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Old 10-22-2013, 09:09 PM
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Generic Keppra from different manufacturers


Hi all,

(Sorry in advance for the length of this post. :P)

It's been a long time since I've been here. I've had really good seizure control for more than four years and, after switching to a lower dose, I haven't had particularly bad side effects. But last night I had another freakin' seizure It was a simple partial motor, but slightly different than previous ones. Unlike most of my simple partial motors which started with my arm twisting up and behind and my neck turning while my leg draws up and I end up twisted like a pretzel on the ground, this one mostly affected my leg. Fortunately, I felt strange and grabbed hold of a door frame before my leg felt like it was being run through a wringer - it was tingly and numb, but there was also some pain which is new for me. My dogs heard me cry out and were gathered around and I thought they were jumping up on me, clawing my leg, but when I looked down, they weren't jumping on my leg. The clawing feeling was a phantom feeling. Anyway, I couldn't tell where my leg was. It felt like it was on the ground, but it was drawn up. When the seizure started to let up, my leg felt like lead and I couldn't move it.

My seizures all began because of a brain tumor. After surgery and chemo, the tumor was all but gone - my MRI's for the last few years have looked good. So when I had this seizure last night, I admit I panicked. I was afraid the tumor was growing back (which is, in fact, likely at some time in the future) so I let my dad call for an ambulance to take me to the ER. They did a CT which didn't show anything new and blood work was fine. They talked to my PCP and they decided to up my dosage again.

Anyway, finally getting to the point. My dad remembered that the pharmacy had run out of the generic Keppra they had been giving me, so this week I have been taking some from another manufacturer. I had enough left of my old to take one of the old and one of the new for a week to transition, but this week it's been all the new ones. But also, this week has been very stressful. I'm a full-time caregiver for my Dad who has MS and many other problems. I won't go into details, but we finally had to get my dad a hospital bed and I've been figuring out how to do things. It's been a lot more work, but I haven't had to worry about him falling, so I thought there was less stress.

Okay, so finally a question: How much might this break-through seizure be due to the switch in Keppra (I know little changes can make a big difference) and how much due to stress? I know there's no one right answer, I was just wondering if anyone else who thought their seizures were under control then had a break-through ever figured out what caused it. I really thought I was taking meds as a precaution. Guess not.
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Old 10-22-2013, 11:35 PM
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travel bug,
I know where you are at, I do know. After my last surgery I went three years no seizure and while they did come back for me, it was only 2-4 per year for the next 6 years. Then last June my bad days came back. I do feel for you and oh how I wish I could tell you just what brought it all back for me. I could tell you many things here or there in my days but for me, they would only be guesses. My neurologist says for each of us it in some way is different... I truly do hope that things quickly jump back into the good field for you.
GJ
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Old 10-23-2013, 12:14 AM
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I am so sorry you had a breakthrough seizure. That really stinks. But it IS nice to see you again.

I don't know the answer to your question, but I can provide some information on the bioavailability of generic drugs (how much is in your bloodstream). I can't remember what country you are in, so I'll answer like you are in the U.S. http://en.wikipedia.org/wiki/Bioequivalence
http://en.wikipedia.org/wiki/Bioavailability

Generic drugs MUST be bioequivalent. The way the FDA defines that is the bioavailability must be between a range of 80% and 125% of the original brand name drug. That means a switch in generic manufacturer could have up to a 45% swing in bioavailability. That's a huge amount, when some people are so sensitive that missing just one dose can set them off!

I have a piece of cardboard with a tablet from each of my drugs that count taped to it. Every time I fill the prescription I compare the tablets to see if they've changed. My pharmacy doesn't always tell me when they change suppliers. I'm no longer on seizure meds, but when I was, a change in generics usually meant seizure activity for me, at least for a little while. So I'd lay low and stay home for a few days, avoiding tasks like hacking weeds with a machete or boiling giant pots of water to can jam.

I hope you (and your dad) feel better very soon.
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Old 10-23-2013, 09:17 AM
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travel bug, when I read your post it did not dawn on me your comment, "Anyway, finally getting to the point. My dad remembered that the pharmacy had run out of the generic Keppra they had been giving me, so this week I have been taking some from another manufacturer."

