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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by Conundrum on September 25, 2010, at 12:33:51
In reply to Re: For those who Wellbutrin or Ritalin helped. » Conundrum, posted by Phillipa on September 25, 2010, at 12:16:46
Well I heard the generics were not always so great with these meds especially wellbutrin, so I might wanna try the brand and see if it works better. Both drugs are supposed to be good for anhedonia and concentration but neither helped me.
Posted by Phillipa on September 25, 2010, at 12:44:35
In reply to Re: For those who Wellbutrin or Ritalin helped. » Phillipa, posted by Conundrum on September 25, 2010, at 12:33:51
Seriously it seems like brand is better in so many meds what will do if only generics are available here? I think I about six years ago took 150mg of wellbutrin and was brand and I appeared manic on it so was put in hospital and taken off it. I think it must have just made anxiety worse at the time as anxiety was higher in a different way. Wellbutrin is one I've read here is better. Phillipa
Posted by linkadge on September 25, 2010, at 14:37:30
In reply to For those who Wellbutrin or Ritalin helped., posted by Conundrum on September 25, 2010, at 12:05:08
I've tried a number of different ritalin brands and formulations. They're all pretty much have the same effect on me.
Mind you, I do well on a low dose (ie. 5mg x2)
Linkadge
Posted by weatherfreak on September 27, 2010, at 22:28:13
In reply to For those who Wellbutrin or Ritalin helped., posted by Conundrum on September 25, 2010, at 12:05:08
I was on proper Ritalin until it went weird on me for 8 months. It was quite possibly the best med I have ever taken for attention, depression and anxiety. Then about 7 months in it became completely unpredictable for me. I was using anywhere between 2.5mg- 20mg a day. I never knew if it would zonk me out or send me manic in the end, even at 2.5mg so I had to stop taking it.
I'm now on Prexaton, generic bupropion. It's been 3 weeks and I feel like I'm sliding backwards into depression again. It's so hard to sleep even on 150mg SR a day. I have terrible tension to the point that when I wake up during the night my head is off the pillow. I'm so tense I'm pulling muscles all over but my pdoc wont let me stop until it's been 4 weeks so my GP just prescribed me Hypnodorm (flunitrazepam) which I just realised is Rohypnol and still available in Australia.
I had been using straight Mogadon (nitrazepam) until I went on bupropion, so hopefully I will finally sleep tonight.
Posted by Conundrum on September 27, 2010, at 23:17:03
In reply to Re: For those who Wellbutrin or Ritalin helped. » Conundrum, posted by weatherfreak on September 27, 2010, at 22:28:13
Hmm thats terrible. I think wellbutrin can have some weird side effects. Hopefully they will go away and it will help, more consistently than the ritalin.
> I was on proper Ritalin until it went weird on me for 8 months. It was quite possibly the best med I have ever taken for attention, depression and anxiety. Then about 7 months in it became completely unpredictable for me. I was using anywhere between 2.5mg- 20mg a day. I never knew if it would zonk me out or send me manic in the end, even at 2.5mg so I had to stop taking it.
>
> I'm now on Prexaton, generic bupropion. It's been 3 weeks and I feel like I'm sliding backwards into depression again. It's so hard to sleep even on 150mg SR a day. I have terrible tension to the point that when I wake up during the night my head is off the pillow. I'm so tense I'm pulling muscles all over but my pdoc wont let me stop until it's been 4 weeks so my GP just prescribed me Hypnodorm (flunitrazepam) which I just realised is Rohypnol and still available in Australia.
>
> I had been using straight Mogadon (nitrazepam) until I went on bupropion, so hopefully I will finally sleep tonight.
Posted by weatherfreak on September 28, 2010, at 2:42:51
In reply to Re: For those who Wellbutrin or Ritalin helped. » weatherfreak, posted by Conundrum on September 27, 2010, at 23:17:03
Thanks for that, I have to admit that bupropion is great for my attention and cognition but that's as far as it goes. I'm in Australia so I'll let you know how the Rohypnol works out. Aside for being a powerful hypnotic it's also a powerful muscle relaxant which is what I want more than anything! I thought I'd tried every muscle relaxant on the market from valium to baclofen but now I have this to try.
