June 17, 2009 - 12:28pm
I just want to put out there something that I have recently been observing with generic vs. brand anti-epileptic drugs. Recently, a good deal of these drugs have been going generic (Topamax, Keppra, Depakote) and patients have been switching accordingly. However, I have had case reports from some patients that, since switching to generic, they have been having seizures. Now, these patients had been having NO seizures until they switched to the generics. Then, when they went back on the brand, they were seizure free. It brings up an interesting concept, brand vs. generic and if they are really equal. In my opinion, as a pharmacist, in most cases the generics out there are of high quality. Most generic companies are actually owned by the brand companies (Sandoz, Par, among others.) Therefore, I know that they follow the same manufacturing practices. However, there are some patients who claim that the generic drugs are not effective, especially among people in pain. While I have to question some claims of this nature (and I do sometimes without pause, a habit of having the "generics are great" argument drilled into my head) I am very concerned about objective measures of a drug failing, such as the seizures, blood pressure, cholesterol, etc. Seeing a patients total cholesterol remain high after 6 months on a generic statin, then decrease after one month on lipitor is, to say the least, fairly alarming. I don't want to cause a panic or hysteria over not getting generics, but I had one of my patients who I was particularly fond of end up in the hospital because their generic seizure medication out and out didn't work. As a tenet of my job, I filed a report with the FDA about this (all health care professionals can do this, nurses doctors, etc.), but I would like to get some feedback about this topic among you all. Not just pain meds, but any other medications in which the generic was ineffective. I feel as if I have to follow this up, because most of the top selling brand drugs are going generic, and I definitely don't want to be promoting a generic that is not effective. That is not only unethical, but bad business as well. If I am schilling a drug as being good, and it isn't, people may lose trust, and that is something I cannot afford. Thanks in advance for the input.
June 17, 2009 - 3:15pm
#2
Generics
I'm glad this post came up because I was placed on a statin for my cholesterol it was Prevastatin generic for Pravacol . I excercised and ate the right things but my bloodwork showed in 6 months I had only come down 25 points. My Dr. raised my dose from 40mg to 80 mg a day,still nothing.I finally bit the proverbial bullet and bought the brand name and 6 months later my cholesterol is below 200. Go figure. My pshyciatrist prescribes me 40 mg generic Prozac because he says 40mg of the generic is equivalent to 20 mg of brand. These are my experiences everybody is different but that's my story. Any thoughts? Thanks, Greg
June 17, 2009 - 6:58pm
#3
As has been discussed
As has been discussed previously on the boards, I've found that generic morhpine made by Endo sent me into full blown withdrawals. Howeve, the Mallinkrodt brand has always done just fine by me.
As for the Topamax, I think you may be on to something. I have been on Topamax for my migraines and neuropathy for a couple of years. Now with the switch I am experiencing waaaaaaay more migraines (I was down to 1-2 a month and in the 2 months I've been on the generic I've had 7...fortunately I have been able to stop them from turning into full blown migraines becuase I have Maxalt). I also have noticed that while I was on the Topamax my nerve damage had basically stopped in its tracks, no longer progressing. In the last 2 months I feel like it's starting to creep up my arms more. Something isn't right with this generic topiramate, and it scares me.
I've also noticed that with generic allergy medications I don't experience the same relief, which is driving me crazy at the moment because the tree pollen is up here and I'm highly allergic to pretty much anything that grows.
Normally I'm fine with generics, but I do think that some really are inferior.
June 17, 2009 - 10:25pm
#4
Very concerned
I am very concerned about this, as some patients are on life-sustaining medications, and if they are less than effective, then that is a serious issue.
June 18, 2009 - 12:43am
#5
It is very concerning. This
It is very concerning. This particular patient attempted to kill himself and others after they switched him to the generic. Although it is possible it was something else, it was almost definitely the med change...
June 18, 2009 - 7:23am
#6
My Mother
had to have her metropolol changed 3 times in 1 week, this medication regulates BP an heart beat an rapid withdraw off this results in heart attack or death, this was earlier this spring
I too getting very concerned of the medications
thanks for posting the information NJRx242
Woodstock
not sure of spelling of the medication, i believe I m close
June 18, 2009 - 10:34am
#7
This is not
a new phemomenon per se. It's been known for some time that certain cholesterol medications, heart medications, and a particular thyroid medication, Synthroid, are almost worthless when taken in generic form.
It does not surprise me in the least that this is occuring.
What ever happened to good ol' Pheno? These new "safer" medications scare me to death to tell you the truth. I choose to go with time tested remedies...
June 18, 2009 - 10:19pm
#8
No problems to report...
as of yet. My wife and I are Rx'ed 28 different items and, due to our Health Ins. Rx copay policy, we are herded towards the generics. In one case this made as much as a $650 difference in price p/mth. When you have an income as small as ours, that is disastrous. We've been fortunate, I guess, that there has been nothing to report, as of yet. Thank you, NJRx242, for manning the barricades for us CPs. It sounds like I need to be writing to my Congressional Delegation a little more often . . . like at least once in my life. This sounds like the time . . .
Q
PS: The case in question was after Purdue's successful litigation against generic OxycodoneCR.