Now after reading Endless' post - "Generic drugs MUST be bioequivalent. The way the FDA defines that is the bioavailability must be between a range of 80% and 125% of the original brand name drug. That means a switch in generic manufacturer could have up to a 45% swing in bioavailability. That's a huge amount, when some people are so sensitive that missing just one dose can set them off!" - I am going to be talking to my pharmacist as they have put me on my main med with a transfer to a new "generic manufacturer" AND this was around the time my seizures started coming back too much.

Not saying that that is the reason but I am certainly going to be talking about it to my pharmacist about it. I sure do hope travel bug that could be coming up as your main issue to be easily fixed. That would be sooooo good

(sorry but I don't have time for a re-read of my text here - fingers crossed my writing it not too off-key)
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Old 10-23-2013, 12:22 PM
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Cadsgj,

Do talk to your pharmacist. They may have specific bioavailability data for the specific manufacturer's product. Then you'd know. The pharmacist might (actually, probably will) give you the old "it's bioequivalent as required by regulations" speech, and say it's not a problem. In any case usually the pharmacist can do nothing about where they get the drug - it's whatever supplier their wholesaler is using at the time.

In my past experience, three possible solutions are to:
1) find out the manufacturer name for your old prescription, and call around to pharmacies until you find some, or
2) together with your doctor, adjust your dose, or
3) wait and hope your body gets used to it over time. (not my favorite option)

Another reason drug sources change a lot is the ever-changing world supply. Drug manufacture is an international business now, with much of it coming from India and other countries. Some factories go out of business. Some can't meet the FDA's standards for safety and quality. Some can't get the raw materials. Some quit making the drug because another drug is more profitable. So there is a lot of churn in suppliers and the drug supply itself. It depends on the particular drug, of course. Not all drugs are in short supply.
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Old 10-23-2013, 01:10 PM
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I've been on lamotrigine (generic lamictal) for the last 6 years. I've felt fine up until recently when I felt "off". (I don't exactly get auras, but I can tell when something's not right in my bean). I checked, and sure enough, my latest rX had been switched from one generic manufacturer to another. I can't be 100% sure that the different batch/manufacturer is at fault, but it seems very likely given that nothing else has changed in my situation.
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Old 10-23-2013, 08:33 PM
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Hi cadsgj

Thanks for the kind words and commiseration. Sorry you've had an increase in seizure activity. It must really stink after being seizure free for three years. I was really shocked at my surprise attack. I truly thought that I was taking meds "just in case", I even thought about asking if I could get off them all together, but stuck with them because I was finally, after getting a left foot accelerator for my car, able to drive and didn't want to risk anything.

Anyway, don't worry about not seeing the thing about different manufacturers; my post was pretty long :P I hope that turns out to be the problem, and that I'll get things straightened out. I hope you are able to figure out what has caused your seizures after all you've been through. Hope it's something easy and straight-forward that can be easily dealt with, but I realize that's rarely the case when it comes to E.

Take care, gj

Last edited by travel bug; 10-23-2013 at 08:53 PM.
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Old 10-23-2013, 08:52 PM
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Hi Endless

Nice to "see" you again, too.

Wow! Thanks for the information and links! I knew that generics could have 80% bioavailability and still be considered bioequivalent, but I didn't know they could be up to 125%. That could make for a huge difference between manufacturers. Yikes!

Fortunately, the pharmacy I use puts the manufacturer on the label so when I noticed that the pills looked a bit different, I was able to see why. I will definitely be on the look-out in the future.

I'm so glad to hear that you are off meds! I hope that things are going well for you.

Thanks again!
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Old 10-23-2013, 08:59 PM
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Hi Nakamova

Yeah, I'd been feeling what I call whickety (my word for feeling like I might have a seizure - I don't know where I got that :P) for a while, but I had completely forgotten about the change in supplier. My dad told me to slow down and take it easy, but I thought that, although I felt strange, I didn't have to worry about seizures anymore. Wrong

Hope you feel better soon!
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Old 10-24-2013, 08:40 AM
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Thanks tbug. I ended up increasing my dose because I was worried about having a seizure while driving. It seems to have helped.
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Old 10-24-2013, 05:01 PM
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i can relate. i had to switch brands from keppra to a generic brand, because they were out of stock. i had another episode within a few days, and i blamed the different type of keppra, but in hind site, i was worried the whoe time that what i was taking wasnt "KEPPRA" and probably brought on the fit by making myself stressed.

