Metformin Brand-Generic Substitution

Discussion in 'Pharmacy' started by pharmalt82, Mar 30, 2013.

  1. pharmalt82

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    Is this correct?

    BRAND-NAMES
    Glucophage 500, 850, 1000
    Glucophage XR 500, 750
    Fortamet 500, 1000 [a 'special' XR fomulation of Metformin, max 2500 as per PI]
    Glumetza 500, 1000 [another 'special' XR fomulation of Metformin, max 2000 as per PI]

    GENERIC-NAMES
    Metformin 500, 850, 1000
    Metformin ER 500, 750 (No ER 1000?)

    My understanding is that only Glucophage and Glucophage XR have cheap generic substitutes.

    Glumetza does not have a generic but you can recommend that the patient give generic Metformin ER a try to save money.

    Fortamet has the following generic: NDC - 68180-0336/7 (Lupin's 500 and 1000mg Metformin ER - high WAC on Red Book Online, but a lot lower than the brand). So, if a doctor writes Fortamet without 'DAW,' you MUST (New York State) substitute with the relatively-expensive-but-cheaper-than-brand generic by Lupin.
     
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  3. zelman

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    Mostly correct, except that you contradict yourself regarding the 1g ER generic (it exists) and you forgot Riomet, the oral liquid product.

    Max dose for glucophage & Riomet is 2550mg daily, Fortamet is 2500mg and everything else is 2000mg
     
  4. pharmalt82

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    Metformin Brand-Generic Substitution - As of 03312013

    BRAND-NAMES
    Glucophage 500, 850, 1000 [max 2550 as per PI]
    Riomet 500mg/5mL [max 2550 as per PI]
    Glucophage XR 500, 750 [max 2000 as per PI]
    Fortamet 500, 1000 [a 'special' XR fomulation of Metformin, max 2500 as per PI, OSM aka Osmotic Release]
    Glumetza 500, 1000 [another 'special' XR fomulation of Metformin, max 2000 as per PI]

    GENERIC-NAMES
    Metformin 500, 850, 1000
    Metformin ER 500, 750 (Glucophage XR Generics)
    Metformin OSM ER 500, 1000 (Fortamet Generics)

    Only Glucophage and Glucophage XR have truly cheap generic substitutes.

    Glumetza does not have a therapeutic equivalent but you can recommend that the patient give generic Glucophage XR a try to save money.

    Fortamet has only the following generic: NDC - 68180-0336/7 (Lupin's 500 and 1000mg Metformin ER - high WAC on Red Book Online, but a lot lower than the brand). So, if a doctor writes Fortamet without 'DAW,' you MUST (New York State) substitute with the relatively-expensive-but-cheaper-than-brand generic by Lupin. Mylan is attempting to come out with a therapeutic equivalent.

    Riomet does not have a therapeutically equivalent generic, but there are compounding formulas for Metformin Suspensions and you could just crush the regular release tablets and eat them with applesauce if necessary and possible.


    DOES THIS SOUND GOOD?
     
    #3 pharmalt82, Mar 31, 2013
    Last edited: Mar 31, 2013
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  5. pharmalt82

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    Also, I've seen plenty of patients who complain that the generic glucophage xr or generic fortamet does not seem to be reducing side-effects to the same extent as the brand-name. On the other hand, I've also seen people who claim that one manufacturer of generic glucophage xr is better for them than another.
    Anyone else have any experience with this?
     
  6. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
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    Someone claim that the generic has more side effects than the brand? No I can't say I have ever heard of anything like that.
     
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  7. pharmalt82

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    I mostly dismiss claims of generics not being effective or causing problems when it comes to something like Norvasc or Lipitor. But, I don't ignore these claims with ER versions of drugs. I allow the patient to try different brands of generics especially at a private pharmacy where I have more flexibility compared to say WAGs or CVS.
     
  8. DrMarkHyman

    DrMarkHyman NOT a gynecologist!
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    What? How do you ALLOW patients to do anything?

    Metformin doesn't work anyway. It's all a big pHARMa scam.

    SDN CAM forum: http://forums.studentdoctor.net/forumdisplay.php?f=938
     
  9. npage148

    npage148 Senior Member
    PhD Pharmacist

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    I'll assume that CAM forum is an early April fools joke. Because its just sad if it is not and has no place on SDN.
     
  10. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
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    CAM is no laughing matter npage.
     
  11. Carboxide

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    I completely agree. In fact, it's downright dangerous some of the time.
     
  12. Ackj

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    We have one patient who requests a special manufacturer of metformin 500mg ER. Think it's the Sun Pharma one. Says his BGs are consistently 10-15 mg/dl lower than with other brands. It's only a few cents more than our preferred product, so we order it in for him.
     
  13. maria1oh

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    I recently had a patient complain about the Sun Pharma brand as being too big and prefer the smaller Amneal brand of metformin er 500
     
  14. waiter

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    Glumetza is crazy expensive but it now has a crazy expensive generic available
     
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  15. NateRobinson

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    First of all, why was a 3 year old thread bumped?

    Second, I don't get your response to his comment. If a patient says that a certain brand doesn't work for him/her, then order another brand. It happens. Some people are allergic to certain excipients or just their bodies just don't agree with certain generic brands.

    If you work for CVS, ordering other generic brands besides the preferred one is a freaking chore. It has to be in a certain queue, you have to call a special number before 7 pm, they only allow you to order 1 bottle per order, and you have to call every time every month. Even then, they question you as if you committed a crime. "WHY ARE YOU ORDERING THIS BRAND? WHY DOESN'T THE PATIENT USE TEVA?"

    If you're at an independent or at Rite Aid, where you can just log on and order whatever the hell you want, then I would say its your duty to order the brand the patient wants. We're all in this to provide good patient service.
     
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  17. zelman

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    Just type a prescription for yourself for the quantity you want, put it straight into out-of-stock, and delete it after it's ordered.
     
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  18. ldiot

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    Isn't there also some kind of special osmotic release metformin? I remember ordering it once
     
  19. CetiAlphaFive

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    Are you joking?
    Our duty is to provide the best outcomes for patients.
    If that means providing bad "patient service" by using your knowledge to provide education, then that's what a pharmacist should do.

    I would and have explained that no, the insignificant difference between two manufacturers of a medication does not matter. Any pharmacist should be able to articulate the reasoning behind this.

    At most, it's either placebo effect or the power of suggestion/ perception.

    If a pharmacist positively reinforces ideas that have no basis in fact or science just to please them, this could seriously impact the patient's health down the line. Who's to say that their favorite NDC of ______ will always be available.
    If it's discontinued, how will this affect their adherence?
     
  20. ldiot

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    I tried articulating this but they still wanted the yellow norco.
     
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  21. CetiAlphaFive

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    LOL.
    Too true.
    I've been dealing with a np recently that indicates which manufacturer of phentermine they want.

    Recently she's sent in duplicate scripts a few days apart with the second script saying "change in brand"
     
  22. zelman

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    Yup

     

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