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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by bleauberry on March 26, 2009, at 18:09:51
This topic comes up from time to time. After having an enlightening talk with my doc yesterday about this, I thought I might bring it up again just for grins and interest.
The controversey between the generic-versus-brand issue is real. Most deny any difference, including the FDA.
The real world tells a different story though, at least in one doctor's office.
My doc is a renowned LLMD. People travel far and wide to see him for complicated illnesses. He sees more than his fair share of Lyme, Fibro, CFS, Depression, Anxiety, and most of these patients are also of poor health as a result of their mysterious diseases that other doctors say they don't have, and they are sensitive.
Story 1. A patient has stabilized on brand Zoloft. He is well for 3 years. In a short time he deteriorates. Doc is puzzled. Asks if the pills have changed. Yes, they are now generic per the insurance company. Patient did not know of the change. Doc didn't know. Doc sends letters and calls the insurance company. Finally gets a head honcho to reverse the decision and put the patient back on generic. Patient is again stabilized in a short time.
One of many examples my doc had to share. Since I was his last appointment of the day, and we seemed to click on this topic, we sat and chatted about it for a good while on free time.
The worst offenders in his clinical experience are:
Wellbutrin vs Bupropion
Prozac vs Fluoxetine
Zoloft vs Sertraline
Celexa vs Citalopram
Klonopin vs Clonazepam
Gabapentin vs NeurontinI personally added Xanax and Lamictal to that list based on my own experiences.
In those cases, he argues that if a patient starts on a generic and does not have a robust response, they need to be switched to brand before considering a different drug. In his experience, it is that much of a difference. He says most of those patients perk right up with a nice response when they get the brand name drug.
On the other end of the spectrum, he has discovered a couple drugs that work better as generics than brand. They were non-psychiatric drugs. He had patients stabilized on brand name pain pills, who then got switched to generic, and their pain control became even better than the brand.
So the generic vs brand thing works both ways, but usually in large favor of the brand.
In situations where generic is better than brand, he keeps close tabs on exactly which generic company it is that is making the good one. Generic does not equal generic. There are differences even among the generics.
There is no science behind this. It is pure clinical observation over years with hundreds of patients. Just open eyes and logic. So many doctors or scientists want to "explain" something, yet pay no attention to the obvious.
I like that my doc doesn't try to explain why these things happen, only that they do, and that they are significant enough to duplicate over and over.
So next time someone is not doing well on their med, check to see if it is generic. If it is, it could be a more rewarding and easier trial to simply switch it to brand rather than a totally different drug. If you were this doctor's patient, that's what would happen. Purely based on a bunch of success doing it.
Posted by Zyprexa on March 26, 2009, at 20:33:19
In reply to Generic versus Brand Meds, posted by bleauberry on March 26, 2009, at 18:09:51
I'm scared of when zyprexa goes generic. Hope one of them are good.
On the other hand. I've found that the Sandoz version of perphenazine is far better than the other generic. Never tried the brand version. But I like the sandoz version a lot.
Posted by myco on March 27, 2009, at 10:41:14
In reply to Generic versus Brand Meds, posted by bleauberry on March 26, 2009, at 18:09:51
I'm curious about this. I've heard many a debate over this but don't have the experience with a variety of meds to compare. I did notice "something different" when comparing brands of alprazolam (both gens I think) but wasn't enough to put me off either.What exactly does say, Wellbutrin for an example as I know that one strikes home alot with you, do differently? Is it a totally different feeling?...does the active ingredient seem void of efficacy entirely? I'm curious to try this comparison as I'm noticing crap results in terms of mood with my use of generic Seroquel for sleep...and once about a year ago on Effexor it seemed better but I dont remember brand.
myco--------------------------
> This topic comes up from time to time. After having an enlightening talk with my doc yesterday about this, I thought I might bring it up again just for grins and interest.
>
> The controversey between the generic-versus-brand issue is real. Most deny any difference, including the FDA.
>
> The real world tells a different story though, at least in one doctor's office.
>
> My doc is a renowned LLMD. People travel far and wide to see him for complicated illnesses. He sees more than his fair share of Lyme, Fibro, CFS, Depression, Anxiety, and most of these patients are also of poor health as a result of their mysterious diseases that other doctors say they don't have, and they are sensitive.
>
> Story 1. A patient has stabilized on brand Zoloft. He is well for 3 years. In a short time he deteriorates. Doc is puzzled. Asks if the pills have changed. Yes, they are now generic per the insurance company. Patient did not know of the change. Doc didn't know. Doc sends letters and calls the insurance company. Finally gets a head honcho to reverse the decision and put the patient back on generic. Patient is again stabilized in a short time.
>
> One of many examples my doc had to share. Since I was his last appointment of the day, and we seemed to click on this topic, we sat and chatted about it for a good while on free time.
