Posted by bleauberry on July 15, 2009, at 5:30:40
In reply to Re: Nortriptyline Generic or Brand Favorites?, posted by linkadge on July 14, 2009, at 19:46:01
> I personally don't see how this is possible.
Well. actually, neither do I. But you and I do not have 25 years worth of patient experience either. I guarantee you my doctor would not be doing this just for grins. And being generics, there certainly isn't any under-the-table motive involved. He has seen what he has seen. Different is different.
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> Nortriptyline is nortriptyline.I was reading some chemistry stuff last night on this topic. Actually, nortriptyline is not nortriptyline. The end molecule looks the same, yes, but it has finite characteristics that are different depending on the actual manufacturing process, crystalization, and a bunch of stuff that is over my head I didn't understand.
>The molecule is identical whoever manufactures it. With some generics I can see an argument that it is less bioequivilant than another.
Even the generic companies themselves admit in writing that bioequivelance does not equal therapeutic equivelance. There is a 7% allowable error in the amount of the drug. There is a 20% allowable error in the bioequivelance of the drug. FDA rules. None of them have been tested for "clinical" effectiveness. In private studies where they were, differences were noted, but not found to be significant enough for the FDA to take action. Of course, that is on a large group average and in doing so waters down what happened on individual bases.
Something else that is important is that the supposed bioequivalance is measured with a single dose, a single blood sample, in HEALTHY volunteers. I'm sorry, none of those things are in any way realistic with the real world of doctor's offices and prescribing guidelines.
>With nortriptyline there is a blood test to determine what level the drug is at. If a doctor uses a blood test, he can find a blood level that works, then it really shouldn't matter what brand is given as long as the drug level is the same.
But it does. One either has to be blind or extremely arrogant to immediately dismiss the reported cases with a shrug of a shoulder.
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> My 2 cents.
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> Linkadge
>
>I will try to find the article I read last night the explained all this stuff very well and then post it here for you to read. There is actually a lot more involved here than what we see at a mere glance.
poster:bleauberry
thread:906750
URL: http://www.dr-bob.org/babble/20090709/msgs/906823.html