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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by iamhappy on February 6, 2006, at 21:19:46
Ok, is it just me or has anyone else noticed a HUGE difference between generic Klonopin and brand name?
Posted by Gabbix2 on February 6, 2006, at 21:21:20
In reply to Brand name Klonopin, posted by iamhappy on February 6, 2006, at 17:48:55
I found them almost incomparable.
(This will probably get redirected to the meds board.)
A friend sent me some, of the real kind once, years ago when I was on it, and it was so much more relaxing, and didn 't make me as depressed as the generic.
Posted by Phillipa on February 6, 2006, at 21:22:07
In reply to Re: Brand name Klonopin » iamhappy, posted by Gabbix2 on February 6, 2006, at 19:14:47
I've heard the same thing about klonopin. Yup meds board. Fondly, Phillipa
Posted by Phillipa on February 6, 2006, at 21:51:03
In reply to Re: Brand name Klonopin » Gabbix2, posted by Phillipa on February 6, 2006, at 19:51:43
Here we are at the meds board anyone want to chime in? Fondly, Phillipa
Posted by RobertDavid on February 6, 2006, at 22:52:19
In reply to Re: Brand name Klonopin, posted by Phillipa on February 6, 2006, at 21:51:03
I've taken klonopin for 12 years. Been on both brand and generic. I got the generic at Kaiser which was a blue pill (1mg). My doctor insisted I go to brand so I did. I noticed a huge difference, much smoother, worked better on my social anxiety, lasted longer in the day, more stable refil to refil.
The FDA allows generics to very up to 20% in strenght compared to brand. Brand is brand, same each dose. My doc was one of the doctors that helped get klonopin approved for use in anxiety disorters. He was very insistant that brand would be better.
I don't think he feels that way about other drugs, but does with klonopin. I have found it less depressing as well. I pay this doctor a ton of money for the privilage to see him so I consider taking his word on brand klonopin more than just my personal experience.
Posted by JenStar on February 6, 2006, at 23:13:03
In reply to Re: Brand name Klonopin, posted by RobertDavid on February 6, 2006, at 22:52:19
So even though it's the exact same chemical formula, made the same way, the generics are allowed to have looser specs on dosage? That sucks! They should be held to the same standards, I would think.
JenStar
Posted by yxibow on February 7, 2006, at 0:31:04
In reply to Brand name Klonopin, posted by iamhappy on February 6, 2006, at 17:48:55
> Ok, is it just me or has anyone else noticed a HUGE difference between generic Klonopin and brand name?
I've never taken brand name benzodiazepines of any form. The last benzodiazepine besides Xanax XR to have a final approval date was Xanax, in 1985, introduced in 1980. There have been no new benzodiazepines produced. To understand the bioequivalency standard, one would have to read the FDA's Orange Book http://www.fda.gov/cder/orange/obannual.pdf
(warning, large PDF file)Drugs basically can have a bioequivalency of 80% to 125% (1/80%). But it gets more complicated, with confidence values that basically render tablets nearly to 100%.
The problem isn't so much that the drugs differ, the active ingredients are there... the problem lies in how the drug is delivered. The "inactive ingredients". E.g. the following drug contains cellulose, magnesium stearate, lactose... FD&C color.... These may affect how a drug is absorbed in the body and each manufacturer may use a different set of them.
Brand name Klonopin is completely outdated and a waste of money as is most brand name benzodiazepines. It also is a subtle drug and you will not feel a "kick" like some other benzodiazepines. If a doctor really believes, or if a patient really believes that the generic is not performing the same, then prescribe a slightly higher amount of the generic. The savings between brand name benzodiazepines and their original counterparts, some of which are now 46 years old, can be as much as 10 times the price.
In fact, a dose of some generic benzodiazepines, depending on the manufacturer, can be less than the copay value.
Posted by RobertDavid on February 7, 2006, at 1:00:33
In reply to Re: Brand name Klonopin » iamhappy, posted by yxibow on February 7, 2006, at 0:31:04
> I've never taken brand name benzodiazepines of any form.
Then how can you compare brand vs generic?
> Drugs basically can have a bioequivalency of 80% to 125% (1/80%). But it gets more complicated, with confidence values that basically render tablets nearly to 100%.
