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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by desolationrower on April 27, 2010, at 0:49:29
There is a lot of money to be had in showing this. Has anyone seen any studies showing this to be the case?
-d/r
Posted by Phillipa on April 27, 2010, at 10:27:12
In reply to proof of superiority of branded medication, posted by desolationrower on April 27, 2010, at 0:49:29
d/r I think the proof is in real life people's stories. Never researched it. Phillipa
Posted by Zyprexa on April 27, 2010, at 12:30:20
In reply to Re: proof of superiority of branded medication » desolationrower, posted by Phillipa on April 27, 2010, at 10:27:12
Well, I think generic wellbutrin sr is superior to the brand! Generic Syntroid is just as good! So its not always true.
Posted by SLS on April 27, 2010, at 13:07:38
In reply to Re: proof of superiority of branded medication, posted by Zyprexa on April 27, 2010, at 12:30:20
> Well, I think generic wellbutrin sr is superior to the brand!
That's really interesting. My friend does poorly on the generic. I wish I knew why. I tried two different brands of generic lamotrigine. Only the name brand Lamictal helps me. For thyroxine T4, a lot of people do better on Levoxyl than Synthroid. It's crazy. How can this be accounted for? Is it a matter of absorption? You would think that this stuff could be easily investigated.
- Scott
Posted by bleauberry on April 27, 2010, at 18:52:53
In reply to proof of superiority of branded medication, posted by desolationrower on April 27, 2010, at 0:49:29
No doubt there is a real issue here. One of my doctors won't even prescribe generics because he has seen too many problems with them. He is one of the few doctors I've ever seen that actually takes pride in the challenge of getting someone better. Generics are like his opponent in that game.
That said, he mentioned one drug that is better in generic than brand. So it goes both ways, but generally in favor of the brand.
For sure, either way, there is a difference that shows up in enough people to not be someone's imagination and to not be a placebo phenomenon.
My doctor said when he retires he is going to write a book on it, and he is constantly gathering the facts and case studies along the way.
I did some google searching a few months ago on this topic. Most of the hits said there was no difference. But they were blanket claims without any real deep explanation. The other hits however explained in great scientific detail while brand and generic are different. There is a lot more to the story than you know.
I don't recall where, but there have been some small informal studies comparing brand and generic. No differences were found. However, that conclusion is flawed. Here's why. When meds were switched, a ton of people either got better or relapsed. A bunch of stuff happened. However, looking at the whole pie, the same percentage of people were still either well or not well as before the switch. Different people though, but they were looking at overall statistics not at actual experiences within the group. A lot of the people that were previously well now were not, and vica versa, but the total percentage within the whole group remained unchanged. Make sense?
Posted by stargazer2 on April 27, 2010, at 21:18:36
In reply to Re: proof of superiority of branded medication, posted by Zyprexa on April 27, 2010, at 12:30:20
What brand of Wellbutrin SR do you take? The one I have now, has a funny smell, but I think there more than one generic manufacturers.
My endo will only prescribe Synthroid so he obviously feels there is a significant enough difference to only prescribe brand.
And when Nardil was released, most people , including myself, who had taken it before, even though it was many years ago, had significantly more side effects than they ever had. So the changes are clear when you are stable for years and the only change is to a generic version of the med and you relapse but recover when put back onto the brand.
One of the meds for hypertesnion is known for this differnce between brand and generic. There should be alot of studies but I haven't looked for any myself.
I just know it to be true from the few instance I have had with a switch from brand to generic.
Cheaper ingredients with less quality controls is part of the problem with generic.
Posted by Phillipa on April 27, 2010, at 21:35:36
In reply to Re: proof of superiority of branded/Zyprexa, posted by stargazer2 on April 27, 2010, at 21:18:36
Synthroid here also. Ever thought about armour? Love Phillipa
Posted by Zyprexa on April 28, 2010, at 15:15:07
In reply to Re: proof of superiority of branded medication, posted by SLS on April 27, 2010, at 13:07:38
The reason I like the generic wellbutrin is because of the lower side effects. Does not make me ready to faint everytime I stand up. When I started brand it had me very shaky and unable to concentrate in school. I'll admit it did take a few months to transition from the brand to generic, but once I did it was much easyer to tolerate. I found the gereric to be very anti depressing, and good for quiting smoking and energy.
