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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by morganator on April 1, 2010, at 2:45:19
Is it possible that someone could react differently to different manufacturers of something like fluoxetine?
Posted by manic666 on April 1, 2010, at 4:34:54
In reply to Different generics Different outcomes?, posted by morganator on April 1, 2010, at 2:45:19
in a word yes
Posted by janejane on April 1, 2010, at 8:46:49
In reply to Different generics Different outcomes?, posted by morganator on April 1, 2010, at 2:45:19
Yes, I actually started a thread about this a few months ago (specifically in regards to prozac), and others have discussed this in past threads as well. A search should bring those up. (Do some googling and you will find a lot of complaints about generic fluoxetine. Unfortunately only a few of them describe the specific kind they had problems with.)
Bottom line, some people do notice a difference and will pay more for the branded drug. Others do fine on a generic, and a few have found specific ones they prefer. When I recently restarted Prozac, I specifically asked for 20 mg fluoxetine tablets because in the US, I believe Par Pharmaceuticals is the only generic manufacturer of that size, and they have a pretty decent reputation, from what little info I could scrounge up. (It's a real crap shoot if the Rx is for capsules since there are tons of manufacturers for those. You will have to call around to see what kind a pharmacy carries.) Unfortunately, the Par gave me headaches and didn't eliminate the depression so I've halted my trial. When I used original Prozac years ago, it worked great with no headaches. I'm considering getting an Rx for Prozac Weekly since it's still on patent and not available as generic. This would make the co-pay higher, but not as bad as a drug that has a generic available. This is strategy that quite a few people seem to use. (I'm going to explore some other things before returning to Prozac, though.)
Wellbutrin XL is another drug where manufacturer really seems to make a difference for some people. I did pay extra for that, to get the branded rather than generic, though I'm not on it anymore.
Posted by janejane on April 1, 2010, at 9:07:33
In reply to Re: Different generics Different outcomes? » morganator, posted by janejane on April 1, 2010, at 8:46:49
I forgot to say that I took a variety of different generic fluoxetine capsules over the course of 10 years or so and got headaches intermittently, especially during the last two or three years. I didn't realize that the headaches were caused by it, and I assumed all generics were the same so I never paid attention to how manufacturer may have affected my symptoms, though of course in hindsight, I really wish I did. There were months where the headaches were really bad, and months when I never had any, and my pills would change color every once in a while. You'd think I'd made a connection, but I didn't. (In case you're wondering, I didn't realize until I stopped taking it completely, and the headaches went away, that it had caused them all along. I thought I had some kind of seasonal allergies since the only thing they responded to was an antihistamine.) If I knew which pills didn't give me headaches, I would've tracked them down instead of going with Par, but I didn't, so I went with it based on what a couple others said about it and the that fact that it would be easy to obtain regularly if I asked for an Rx specifying tablet versus capsule. Unfortunately, it was a headache-causing one for me.
Posted by Laney on April 1, 2010, at 10:15:23
In reply to Re: Different generics Different outcomes?, posted by janejane on April 1, 2010, at 9:07:33
Janejane,
If you don't mind me asking what are the other things your going to explore before going with the Prozac?
Thanks!
Laney
Posted by Phillipa on April 1, 2010, at 12:34:51
In reply to Re: Different generics Different outcomes?, posted by Laney on April 1, 2010, at 10:15:23
I have a bill in my basket of meds never took I'd assumed it now came only in tablets as original was a capsule too. Does it help anxiety for anyone? Phillipa
Posted by morganator on April 1, 2010, at 22:50:25
In reply to Re: Different generics Different outcomes? » morganator, posted by janejane on April 1, 2010, at 8:46:49
Man I really wish I knew which generic worked best for me. I just went to get my script today and they gave me a different generic. This sucks!
Posted by bleauberry on April 2, 2010, at 18:06:36
In reply to Different generics Different outcomes?, posted by morganator on April 1, 2010, at 2:45:19
> Is it possible that someone could react differently to different manufacturers of something like fluoxetine?
Definitely.
Happens all the time.
I was just discussing with my spouse, why doesn't someone either sue the FDA or sue the drug company for allowing inconsistent treatments to be accepted as equivalent?
Brand is not the same as generic.
Generic A is not the same as generic B.
Different is different.
There is no way to predict which would be better or worse.
Skeptics would say if 50% of people on the brand and 50% of people on the generic improved, then they are equivalent. Not true.
Did every single person in the brand group stay well when switched to generic? See the flaw in the way they approach these tests?
No, the people responding were all over the map. The total stayed about the same at 50%, in this hypothetical example, but they were not the same exact people as the initial 50% group. There was not consistency from one group to the next. Only the totals appeared consistent. Within, there was a lot of discrepancy.
A more accurate test would be to take robust responders to brand and them switch them to generic.
Sometimes generic is better.
Sometimes one particular generic is better and all the others suck.
Sometimes all the generics seem to feel different from one another, each with its own unique quirks and differences.
Sometimes someone will respond equally well to either one and it makes no difference to them.
Bioequivalence does not equal clinical equivalence. And in fact, long complicated story, they are not bioequivalent.
