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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Racer on April 28, 2004, at 12:10:57
I've heard that the generic benzos can have a lot of variability in their composition. Can anyone direct me to any reputable websites about this? I've got a lot of anxiety about seeing my doctor and having to explain why I think that the drugs I got last time were 'bad', and would like some ammunition to take in with me. I"m afraid that if I go in and say, "gee, Doc, I took my usual dose and it make me so agitated and wired and I couldn't sleep and started shaking so bad..." well, you can see that that sounds kinda crazy, right? So, if anyone can link me to any sort of reputable website that a doctor might believe, saying that the generics aren't always as reliable as the name brands, that would help relieve my anxiety a great deal.
Thanks!
Posted by chemist on April 29, 2004, at 0:08:54
In reply to Generic Xanax variability?, posted by Racer on April 28, 2004, at 12:10:57
> I've heard that the generic benzos can have a lot of variability in their composition. Can anyone direct me to any reputable websites about this? I've got a lot of anxiety about seeing my doctor and having to explain why I think that the drugs I got last time were 'bad', and would like some ammunition to take in with me. I"m afraid that if I go in and say, "gee, Doc, I took my usual dose and it make me so agitated and wired and I couldn't sleep and started shaking so bad..." well, you can see that that sounds kinda crazy, right? So, if anyone can link me to any sort of reputable website that a doctor might believe, saying that the generics aren't always as reliable as the name brands, that would help relieve my anxiety a great deal.
>
> Thanks!chemist here...go to the FDA online orange book for therapeutic dose equivs...bts, all the nezos are AA or AB, which is excellent.....best, chemist
Posted by Racer on April 29, 2004, at 11:53:04
In reply to Re: Generic Xanax variability? » Racer, posted by chemist on April 29, 2004, at 0:08:54
Thank you so much for responding, and I hope you'll be willing to respond again once I make the problem clearer. I had a bad experience with generic Xanax. I had been taking it regularly, with no problems, worked consistently, worked well, etc. Then, the first time I took it from a new prescription bottle, it suddenly didn't work. Worked fine on Tuesday, didn't work on Wednesday. Tuesday it knocked me out, just like it was supposed to do. Wednesday, no sleep at all, racing thoughts, agitation, even mild tremors. Thursday, same deal -- despite taking more than double what I had been taking. Friday, the mild tremors were full body shaking and jerking, and I was vomiting and just not very comfortable. (I spent the entire night on the living room floor, crying and really miserable.)
The doctor's office just said that there couldn't be anything at all wrong with the xanax, so keep taking everything just as prescribed and come back in a month for my regular appointment.
I know I've read things online about generic benzos sometimes not being reliable, and am hoping to find something to take in to the doctor about that, since otherwise I expect that I'll get the "but generics are the same as name brands, etc" lecture. Generally, I believe that generics are equivalent to name brands, but I also know that I didn't imagine what happened, and I really don't want to hear -- again -- that I did. Do you have any reputable sources for me?
Thank you so much! I really appreciate your answering my post, and hope that you'll answer again.
Posted by chemist on April 29, 2004, at 13:09:40
In reply to Heheheh, guess i wasn't clear.... » chemist, posted by Racer on April 29, 2004, at 11:53:04
> Thank you so much for responding, and I hope you'll be willing to respond again once I make the problem clearer. I had a bad experience with generic Xanax. I had been taking it regularly, with no problems, worked consistently, worked well, etc. Then, the first time I took it from a new prescription bottle, it suddenly didn't work. Worked fine on Tuesday, didn't work on Wednesday. Tuesday it knocked me out, just like it was supposed to do. Wednesday, no sleep at all, racing thoughts, agitation, even mild tremors. Thursday, same deal -- despite taking more than double what I had been taking. Friday, the mild tremors were full body shaking and jerking, and I was vomiting and just not very comfortable. (I spent the entire night on the living room floor, crying and really miserable.)
>
> The doctor's office just said that there couldn't be anything at all wrong with the xanax, so keep taking everything just as prescribed and come back in a month for my regular appointment.
>
> I know I've read things online about generic benzos sometimes not being reliable, and am hoping to find something to take in to the doctor about that, since otherwise I expect that I'll get the "but generics are the same as name brands, etc" lecture. Generally, I believe that generics are equivalent to name brands, but I also know that I didn't imagine what happened, and I really don't want to hear -- again -- that I did. Do you have any reputable sources for me?
