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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by dondon on April 3, 2006, at 21:16:49
Are generics weaker than name brand?
Posted by Racer on April 3, 2006, at 21:55:00
In reply to are generics weaker, posted by dondon on April 3, 2006, at 21:16:49
No, they have to have the bioequivalent availability as the brand name. The changes aren't to the active ingredient, but the binders. (Usually. Sometimes there's no change, really...)
Hope that helps.
Posted by Phillipa on April 3, 2006, at 22:45:56
In reply to Re: are generics weaker, posted by Racer on April 3, 2006, at 21:55:00
It depends there's a 20% leeway either way. the binders affect the way the med works. Not all of them. you have to try and see. Love Phillipa
Posted by RobertDavid on April 4, 2006, at 1:26:58
In reply to Re: are generics weaker, posted by Racer on April 3, 2006, at 21:55:00
Yes, they are different, variations in dose compared to brand which could mean significant differences refil to refil. If you got one refil that was say, 20% on the low side and the next batch that was 20% on the high side you'd definately have issues, a possible 40% change in dose.
My doc said when klonopin went generic, that the patients he was treating with it suddenly started having significant problems. When he switched them back to brand, the problem was eliminated, the 20% variance and perhaps other changes in ingredients did make a difference according to him.
I take klonopin and he writes on my scripts "brand only." He doesn't want me to waste my money as it does cost more, but I had problems when I tried brand without telling him. My condition was worse during that time. It's definately better now.
I know others will dispute this and I'm not looking for an argument here, but I realy believe it to be true.
If I was taking a drug on a prn basis I probably wouldn't be as concerned. That said, I do think there are many drugs that are fine as generics, that brand isn't necessary with every drug.
Just my take..
Rob
Posted by blueberry on April 4, 2006, at 20:40:37
In reply to are generics weaker, posted by dondon on April 3, 2006, at 21:16:49
There is mounting evidence that generics are not equal. For example, a recent study with celexa showed that many people who were already stable on brand celexa relapsed beginning in 8 days after they had been unknowingly switched to generic. They recovered again after being switched back to brand.
Personally I can tell a subtle difference between brand prozac and generic. I can tell a big difference between brand remeron and generic.
Even though the drugs are basically the same, there may be different methods for arriving at the same molecule. And even just the tiniest little indetectable difference in a molecule or how that molecule was created can be a big thing when you're talking about the brain.
The debate goes on. But more and more there is evidence in scientific literature, like with celexa for example.
Posted by yxibow on April 5, 2006, at 1:08:47
In reply to Re: are generics weaker, posted by blueberry on April 4, 2006, at 20:40:37
> Personally I can tell a subtle difference between brand prozac and generic. I can tell a big difference between brand remeron and generic.A lot of this can be explained by placebo, whether you believe it or not. Medications take a time period to change the brain unlike ECT, and it is unlikely that a blind "taste test" between a generic and "the real thing" on a given day could be detected easily.
We've argued this back and forth across the board and I'm sure this will be the 3rd or 4th argument.
Basically, if one is taking a generic (and there really is no need to take brand name benzodiazepines since the generics are cheap as dirt and the last produced one besides Xanax XR was in the 80s) -- one should consistently take the same manufacturer, or insist at the pharmacy on the same supplier. Then there will be no "inconsistency" if there is.
But as mentioned by other posters, binders, fillers, they all affect things too, and have nothing to do with the active ingredient. They may be detectable simply because they're absorbed in a different way.
Tidings
Jay
Posted by bassman on April 5, 2006, at 13:19:18
In reply to are generics weaker, posted by dondon on April 3, 2006, at 21:16:49
This is one of those over-intellectualized things. If a med has the same active molecule and achieves the same blood levels, then it has to have the same effects, right? So generics would always be the same as brand name, other than the fact that they can be off by 20% from the brand name in bioavailabilty. But the real-world data is different- a study I read yesterday where Xanax was changed to a generic without telling the folks on the study caused severe withdrawal-no placebo effect there; they didn't know. I think for psychoactive meds, you're always better off trying them initially as the brand name-then if they don't work, it's because they didn't work. After you have a med that works and want to try the generic, just pay attention to whether the med conitues to work in the same way-and if it doesn't-try going back to the brand name before giving up. That's my 2 cents.
Another way of thinking about it: take alcoholic beverages: same active ingredient, so if you any of them to the same blood level, they will affect you identically, right? (the "generics are equivalent" argument). Is that your experience, that wine, beer, whiskey, etc. affect you the same way?
