can't see this, but I suppose if the Lamictal is working especially well and there is low tolerance for any mg change, then maybe something could happen.It is ironic that a friend of mine was recently changed from the brand name Lamictal to the same generic that I was dispensed. She had been doing very well on it. She was then changed to a third preparation of lamotrigine with disasterous effects. She all but relapsed completely into depression. She couldn't wait to be switched back to the first generic she was on. She is recovering very nicely.
> Oh, there's no reason to be secretive, its in the Orange Book. I think there's a handful of generic companies for lamotrigine.
Yes, but the CVS wholesaler would only supply the pharmacy with one brand of generic lamotrigine. I had to have them call as a special order for another manufacture's preparation. So, I know of at least three generic versions of lamotrigine.
> There is also, as you know, a placebo factor.
Actually, I sort of fell for the lie that depression tells. I attributed my feeling worse to a situational issue that I don't usually react to so negatively. I did not expect to feel worse. I really didn't expect anything at all. Because I experienced an increase in vegetative symptoms, I have become quite sure that it was a worsening of my bipolar depression. The situation didn't help, though.
> Also psychological reasons may place a "decline", and although admittedly the rule is the last medication change, there are other things involved in conditions.The only variable I can think of is my exposure to memantine (Namenda). I suppose it could have destabilized me so as to leave me more depressed as late as one week after discontinuing the drug.
> Causality is not always causation, though there can be suspicions.
I agree.
> > I now have to reevaluate my recent negative experiences while taking Namenda (memantine). I tried it while taking the generic lamotrigine. It might make sense to restart it, especially if I feel better after switching brands of lamotrigine.
> I know your medication combination is probably as complicated as mine -- but I have seen no difference with generic Lamictal (Teva). Of course, whether it is doing anything important at one point or another is another story.If it is not helping at all, then it would not really matter whether or not the Teva brand were inferior to the GSK brand. You would feel no worse for switching to placebo.
> Fewer medications are always better than more, but that's just a side comment.
Mine is that one should enter treatment with the goal of taking as few medications at the lowest effective dosages as is possible.
At the moment, I have tested all of the four drugs I am taking by attempting to reduce the dosage and/or discontinuing it. After I relapsed, I titrated the dosages again in order to establish the minimum dosage that produces maximal effect. It turned out that each drug contributes to the improvement I glean from the treatment regime.
Currently:
Parnate 80mg
nortriptyline 150mg
lamotrigine 200mg
Abilify 20mgCompared to some people here, this is relatively few drugs to treat a depression so severe and recalcitrant.
> Namenda was horrible for me at 20mg,Gosh. That doesn't so sound good.
In what ways did Namenda affect you?
Thanks, Jay.
- Scott
Posted by yxibow on May 28, 2009, at 6:22:31
In reply to Re: Generic Lamictal - lamotrigine » yxibow, posted by SLS on May 28, 2009, at 5:28:33
> > I know your medication combination is probably as complicated as mine -- but I have seen no difference with generic Lamictal (Teva). Of course, whether it is doing anything important at one point or another is another story.
>
> If it is not helping at all, then it would not really matter whether or not the Teva brand were inferior to the GSK brand. You would feel no worse for switching to placebo.Oh it's unclear whether it adds something to the mix -- I think my doctor feels that Lamictal alone is an a antidepressant and that it may add some suppression of suicidal thoughts.
> Mine is that one should enter treatment with the goal of taking as few medications at the lowest effective dosages as is possible.Agreed...
> At the moment, I have tested all of the four drugs I am taking by attempting to reduce the dosage and/or discontinuing it. After I relapsed, I titrated the dosages again in order to establish the minimum dosage that produces maximal effect. It turned out that each drug contributes to the improvement I glean from the treatment regime.
>
> Currently:
>
> Parnate 80mg
> nortriptyline 150mg
> lamotrigine 200mg
> Abilify 20mg
>
> Compared to some people here, this is relatively few drugs to treat a depression so severe and recalcitrant.
Yep, considering I'm on 6 medications, although one is not psychiatric, Skelaxin (not really sure if it is doing anything but after being on Robaxin for some time, it seemed to produce an odd heat sensation with serotonergic agents that was uncomfortable).
Of course, the only thing that really melts all my dystonic syndromes is Soma (Robaxin is the poor cousin and probably did a little bit), but I cant get that prescribed... (too many CNS depressants)
> > Namenda was horrible for me at 20mg,
>
> Gosh. That doesn't so sound good.
>
> In what ways did Namenda affect you?
Oh well we tried it for memory loss from the catch-22 of medications I'm on, mostly the Valium -- by the time it reached 20mg, things were just "WRONG" -- its hard to explain, my visual perception of people walking (ugh and cars), is skewed for some reason to be confusing or in the case of cars, faster than normal.