I am surprised the FDA has not been taken down by massive lawsuits on this topic. People have probably died from being switched from a stable condition on a heart drug or seizure drug or whatever to a different version of that same drug. Of course, it was blamed on the disease, not the switch.
Ask SLS his experience with brand and generic Lamictal.
That is just one of hundreds of stories I could point my finger at.
Posted by morganator on April 2, 2010, at 18:21:08
In reply to Re: Different generics Different outcomes?, posted by bleauberry on April 2, 2010, at 18:06:36
Yeah I've never dealt with this generic situation before. I can't believe there are so many generic fluoxetine brands.
This is just a lesson to all out there. If you are doing pretty well and not experiencing side effects on a brand name medication(in my case it was Zoloft), don't even think twice about getting off that medication. If I hadn't stopped taking Zoloft I may have still had a tough time in some ways but I can guarantee I would not be in this bad of shape.
I wish I had a list of generic manufacturers of fluoxetine and which ones have worked the best for people. Now I don't know what to do. 60 capsules of Prozac was over 700 dollars without insurance!!!! I need to get my insurance going again and have my psychiatrist call them and tell them I NEED the brand. I'm not even sure if fluoxetine in any version is going to work for me, I've only been taking it for 12 weeks and I'm not even sure which dose is going to be the right one. This truly is a nightmare. I have some samples of 3/25 symbyax. I'm temped to double up on them and start taking it until I see my p doc next week.
Posted by manic666 on April 3, 2010, at 4:07:47
In reply to Different generics Different outcomes?, posted by morganator on April 1, 2010, at 2:45:19
if you did well on zoloft ,i was on the geniric sertraline an did a trouble free tapper on to citalopram///the pretty much the same med //mabye sertraline is the stronger//but i had a few side effects with sertraline that were issuies , but i to was scared obout the tapper ,worth a try i was on 150mg sertraline an just dropped to 30mg of citalopram
Posted by morganator on April 3, 2010, at 13:29:36
In reply to Re: Different generics Different outcomes?, posted by manic666 on April 3, 2010, at 4:07:47
I've been on Celexa and I've tried Zoloft two more times. I've also tried Lexapro. I hindsight, I probably should have stayed on Lexapro longer than I did.
I really don't think Zoloft and Celexa are very similar when it comes to SSRIs. Celexa and Lexapro are very similar though.
Posted by manic666 on April 3, 2010, at 14:45:16
In reply to Re: Different generics Different outcomes?, posted by morganator on April 3, 2010, at 13:29:36
we dont get lexepro un england yet its not generic ///so we dont get it yet, so i carnt answer you on that one. its not on the medical list of cheap meds yet.//that the NHS for you
Posted by manic666 on April 3, 2010, at 14:56:00
In reply to Re: Different generics Different outcomes?, posted by morganator on April 3, 2010, at 13:29:36
sorry i forgot to ask //what do you find differnt in sertraline an citalopram ///i finished a trouble free tapper an i fell no different// same side effects nothing different only the sex is worse on citalopram// i no lexapro an citalopram are simular //its the same med with a bit of mod,added like this one finished at one date an the other started next day thats obout it, //one,s geniric an cheap, one isnt an expensive //good plan by the med company
Posted by ed_uk2010 on April 3, 2010, at 15:25:31
In reply to Re: Different generics Different outcomes?, posted by manic666 on April 3, 2010, at 14:56:00
> sorry i forgot to ask //what do you find differnt in sertraline an citalopram ///i finished a trouble free tapper an i fell no different// same side effects nothing different only the sex is worse on citalopram// i no lexapro an citalopram are simular //its the same med with a bit of mod,added like this one finished at one date an the other started next day thats obout it, //one,s geniric an cheap, one isnt an expensive //good plan by the med company
Escitalopram (Lexapro) is called Cipralex in the UK. It's not as widely used as sertraline, citalopram and fluoxetine but some doctors like it. Cipralex is very similar to citalopram but much more expensive, which is why it's not generally recommended. I've taken both but I honestly couldn't tell the difference.
Posted by ed_uk2010 on April 3, 2010, at 15:36:51
In reply to Different generics Different outcomes?, posted by morganator on April 1, 2010, at 2:45:19
> Is it possible that someone could react differently to different manufacturers of something like fluoxetine?
I've taken loads of different generics (of fluoxetine and other meds). I've also taken Prozac. I never noticed a difference to be honest. I have good days and bad days, regardless of which brand I'm on. If I blamed my bad days on generics I'm sure I could come up with inaccurate ideas about which brand was best. Truth is, I had bad days on Prozac too. These meds can help somewhat, but they don't eliminate symptoms altogether, regardless of the brand. That would be too much to expect.