You pointed out the variance which doesn't make me feel comfortable, but who quoted the confidence value?
> The problem isn't so much that the drugs differ, the active ingredients are there... the problem lies in how the drug is delivered. The "inactive ingredients". E.g. the following drug contains cellulose, magnesium stearate, lactose... FD&C color.... These may affect how a drug is absorbed in the body and each manufacturer may use a different set of them.
Doesn't that mean effect could be different vs brand?> Brand name Klonopin is completely outdated and a waste of money as is most brand name benzodiazepines. It also is a subtle drug and you will not feel a "kick" like some other benzodiazepines. If a doctor really believes, or if a patient really believes that the generic is not performing the same, then prescribe a slightly higher amount of the generic. The savings between brand name benzodiazepines and their original counterparts, some of which are now 46 years old, can be as much as 10 times the price.
A doctor should perscribe a higher dose if he/she believes it's not performing as well? How would he/she know whether or not to perscribe a higher dose or lower dose especially when each maker of generic may be stronger, weaker or with different inactive ingreadiants?
I don't want to seem argumentative here and appreciate your impute, but many generics are made overseas. That concerns me. My source informing me was involved in many of the studies for using klonpin for SP, a savvy doctor/researcher not making any money selling brand who highly recomends brand of klonopin and experience treating patients with both brand and generic. I have personally noticed a difference for the better with brand. I would suggest a test for those that can afford it. Do one refil brand and see if you feel better/different. I know that's not an option for many, but if you can, wouldn't you like to decide for yourself?
I'm sticking to brand and think the 10 times cost or whatever it is worth it for me. Others I personally know who have done the same thing stay with brand after trying it.
Just my take for what it's worth.
Posted by yxibow on February 7, 2006, at 2:19:34
In reply to Re: Brand name Klonopin, posted by RobertDavid on February 7, 2006, at 1:00:33
> > I've never taken brand name benzodiazepines of any form.
>
> Then how can you compare brand vs generic?It was more a statement that brand name benzodiazepines are not prescribed any more on any regular basis except perhaps for epilepsy where tolerance is of the utmost importance because they're simply way too cheap to produce generic, and work just as well.
>
> > Drugs basically can have a bioequivalency of 80% to 125% (1/80%). But it gets more complicated, with confidence values that basically render tablets nearly to 100%.
>
> You pointed out the variance which doesn't make me feel comfortable, but who quoted the confidence value?The scientists at the FDA -- you can go argue with the Orange Book :)
>
> > The problem isn't so much that the drugs differ, the active ingredients are there... the problem lies in how the drug is delivered. The "inactive ingredients". E.g. the following drug contains cellulose, magnesium stearate, lactose... FD&C color.... These may affect how a drug is absorbed in the body and each manufacturer may use a different set of them.
>
> Doesn't that mean effect could be different vs brand?Its possible. Its a matter of delivery system. I'm not disputing that someone sensitive enough could notice a difference.
>
> > Brand name Klonopin is completely outdated and a waste of money as is most brand name benzodiazepines. It also is a subtle drug and you will not feel a "kick" like some other benzodiazepines. If a doctor really believes, or if a patient really believes that the generic is not performing the same, then prescribe a slightly higher amount of the generic. The savings between brand name benzodiazepines and their original counterparts, some of which are now 46 years old, can be as much as 10 times the price.
>
> A doctor should perscribe a higher dose if he/she believes it's not performing as well? How would he/she know whether or not to perscribe a higher dose or lower dose especially when each maker of generic may be stronger, weaker or with different inactive ingreadiants?
>
> I don't want to seem argumentative here and appreciate your impute, but many generics are made overseas. That concerns me.Actually many expensive brand name drugs are developed "overseas" by subsidiaries or contractors of large drug companies. They may or may not be produced in the US directly.
Abilify - aripiprazole - Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan.
Copaxone - glatiramer acetate injection for MS. Teva Pharmaceuticals, Petach Tikva, Israel.
