aplenzin (bupropion hydrobromide) vs bupropion hcl
Started by ronkoshy
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Speaking of Aplenzin... a blog post from the other day on a decent pharmacist blog. "The Hall of Shame Part 2".. drugs that are pointless and examples of corporate greed.
Aplenzin made the list this round
Aplenzin made the list this round
I guess the only notable difference is that one undergoes an anti-markovnikov reaction and the other doesn't.
*runs before getting shot*
*runs before getting shot*
Notable.....maybe for a Organic chemist....
I do my best to stop physicians for writing for crap like this.
I have to say, I see a fair bit of arrogance in this thread. People can react very differently to the same medication. Just because you think you understand chemistry, you thing you can judge a person's reaction to a drug. In practice, for some, this drug is less effective and has more side effects than others. For others, it is a literal lifesaver. Given that so many varied responses can happen from even the same medication, it is important to have more tools in the tool shed. I personally know someone for whom this medication was an enormous improvement over others that "should have been" nearly chemically equivalent. We are complicated creatures, us humans.
Actually, fluticasone propionate and fluticasone fumarate are not salts, but rather describe ester side chains on a fluticasone backbone. Neither is metabolized to fluticasone in humans.
Otherwise, your point is 100% correct. Cash grab.
Studies have shown that people who are told their drug is more expensive find it to be more effective. Don't blame your misunderstanding of psychology on my understanding of pharmacology & biochemistry.
This. The placebo effect is very strong. If it was someone like Bill Gates wanting to pay for the super expensive drug, I'd tell him to go for it. But the problem is when people expect OTHER people (either taxpayers or other insurance policy holders) to pay for their very expensive drug that has no advantage of cheaper drugs.
Yes, we are complicated, which means that evaluating the relative clinical effectiveness of various anti-depressants is difficult. Are you familiar with all the subjective measures and the weaknesses of HAM-D scores and the difference between statistical significance and clinical significance? Do you know about "evergreening," such as the introduction of escitalopram to supplant citalopram, and all the Lundbeck-funded studies resulting in a finding of statistically significant superiority of escitalopram, to the (surprise!) benefit of Lundbeck's newly-patented escitalopram and the detriment of (newly genericized) citalopram?
We also know about how bupropion is dopaminergic, and has potential for misuse, and we have encountered all sorts of drug-seeking behaviour from people who otherwise are not good candidates for Welbutrin. People get passionate about bupropion the way they just don't with, say, fluvoxamine or mirtazepine.
We are more than just chemists.
Speaking of chemistry, I'm too lazy to look up my orgo; what's the implication of the difference between the new formulation and the older ones?
I came across this site because before today, I had never heard of Aplenzin. I agree that patients can and do have varied reactions to different medications, even the same drug that is made by different generic drug companies. However, it's difficult to believe that Aplenzin is much more tolerable than Wellbutrin, Wellbutrin SR or Wellbutrin XL based on the reaction of the hydrobromide salt. Generic Wellbutrin XL has an AWP of about $4.85 per tablet. The equivalent dose of Aplenzin has an AWP of about $57.85 per tablet (oddly enough, brand name Wellbutrin XL cost about the same as Aplenzin, both manufactured by Valeant Pharmaceuticals). That's a HUGE price difference between the generic Wellbutrin XL and Aplenzin. I'm skeptical that the difference in salts justifies such a drastic price increase. Considering brand name Wellbutrin XL (with an available generic) cost about the same as Aplenzin (brand name only), this seems like pure greed on Valeant's behalf (and GSK with the Wellbutrin to the Wellbutrin SR to the Wellbutrin XL, not to mention Zyban).
Thank you for your voice of reason! Here's my experience:
Eight years ago, I was taking budeprion hcl XL for depression and doing well. Then the mail-order pharm unexpectedly refilled my Rx with bupropion XL instead of budeprion XL. Since the active ingredient was the same, I did not object. After several months, my depression worsened and I developed cystic acne on my face. So my doc began specifying budeprion XL instead of bupropion XL on my prescriptions. My depression improved and the acne subsided.
In 2012, the FDA took budeprion XL off the market. Since I had poor results taking the alternative bupropion XL, my doc began specifying name-brand Wellbutrin XL, which worked well for 2 years. After changing insurance, I opted to try the generic bupropion XL again since my copay for Wellbutrin XL was much higher. After 12 weeks on bupropion XL, my depression worsened and the cystic acne returned. So I went back on name-brand Wellbutrin XL, and my depression improved considerably and the acne subsided.
