Quantcast

generic zoloft

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

stoic

"Time you enjoy wasting, was not wasted"
Lifetime Donor
15+ Year Member
Joined
Nov 4, 2000
Messages
7,635
Reaction score
356

Members don't see this ad.
howdy -

i've posted in another thread about finding ways to make common (ie primary care) psych drugs more affordable to pts. obviously one of the best ways is to rx for generics when available. (the pcp doc i work with works with a lot of urban folks w/o good insurance).

i've heard some news in the last month or so about zoloft going generic... and we no longer get samples of it... anyway, i've checked with a couple pharmacies and no one has generic sertraline yet, or knows when it will be in. do you guys have any info on this? generic zoloft would definately be a big relief to many of he pts i see.

thanks,
dave
 

Anasazi23

Your Digital Ruler
Moderator Emeritus
10+ Year Member
15+ Year Member
Joined
Feb 19, 2003
Messages
3,505
Reaction score
35
Novel cis-isomeric derivatives of 4-phenyl-1,2,3,4-tetrahydro-1-naphthalenamine are useful as antidepressant agents. These novel compounds act to block the synaptosomal uptake of serotonin (5-hydroxy-tryptamine), thereby alleviating serotonin abnormalities at central receptor sites. The preferred embodiment is the enantiomer cis-(1S)-N-methyl-4-(3,4-dichlorophenyl)-1,2,3,4-tetrahydro-1-naphthalenam ine and its pharmaceutically acceptable acid addition salts.

Patent expires June, 30 2006.
 

lsmurr

New Member
10+ Year Member
Joined
Sep 3, 2006
Messages
1
Reaction score
0
Although the patent has expired, Pfizer has it in litigation. The generic will likely be out by the end of this year.
 

sdn1977

Senior Member
10+ Year Member
Joined
Jul 28, 2005
Messages
3,547
Reaction score
19
Sorry....I haven't visited here in awhile. But...generic zoloft is available & has been available for approx 2 weeks. I no longer carry nor dispense brand name.

Teva, a generic manufacturer based in Israel, recently acquired Ivax, another generic manufacturer, & has a 180 day exclusive marketing rights to generic sertraline. They began shipments Aug 14. In a few months there may be more manufacturers in the marketplace.....
 

sdn1977

Senior Member
10+ Year Member
Joined
Jul 28, 2005
Messages
3,547
Reaction score
19
I should add....generic Effexor (not the XR...just the tablets) was released about the same time as sertraline.

There are others in the pipeline...I'll try to make you aware when they become available.....
 

fiatslug

Senior Member
10+ Year Member
15+ Year Member
Joined
May 9, 2000
Messages
771
Reaction score
2
is that the version that earned the nickname "side effexor"? ;)
 

tinykitty

New Member
10+ Year Member
Joined
Dec 5, 2005
Messages
5
Reaction score
0
Generic zoloft is available in wisconsin (at least at walgreens pharmacies)
 

whopper

Former jolly good fellow
15+ Year Member
Joined
Feb 8, 2004
Messages
7,336
Reaction score
2,448
If you can't find any Sertraline in your area--refer your patients to drugstore.com. Its an online pharmacy, that from my own experience is cheaper than several pharmacies in my area.

Unfortunately the price of generic Zolift isn't much cheaper than Zoloft. Further, because its gone generic--the drug rep in my area for Zoloft no longer gives samples.

We got lots of patients that need samples, but since we can't give them, and the only SSRI we got is Lexapro, some of the attendings are suggesting we treat their disorder with Lexapro even though Lexapro isn't FDA approved for their illness (e.g. OCD, PTSD). These are d/o's treated by Zoloft.

So in short, I am bugged by this. You figure if Zoloft went generic it'd make it more accessible, but at least in my own area it hasn't. The poor people can't get samples and the people that can buy Sertraline aren't saving much vs Zoloft.

So what I've been doing is prescribing fluoxetine for the OCD & PTSD or other patients who need an SSRI but can't afford sertraline. Fluoxetine goes for only about $20 a month. I still don't like it because fluoxetine is considered one of the dirtier, more primitive SSRIs.
 

sdn1977

Senior Member
10+ Year Member
Joined
Jul 28, 2005
Messages
3,547
Reaction score
19
If you can't find any Sertraline in your area--refer your patients to drugstore.com. Its an online pharmacy, that from my own experience is cheaper than several pharmacies in my area.

Unfortunately the price of generic Zolift isn't much cheaper than Zoloft. Further, because its gone generic--the drug rep in my area for Zoloft no longer gives samples.

