Does generic keppra has more side effects

[ancienbon]

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There is a child that has been doing very well on generic keppra for the past 10 months. According to mom, medication has been working very well as the child has not had a seizure attack ever since he has been taking it. Today i was surprised to receive a prescription for the brand to be dispensed medically necessary due to side effects of generic. I then called mom who told me that the kid has been bullied at school by his teacher and others students. Therefore the kid has been depressed. When the mom explained that to the neurologist, he said it might be due to the side effect of the generic. So neurologist changed generic to brand name..
Does anyone know if generic keppra is more likely to cause depression than the brand name?

 

[hereticmnk]

This is probably the MD acting on anecdotal leanings vs. actual evidence. I did a quick search but found nothing on the generic Kepra being more likely to cause depression but I would be curious to know what you find. I can never figure out how neurologists and psychiatrists work 😕

 

[WVUPharm2007]

There is a child that has been doing very well on generic keppra for the past 10 months. According to mom, medication has been working very well as the child has not had a seizure attack ever since he has been taking it. Today i was surprised to receive a prescription for the brand to be dispensed medically necessary due to side effects of generic. I then called mom who told me that the kid has been bullied at school by his teacher and others students. Therefore the kid has been depressed. When the mom explained that to the neurologist, he said it might be due to the side effect of the generic. So neurologist changed generic to brand name..
Does anyone know if generic keppra is more likely to cause depression than the brand name?

More than likely just another MD that doesn't know WTF they are talking about. It's an instant release molecule. What magical inactive ingredient can they really add that will contribute to depression? This happens to me every week. I had a girl talk to me this weekend about her Ocella not working as well as Yasmin. I flipped the boxes of each product to reveal that they are both made by Bayer in Germany. Of course, they use the same ingredients, process, hell, they probably use the same machines. And, of course, what does she say? "But I was reading on the internet..." Good old internet forum geniuses making my job harder.

This is the same thing, but the MD should REALLY know better. I can forgive a layman not knowing any better. But a physician should know better. A change in symptoms isn't usually and certainly isn't always because of a new generic. Meanwhile, the patient probably had something change in their everyday life independent of which facility manufactured their molecule...and its being ignored in favor of some idiotic "it's a generic, therefore it must be what's causing these new issues" theory.

Also, you'll notice that generic medications never seem to work as good as the brand name, not the other way around. Brand name medications are made with Pixie dust and holy scripture marketing. I'll probably fall over dead from shock if anyone every claimed the generic worked better for them than the brand. The "brand name is a premium product" meme is so ingrained into American psyche that it quite literally makes people imagine things or make faulty assumptions in medical practice.

 

[Momus]

All, if not most, of these self reported side effects are due to placebo effects. Blue being better for an anti depressant, fancy markings, fancy odd shaped, fancy packaged drugs is better, Vicodin imprint is better than hydrocodone/acetaminophen. Heck, I could sell a plastic bag with Hermes written all over it and people will buy it for $50 each.

People are idiots.

 

[farmadiazepine]

I would have told the mom it's time to find a new neurologist.

Kraft cheese is a premium product. Keppra brand is not.

 

[Ackj]

If it was a recent switch that made the kid wacky, it might have a shred of validity. However, if they've been taking it for 10 months, there is not a chance in the world. But what the heck, charge the parents the big bucks, the kid won't stop being depressed, and then in a few months the MD will have to finally address the problem.

 

[ancienbon]

What surprises me it that a neurologist would say something so stupid. I just don't get it. One time i was floating at a store when a patient called and asked why we filled his medication with generic without telling him. He even mentioned that his doctor said the brand name works better. I got that from patient all the time.. but for a neurologist to write something so stupid on e-prescription makes me shocked.

 

[All4MyDaughter]

Did insurance cover the brand?

 

[gotdrugs]

All, if not most, of these self reported side effects are due to placebo effects. Blue being better for an anti depressant, fancy markings, fancy odd shaped, fancy packaged drugs is better, Vicodin imprint is better than hydrocodone/acetaminophen. Heck, I could sell a plastic bag with Hermes written all over it and people will buy it for $50 each.

People are idiots.

Actually the bolded part is 100% true depending on who is asking. That signifies 100% that it's Vicodin (i.e. hydrocodone) when sold on the streets so therefore you can ask for a premium prices. The generics require a bit a trust between seller and buyer and usually a discount in comparison to brand names.

So in terms of $$$ Vicodin is better.

 

[ancienbon]

Did insurance cover the brand?

yeah medicaid covers the brand

 

[smercer]

More than likely just another MD that doesn't know WTF they are talking about. It's an instant release molecule. What magical inactive ingredient can they really add that will contribute to depression? This happens to me every week. I had a girl talk to me this weekend about her Ocella not working as well as Yasmin. I flipped the boxes of each product to reveal that they are both made by Bayer in Germany. Of course, they use the same ingredients, process, hell, they probably use the same machines. And, of course, what does she say? "But I was reading on the internet..." Good old internet forum geniuses making my job harder.

Hey...Its hard work getting an Internet PhD.

The ignorance of the general public is at times frightening. Most really are just sheep waiting to be herded to the next pasture.