for a ling time, maybe 4 years i avoided that type of no name keppra so to speak, until i had no choice and needed them for a holiday. i was in the same jam, but all was good, so now i take the cheaper brand, it does the same thing, and i have had some good chats with the chemist guy and he swears its the same.

that was some warped seizure you had man, i know the felling. so i guess what im saying is that epilepsy is a real bitch, one second its all cool and not annoying you, and the next all your shit is thrown out on the lawn and ur car has been scratched with a screw driver and it happens in a flash.

its not the meds, its just ur body reminding you that ur still not the boss.

it sucks, but people ave it worse i guess.

catch ya pretzel boy. can i use that one ?

kaden
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Old 10-25-2013, 02:25 AM
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Yep, better safe than sorry, especially when it comes to driving and keeping your driving privileges.
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Old 10-25-2013, 02:53 AM
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Hey kayden

Yes, generic and brand name are supposed to be the same, but even so, when I first made the switch, my phamacist told me to take one brand name in the morning and one generic in the evening for a couple of weeks before finally transitioning to the generic completely. I think the active ingredient is the same, but other ingredients can affect the way the body absorbs the drug. I think in my case it was a combination of the change in generics and stress. Because you're right, I think sometimes your body just has to give you a "gentle" hint by by whacking you over the head. I had been pushing myself too hard so my body said "we can do this the easy way or we can do this the hard way"

And you're right - I'm very lucky compared to others. I need to keep that in mind.

Originally Posted by fuzzalo View Post:

catch ya pretzel boy. can i use that one ?

kaden
Well maybe pretzel girl...even though it's been a bit since I could call myself a girl

Take care, kayden
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Old 01-11-2014, 09:17 AM
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I have been taking generic Keppra for 2 years with no problem. My pharmacy just switched to a different supplier, Lupin, & the first day I took them I had a seizure. Does the body/brain have to get used to this new pill?
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Old 01-12-2014, 01:52 AM
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Hi Sturg,

That's interesting. It was after switching to generic Keppra manufactured by Lupin that I had my breakthrough seizure.

Here's some info from Endless' post above about bioavailability:

Generic drugs MUST be bioequivalent. The way the FDA defines that is the bioavailability must be between a range of 80% and 125% of the original brand name drug. That means a switch in generic manufacturer could have up to a 45% swing in bioavailability. That's a huge amount, when some people are so sensitive that missing just one dose can set them off!

I suspect Lupin's generic is on that low end. However, even after being on a higher dose (1500) for more than a month, I've had two more seizures. My doc upped my dose again to 2000mg and put me back on name brand Keppra. I've been on that for about a week now, and it seems like I can feel the difference. I had been experiencing little short circuit-y feelings when tired or performing certain tasks. But I haven't had that since about day two back on real Keppra. So it could be that it had nothing to do with Lupin generics. Maybe I just needed to have that higher dose and/or brand-name Keppra.

As for your question: my old pharmacist told me that when I change from one dosage to another or change from one supplier to another I should take one of the old pills in the morning and one of the new ones in the evening. Or the other way around - the important thing is to transition from one to the other over about a week so your body gets used to the difference. Of course, if your pharmacy springs the new ones on you and you don't have any of the old ones left to make the transition it makes it hard.

Take care! I hope it was just a matter of getting used to the new pills and that you have no more problems.
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Old 01-12-2014, 08:45 AM
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Thank You


😀 Thank you so much for your response Travel Bug. I do have some of the older levetirecetam pills. I will combine & maybe this transition will come easier.😉Sturg
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Old 01-14-2014, 02:11 PM
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I originally started with generic Keppra by Lupin, and had auras, was wired, and unable to sleep. I was switched to namebrand Keppra and have been fine for 2 years(no seizures) Now with my new plan I am being advised even though my dr put in a prior auth my insurance company wants me to go back to generic otherwise I will have to pay a product selection fee(under our outpatient prescription rider-wasn't there in previous years). this will run me around $585 a month to stay on namebrand. Anyone aware of how to get this fee waived and or the right way to appeal this with insurance to get this fee waived? I went back to generic again last month, and the same thing happened(lupin) and did receive a 1x prescription refill for namebrand keppra at $60 for 1 month so I can appeal.
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