Coumadin vs. Warfarin and INR

[Brixius]

Question for you guys ... we all see the physicians that refuse to prescribe warfarin versus Coumadin, claiming that they get more "consistent" INR results with brand Coumadin. I've asked a few pharmacists in the anti-coagulant clinic about this and they seem to think that's a bunch of bunk -- they, however, couldn't point to any particular studies or reasonings other than personal experience. Does anybody in here have any strong feelings either way?

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[firefighter9015]

As long as the two are AB rated in the orange book, then there shoulden't be a problem. But that is from my limited knowledge being a lowly PY2.

 

[RxWildcat]

I've worked in a community setting for over 3 years and I've only had 1 pt that was on brand name coumadin. I didn't realize it was common for physicians to prescribe it over warfarin. Kinda off topic, but do you buys ever notice that most prescribers that don't like generic drugs are usually really old, like late 60s or 70s?

 

[Brixius]

I've worked in a community setting for over 3 years and I've only had 1 pt that was on brand name coumadin. I didn't realize it was common for physicians to prescribe it over warfarin.

Wow, really? Maybe it's just an Iowa thing, but I'd say for every 3 warfarin scripts I get, I get 1 DAW Coumadin.

 

[Brixius]

As long as the two are AB rated in the orange book, then there shoulden't be a problem. But that is from my limited knowledge being a lowly PY2.

Heh, I know it, hence my skepticism.

 

[Caverject]

that's because the "good" people over at Dupont are excellent at sales and talking up bull. While it is an NTI drug, they can't prove there are problems with the generic

 

[NormalSaline]

Question for you guys ... we all see the physicians that refuse to prescribe warfarin versus Coumadin, claiming that they get more "consistent" INR results with brand Coumadin. I've asked a few pharmacists in the anti-coagulant clinic about this and they seem to think that's a bunch of bunk -- they, however, couldn't point to any particular studies or reasonings other than personal experience. Does anybody in here have any strong feelings either way?

I was under the impression that any inconsistencies arise when switching from brand to generic or vice versa. The explanation being that the body is so sensitive to this drug (as well as thyroid and birth control among others) that even a change in the excipients in the tablets can cause alterations in lab values.

 

[Priapism321]

I was under the impression that any inconsistencies arise when switching from brand to generic or vice versa. The explanation being that the body is so sensitive to this drug (as well as thyroid and birth control among others) that even a change in the excipients in the tablets can cause alterations in lab values.

Some people are just too impressionable.

I will link citations to a couple of studies indicating no important difference between brand and generic warfarin. You will have to figure out how to access these articles for yourselves; if you cannot access them, you probably shouldn't be commenting in this thread.

Patterson JM, et. al. JAMA 2006;296:1969-72
Weibert RT, et. al. Ann Pharmacotherapy 2000;984:981-8.

A small bone I am willing to throw to the peanut gallery: abstract to article number two:

http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

[acetyl]

You will have to figure out how to access these articles for yourselves; if you cannot access them, you probably shouldn't be commenting in this thread.

Hahaha. Dude you crack me up. How about a study proving why SSRI's work like sugar pills?

 

[Priapism321]

Hahaha. Dude you crack me up. How about a study proving why SSRI's work like sugar pills?

Haha, you know I can link up several of those. In a nut shell, it would consist of the 67% of the studies evaluating the usefulness of these medications; this would be the proportion not used to gain FDA approval.

 

[Priapism321]

Hahaha. Dude you crack me up. How about a study proving why SSRI's work like sugar pills?

Well what do you know, more data indicating SSRIs are no more effective than placebo, yet much more likely to cause severe adverse events. Selective publishing and manipulation of science is the only evidence substantiating the clinical utility of these agents. This actually sickens me.

http://iospress.metapress.com/content/k36834543w9063rr/?p=70dd165df7314a01ae3385be0cd09f01&pi=6

Blog posting regarding the article here: http://www.pharmalot.com/2008/04/what-negative-data-paxil-selective-reporting/

 

[laimyours]

Coumadin is one of those drugs that once someone has started taking either the generic warfarin or the brand Coumadin, they should stick with it. Like Synthroid and Lanoxin. A small amount of variance in the drug can lead to a potential problem. I've notived too it's mostly older people (over 60). That's probaly because they've been taking the drug so long they started when it was brand name only.

 

[b*rizzle]

Coumadin is one of those drugs that once someone has started taking either the generic warfarin or the brand Coumadin, they should stick with it. Like Synthroid and Lanoxin. A small amount of variance in the drug can lead to a potential problem. I've notived too it's mostly older people (over 60). That's probaly because they've been taking the drug so long they started when it was brand name only.

Agreed. It doesn't matter what they start on, as long as they stay on it.

Gotta love GSK. Almost as good as trying to get approval for Advair's indication for reduction of mortality in COPD patients with statistically insignificant numbers (granted, they were really close...)