 

[farmadiazepine]

yeah medicaid covers the brand

And we wonder why the health care system is sooo stressed.

 

[pezdispenser]

Actually the bolded part is 100% true depending on who is asking. That signifies 100% that it's Vicodin (i.e. hydrocodone) when sold on the streets so therefore you can ask for a premium prices. The generics require a bit a trust between seller and buyer and usually a discount in comparison to brand names.

So in terms of $$$ Vicodin is better.

Don't you just hate it when every second call you get goes: "Hi, I found these pills in my kid's school bag. Can you tell me what they are? They're white and say Watson 349."

Well once it was 44 104 and the caller got really angry for some reason...

 

[WVUPharm2007]

Actually the bolded part is 100% true depending on who is asking. That signifies 100% that it's Vicodin (i.e. hydrocodone) when sold on the streets so therefore you can ask for a premium prices. The generics require a bit a trust between seller and buyer and usually a discount in comparison to brand names.

So in terms of $$$ Vicodin is better.

Man, please. A true addict knows the imprint and name of the manufacturer on sight.

 

[gotdrugs]

Man, please. A true addict knows the imprint and name of the manufacturer on sight.

Good point.

But think of the ones starting out.

 

[browneyes021]

Man, please. A true addict knows the imprint and name of the manufacturer on sight.

That is so sad and true. I remember on one of my rotations at a pain management clinic hearing people refer to different pain meds by asking for particular manufacturers, not just just color. Somas were the ones with dan written on them or the oxycodones by qualitest not mallinkrodt (sp?). One customer told me that she didn't want her hydrocodone tablets by mallinkrodt do be the ones with the green speckles on it because it made her head hurt. It makes me wonder for legitimate customers (not abusers) is it just all in their head and when switching from one manufacturer to another it just causes some type of negative thinking that that particular pill won't work?

 

[ancienbon]

i just spoke with the mom again as i just cant believe a doctor can be so stupid. the mon said the kid has never been depressed until he got bullied at school and he is otherwise fine at home. she said the doctor said some of his patients said they are depressed when taking the generic lol

 

[genesis09]

For pain medicines, the placebo effect is strong. For instance for Nucynta's approval study, in its placebo group nearly a quarter to a third reported benefits. There have been other studies showing placebo effect.

 

[MountainPharmD]

Yes! All generics are bad! Brand name only please!

 

[owlegrad]

I am allergic to genetics and it is illegal for you to charge me more for brand.

 

[MountainPharmD]

There is a child that has been doing very well on generic keppra for the past 10 months. According to mom, medication has been working very well as the child has not had a seizure attack ever since he has been taking it. Today i was surprised to receive a prescription for the brand to be dispensed medically necessary due to side effects of generic. I then called mom who told me that the kid has been bullied at school by his teacher and others students. Therefore the kid has been depressed. When the mom explained that to the neurologist, he said it might be due to the side effect of the generic. So neurologist changed generic to brand name..
Does anyone know if generic keppra is more likely to cause depression than the brand name?

I see BS like this everyday! I have read every possible reason and excuse imaginable for generics not working..

 

[All4MyDaughter]

I see BS like this everyday! I have read every possible reason and excuse imaginable for generics not working..

You should start your own thread: MountainPharmD's Prior Authorization Hall of Shame and post all the travesties that you see every day.

 

[genesis09]

One of my favorites is that a NP wanted a PA for Apriso. State has Asacol as the preferred agent. The reason for the PA was that the patient was allergic to Asacol. I called the NP, and told her if she was allergic to Asacol than she shouldn't use Apriso because they are the same thing. Good grief.

 

[ancienbon]

One of my favorites is that a NP wanted a PA for Apriso. State has Asacol as the preferred agent. The reason for the PA was that the patient was allergic to Asacol. I called the NP, and told her if she was allergic to Asacol than she shouldn't use Apriso because they are the same thing. Good grief.

Lol. What did she say?

 

[rxlea]

You should start your own thread: MountainPharmD's Prior Authorization Hall of Shame and post all the travesties that you see every day.

I think this is a fabulous idea.

 

[genesis09]

Lol. What did she say?

Said it wasn't a true allergy but an intolerance.

 

[MountainPharmD]

You should start your own thread: MountainPharmD's Prior Authorization Hall of Shame and post all the travesties that you see every day.

I started something similar at work. I call it the letter of medical necessity of the year contest. Everytime someone finds a real winner of a letter from some idiot physician like the neurologist above I have them send it to me and I save it. At the end of the year I am going to select the best ones and we are going to vote on the winner. Who ever submitted the winning entry will get a prize. I am also thinking about getting a trophy made up and sending it to the physician who wrote the winning entry.

 

[joetrisman]

I started something similar at work. I call it the letter of medical necessity of the year contest. Everytime someone finds a real winner of a letter from some idiot physician like the neurologist above I have them send it to me and I save it. At the end of the year I am going to select the best ones and we are going to vote on the winner. Who ever submitted the winning entry will get a prize. I am also thinking about getting a trophy made up and sending it to the physician who wrote the winning entry.