I guess the lesson to be learned from this is you just gotta try them all for your self.
I didn't like the generic of celexa as much.
Posted by Zyprexa on April 28, 2010, at 15:35:48
In reply to Re: proof of superiority of branded/Zyprexa, posted by stargazer2 on April 27, 2010, at 21:18:36
I've tried the Teva and Sandoz versions and find them to be almost the same. They both have a sweet smell, very much unlike the brand which smells of rotten eggs. Teva makes the 200mg pill, Sandoz makes the 100mg pill. I've never taken the 150mg pill, so don't know who makes that.
My previous doctor would only Rx brand. Because they are better, she would say. I've taken many gernerics which work very well, and I never even tried the brand of some.
I started on brand syntroid and it worked. I told my new doctor that I wanted to try the generic and it does a great job on my TSH. So what is wrong with that? I still take the generic. I think the reason they say the brand is better is because between all the generics and brand they work out to be of slight difference of strength. So if you take brand the pharmacy won't give you a different generic. But!, you can have the pharmacy fill only one particular manufacturer of the generic, so you won't have this problem, which also suggests that there is a difference between manufacturers. You just get the doctor to write on the script, the 1. generic name of drug, 2. manufacturer you want, 3. dispense as writen. I do this with my perphenazine, because one is much better than the other, and with my gen syntroid.
Posted by ed_uk2010 on April 28, 2010, at 16:37:46
In reply to proof of superiority of branded medication, posted by desolationrower on April 27, 2010, at 0:49:29
> There is a lot of money to be had in showing this. Has anyone seen any studies showing this to be the case?
In reference to which drug?
Someone could do a study comparing one specific brand (eg. Paxil) against one specific generic (eg. TEVA paroxetine). This wouldn't prove anything about other generics however.
Posted by ed_uk2010 on April 28, 2010, at 16:42:49
In reply to Re: proof of superiority of branded/Zyprexa, posted by stargazer2 on April 27, 2010, at 21:18:36
>Cheaper ingredients with less quality controls is part of the problem with generic....
Expensive ingredients are not generally used in any pharmaceuticals, branded or otherwise. Most of the ingredients used in tablets/capsules are very inexpensive eg. lactose, magnesium stearate, microcrystalline cellulose, gelatin, starch etc.
Posted by Phillipa on April 28, 2010, at 21:25:53
In reply to Re: proof of superiority of branded/Zyprexa » stargazer2, posted by ed_uk2010 on April 28, 2010, at 16:42:49
Ed that's true so what is the difference between the active ingrediant? I just don't know asking you. Love PJxx
Posted by desolationrower on April 30, 2010, at 10:06:23
In reply to Re: proof of superiority of branded medication » desolationrower, posted by ed_uk2010 on April 28, 2010, at 16:37:46
> > There is a lot of money to be had in showing this. Has anyone seen any studies showing this to be the case?
>
> In reference to which drug?
>
> Someone could do a study comparing one specific brand (eg. Paxil) against one specific generic (eg. TEVA paroxetine). This wouldn't prove anything about other generics however.
>
>it would provide evidence of some excipients being bad.
a study of one med wouldn't PROVE something about another, but would at least make it plausible that generic makes are inferior.
But, there does not appear to be any evidence of this.
-d/r
Posted by ed_uk2010 on April 30, 2010, at 13:06:45
In reply to Re: proof of superiority of branded medication » ed_uk2010, posted by desolationrower on April 30, 2010, at 10:06:23
>it would provide evidence of some excipients being bad......
Generic medicines use relatively 'standard' excipients, all of which are also used in branded products.