And well -- people were ... oh it was just not good. Dropped the memantine and things went back to their ... well... bett-er state.Deplin did something else weird I can't recall at the moment.... not completely innocuous stuff.
But then I have odd reactions to medications sometimes -- sensitive to a select some, metabolize others for dinner... perhaps my weight, who knows there.
-- Jay
Posted by SLS on May 28, 2009, at 8:03:52
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by yxibow on May 28, 2009, at 6:22:31
Hi Jay.
I don't doubt that Lamictal can produce enough of an antidepressant effect to quiet suicidal thinking. It does for me. I don't think it hurts to have it remain in place. The only thing I can think of as a negative consequence of taking Lamictal in combination with other drugs is a theoretical possibility that it might antagonize the therapeutic effects of Provigil or vice versa.
You are an enigma, my friend. I have great respect for you and the manner in which you deal with the struggles your conditions pose.
- Scott
Posted by raisinb on May 28, 2009, at 10:48:59
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
Oh, boy. This resonated with me as I just started generic Lamotrigine (Teva) about 6 weeks ago. So far I'm up to 100 mg a day and am not feeling a huge difference, but I am doing fine.
Keep us posted on how these different generics work for you.
Posted by bulldog2 on May 28, 2009, at 11:45:12
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
> I was dispensed a generic version of Lamictal for the first time this past month. My doctor thinks it is possible that this change is what has allowed for my recent deterioration. I had my pharmacy special order another brand of generic. I don't want to mention any names just yet. I have some old Lamictal laying around that I will take for the next week to see if it makes a difference. My doctor showed me the pill bottles that people brought in to him that had been filled with a generic. All of these people had relapsed on this one particular brand.
>
> I now have to reevaluate my recent negative experiences while taking Namenda (memantine). I tried it while taking the generic lamotrigine. It might make sense to restart it, especially if I feel better after switching brands of lamotrigine.
>
>
> - ScottI have found teva makes a good generic.
Posted by SLS on May 28, 2009, at 12:12:07
In reply to Re: Generic Lamictal - lamotrigine, posted by bulldog2 on May 28, 2009, at 11:45:12
> I have found teva makes a good generic.
I'm hoping that Mylan does too. Mylan is the drug company that is to supply me with lamotrigine. I should be able to pick it up later today. If not, I still have enough Lamictal to get by for a few days.
It may be that each drug that comes from a generic drug company must be judged separately. For instance, Teva might make a great generic fluoextine, but a poor generic lamotrigine.
In any event, it seems that there are sometimes differences in clinical outcome when one is switched from a name brand to a generic.
The thing I wonder is if a generic drug proves insufficient to maintain an improvement, perhaps a dosage adjustment is all that is needed.
- Scott
Posted by fayeroe on May 28, 2009, at 14:56:33
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
> I was dispensed a generic version of Lamictal for the first time this past month. My doctor thinks it is possible that this change is what has allowed for my recent deterioration. I had my pharmacy special order another brand of generic. I don't want to mention any names just yet. I have some old Lamictal laying around that I will take for the next week to see if it makes a difference. My doctor showed me the pill bottles that people brought in to him that had been filled with a generic. All of these people had relapsed on this one particular brand.
>
> I now have to reevaluate my recent negative experiences while taking Namenda (memantine). I tried it while taking the generic lamotrigine. It might make sense to restart it, especially if I feel better after switching brands of lamotrigine.
>
>
> - ScottScott, I am on a generic and I can't tell a difference. I'll look on my bottle tonight and post the name tomorrow if that is okay..Pat
Posted by SLS on May 28, 2009, at 23:06:57
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by fayeroe on May 28, 2009, at 14:56:33
> Scott, I am on a generic and I can't tell a difference. I'll look on my bottle tonight and post the name tomorrow if that is okay..Pat
That would be great.
Thanks, Pat.
- Scott
Posted by SLS on May 29, 2009, at 15:49:49
In reply to Re: Generic Lamictal - lamotrigine, posted by SLS on May 28, 2009, at 12:12:07
Okay. I guess I can now state with confidence that it was my switch to a generic that allowed me to relapse. I have been taking the brand name Lamictal for a few days and feel significantly better. I just hope the Mylan generic is just as good.
The drug company that manufactured the generic lamotrigine that I failed to respond to adequately was Teva.
I know people who do well on it, but...
I still wonder if the majority of problems with generics is related to absorption and bioavailability. There might even be chemical interactions between the excipients and the drug for all I know. Would making a simple dosage adjustment remedy most problems with generics?