Damn, those sound entertaining. I wish sparda had your job so that he'd post them online for us all to read

 

[joetrisman]

On a related note, nothing shuts me down faster than a patient adamantly saying generics don't work/aren't as good/have greater SEs/etc. I have no patience at that point. I find it insulting. Its like, "Doc, I know you have 8years of school and have studied this **** extensively, but my favorite interweb blog says it just aint the same". I find it comical when patients expect us to know every niche condition known to man that has nothing to do with medications (directly) and yet act like we don't know what we are talking about when it comes to brand vs generic. Its quite obvious to me that the general public has no clue what it is we do exactly in school.

 

[Fai]

On a related note, nothing shuts me down faster than a patient adamantly saying generics don't work/aren't as good/have greater SEs/etc. I have no patience at that point. I find it insulting. Its like, "Doc, I know you have 8years of school and have studied this **** extensively, but my favorite interweb blog says it just aint the same". I find it comical when patients expect us to know every niche condition known to man that has nothing to do with medications (directly) and yet act like we don't know what we are talking about when it comes to brand vs generic. Its quite obvious to me that the general public has no clue what it is we do exactly in school.

Obv pharmacists count pills in school and learned to never give advice to the physician and answer to the physician's recommendation of drugs without any question, duh! (I had a friend who legitimately thought that you didn't need to go to school to be a pharmacist)

Also I felt like popping in for funsies.


Sent from my iPhone using SDN Mobile app

 

[amox]

Obv pharmacists count pills in school and learned to never give advice to the physician and answer to the physician's recommendation of drugs without any question, duh! (I had a friend who legitimately thought that you didn't need to go to school to be a pharmacist)

Also I felt like popping in for funsies.


Sent from my iPhone using SDN Mobile app

I had a patient ask me how long my internship was to become a pharmacist. I said 4 years, she was speachless. If only she knew there was 4 years of school prior to that!

 

[PharmDstudent]

I am allergic to genetics and it is illegal for you to charge me more for brand.

That's a new one.

I had a patient ask me how long my internship was to become a pharmacist. I said 4 years, she was speachless. If only she knew there was 4 years of school prior to that!

Whenever customers start chatting at the counter about how long it takes to become a pharmacy tech, I respond by telling them that I went to school for 8 years to be a pharmacist. You should see the look on their face whenever they realize that I'm not a pharmacy tech...

 

[Momus]

You should see the look on their face whenever they realize that I'm not a pharmacy tech...

I get that every day... fuuuking Asian gene, I'd probably turn 40 and people still think I am 25 >_>;

 

[Rx MPLS]

Any idea why Medicaid in my state allows us to dispense the branded version of Adderall (might be the XR; can't remember) but not the generic?

 

[Dr Wario]

Any idea why Medicaid in my state allows us to dispense the branded version of Adderall (might be the XR; can't remember) but not the generic?

The reasoning behind this is quite simple. When a branded product comes off of patent, the first company to submit and receive approval for a generic equivalent is given 180 days of exclusivity to produce the drug. Often times, a brand manufacturer will contract with an external company to distribute their drug as a generic alternative. The reason this is done is because the brand product will undoubtedly pass the bioequivalency requirement because it is the exact same product, and the brand manufacturer already has the equipment in place to produce the medication. This effectively gives the brand manufacturer a six month extension on their patent, and when you a talking about a drug that sells billions of dollars a year, the return is massive.

This is the exact case with generic Adderall XR as the manufacturer is the same as the brand. The reason why your state medicaid probably only covers the brand version is due to the company giving them a rebate on the product (aka kickback) because it costs extra money to contract with an outside entity to distribute the product they already produce. To put it simply, the cost of the brand product is less than the generic to medicaid.

 

[hereticmnk]

Any idea why Medicaid in my state allows us to dispense the branded version of Adderall (might be the XR; can't remember) but not the generic?

My understanding is that its about the money. The reimbursement discounts that PBM's get with the brand name Adderal is substantial to the point where a lot of insurance companies prefer the brand over the generic I wonder that's why Medicaid does it too. Adderal is the only brand name that I can think of that does it.

 

[Rx MPLS]

Thanks heretic and DrWario; useful information!

 

[BidingMyTime]

Also, you'll notice that generic medications never seem to work as good as the brand name, not the other way around. Brand name medications are made with Pixie dust and holy scripture marketing. I'll probably fall over dead from shock if anyone every claimed the generic worked better for them than the brand.

This actually happened to me once. The generic Armour Thyroid was back-ordered, so we were going to fill with the brand Armour Thyroid....the lady was quite upset and said the Armour didn't work as well as the Thyroid NP. Although, I'm not sure she really believed me when I explained the Armour was the brand version anyway.

 

[hereticmnk]

This actually happened to me once. The generic Armour Thyroid was back-ordered, so we were going to fill with the brand Armour Thyroid....the lady was quite upset and said the Armour didn't work as well as the Thyroid NP. Although, I'm not sure she really believed me when I explained the Armour was the brand version anyway.

Well with that drug, there is actual difference between brand and generic. Tbh, there is difference between batches of the same generic brand. I dont know why people still use this drug, just go use levo.. so much better.