We got lots of patients that need samples, but since we can't give them, and the only SSRI we got is Lexapro, some of the attendings are suggesting we treat their disorder with Lexapro even though Lexapro isn't FDA approved for their illness (e.g. OCD, PTSD). These are d/o's treated by Zoloft.

So in short, I am bugged by this. You figure if Zoloft went generic it'd make it more accessible, but at least in my own area it hasn't. The poor people can't get samples and the people that can buy Sertraline aren't saving much vs Zoloft.

So what I've been doing is prescribing fluoxetine for the OCD & PTSD or other patients who need an SSRI but can't afford sertraline. Fluoxetine goes for only about $20 a month. I still don't like it because fluoxetine is considered one of the dirtier, more primitive SSRIs.

Whopper - when it comes to prescription drugs, accessibility takes many forms & is not directed solely by acquisition price by the pharmacy. When I buy sertraline, I buy it at a lower price than Zoloft. But....the price that is charged to the pt is set by their insurer - not by the pharmacy they go to, unless it is a cash paying patient.

When a prescription drug becomes generic - it is usually "lowered" on the forumulary tier of insurance plans - Medicaid included. There are some which are not - a good example is the current Zocor/simvastatin controversy (which has gone to a judge for a ruling for a stay of approval last week...). Another example is Wellbutrin (not XL nor SR - just straight Wellbutrin). In my state Medicaid will pay for Wellbutrin brand only - not buproprion, which has been available for many, many years generically. Why? because of preferential pricing on other drugs within that manufacturers line of products.

The reasoning is governed by contractual agreements insurers have with drug manufacturers. The poor (I'm assuming you mean poor enough to qualify for Medicaid) are not the issue here. It is the "working" poor - those who work, altho they may have poor drug coverage (which means SSRIs are ALWAYS in the highest tier - they want you to use the older types of medications before the SSRIs, so they use economics to force that) or, what is occurring currently this Aug-Sept, are the Medicare Part D folks who are now falling into the "donut-hole" part of the plan. This means, their initial covered amount has been used up & they now pay full price out of pocket until they hit the $5000 mark, then their coverage begins again...probably about Dec 15.

So....it is very complicated when it comes to finding a drug which fits the diagnosis & the economics of the pt. Fluoxetine, I'd agree, has its issues. But...when you understand they really would rather you go back to the tricyclics...you can understand why giving fluoxetine another go would be worth a try.

No - you won't get samples from a generic company. There is no incentive for them. They don't need to market - the originator of the drug has already done that. There is no reason for the Zoloft rep to give you samples either. His company owns one of the companies which will be a generic manufacturer...so he doesn't need to "entice" you any further.

Insurance drug coverage has become a dirty business - very, very dirty! We hate it at the pharmacy level & usually try to work with the pt & prescriber to work out what will be best for that pt. But....what works this year won't necessarily be applicable next year (or for Medicare Part D folks - their forumularies can change monthly without notice!).

As for online pharmacies - yes...they will usually be able to provide a lower price for the cash paying pt by 30-45% depending on the drug. As long as you have a stable pt - a 90 day supply will be the least expensive. But...I would never, ever encourage anyone to go outside the country (with one and only one exception) to obtain medication - far, far too many instances of tampering & adulteration.

Good luck - its tough, I know!
 

whopper

Former jolly good fellow
15+ Year Member
Joined
Feb 8, 2004
Messages
7,336
Reaction score
2,448
They all work if you dose it right.

Supposedly (though as mentioned above, some drugs just don't seem to work in some patients)

Not having an FDA approval--adds a little more risk in terms of defensive medicine.

I'm going to go off on a slight tangent and mention Lexapro and its use of OCD & PTSD & Panic D.O. I've heard from several attendings that at dosages higher than 20mg, it can effectively treat those disorders. However Lexapro's parent company will not make the approved dose higher than 20mg.

I believe there is good reason to this. The company did not arbitrarily choose 20mg as their max dose.

From my own research, about 600mg of Lexapro is enough to cause fatal QT prolongation. At 20mg a day, 30 tablets is 600mg. So if a pt wanted to commit suicide--a month's supply is the upper limit to do so. Notice that the max dose is 20mg, and most doctors prescribe in units of 30 at a time?

One theory I have is the company made the limit 20mg to prevent suicides. After all, a dosage higher than that such as 40mg--well now you only need 2 weeks worth to kill yourself.

Further, there have been various side effects established at higher doses of Lexapro such as 80mg. I don't think the company figured out the side effect profile to expect at 40mg, and I think they don't want to find out the hard way.