Posted by Conundrum on September 28, 2010, at 9:53:07
In reply to Re: For those who Wellbutrin or Ritalin helped. » Conundrum, posted by weatherfreak on September 28, 2010, at 2:42:51
So did you already have muscle pain, or did it develop after you started taking wellbutrin?
Posted by bleauberry on September 28, 2010, at 17:49:06
In reply to For those who Wellbutrin or Ritalin helped., posted by Conundrum on September 25, 2010, at 12:05:08
I am totally convinced of remarkable differences between most generics compared to their brands. Usually the brand is reliably better than the generic. My pain/fatigue doctor says that is mostly the case except he has found a generic version of an opoiod pain med that works better than the brand. So it goes both ways sometimes.
Being a champion of brand meds, I can't tell you how stunned I was to discover I liked immediate release generic Ritalin much better than time released expensive brand version. I mean, the brand felt harsh and mean, nothing good at all, angry, irritable. The generic is almost like a totally different med to me. Warm energy and a brighter mood for a little while.
I hardly ever take ritalin. But when I do, I like generic better than brand, and I like immediate release better than slow release.
With practically all other meds I can think of, my opinion is that brand is better. My doctor agrees. He rarely prescribes generic and goes the extra step of convincing the patients' insurance companies to cover it.
There is no difference with many people. When differences do happen, they can be as significant as major relapse.
Posted by weatherfreak on September 28, 2010, at 19:05:03
In reply to Re: For those who Wellbutrin or Ritalin helped. » weatherfreak, posted by Conundrum on September 28, 2010, at 9:53:07
> So did you already have muscle pain, or did it develop after you started taking wellbutrin?
Yes I did but it was tolerable, even on an old sedating tetracyclic and Remeron. Now it's off the charts
Posted by Conundrum on September 28, 2010, at 20:36:27
In reply to Re: For those who Wellbutrin or Ritalin helped., posted by bleauberry on September 28, 2010, at 17:49:06
Bleauberry, I just found this comment you made last year where you went in to more depth about the difference between generics and brand drugs.
http://www.dr-bob.org/babble/20091021/msgs/921841.html
Perhaps brand Well XL is worth a shot? I tried Teva SR with no luck. I have tried sandoz ritalin IR which is rated pretty high at addforum.com, so I don't think I need another ritalin trial. I wish I had known the buspar generic wasn't very reliable too.
Maybe I'll should give effexor a go even though pristiq didn't work, since venlafaxine slightly blocks the reuptake of dopamine, but its metabolite, desvenlafaxine, does not.Sometimes you lose something with these "me too" drugs. I would think the same holds true with celexa. Its probably a more gentle than lexapro which, for me, really knocked me out.
Maybe we should start a thread naming generics that don't work well? If we put good keywords others may be able to find it while searching the web.
Posted by weatherfreak on September 29, 2010, at 7:24:32
In reply to Re: For those who Wellbutrin or Ritalin helped. » bleauberry, posted by Conundrum on September 28, 2010, at 20:36:27
> Bleauberry, I just found this comment you made last year where you went in to more depth about the difference between generics and brand drugs.
>
> http://www.dr-bob.org/babble/20091021/msgs/921841.html
>
> Perhaps brand Well XL is worth a shot? I tried Teva SR with no luck. I have tried sandoz ritalin IR which is rated pretty high at addforum.com, so I don't think I need another ritalin trial. I wish I had known the buspar generic wasn't very reliable too.
>
>
> Maybe I'll should give effexor a go even though pristiq didn't work, since venlafaxine slightly blocks the reuptake of dopamine, but its metabolite, desvenlafaxine, does not.
>
> Sometimes you lose something with these "me too" drugs. I would think the same holds true with celexa. Its probably a more gentle than lexapro which, for me, really knocked me out.
>
> Maybe we should start a thread naming generics that don't work well? If we put good keywords others may be able to find it while searching the web.Generics in Australia have to be literally identical to the brand or they are not allowed. There is none of this 10-20% difference in strength or difference factor allowed. I don't know how the US Government allows it. It's dangerous!