The excipients are not manufactured by the pharmaceutical companies, they buy them from chemical suppliers which specialise in the production of bulk ingredients. This applies to virtually all branded medicines and all generics. In many cases, the excipients used in branded drugs will come from the same manufacturer as the excipients used in generics.
Posted by ed_uk2010 on April 30, 2010, at 13:36:26
In reply to Re: proof of superiority of branded/Zyprexa » ed_uk2010, posted by Phillipa on April 28, 2010, at 21:25:53
>.........so what is the difference between the active ingredient?
The active ingredient (the drug) is exactly the same, and is present in the same quantity.
For example, standard strength Prozac capsules contain 20mg of fluoxetine hydrochloride. The generic versions also contain 20mg of fluoxetine hydrochloride.
Generic products sometimes contain different excipients to the branded equivalent, but not always. 'Excipient' means anything other than the actual drug which is present in the tablet/capsule. Excipients are sometimes called 'fillers' but this is not particularly accurate because they serve numerous different functions.
For example........
Prozac 20mg capsules (UK version) contain the following excipients.......
1. Starch and dimeticone (powder inside the capsule, mixed with the fluoxetine powder)
2. Gelatin (the capsule shell)
3. Patent blue V, Yellow iron oxide and Titanium dioxide (colourings - used to colour the capsule with the familiar white and green shades)
4. Edible printing ink (used for the black writing on the outside of the capsule)Compare this with generic fluoxetine capsules made by Winthrop UK........
1. Starch and dimeticone (the same as Prozac)
2. Gelatin (the same as Prozac)
3. Patent blue V, Erythrosine and Titanium Dioxide (colourings - slightly different to Prozac.....which is why the Winthrop generic capsules are blue and white rather than green and white)
4. Edible printing ink (as per Prozac)In this case, the main difference between the brand and the generic is the colourings. Other differences may be present with different products.
Hope this helps.
Posted by Zyprexa on April 30, 2010, at 15:41:25
In reply to Re: proof of superiority of branded/Zyprexa » Phillipa, posted by ed_uk2010 on April 30, 2010, at 13:36:26
How can the filers have that much effect on the actions of the drug? If the active ingredient is identical.
Posted by Phillipa on April 30, 2010, at 20:14:12
In reply to Re: proof of superiority of branded/Zyprexa » Phillipa, posted by ed_uk2010 on April 30, 2010, at 13:36:26
Ed thank you. Very good explanation. Love PJxxx
Posted by ed_uk2010 on May 1, 2010, at 2:32:42
In reply to Re: proof of superiority of branded/Zyprexa » ed_uk2010, posted by Zyprexa on April 30, 2010, at 15:41:25
>How can the filers have that much effect on the actions of the drug? If the active ingredient is identical.
It depends on the product. With modified release medicines eg. Effexor XR, the excipients are used to control the rate of absorption of the drug.
Excipients can affect things like the rate at which the tablet disintegrates in the stomach. Disintegration, dissolution and absorption are tested for any new generic, to check that they are the same as the brand originator.
For some meds eg. the immunosuppressant ciclosporin, the type of excipients can affect absorption considerably and it is advised that patients should remain on the same brand. For the majority of drugs, this is not necessary as the differences between the brand and the generics are extremely small.
Posted by Phillipa on May 1, 2010, at 19:57:06
In reply to Re: proof of superiority of branded/Zyprexa » Zyprexa, posted by ed_uk2010 on May 1, 2010, at 2:32:42
Ed that must be why the endo says always take brandname synthroid. Love PJxx
Posted by ed_uk2010 on May 2, 2010, at 7:03:37
In reply to Re: proof of superiority of branded/Zyprexa » ed_uk2010, posted by Phillipa on May 1, 2010, at 19:57:06
> Ed that must be why the endo says always take brandname synthroid.
Because levothyroxine is a hormone which is always present in the blood, it isn't possible to accurately study the bio-equivalence of different brands. This is only possible with drugs. Differences between the various brands of levothyroxine are probably small, but may be relevent for some patients. Taking the dose on an empty stomach is probably more important than sticking to the same brand.
This is the end of the thread.
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