Lexapro has a reputation for being extremely clean and almost side effect free. I believe one possible reason why its company won't make it in a dosage higher than 20 mg is they want to keep that public perception by psychiatrists. If for example it was available as a 40mg tablet--several docs won't think of it as the "almost side effect free" med anymore.

Lexapro did not get an approval for panic disorder despite an attempt to do so. From what I understand and this is anectdotal info--they could've easily acheived this had the dosage been higher than 20mg a day.

So, in short--you are right that at the right doses, in theory, any SSRI should be able to treat a d.o. that any other SSRI could treat. However despite this, I am not going to go over Lexapro 20mg Q daily in most cases. I have my reasons to believe that the 20mg max dosage is an appropriate one, though I don't know what the company's official reason for making 20mg the max.
 

Anasazi23

Your Digital Ruler
Moderator Emeritus
10+ Year Member
15+ Year Member
Joined
Feb 19, 2003
Messages
3,505
Reaction score
35
From my own research, about 600mg of Lexapro is enough to cause fatal QT prolongation. At 20mg a day, 30 tablets is 600mg. So if a pt wanted to commit suicide--a month's supply is the upper limit to do so. Notice that the max dose is 20mg, and most doctors prescribe in units of 30 at a time?

By 'research' you mean you're clinical experience? Bench research (LD50, etc) in rats? This is interesting.

Even Stahl mentions the upper limit of rx'ing lexapro at 40mg, which for him, is conservative in comparison...this is in line with what you're saying.
 

OldPsychDoc

Senior Curmudgeon
Moderator Emeritus
15+ Year Member
Joined
Dec 2, 2004
Messages
6,349
Reaction score
4,231
... But...I would never, ever encourage anyone to go outside the country (with one and only one exception) to obtain medication - far, far too many instances of tampering & adulteration.


Do tell, what's the acceptable exception? Canada in general? Or a specific drug, like moclobamide, which is unavailable here?
 

stoic

"Time you enjoy wasting, was not wasted"
Lifetime Donor
15+ Year Member
Joined
Nov 4, 2000
Messages
7,635
Reaction score
356
generic zoloft is still not available in KS.

and that's an interesting discussion about the max daily dosage of lexapro. It's also struck me as odd that there's such a narrow dose range for lexapro, especially because its such a good drug. i've seen a few pts on 30mg/day, but never more than that. (keep in mind though, that i have very limited clinical experience... family medicine only). do you psychiatrist type folks put people on 30 or 40mg/day on a regular basis? ever higher? what's the ssri of choice for OCD? Is zoloft at 200mgs/day "cleaner" than lexapro at 40mg/day?

thanks for the edumacation,
dave
 

whopper

Former jolly good fellow
15+ Year Member
Joined
Feb 8, 2004
Messages
7,336
Reaction score
2,448
By 'research' you mean you're clinical experience? Bench research (LD50, etc) in rats? This is interesting.

Even Stahl mentions the upper limit of rx'ing lexapro at 40mg, which for him, is conservative in comparison...this is in line with what you're saying.

Every single case that's been published where someone reached potentially fatal QT prolongation (and its not that many patients, I think its only around 12 tops) on Lexapro was at about 600 mg.

Further, if I remember correctly, the same corresponding dose of Celexa was about the same needed for the same effect.

Further when the same thing happened to dogs, it was at their equivalent of 600mg, when adjusted for their body weight.

I know that 12 patients isn't exactly a large sample size, but the effect in dogs and the celexa had higher sample sizes and the dogs-well if I remember correctly they had a huge sample size.

I used to work with a Ph.D. in pharmacology who developed new meds. You got to remember, the drug companies set the limits for medications for a marketing reason. There's got to be a reason why they chose 20mg as their maximum dose when they could've made it 30 or 40mg and been able to get more FDA approvals for other disorders.

I started extensively researching (lit searches) Lexapro after one of my patients overdosed on about 600mg and got the near fatal QT prolongation.

After the event, I told the other residents I work with what had happened, and mentioned that since 600mg seems to be the magic number as far as I can tell, that giving out 40mg in a patient with a history of OD'ing is dangerous. With only a 2 week supply--they got enough to take out 2 people--when they are given their typical month's supply.

We as doctors ought to know our meds more than on the simple level of just giving it at the prescribed dosages. Further, if we decide to go over the manufacturer's reccomended limit, we ought to know what exactly is going to happen to the patient and why, if any reason did the company set that limit.

The manufacturer of Lexapro as far as I know did not give out their reason for making 20mg's the top dosage, but after I did my lit searches, I have my own little conspiracy theory.
 
Top