In July of this year, I noticed there was a different ID stamp on the name-brand Wellbutrin tablets I was receiving by mail.After 2 months using this new “version” of Wellbutrin XL, my depression worsened and the acne started up again. Pharmacies I contacted could not ensure that the Rx would be filled with name-brand tablets bearing the same ID stamp that I had received previously.
My docs suspect that one (or more) of the inactive ingredients is causing the acne and perhaps interfering with the Wellbutrin XL’s effectiveness for me. Aplenzin, whose active ingredient is only slightly different from Wellbutrin and whose inactive ingredients are substantially different, is a logical alternative in my situation. I recently switched to Aplenzin, and so far so good. Unfortunately, my current insurance refused my formal appeal to cover Aplenzin as “medically necessary.”
Bottom line: There are patients like me who react differently to variations in inactive as well as active ingredients. Having alternatives is vital for us.
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Not really. You're citing an anecdotal evidence and I'm sure those will exist for many other medications as well on a case by case basis. No one here is denying the variance from patient to patient. Overall, most of these drugs ARE patent extenders for these companies. They didn't drop millions of dollars on FDA submissions to just accommodate a few cases like your friend. From a clinician point of view, what is the thought process on initiating aplenzin? So failed wellbutrin therapy necessitates aplenzin trial? No. These cases are very rare.
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Created an account just to prove that most of the people on this thread are, in fact, arrogant. Maybe if you guys attempt to engage in even the most basic level of research (e.g. a simple Google search) next time you can avoid this mistake in the future.
https://www.ncbi.nlm.nih.gov/pubmed/19557114/
https://www.ncbi.nlm.nih.gov/pubmed/19557114/
Find us the human studies, too. Thanks.
lol
Ummmm.....
So, if a 200lb patient is taking eleven thousand milligrams of Wellbutrin, it would be safer for them to be on Aplenzin. I'll keep that in mind.
bromide
noun | bro-mide
1. a binary compound of bromine with another element or a radical including some (such as potassium bromide) used as sedatives
2. a commonplace or tiresome person
3. a commonplace or hackneyed statement or notion
How about that- all three definitions apply to this discussion.
https://www.merriam-webster.com/dictionary/bromide
noun | bro-mide
1. a binary compound of bromine with another element or a radical including some (such as potassium bromide) used as sedatives
2. a commonplace or tiresome person
3. a commonplace or hackneyed statement or notion
How about that- all three definitions apply to this discussion.
https://www.merriam-webster.com/dictionary/bromide
Regardless of the dosage this is still a significant response that you completely disregard; this thread is an echo chamber. If you are medical doctors you should be ashamed... thank you for further proving my point.
http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm153270.htm
Remember this? Probably not, or you simply disregard this, too. Not all drugs are created equal, but I'm sure if a patient came to you complaining about their Teva generic of Wellbutrin XL you would tell them generics are identical and that their symptoms were psychosomatic.
Remember this? Probably not, or you simply disregard this, too. Not all drugs are created equal, but I'm sure if a patient came to you complaining about their Teva generic of Wellbutrin XL you would tell them generics are identical and that their symptoms were psychosomatic.
No, not regardless of dosage. Dosage is very important. Your single study on rodents using doses nearly 100 times the normal human dose proves very little.
Also, you're resurrecting a thread from 2011.
Read the link I posted from the FDA. Actual dosage response doesn't necessarily translate to expected response at a different dosage, and this study should not be disregarded precisely for that reason. The high dosage in the study was NECESSARY to induce seizures in the mice population because it should be assumed that most mice are not prone to seizures, much like humans. It would be unethical to test this on seizure-prone humans, although the hydrobromide salt would possibly display a significant reduction in seizures when compared to a hydrochloride salt. If a seizure-prone patient benefits from Wellbutrin, the results of such a study would be crucial in determining a prescription that exerts the most benefits with the least side-effects, such as seizures. If you could get past your arrogance you would consider ALL data available in prescribing drugs.
LOL.
There's a reason everyone groans when you walk into the pharmacy.
Do you also lecture aerospace engineers before getting onto a plane?
Have you ever eaten an almond flavored cookie?
Did you know that natural almond flavor contains cyanide? And artificial almond flavor does not?
Can you tell me the number of people who have died from cyanide poisoning from eating almond flavored cookies? Probably not. Because YOU WOULD NEED TO EAT ELEVEN THOUSAND OF THEM* FOR THE DIFFERENCE IN CYANIDE CONTENT TO MATTER!
Now please take that information and lecture some people on a baking forum.
*not a calculated quantity. Just trying to forcibly draw a correlation.
Also, a seizure prone patient on any form of bupropion should sue their doctor for malpractice.
You realize that your example proves that the system works? There was an issue, it was identified and corrected. Huzzah the system works! I actually love this example for that exact reason.