Posted by yxibow on April 6, 2006, at 1:39:48
In reply to Re: are generics weaker, posted by bassman on April 5, 2006, at 13:19:18
> This is one of those over-intellectualized things. If a med has the same active molecule and achieves the same blood levels, then it has to have the same effects, right? So generics would always be the same as brand name, other than the fact that they can be off by 20% from the brand name in bioavailabilty.
They can be off, but they rarely are off by that much, that is just a legalese. Its really more in the binding ingredients that make a difference, if at all.
But the real-world data is different- a study I read yesterday where Xanax was changed to a generic without telling the folks on the study caused severe withdrawal-no placebo effect there; they didn't know.
Hmmm.. is this a peer reviewed journal ? I'd be curious of that study. I would say that perhaps the most sensitive of people might have that problem, only because of Xanax's short half life, which can be equal or less than 4-6 hours in some people's chemistry. I'd be cautious of such a study too, because Xanax is the only benzodiazepine currently being "patent extended" by Xanax XR.
I think for psychoactive meds, you're always better off trying them initially as the brand name-then if they don't work, it's because they didn't work.
Well, some psychoactive meds are so old that the brand name isn't even around any more.
After you have a med that works and want to try the generic, just pay attention to whether the med conitues to work in the same way-and if it doesn't-try going back to the brand name before giving up. That's my 2 cents.
But it doesn't matter if it "works" as generic or "works" as "the real thing" -- as long as you're still getting the same generic... or the same "real thing." In fact, even the real thing is allowed to vary too. I've seen oddities in things like colours of "real" Cymbalta pills varying from dose to dose.
Unfortunately its much more than 2 cents... some health plans won't cover the brand names or will charge large copayments. Just looking at the price differences between brand name benzodiazepines and their generics is astronomical.
>
> Another way of thinking about it: take alcoholic beverages: same active ingredient, so if you any of them to the same blood level, they will affect you identically, right? (the "generics are equivalent" argument). Is that your experience, that wine, beer, whiskey, etc. affect you the same way?That has more to do, at least with some alcoholic beverages, the inactive constituencies, again... the binding arguments. Some people are very sensitive to sulfur dioxide which is in most wines. Beer can have fish filings and eggs in it to foam it up. Who knows what's in a wiskey barrel.
Posted by mike99 on April 6, 2006, at 5:51:46
In reply to Re: are generics weaker » bassman, posted by yxibow on April 6, 2006, at 1:39:48
I was excited when generic flonase recently became available (in the us), but I have personally found it inferior to the brand.
Posted by bassman on April 6, 2006, at 14:14:31
In reply to Re: are generics weaker » bassman, posted by yxibow on April 6, 2006, at 1:39:48
Looks like we both have our minds made up on the value of generics; as probably areo any readers of this thread. Just to answer your questions: Perhaps you recall the generic house scandals, where the bioavailability failed for the generic house formulations, so they bought the brand name and used that. So sometimes, the generic house formulations don’t work at all. No one think that’s still isn’t going on in some form.
Yes, the Xanax generic caused withdrawal after Xanax was in a peer-reviewed journal. Valium, Tofanil are a very old meds-you can still them as the brand name.
”Unfortunately its much more than 2 cents... some health plans won't cover the brand names or will charge large copayments. Just looking at the price differences between brand name benzodiazepines and their generics is astronomical.”
The price difference to the pharmacist is huge, too. The pharmacies don’t make a lot of money on brand names, they do make a lot of money on generics.
With alcoholic beverages not being equivalent, I meant in terms of intoxication (the drug effect, if you will), not reaction to sulfites, other organic ompounds, etc. Many people can’t drink vodka, which is the purest of the alcoholic sources, although they can drink the much more complex beer and wine.
I just don’t like the idea of chronically taking meds that were made by the cheapest possible process, with untested (although small amount) impurities, on a formulation that has not been tested in a bizillion people, like Phase III trials for the brand name, and shown to be reasonably safe and effective. If I’m going to be used as a test subject for a new formulation, please, give me my meds free.
My bias is no doubt from being a pharmaceutical research chemist and seeing analytically the difference between generic and brand name. I really wish I could say (being a very frugal person), “get generics, they’re really the same thing”, but in my experience, that’s not always the case. Pharmaceutical companies do a lot of things that aren’t very socially friendly, but they do make quality products-not for any eithical reasons, it’s just because it doesn’t make sense to cut corners when you are making a billion dollars (literally) a year on a product. For a generic house, the lowest cost/quality that passes specs is the goal. Thus my advice, which comes down to, “be careful”.
This is the end of the thread.
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