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Discussion in 'Pharmacy' started by sleazye, Apr 22, 2007.
Do you feel there is a significant difference in quality? I've had people try to argue both sides.
Assuming they are AB/AT/whatever rated by the FDA, no. Period.
Anybody who says otherwise is stupid and you can tell them I said that....
As far as i know, the active ingredients of both brand and generic will be same but the inactive ingredients may be different. For narrow therapeutic index drug like warfarin, levothyroxin etc, you want to stick with one type.. thats what i have understood.
No, generics have to prove to the FDA that they're just as good as the "real thing." I think a lot of patients don't realize this, that the generics are still regulated.
It might become as issue, though, if you have a patient allergic to one of the fillers in a certain manufacturer's generic. Then you would want to stick with brand (granted it didn't use that filler) or another company's generic.
Someone I know has been taking Levoxyl for at least the past 5 years. She has no problem with generics but the doctor prescribed Levoxyl and for some reason, CVS didn't have levothyroxin as a generic sub for Levoxyl (it was only a sub for Synthroid). Now, CVS has changed it so that it does come up as a generic sub. From what you said, it seems as if she should stick with Levoxyl. It's not a monetary issue since the copay is the same, but wouldn't it be better for everyone (except Levoxyl's company) to go with the generic? It would save the insurance company money and in turn the members (particularly if its a non profit organization).
Should I tell her to change to the generic or stick with Levoxyl since she's been taking it for a long time now? The main reason for the question is that I don't know if there was a reason it didn't come up as a sub before or if the difference of inactive ingredients would make a difference here since its a low therapeutic index drug (assuming she's not allergic to either). I'm in Rutgers Pharmacy School right now. But I'm only in the first professional year so I can't answer this question (looks like it could be a therapeutics issue). I would really appreciate any comments on this.
I do agree that with the narrow TI drugs, switching might be more of a concern, but I don't think it's a reason not to switch. The patient and his/her doctor just need to be aware that there might be some fluctuations in serum drug concentrations during the switch...so the doctor just needs to monitor the patient more frequently during this time and be aware that the dose may need to be adjusted (i.e. 112 mcg Levoxyl may correlate to 125 mcgh of levothyroxine for that patient). If the patient will be compliant with coming in for blood tests (checking the INR with warfarin, checking TSH with levothyroxine), then go for it. One of our professors also said that switching to generic phenytoin was also problematic at times.
I didn't think any products were AB rated for Synthroid...Does NJ not use the Orange Book? Or have I just confused it with one of the other thyroid preps?! Anyone have any insight?
I've always said they were the same thing.
but I recently changed OC to a different generic (Microgestin to Junelle)
HUGE difference. moodier, crampier, n+v, etc etc etc.
makes me not want to change other meds that just went generic and pay the $$ for brand. I've decided patients aren't always full of crap and it's not just a placebo effect as I didn't expect any change at all and it took me a couple weeks to realize that if I miss one and take 2 of these at night I will feel like crap in the morning and quite possibly throw up. Never was an issue in the past.
All states use the orange book.
Just don't change back & forth between brands unless absolutely necessary (as in the last recall of about 6 months ago).
As difficult as your own personal situation was, it probably would be an outlier in the statistics - both if we measured hormone levels and things like FSH, LH, etc....
The issue here is - you may not have reacted well to the switch. You can either spend a few months getting adjusted & using other means of contraception &/or readjusting the hormones (the Microgestin might have actually been LESS bioavailable!)....or you could go back to what you were on previously.
However, one acedotal report (which yours is - altho not meant to diminish it - it is just trying to put it into perspective of the numbers of drug experiences) does not change recommendations for switching. We base on large numbers only - not just a few.
Best of luck!
oh I absolutely agree. I just now think it's not all placebo effect and maybe some of the little old ladies aren't full of it when they claim things are different between generics or generic/brand. I've only had the one month retail rotation (and in the hospital almost everything is unit dose or pre packaged so I don't have to smell it) but I remember there were a couple FOUL smelling generics. that alone would be incentive to pay up for the brand.
this may very well have been an outlier case but it has helped me keep that +/- 10% difference in perspective.
Sorry about the last post. I don't know how that happened but I didn't mean to repost this morning. Thanks for the help.
Hmm...I've worked for the past 4 years for CVS, and I've heard everything under the sun about how generics are different, they're allergic to generics (in general, mind you), they know that generics are different from brands, etc... However, in theory, you should be able to switch any generic for any brand and vice versa as long as they are AB rated. The only medication that I've ever heard of was already mentioned, that being the Levoxyl/levothyroxine, but that was all before an AB-rated generic came out and they recalled the old generic.
Whenever I have a patient that is concerned about getting a gereric medication and whether it's the same as the brand, I always tell them that they have to be. Otherwise, the FDA would not allow the dispensing of those generics. This usually persuades the patients to save themselves money, and I've never had a patient come back to say that the generic "didn't work." If the medication did, in fact, lack the same efficacy as the brand, then that's in the hands of the generic manufacturer, not the pharmacy itself.
You'd think people would pay attention to other real world brand/generic substitutions that seem to slip under the radar. Think about it. Con Agra has a slip up in a peanut butter packaging plant. What gets affected? Great Value (I consider Wal-mart brand generic here) and Peter Pan. E.Coli outbreak in spinach farm/packaging plant and how many different brands/generics get yanked from the shelf. The only difference I see is people don't equate other products with drugs. If a retailer tried sticking iceberg lettuce as generic romaine everyone would go nuts. The only reason they don't sell as often as brand is they're thought to be of "lesser value" bring up Peter Pan vs Great Value and I think that tends to fade a little. Not sure how that would work with a real customer who already knows everything though.