>
> The worst offenders in his clinical experience are:
> Wellbutrin vs Bupropion
> Prozac vs Fluoxetine
> Zoloft vs Sertraline
> Celexa vs Citalopram
> Klonopin vs Clonazepam
> Gabapentin vs Neurontin
>
> I personally added Xanax and Lamictal to that list based on my own experiences.
>
> In those cases, he argues that if a patient starts on a generic and does not have a robust response, they need to be switched to brand before considering a different drug. In his experience, it is that much of a difference. He says most of those patients perk right up with a nice response when they get the brand name drug.
>
> On the other end of the spectrum, he has discovered a couple drugs that work better as generics than brand. They were non-psychiatric drugs. He had patients stabilized on brand name pain pills, who then got switched to generic, and their pain control became even better than the brand.
>
> So the generic vs brand thing works both ways, but usually in large favor of the brand.
>
> In situations where generic is better than brand, he keeps close tabs on exactly which generic company it is that is making the good one. Generic does not equal generic. There are differences even among the generics.
>
> There is no science behind this. It is pure clinical observation over years with hundreds of patients. Just open eyes and logic. So many doctors or scientists want to "explain" something, yet pay no attention to the obvious.
>
> I like that my doc doesn't try to explain why these things happen, only that they do, and that they are significant enough to duplicate over and over.
>
> So next time someone is not doing well on their med, check to see if it is generic. If it is, it could be a more rewarding and easier trial to simply switch it to brand rather than a totally different drug. If you were this doctor's patient, that's what would happen. Purely based on a bunch of success doing it.
Posted by bleauberry on March 27, 2009, at 14:48:57
In reply to Re: Generic versus Brand Meds, posted by Zyprexa on March 26, 2009, at 20:33:19
> I'm scared of when zyprexa goes generic. Hope one of them are good.
>
> On the other hand. I've found that the Sandoz version of perphenazine is far better than the other generic. Never tried the brand version. But I like the sandoz version a lot.Well, your own case report of your sample of one is added to the growing anecdotal cases of thousands. That is, there IS a difference, not only from brand to generic, but from generic to generic. A difference large enough to impact efficacy.
Is it due to the quality of the actual ingredient? Is there maybe some tiny miniscule molecular quirk in the active ingredient from one manufacturer to the other? Is it the fillers impacting absorption rates?
And why exactly is old Nardil so different than new Nardil? I mean, they are both the same ingredient, right? The only things that really changed are the manufacturing methods and the fillers/binders. Some Nardil fans/chemists theorize that the unique binders of old Nardil caused a particular absorption efficiency that is now missing in the new Nardil.
I don't think anyone has any answer at this time.
Posted by bleauberry on March 27, 2009, at 14:53:58
In reply to Re: Generic versus Brand Meds » bleauberry, posted by myco on March 27, 2009, at 10:41:14
> What exactly does say, Wellbutrin for an example as I know that one strikes home alot with you, do differently? Is it a totally different feeling?...
For me, yes. Brand wellbutrin felt a lot like speed. It was definitely a stimulant. Generic wellbutrin feels like a downer.
>does the active ingredient seem void of efficacy entirely?
For me, yes.
>I'm curious to try this comparison as I'm noticing crap results in terms of mood with my use of generic Seroquel for sleep...and once about a year ago on Effexor it seemed better but I dont remember brand.
Well, I think it makes rational sense to at least try the brand before giving up on the med completely. My doctor wouldn't be doing that himself if there was no worth to it.
>
>
Posted by TriedEveryDrug on March 27, 2009, at 17:08:48
In reply to Re: Generic versus Brand Meds » Zyprexa, posted by bleauberry on March 27, 2009, at 14:48:57
For wellbutrin XL at least, the name brand's sustained release mechanism is a bunch of complicated polymer substances made by a company in Germany.
I can't remember the company's name, but I looked at their site and it looks like they put a lot of work into making this mechanism.
I could see how a generic could not get that right.
But it is puzzling when non-SR/XL/CR/XR generic drugs are less efficacious. Do the generic makers like Teva cut corners or have poor yields? Is there some sort of collusion to purposely make the generics less effective to protect sales of the original?
It seems like generics should have to go through some sort of clinical trial to make sure they actually work as advertised. Of course, this will make them more expensive.
Posted by Zyprexa on March 27, 2009, at 23:51:24
In reply to Re: Generic versus Brand Meds » Zyprexa, posted by bleauberry on March 27, 2009, at 14:48:57
I'm just going to guess. But I think its the ingredients they use. Just like vodka, or any liquor for that matter. One is better than the other, bassed on what they use to make it with. They all have the same alcohol. But taste different.
This is the end of the thread.
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