Posted by Brainbeard on October 3, 2010, at 14:24:09
In reply to Re: For those who Wellbutrin or Ritalin helped. » Conundrum, posted by weatherfreak on September 29, 2010, at 7:24:32
I really don't understand how legitimate generic formulations could have different effects from brand products. We're talking about the same freakin' molecules. If there are differences, wouldn't they rather be due to non-active substances and differences in absorption rates? Then I'd say that such differences are way more subtle than the placebo effect, which is likely to impost itself onto the minds of those already believing brand to be superior to generics.
I'm inclined to believe it myself. But my rational self holds up a 'Stop!'-sign here.
Posted by ed_uk2010 on October 3, 2010, at 14:29:15
In reply to The Brand Vs. Generic.. Myth?, posted by Brainbeard on October 3, 2010, at 14:24:09
>I really don't understand how legitimate generic formulations could have different effects from brand products.
Although there are sometimes small differences, brand versus generic issues receive far too much attention. Some people obsess about it so much that they make themselves ill with worry.
Posted by Conundrum on October 3, 2010, at 15:26:49
In reply to The Brand Vs. Generic.. Myth?, posted by Brainbeard on October 3, 2010, at 14:24:09
Maybe in your country the rules regarding generics are a bit stricter. I think there can be around 15% difference in the amount of the drug in the U.S. A recent problem was with Wellbutrin XL. THere were so many complaints that the FDA had to test the generics and said it was fine. So what is the difference? Time release. The brand uses a matrix pill that leaks out the bupropion gradually and you pass the shell into the toilet. This type of pill is patented. The Teva generic is a tightly packed pill. So you're getting more of the drug at once and then it is wearing off sooner. Its almost like drinking 4 beers at once and getting drunk instead of spreading them out through the day and being relaxed.
Posted by ed_uk2010 on October 3, 2010, at 16:13:35
In reply to Re: The Brand Vs. Generic.. Myth? » Brainbeard, posted by Conundrum on October 3, 2010, at 15:26:49
>I think there can be around 15% difference in the amount of the drug in the U.S.
That is not the case in any country! The amount of drug present in the tablet has to be exactly the same. No generic would be allowed to contain 15% less medication in the tablet, that would be ridiculous!
New generics are tested for bioequivalence to the brand leader. The criteria used by the FDA are similar to the criteria used in Europe.
In general, to establish bioequivalence, the calculated 90% confidence intervals for the AUC and Cmax should fall within the range 80% to 125%. Tighter limits are required for certain drugs. The 80% to 125% range is part of a statistical calculation, it does not mean that the generic is permitted to be 20% less bioavailable. The manufacturer will submit graphs of plasma level versus time for their product versus the brand leader.
Most studies of new generics reveal extremely similar bioavailability to the brand leader. Differences are more likely for sustained release products compared with standard release medicines.
Posted by emme on October 3, 2010, at 18:43:55
In reply to The Brand Vs. Generic.. Myth?, posted by Brainbeard on October 3, 2010, at 14:24:09
> I really don't understand how legitimate generic formulations could have different effects from brand products. We're talking about the same freakin' molecules. If there are differences, wouldn't they rather be due to non-active substances and differences in absorption rates? Then I'd say that such differences are way more subtle than the placebo effect, which is likely to impost itself onto the minds of those already believing brand to be superior to generics.
>
> I'm inclined to believe it myself. But my rational self holds up a 'Stop!'-sign here.
>In theory, I guess they should all work fine. But what I know from experience is that the Teva brand generic lamotrigine was doing just fine for me. When a refill came back with the new Dr. Reddy's generic lamotrigine, I didn't bat an eye since I'd never been unhappy with a generic. After a week, I was starting to slip into depression. After another week I put two and two together. I looked on some of the epilepsy boards and saw a lot of complaints about Dr. Reddy's lamotrigine. The pharmacy was good enough to switch out my bottle for the Teva brand, and about 5-6 days later I was doing better, which is about the time it usually takes for me to register dose changes with lamotrigine. Generics for my other meds have been okay.
Posted by Conundrum on October 3, 2010, at 21:31:23
In reply to Re: The Brand Vs. Generic.. Myth? » Conundrum, posted by ed_uk2010 on October 3, 2010, at 16:13:35
Its rare to hear complaints about generics for drugs that have longer half lives. It seems like most complaints are with shorter acting drugs like wellbutrin, stimulants, nardil, buspar etc. You rarely hear complaints about generic prozac, and the generic TCAs with longer half lives.