- Scott
Posted by fayeroe on May 29, 2009, at 16:32:12
In reply to Re: Generic Lamictal - lamotrigine, posted by SLS on May 29, 2009, at 15:49:49
I am doing very well on the lamotrigine. I had Lamictal the first go around and then he asked me if I minded the switch..Lamictal and the generic has changed my life for the better.
Posted by ricker on May 29, 2009, at 16:32:58
In reply to Re: Generic Lamictal - lamotrigine, posted by SLS on May 29, 2009, at 15:49:49
> Would making a simple dosage adjustment remedy most problems with generics?
Hi Scott, glad to hear you're responding to the change in brands.
I don't know if dosing according to brands would help or hinder. I guess if one doesn't do well at dose-a, perhaps dose-b would help. On the other hand, if response is negative as was your case, perhaps an increase would have intensified the decline?
Such a hit & miss with these meds, isn't it? :-(Rick
Posted by SLS on May 29, 2009, at 17:02:54
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by fayeroe on May 29, 2009, at 16:32:12
> I am doing very well on the lamotrigine. I had Lamictal the first go around and then he asked me if I minded the switch..Lamictal and the generic has changed my life for the better.
Weird, isn't it?
What dosage are you taking, if I may ask?
- Scott
Posted by SLS on May 29, 2009, at 17:08:03
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by ricker on May 29, 2009, at 16:32:58
> Such a hit & miss with these meds, isn't it? :-(
It's perplexing. You would think there would be more interindividual similarities rather than differences.
Diversity - it makes the world go around.
- Scott
Posted by bleauberry on May 30, 2009, at 14:54:53
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
What happens if someone has the wrong supposedly neutral filler put in their compounded Low Dose Naltrexone capsules? Instead of the LDN having about a 4 hour effect which is what makes it work, it has a delayed somewhat time-release effect instead, and the whole idea doesn't work that way. What if they use a different filler that the person is unknowingly allergic to? They will not feel the benefits because some weird minor negatives will drown them out. The neutral filler has to be very specific in the way the active ingredient works.
Just one example. I would venture a guess that the supposedly neutral fillers of meds do make a difference in ways we have no clue about. As SLS said in another post on this very topic, "Different is different".
The active ingredient of Lamictal combined with filler A is not the same drug as the active ingredient of Lamictal combined with filler B. Similar, but different. Similar enough for some people to not notice any problem, but different enough for others to experience a problem.
And of the course the topic of potency acceptability by the FDA. They do not require the exact dose of brand is in each generic pill. There is variation allowance. If one pill is 8% too low in potency, and the next is 8% too high, guess what, that is a 16% difference. Cut your dose, or increase your dose, by 16% and see if you don't feel something different.
I don't know much about chemistry, so I cannot back up what I am about to say. But I can't help but wonder, does the process of actually cooking up the active ingredient somehow make it a little different than a different approach to cooking it up, even though the final molecule is supposedly the same? I'm sure most people would say, "no, salt is salt, it's still sodium chloride." Yeah, but depending on how it is made, the molecules under a microscope look different.
Different is different. That's all there is to it. Simple as that.
My doctor is prepping to write a book on this topic. He has seen it enough to inspire him to research it and try to offer explanations as to why meds with the same active ingredient can show the potential to be different meds. And how the politics of the FDA plays into, and such.
Most of the cases he witnessed were blind placebo...in other words, neither he nor the patient knew they have been switched. All they knew for sure is that, once they had an "ah ha" moment and figured out what had changed, the patients got well again on their previous medication brand. Whether that previous good brand was the actual brand or a specific generic company didn't matter, only that it was THAT brand.
There are plenty of skeptics to this whole topic. That's only because they themselves have not experienced it. Some people have rigid ways of viewing the complex world as if it were somehow simple enough for a mere human to understand. I think many in the human race assume we are smarter than we actually are, which is where this whole generic=brand equivalency assumption was born.
Posted by Neal on May 30, 2009, at 23:13:58
In reply to Re: Generic Lamictal - lamotrigine, posted by SLS on May 29, 2009, at 15:49:49
Scott-
Since your mail is off, I'm going to post this where I think you'll read it. Assuming that things haven't gelled yet to your complete satisfaction; a question, - nothing in the benzo or similar line has helped you in the past?
I just ask because I could swear the lorazipam I take is acting as an AD as well as an anxiolitic. Anyway, just speculating. No need to "answer" this query. Just a note in lieu of babblemail.
~Neal
Posted by garnet71 on May 30, 2009, at 23:23:04
In reply to Generic Lamictal - lamotrigine, posted by SLS on May 27, 2009, at 17:58:42
If you all are suspecting a problem with generic Lamictal, why not report it here? If the FDA gets a lot of complaints, maybe they will look into it. The complaints are for quality issues too-read below. Just imagine all the people who don't come to Dr. Bob's forum and read about generic Lamictal....It might do some good, and eventually prevent all this pharmacy special ordering crap everyone has to go through.
http://www.fda.gov/Safety/ReportaProblem/ucm059044.htm#med
How do I report non-emergencies about medical products: medicines, medical devices, blood products, biologics, special nutritionals?