Ambien - zolpidem - Sanofi-Adventis, Paris, France
Ketek - telithromycin - Sanofi-Adventis, Paris, FranceMy source informing me was involved in many of the studies for using klonpin for SP, a savvy doctor/researcher not making any money selling brand who highly recomends brand of klonopin and experience treating patients with both brand and generic. I have personally noticed a difference for the better with brand. I would suggest a test for those that can afford it. Do one refil brand and see if you feel better/different. I know that's not an option for many, but if you can, wouldn't you like to decide for yourself?
>
> I'm sticking to brand and think the 10 times cost or whatever it is worth it for me. Others I personally know who have done the same thing stay with brand after trying it.
>
> Just my take for what it's worth.I wasn't saying you couldn't try it.. but they're still around 5-10 times the price of a generic, which are largely still made in the United States.
Mylan, Canonsburg, PA.
etc.
There are a few drugs, and you have to search the Orange Book, that are listed as possible differences. These are largely drugs for life threatening conditions, where consistency must remain the same. But, one must remember, consistency can also differ at a "brand name" company. I noticed for a while that the colours were slightly different on Cymbalta 20s. Odd.This subject has been debated alot on psycho babble and I dont think this is the last of it. May you have better results if you wish.
Tidings
-- Jay
Posted by Gabbix2 on February 7, 2006, at 13:06:10
In reply to Re: Brand name Klonopin » iamhappy, posted by yxibow on February 7, 2006, at 0:31:04
> Brand name Klonopin is completely outdated and a waste of money as is most brand name benzodiazepines. It also is a subtle drug and you will not feel a "kick" like some other benzodiazepines. If a doctor really believes, or if a patient really believes that the generic is not performing the same, then prescribe a slightly higher amount of the generic.
>>That doesn't work.
I became literally, suicidally depressed when my dose was increased and was hospitalized.
Somehow then the difference in cost didn't matter as I'm sure it wouldn't to many, depression and anxiety can be fatal too.
It wasn't my imagination I wasn't expecting a difference, I'd never even thought about it actually.
I don't know how you can say the generics perform just as well when you haven't taken them.
Although I've heard that some of the generics are much better than others
This reminds me of my P-doc telling me that certain reactions I've had to medications are "impossible" and then reading this board and finding out it's actually quite a well known reaction among people who actually *take* the medication.
Posted by Gabbix2 on February 7, 2006, at 13:16:29
In reply to Re: Brand name Klonopin » Gabbix2, posted by Phillipa on February 6, 2006, at 19:51:43
> I've heard the same thing about klonopin. Yup meds board. Fondly, Phillipa
Yeah, those were the good ol' days when I knew nothing about medication and thought Clonazepam was Clonazepam. I didn't even know about brand name or generic. When I took the brand name for a while I thought "Man, rich people even get better medication"
I tried brand name Valium but it didn't make a difference to me. That V in the middle is pretty cool though :D
Posted by yxibow on February 8, 2006, at 1:04:29
In reply to Re: Brand name Klonopin » yxibow, posted by Gabbix2 on February 7, 2006, at 13:06:10
> > Brand name Klonopin is completely outdated and a waste of money as is most brand name benzodiazepines. It also is a subtle drug and you will not feel a "kick" like some other benzodiazepines. If a doctor really believes, or if a patient really believes that the generic is not performing the same, then prescribe a slightly higher amount of the generic.
>
> >>That doesn't work.
> I became literally, suicidally depressed when my dose was increased and was hospitalized.
> Somehow then the difference in cost didn't matter as I'm sure it wouldn't to many, depression and anxiety can be fatal too.Depression and anxiety are fatal when one is suicidal. I won't deny that. They're not fatal on their own, although they're a miserable experience and I've been there many times. Klonopin (or clonazepam) tends to be more depressive than other benzodiazepines, although they all can cause depression in some people. They both cause CNS depression and also affect neurotransmitters to a limited degree. Dosage needs to be adjusted for a particular patient and their needs. But I fail to see how on one hand one claims generic isnt as potent, and on the other hand, adjusting for that account (a very slight partial dose) and seeing what takes effect. If a drug truly is 80% as effective than prescribe 25% more of the generic medication. And you'll have money left over to buy a lot more things.
> It wasn't my imagination I wasn't expecting a difference, I'd never even thought about it actually.