Posted by ed_uk2010 on October 4, 2010, at 13:26:06
In reply to Re: The Brand Vs. Generic.. Myth? » ed_uk2010, posted by Conundrum on October 3, 2010, at 21:31:23
> Its rare to hear complaints about generics for drugs that have longer half lives. It seems like most complaints are with shorter acting drugs like wellbutrin, stimulants, nardil, buspar etc. You rarely hear complaints about generic prozac, and the generic TCAs with longer half lives.
Issues are more likely with Wellbutrin because it's a sustained release product. The release profile of different brands may be slightly different.
As far as I know, there is no generic version of Nardil (at least there isn't in the UK). The complaints have been about the formulation change of branded Nardil which took place a few years ago. For reasons that I do not know, the manufacturer decided to change the excipients in the tablets.
Posted by Brainbeard on October 4, 2010, at 13:39:05
In reply to Re: The Brand Vs. Generic.. Myth? » Conundrum, posted by ed_uk2010 on October 4, 2010, at 13:26:06
Time released formulations, yeah, that's a different story. But instant release, same molecule... It's irrational to assume that the molecule is magically influenced by the company producing it.
Posted by ed_uk2010 on October 4, 2010, at 15:47:57
In reply to Re: The Brand Vs. Generic.. Myth?, posted by Brainbeard on October 4, 2010, at 13:39:05
>It's irrational to assume that the molecule is magically influenced by the company producing it.
Pharmaceutical manufacturers don't always produce the drug itself, they sometimes just make the tablets. The drug (active pharmaceutical ingredient) is frequently supplied by a third party fine chemicals supplier. Multiple generics companies can use the same API source.
The largest generics companies such as TEVA tend to manufacture their own APIs, as well as supplying other companies.
Posted by Conundrum on October 5, 2010, at 9:12:58
In reply to Re: The Brand Vs. Generic.. Myth?, posted by Brainbeard on October 4, 2010, at 13:39:05
But people complain about certain generics and not about others. If it was the placebo effect, then would be complaints when all drugs went generic. I've never read many complaints about generic SSRIs or TCAs, but there are plenty for budeprion, some methylphenidate generics, some adderall and some dexedrine generics. If some generic versions work and others don't is it really a bias against generics? I don't think so. The fillers may have more of an effect on drugs with a shorter half life than many people think.
Posted by Brainbeard on October 5, 2010, at 10:50:59
In reply to Re: The Brand Vs. Generic.. Myth? » Brainbeard, posted by Conundrum on October 5, 2010, at 9:12:58
> I've never read many complaints about generic SSRIs or TCAs
Well, there are plenty on the web, believe me. Dramatic stories of complete reversal of luck after changing to generic, say, Zoloft (sertraline), or whatever.
But OK, if there are bulk suppliers as Ed says, maybe there could be a question of impurity, bad batches, or something of the sort. But there is no research to back this up, as has already been argued in this thread.
Posted by Conundrum on October 5, 2010, at 11:15:51
In reply to Re: The Brand Vs. Generic.. Myth?, posted by Brainbeard on October 5, 2010, at 10:50:59
In the U.S. generic manufactures don't have to test their product against a placebo like the brand version. So there are no double blind studies to test whether generics are EFFECTIVE, we know just that they are bioequivalent, and just assume that make it effective. Maybe the fillers do make a difference, but we will never know.
Posted by ed_uk2010 on October 5, 2010, at 11:50:12
In reply to Re: The Brand Vs. Generic.. Myth? » Brainbeard, posted by Conundrum on October 5, 2010, at 11:15:51
> In the U.S. generic manufactures don't have to test their product against a placebo like the brand version. So there are no double blind studies to test whether generics are EFFECTIVE, we know just that they are bioequivalent, and just assume that make it effective. Maybe the fillers do make a difference, but we will never know.
If a product is bioequivalent, the effect will be the same. If a product was actually not bioequivalent, then it might not be.
Posted by KarenRB53 on October 8, 2010, at 12:22:51
In reply to Re: For those who Wellbutrin or Ritalin helped., posted by linkadge on September 25, 2010, at 14:37:30
If Wellbutrin is just a tad too strong for me what would be the next best thing? Is there anything?
This is the end of the thread.
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