MedWatch -- The FDA Safety Information and Adverse Event Reporting Program allows healthcare professionals and consumers to voluntarily report serious problems that they suspect are associated with the drugs and medical devices they prescribe, dispense, or use. These problems include serious adverse reactions and events, product quality problems, and product use errors. Reporting can be done online, by phone, or by submitting the MedWatch 3500 form by mail or fax. Visit the MedWatch How To Report page for more details.
Posted by SLS on May 31, 2009, at 6:44:17
In reply to Re: Generic Lamictal - lamotrigine » SLS, posted by Neal on May 30, 2009, at 23:13:58
> Scott-
>
> Since your mail is off, I'm going to post this where I think you'll read it. Assuming that things haven't gelled yet to your complete satisfaction; a question, - nothing in the benzo or similar line has helped you in the past?
>
> I just ask because I could swear the lorazipam I take is acting as an AD as well as an anxiolitic. Anyway, just speculating. No need to "answer" this query. Just a note in lieu of babblemail.
>
> ~Neal
Thanks, Neal.I have taken lorazepam (Ativan) in the past for MAOI-induced insomnia. I don't think it helped the depression at all, but it would have been hard to tell at the time as the MAOI was producing an improvement on its own.
It is interesting that lorazepam, and not alprazolam (Xanax), has produced an antidepressant effect for you. Have you ever tried alprazolam?
I don't doubt that an anxiolytic can reduce certain people's depression, as it seems that it is the anxiety that drives it in the first place. How long after you started lorazepam did you first feel better?
- Scott
Posted by SLS on May 31, 2009, at 6:45:41
In reply to Re: Generic Lamictal - lamotrigine, posted by garnet71 on May 30, 2009, at 23:23:04
> If you all are suspecting a problem with generic Lamictal, why not report it here?
>
> http://www.fda.gov/Safety/ReportaProblem/ucm059044.htm#med
That's a great idea. I wouldn't have thought to do that. Thanks.
- Scott
Posted by Neal on May 31, 2009, at 19:04:29
In reply to Re: Generic Lamictal - lamotrigine » Neal, posted by SLS on May 31, 2009, at 6:44:17
> > Scott-
> >
> > Since your mail is off, I'm going to post this where I think you'll read it. Assuming that things haven't gelled yet to your complete satisfaction; a question, - nothing in the benzo or similar line has helped you in the past?
> >
> > I just ask because I could swear the lorazipam I take is acting as an AD as well as an anxiolitic. Anyway, just speculating. No need to "answer" this query. Just a note in lieu of babblemail.
> >
> > ~Neal
>
>
> Thanks, Neal.
>
> I have taken lorazepam (Ativan) in the past for MAOI-induced insomnia. I don't think it helped the depression at all, but it would have been hard to tell at the time as the MAOI was producing an improvement on its own.
>
> It is interesting that lorazepam, and not alprazolam (Xanax), has produced an antidepressant effect for you. Have you ever tried alprazolam?
>
> I don't doubt that an anxiolytic can reduce certain people's depression, as it seems that it is the anxiety that drives it in the first place. How long after you started lorazepam did you first feel better?
>
>
> - ScottScott-
I personally think that anxiety has a basis in many people's depressions. Whether it has a basis in your own situation, only you know.
I only took Xanax for a short time long ago, but it's such a short half-life. It might work for experimenting to see if benzos would help you. Going on any benzo for a long period (say, over a week)is something to think about as you know, because sometimes lowering later is a problem. Having said that, I think for depression that lorazipam or Klonopin would be better because of long half-life, so that your mood and anxiety don't swing up and down during the day due to a med with a short half-life.
As far as how soon it begins working, it's been sooo long since I started the lorazipam. But it's soon, baby, very soon, almost immediately in the case of anxiety. As far as AD effect, I don't remember, I've been taking this med for 5-6 years. All I know is that for me, anxiety, even anxiety that I'm not consciously aware of, can lead to mood problems in the long run.
Best to you,
~Neal
Posted by Phillipa on May 31, 2009, at 19:32:20
In reply to Re: Generic Lamictal - lamotrigine, posted by Neal on May 31, 2009, at 19:04:29
Led to mine and I've been on benzos about 40 years now. Seems my body now needs less of them on it's own so take less. Xanax I used for the longest amount of time no problem with dosing just took every four hours. Sometimes I'd have times din't take more than .125 a day. Love Phillipa
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