>
> Thank you so much! I really appreciate your answering my post, and hope that you'll answer again.hi racer, this sounds very unusual and you have my empathy/sympathy for your recent misery...let me fill you in a little on the generic biz, and offer some suggestions, if i might...when a company secures a patent for a new drug, they own the exclusive rights to manufacture and, by extension, receive compensation for said drug until the patent expires. there are several generic ``houses'' that come into the picture in the year or two before the patent expires. the generic manufacturer must be first in line with the FDA (i do not know if you are in the US, but i am and will use the procedures i know about here) to be granted the exclusive rights to market the generic for 6 months from the time the patent on the name brand expires. after 6 months, any manufacturer can (and will) market their own generic. hence, the 6 months of exclusive manufacture/marketing of the generic are very, very important from the revenue standpoint. the generic company will (literally) stockpile large amounts of the drug and ship the minute (yes, the minute!) the patent for the brand name expires. so, for example, take the allergy medication Claritin. the drug company Novartis used to own a subsidiary called Geneva Pharmaceuticals (now owned by Sandoz), which was devoted entiely to making generics. Geneva was the first in line to get approval of their generic version of Claritin, so when Schering's patent expired, all the good, cheap loratadine - which, incidentally, was approved for over-the-counter (OTC) sales at roughly the same time - came exclusively from Geneva. so Geneva makes all their money in those 6 months, and you have no choice but to buy brand-name from Schering or generic from Geneva. then, at the 6-month point, all the others get in on the act, including Schering, but mostly generic houses like Teva and Watson. so: how does Geneva make money? 6 months of sales are a lot, but what did they do to get FDA approval (besides filing first)? they use the same active ingredient - loratadine - but they skimp on things like the stuff that holds the pill together (binders) and stuff that allows the drug to enter your system after you ingest (dispersants). generic houses do not do synthesis: they are like bakeries, and they buy all the raw material from the lowest bidder, then use their own recipe for the lowest manufacturing cost while producing a pill that *according to the FDA* is either demontrated to be totally bioequivalent to the brand-name (this is rare, but happens, like Barr's formulation of dextroamphetamine, Dexedrine) or, more likely, has shown to be good enough by using certain metrics. in my experience, drugs that are formulated in pill form (as generics) usually turn out in the second category (AB). you run into trouble with things like capsules (does the capsule degrade in your gut as fast/slow as the original?) and especially ointments and gels, where a cheaper binder does not allow the therapeutic dose to be delivered transdermally as in the case of the brand-name. about your xanax: the FDA therapeutic equivalance of every one is AB. this means that any generic - be it from Mylan, Ivax, Purepac, Sandoz, Teva, Watson, or Alphapharm - ought to be as good as the brand-name from Upjohn. however, the side-effects you mention could be the result of a bad batch of the drug (perhaps it has sat around for a while and degraded to the point where there was very little alprazolam in it), a batch where there was very little alprazolam to begin with, or contains an ingredient used for coloring that you are allergic to (a common on is tartrazine, and if you have an aspirin sensitivity, this will do it...it is also known as FD&C yellow #5). the first scenario is unlikely, given the amount of generics being shipped out; the second is almost unheard of, given the very, very tight quality assurance/quality control (QA/QC) measures enforced at the generic houses. which leaves the third or, possibly, that your pharmacist gave you tablets that were half the strength of the ones that were prescribed, i.e., your script was for the 1 mg tabs and you got the 0.5 mg ones instead, and given the short half-life of elimination of alprazolam from your system, you went into an abrupt taper. finally, you could have gotten a different drug entirely if your pharmacist (or more likely, assistant) grabbed the bottle of Xeloda (an anticancer drug) off the shelf. this happens quite frequently with name brands, as your generic alprazolam would not be on the shelf near Xeloda, but Xenical would. all of this said, the therapeutic equivalence of any drug can be found using the link in my previous post, to the FDA's online Orange Book. i realize this has been a long lecture with few answers, but i think you might have an allergy to an ingredient in a generic from a specific company or that you were given an entirely different drug. one way to fid out: ask your doctor to make your prescription for Xanax and ask her/him ``to dispense as written.'' (DAW). you will get the brand-name Xanax (and pay for it!) and can confirm that maybe - and this is possible - you can only tolerate certain generics due to the formulation. all the best, chemist
Posted by Kon on April 29, 2004, at 13:13:07
In reply to Generic Xanax variability?, posted by Racer on April 28, 2004, at 12:10:57
I think overall the difference between generics and brand-names is not significant and all of the web-sites devoted to pointing major differences are IMO bogus(although brand-name companies would like you to think otherwise). You will find in the literature a few studies suggesting some differences. The majority of such studies are funded by brand-name companies (bias?). But here's an older article where one such reaction in one patient to generic xanax was believed to occur. You'll have to hunt down the journal article from the university library, however. It was for Apotex brand from Canada.
Ross CA. Am J Psychiatry. 1991 Nov;148(11):1607. Adverse reaction to generic alprazolam.
Posted by Escher Dementian on May 2, 2004, at 5:09:12
In reply to Re: Generic Xanax variability?, posted by Kon on April 29, 2004, at 13:13:07
i have had an adverse reaction to two generics that did not occur while taking the brandname versions.
One was Adderall, and the other was Xanax.
i do not take Xanax regularly, but was treated for PTSD "terror episodes" for a period close to a year. i found the very same difference that you did, Racer.When i noticed the difference in my Adderall this past year, i phoned the pharmacy/apothecary that i trust and also has ND, & Homeopathic trained pharmacists on call for answering questions, and asked them why i was experiencing "something different". The actual container was located, and it was revealed that the brandname company had changed their 'inactive' ingreds., and YES some people can have a sensitivity to any of the various inactive ingredient formulas that are used. There are also _very many_ different companies that produce and supply the generics to pharmacies, all of which are bound by law to contain the correct dose of the actual medicine, but can and DO vary in the inactive ingreds.
My best to you,
Escher
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