> I don't know how you can say the generics perform just as well when you haven't taken them.
> Although I've heard that some of the generics are much better than othersI'm not saying that there couldn't be a difference between brand name Klonopin and some generics, I'm just saying its godawful expensive, and nearly no doctor or hospital prescribes brand name benzodiazepines because they've been expired for more than 20 years except for Xanax's attempt at patent extension with Xanax XR. Most anyone who is prescribed a benzodiazepine in my experience has never taken the original medication unless they're at least over 40 (no ageism meant). At Walgreens, Klonopin is like 3-4 times more expensive than generic clonazepam. At Costco its 5-8 times more expensive -- we're getting up into the new antidepressant costs like Cymbalta. And generic Valium is pocket change. In fact, scripts for benzodiazepine medication are not even written for the name of the drug any more -- they're written, clonazepam, diazepam, alprazolam (11-14x more expensive as Xanax).
> This reminds me of my P-doc telling me that certain reactions I've had to medications are "impossible" and then reading this board and finding out it's actually quite a well known reaction among people who actually *take* the medication.
Actually I agree with you there -- but a good doctor weighs what he or she has seen in evidence based psychiatry, over a large number of patients. There's also the placebo effect, believe it or not, 33% of the time that is the case. But I'm not trying to insult your judgment -- I also found out anecdotally that Trazodone causes the munchies from several people here. But that's the thing -- where do you define "well known." The board is a sounding off place where people can describe how they experience medications. But when an effect is 1% or less on a medication, its deemed fairly unlikely. People tend to post more here when they get side effects, so it doesnt mean that a particular medication is terrible, it just means that in their body, it is atrocious. Statistically, one has to examine things on a much larger scale -- where are the silent voices of people who dont have these side effects, but are still on the board. You could have 10 people with a particular side effect, but one has to realize that probably half a million people have taken that drug. That still doesn't mean your doctor shouldn't listen to what you have to say, and take that into account when prescribing medication. I don't think a good doctor should not listen to your experiences.
Cheers
- J
Posted by RobertDavid on February 8, 2006, at 1:45:32
In reply to Re: Brand name Klonopin » Gabbix2, posted by yxibow on February 8, 2006, at 1:04:29
>But I fail to see how on one hand one claims generic isnt as potent, and on the other hand, adjusting for that account (a very slight partial dose) and seeing what takes effect. If a drug truly is 80% as effective than prescribe 25% more of the generic medication. And you'll have money left over to buy a lot more things.
It's my understanding from my doctor that generic "klonopin" can be either less potent or more potent which if true causes even more concern. If a doctor assumes generic is less potent and perscribes more, a patient might get a significantly stonger batch and over medicate. As my doctor pointed out to me, as you go from refil to refil, one might have a 80% strenght compared to brand then go to a 120% strenght compared to brand which would really be problematic.
> I'm not saying that there couldn't be a difference between brand name Klonopin and some generics, I'm just saying its godawful expensive, and nearly no doctor or hospital prescribes brand name benzodiazepines because they've been expired for more than 20 years except for Xanax's attempt at patent extension with Xanax XR. In fact, scripts for benzodiazepine medication are not even written for the name of the drug any more -- they're written, clonazepam, diazepam, alprazolam (11-14x more expensive as Xanax).My doctor, the chairman of Cedar Sinai Psychiatry Dept. writes on my scripts Klonopin "brand only", he does not want me to take generic. I pay the extra cost gladly, I know not everyone can though.
> Actually I agree with you there -- but a good doctor weighs what he or she has seen in evidence based psychiatry, over a large number of patients. There's also the placebo effect, believe it or not, 33% of the time that is the case.I too believe in a placebo effect, but I'm told that's not the case concerning Klonopin based on his research and extensive use in treating patients with anxiety disorters. Seems many other meds are fine as generics. For example I see many people do fine with generic valium (though I'm not saying there may not be a variance there, just don't hear people make issue of it like I do with klonopin - perhaps that's a med that generic is just fine).
I agree that this place is a good sounding board. That's what we're doing here and I think people can take info here and further explore it with their doctors.
