The Controversy over Generic Antiepileptic Drugs

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Dolores

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I came across this article on The Controversy over Generic Antiepileptic Drugs. (Sorry if someone else has posted it)
I found it very interesting in that they actually talk about the problem of bioequivalence (or lack thereof) between generics vs brand-name drugs (generics can be within 80% to 125% bioequivalent of brand name (Link)) and how this can have serious consequences for people using drugs to help control their epileptic seizures.

I was told a long time ago to always take brand name Dilantin and always have. So I haven't had the problems of generic bioequivalence. However I recognize how seriously they could affect me since my blood levels tend to vary even on Dilantin. I think this is totally due to life-style changes including stress. The last thing I need is for the bioequivalency of the Dilantin to actually change.

A very interesting point is brought up that
While the drug concentration differences between the brand name drug and each generic formulation are unlikely to be substantial, the differences with generic-to-generic switches will be greater and potentially clinically significant.

I personally wouldn't trust switching to generic phenytoin from brand-name Dilantin given my personal history. But I hadn't truly realized the bigger problem in switching generic suppliers since that could give you a boost (or drop) of up to 45% in bioequivalence.

The article also does point out that
In contrast, a 10% decrease in AED concentration may cause a previously seizure-free patient to suffer a breakthrough seizure, which has considerable consequences such as injury or death to the patient or others, loss of driving privileges (up to one year, depending on the state), loss of employment, and emotional distress. There is also the added burden of hospitalization, increased doctor visits, time off work, and cost of other medications to address the effects. Thus, for the individual with epilepsy, the stakes are higher in the generic/brand debate.

A most interesting article in understanding generics vs brand-name AEDs.
 
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I have to agree. If I had the choice I would only take brand name for epilepsy meds. however my doc will not put on the script pad medically neccessary on the script so the pharmacy will only fill generic for you here in FL it really does not come into play if it is a customer service issue or if your insurance will cover it or not. I have found though if you have a good working relationship with your pharmacy staff however they will find the right generic for you and will stock the same brand generic for your epilepsy drugs I have found that to be helpful for me. In my case that happens to be the Mylan brand topomax and keppra they have to be ordered in every month by CVS they stopped carrying it but they are very happy to order it for me. The Glenmark brand was giving me problems.

Tina
 
My daughter takes generic lamotrigine and it seems fine. However, while I don't have E I've had unhappy experiences with the generic of my antidepressant, fluoxetine (Prozac), from just feeling I wasn't getting the full benefit to feeling a bit crazy (zier than usual), so I do think there can be issues with generics.
 
I take brand name AEDs I've had problems with generic such as Carbamazephine which sends my sz's through the roof.Anything in the Tegretol that's not the original tegretol I can't take.
I was able to take generic Klonopin when I was on it.That makes the only AED I can.
 
My daughter takes generic lamotrigine and it seems fine. However, while I don't have E I've had unhappy experiences with the generic of my antidepressant, fluoxetine (Prozac), from just feeling I wasn't getting the full benefit to feeling a bit crazy (zier than usual), so I do think there can be issues with generics.
I do agree that there are more issues with generics than "they" tell us. And of course insurance companies are praising how wonderful generics are. That may be true for some medications but definitely not all. And the issue isn't limited to epilepsy medications, though they have a bigger down-side than most. I told my sister about the bioequivalency issue between generics and brand-name and she said that it finally made sense why she never felt as good on generic blood pressure medications as she did on the brand name.

What angers me is that they keep telling us it is the same medication and never mention that it might not be as effective. They refuse to warn us that there might be serious differences. Nor do they ever mention the even more serious problem of switching generic suppliers. Most drugs might be "just as good". But please, treat me like I have a modicum of intelligence! Tell me what the differences are and why.

That's what I really like about the article - it is the first time I've seen these details explained so well. I've known not to take generic Dilantin. Now I can explain precisely why.
 
What angers me is how insurance companies fight you on getting brand name meds. They are so worried about money that they don't care to even research and understand that this is NECESSARY for those with E.


I also took brand name Dilantin for many years, which wasn't bad due to the low cost of dilantin brand name in general. However, after being moved to keppra, I had to fight for brand name because it is crazy expensive.

Plus, I tried generic keppra first and broke out in light rashes. These went away when we went to brand name. So, its not just the varying percentages of the drug that can be a problem, but the differing "filler" they use in generics that can cause you other problems as well. It just best all around to take something that will not change from month to month depending on if a pharmacy finds a cheaper supplier..
 
Having a generic drug isn't really the problem. It's when the pharmacy
keeps switching the generic drugs you're on because the insurance company
wants the cheapest.

Several times I experienced problems with generics. I'd have a Rx for my Trileptal with refills. The first time I'd get Brand A, the next it was Brand B. While the next bottle had Brand C & Brand D inside, separated by a piece of cotton. The generics would keep me from having tonic clonics. But my CPS would be unpredictable. There were times I may have as few as four or ten a month. This was just creating more stress on me. As the
stress level increased, so did the number of CPS.

I had to make a change. So at least two years ago I had my neurologist fix this problem for me. I explained the problem I was having with the generics. He explained about the generic drugs variants/fillers. After the issue was clear, my revolving door of generics was put to an end.

From then on all my Trileptal Rx were DAW [Dispense As Written]. Since then my CPS numbers stabilized to a point. I just didn't have to worry about my AED being a cause for my seizures. Everything was fine afterwards up to about a year ago. My insurance company wanted to force me back onto generics. To avoid this my neurologist needed to fill out a waiver form. This form states that it's medically necessary for me to take name brand Trileptal only. This form would have to be filled out each year. For as long as I will be on it. *Which will hopefully be only two more years. :)
 
Looks like a great find Dolores.

I didn't have time to read it all but I moved it to the Library since it seems to be a great piece of information.
 
Looks like a great find Dolores.

I didn't have time to read it all but I moved it to the Library since it seems to be a great piece of information.

Thanks, Epileric! I too thought it a great find. I'm not sure how I came across it but glad I did. And my first thought was that I had to post it at CWE given the constant questions regarding generics.

I thought it would be good for the Library but wasn't sure; thanks for moving it there for me.

One of the best things is that I found it to be quite an easy read unlike many of the other medical papers I have attempted to read.
 
I haven't had any problems switching from brand name to generic, but I think it's possible that generic-generic switches have affected me. It's hard to tell -- I haven't had any breakthrough seizures after a such a switch -- but I have felt a little "off". My dose is about as low as I can go and still have seizure control, so a generic-to-generic switch with the newer drug being less potent could have an effect.
 
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