Posted by manic666 on April 4, 2010, at 3:50:23
In reply to Re: Different generics Different outcomes?, posted by ed_uk2010 on April 3, 2010, at 15:36:51
ed, i was refused point blank at hospital an gp escitalopram, because of cost in mansfied they have a list from the nhs an if its not on it you dont get it//i once asked for viagra an he said i cant get you a reduced script but not a free nhs one,,you dont come under the guild lines//i said why it yours drugs that make me this way ,so why not your drugs to rectify//he said you can have them at £25 instead of £40 .i said i can get them in the pub for £10 so f*** you
Posted by ed_uk2010 on April 4, 2010, at 6:55:59
> ed, i was refused point blank at hospital an gp escitalopram, because of cost in mansfied they have a list from the nhs an if its not on it you dont get it
It depends on your local Primary Care Trust's (PCT) guidelines. The PCT makes recommendations to doctors on which drugs are most suitable for prescribing. Some doctors stick to the guidelines but others don't take too much notice! They are only guidelines after all, they have no legal basis.
>i once asked for viagra an he said i cant get you a reduced script but not a free nhs one,,you dont come under the guild lines//i said why it yours drugs that make me this way ,so why not your drugs to rectify//he said you can have them at £25 instead of £40 .i said i can get them in the pub for £10 so f*** you
Viagra is different to other meds because prescribing is controlled by the 'Selected List Scheme', SLS. SLS means that Viagra can only be prescribed on the NHS if certain conditions are fulfilled eg. if the patient has diabetes, prostate cancer or MS. They same restrictions apply to similar drugs such as Cialis.
Posted by ed_uk2010 on April 4, 2010, at 7:07:40
In reply to Re: Different generics Different outcomes?, posted by manic666 on April 4, 2010, at 3:50:23
> ed, i was refused point blank at hospital an gp escitalopram, because of cost in mansfied they have a list from the nhs an if its not on it you dont get it//i once asked for viagra an he said i cant get you a reduced script but not a free nhs one,,you dont come under the guild lines//i said why it yours drugs that make me this way ,so why not your drugs to rectify//he said you can have them at £25 instead of £40 .i said i can get them in the pub for £10 so f*** you
I just replied but my post seems to have disappeared.
Most PCTs do not recommend escitalopram. Doctors are provided with NHS guidelines on what to prescribe for common conditions such as depression. Regarding escitalopram, these guidelines are only recommendations and have no legal basis. Some doctors stick to the guidelines but others don't.
About Viagra. Viagra is different to most meds because prescribing on the NHS is restricted by the Selected List Scheme (SLS). This means that doctors are only supposed to prescribe it on the NHS for patients who suffer from conditions on the list eg. diabetes and prostate cancer. The Selected List Scheme is part of NHS regulations and so doctors are not supposed to prescribe Viagra for other conditions, except on a private prescription. This is bad news if you need Viagra because of the other meds which your doc so kindly prescribed.
Posted by ed_uk2010 on April 4, 2010, at 7:11:47
In reply to Re: Different generics Different outcomes?, posted by manic666 on April 4, 2010, at 3:50:23
No wonder I couldn't find my previous post. I posted it as a new thread by mistake. Silly me :)
Posted by Phillipa on April 4, 2010, at 11:21:16
In reply to Re: Different generics Different outcomes?, posted by ed_uk2010 on April 4, 2010, at 6:55:59
Ed could you explain more on how your healthcare works as so many changes happening here. Thanks what other meds would be included excluded. Love PJxx
Posted by manic666 on April 4, 2010, at 12:46:54
In reply to Re: Different generics Different outcomes?, posted by ed_uk2010 on April 4, 2010, at 7:11:47
i didnt need the viagra as i was functioning , but the libedo was low ///an the mad shrink said your gp will give you viagra free,, so i thought why not ///i had a big argument with this gp about not suppling it me// only on the reduced rate//like a fool i was fighting in the p doc,s corner an he had misinformed me the nob//the pdoc said i will write the gp a letter, an the gp bounced it straight back to him with a few sharp words///the doc was perfectly right , i didnt get any i was only after the free ones, i needed a bit of spring back in the old python no erection probs
Posted by ed_uk2010 on April 4, 2010, at 13:13:33
In reply to Re: Different generics Different outcomes?, posted by manic666 on April 4, 2010, at 12:46:54
Oh well. Viagra has no effect on libido anyway, it's purely an aid to getting an erection.
> i didnt need the viagra as i was functioning , but the libedo was low ///an the mad shrink said your gp will give you viagra free,, so i thought why not ///i had a big argument with this gp about not suppling it me// only on the reduced rate//like a fool i was fighting in the p doc,s corner an he had misinformed me the nob//the pdoc said i will write the gp a letter, an the gp bounced it straight back to him with a few sharp words///the doc was perfectly right , i didnt get any i was only after the free ones, i needed a bit of spring back in the old python no erection probs
Posted by Dr. Bob on April 6, 2010, at 0:18:59
In reply to Re: Different generics Different outcomes? » ed_uk2010, posted by Phillipa on April 4, 2010, at 11:21:16
> Ed could you explain more on how your healthcare works as so many changes happening here.
Sorry to interrupt, but I'd like to redirect follow-ups regarding how heathcare systems work to Psycho-Babble Politics. Here's a link:
http://www.dr-bob.org/babble/poli/20090821/msgs/942420.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there. Thanks,
Bob
This is the end of the thread.
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