But for me on this topic, I feel I'm seeing one of the best Psychiatrists in the nation on anxiety disorters, paying him the big bucks for his savvy, he tells me to swith to brand, writes the scripts that way, I follow his advise and have better relief at same generic dose for my SP. That's good enough for me. It's just my 2 cents worth.
Posted by yxibow on February 8, 2006, at 11:30:28
In reply to Re: Brand name Klonopin, posted by RobertDavid on February 8, 2006, at 1:45:32
> It's my understanding from my doctor that generic "klonopin" can be either less potent or more potent which if true causes even more concern. If a doctor assumes generic is less potent and perscribes more, a patient might get a significantly stonger batch and over medicate. As my doctor pointed out to me, as you go from refil to refil, one might have a 80% strenght compared to brand then go to a 120% strenght compared to brand which would really be problematic.Not quite. There's an allowance between 80 and 1/80% (125%) of effective dose. But then we get into complicated things like AUC and blood levels, confidence intervals and statistics and it averages out closer to the original drug.
> My doctor, the chairman of Cedar Sinai Psychiatry Dept. writes on my scripts Klonopin "brand only", he does not want me to take generic. I pay the extra cost gladly, I know not everyone can though.
Just how much Klonopin are you taking that 80 to 120% makes that much of a swing ? If you're taking the equivalent of what I take in Valium, that's one thing, but most people don't. I do believe it could be interpreted as also a little snide to others who aren't as fortunate for one to mention how powerful one's doctor is. But as long as we're here, by the way, my doctor has been chairmain of two places but I don't usually drop names because that's not in the spirit of things.
> I too believe in a placebo effect, but I'm told that's not the case concerning Klonopin based on his research and extensive use in treating patients with anxiety disorters. Seems many other meds are fine as generics. For example I see many people do fine with generic valium (though I'm not saying there may not be a variance there, just don't hear people make issue of it like I do with klonopin - perhaps that's a med that generic is just fine).
I do not that much better with generic Valium than I had done with generic Klonopin.
>
> I agree that this place is a good sounding board. That's what we're doing here and I think people can take info here and further explore it with their doctors.That much I can agree and that's important here.
>
> But for me on this topic, I feel I'm seeing one of the best Psychiatrists in the nation on anxiety disorters, paying him the big bucks for his savvy, he tells me to swith to brand, writes the scripts that way, I follow his advise and have better relief at same generic dose for my SP. That's good enough for me. It's just my 2 cents worth.You can follow your good doctor's advice but if you start stacking up medications, polypharmacy, like I do, soon generic medications sound much better for the wallet. Copays go way down. Especially on PPOs.
Anyhow... tomato, tomahto... if you feel fine with your brand name Klonopin, be my guest. But you could buy someone something special for valentine's with the money saved :)
Tidings and cheers
-- Jay
Posted by Gabbix2 on February 8, 2006, at 11:42:13
In reply to Re: Brand name Klonopin » Gabbix2, posted by yxibow on February 8, 2006, at 1:04:29
Fair enough! : )
Posted by RobertDavid on February 8, 2006, at 12:07:17
In reply to Re: Brand name Klonopin » RobertDavid, posted by yxibow on February 8, 2006, at 11:30:28
>I do believe it could be interpreted as also a little snide to others who aren't as fortunate for one to mention how powerful one's doctor is. But as long as we're here, by the way, my doctor has been chairmain of two places but I don't usually drop names because that's not in the spirit of things.
First, let me say that as far as my sensitivity to others that may not be able to afford brand, I have always exressed concern over that issue when posting on this board and understand many can't afford it. I just share info here and do try to not offend anyone.And my point in mentioning the doctor who is giving me the advise to use brand vs generic was mearly to show I wasn't pulling it out of my pants and that it wasn't from some general doctor who wasn't expert and a well published doctor in the field of treating anxiety disorters. My intent was to show it was what I consider to be a credit source rather just from observation, to give others that may read these posts a sense of where the info came from. It's just more info which I think is good and would like to hear from others if they have what they consider credible sources.
As for the rest of the issues no point in going back and forth, it's okay with me that we don't agree. I'll use brand klonopin an you can use what you like and yes, you'll spend less money. I think that's all I got on this topic. Best of luck!
This is the end of the thread.
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