June 18, 2009 - 10:07pm
#9
Not new Feliks, just more noticable
Because seizures are very objective: You have one or you don't. It seems to me that the attitude of most pharmacists is that generics are equals, which most of them definitely are. But, there is definitely something wrong when generic medication fails, and I think it is an underreported problem in the US. I read in my trade magazines, several editorial replies saying pharmacists like myself should be ashamed of myself for attempting to cause a panic and question the validity of generics, and I will cause more harm than good. What? I was astounded at that comment. Here, I thought I was looking out for the patients best interest, in that they are seizing on generic AEDs. The problem is that generics are absolutely necessary to control medical costs, and the FDA has deliberately turned a deaf ear on this problem. Anybody interested in this, read "Best choices from the Peoples Pharmacy" It is written by pharmacists (not myself, not schilling a book I wrote) that shows the dark side of what goes on behind the counter, in the doctors office, and in the clandestine wholesale drug market. For example, not many people know that generic drugs often are not tracked. In other words, I have no clue as to where these drugs come from between being created in a factory to my wholesaler. It can literally change hands ten times before it hits my drug wholesaler. This leads to a huge oppurtunity for counterfeit, diversion, and other illicit activities. Reading that book really woke me up to how much I don't even know about my own profession.
June 18, 2009 - 10:50pm
#10
synthroid
my dr. writes my synthroid brand name only. she says the generic are not as good.
June 18, 2009 - 11:54pm
#11
The generic is alright if
you start on it from the beginning. With Synthroid, Coumadin, AEDs, I tend to recommend that the patient remain on what they have been on. Unfortunately, many insurance companies make this exceedingly difficult.
June 19, 2009 - 5:54am
#12
Hmmm very interesting post.
Hmmm very interesting post. This just makes me think that the FDA is slacking on their job right? Just my opinion. I thought you have to get approved by them before you can put it on the market and it had to basically be the same chemical make up as the name brand and potency. This seems like a third world country.... how is it happening in our own backyard?
June 19, 2009 - 1:40pm
#13
FDA
Slacking is just the right phrase, they should be protecting the consumer, after my wifes run with the faulty hydrocodone they only took a Medalert , an thank us, but never gave no guidance of where to see in regards to having the complaint investiaged.
the State Board of Health Professionals, stated that Watsons were in Corona CA., an outside their jurisdiction
NJRx242, do you have any suggestions on who to contact to have a drug manufactor , checked for making a ineffective product
Woodstock
June 19, 2009 - 2:18pm
#14
JJ-
Not a Third World country, but this is a CAPITALIST COUNTRY. When healthcare is a private industry, money takes priority over all else, including quality of care (and life for that matter.)
The insurance companies and drug manufacturers could care less about the patient who gets thrown, or more accurately falls under the Brinks truck in the process of trying to obtain quality care, but fails to do so because he dosen't own a money tree.
Look at the quality of care that affluent individuals recieve as opposed to the general population. Take Magic Johnson for instance. If he was an average joe, he'd already be wasting away. Instead, he looks healthier than ever.
June 19, 2009 - 2:14pm
#15
posting via mobile, excuse grammar
it really is a sad situation...
ive had some bad experiences with doctors trying to %?#$$ me out of money so i tend to be pretty skeptical/cynical whenever i see a new doctor. my new spine specialist is sending me for all these extra tests and i'm pretty sure 2/3 of these expensive tests are unnecessary but im going to give him the benefit of the doubt. im sitting in the lobby waiting for a "nuclear medicine scan" as we speak. we'll see but i think its going to prove useless in my treatment...
i dont care what anyone says i think we should give socialized medicine a chance...just being a human being should qualify you for quality medical care when you are sick or injured. you shouldnt have to be of a certain social class...grrrr. being poor and injured sucks
June 19, 2009 - 10:37pm
#16
oneir
Perfect example...anyone who chooses to bash socialized (cradle to grave) healthcare can send me a p.m. if they're so inclined. I'm not interested in entering into a public debate on the topic.
That being said, I've personally had extreme financial highs, and extreme financial lows, so I have seen both ends of the spectrum. I've also lived in Eastern Europe and America and have had experience with both systems.
The vast majority of Drs. in the United States practice for the cash, not because they're compelled to help their fellow man. This fact alone poses several problems.
It's common knowledge that students currently enrolled in med. school don't want to go into primary care because the starting pay is only 80-100 grand the first year, so they're planning on going into specialty fields so they can rake it in....
You know, healthcare can be outsourced. It's becoming more and more common for patients to go abroad for medical procedures. India, for example has some excellent, U.S. trained cardiologists who will do procedures for a fraction of what greedy American physicians will demand. Radiology is also being outsourced to countries around the globe. Example: American radiologist charges 250 to read film and report, Chinese radiologist gets the report via the internet charges 20 bucks. Both graduated from med. school in the U.S.
Just like other industy in America, money and lack of integrity among those in power will eventually lead to serious problems.
June 19, 2009 - 2:45pm
#17
Call me crazy but, I do not
Call me crazy but, I do not want someone in Washington telling me whether or not I need a certain medicine. Look at Medicaid and Medicare very poorly ran. Nothing is ever free. I think people tend to think the grass is greener on the other side and it never is. This is my opinion and no debate will change it. Take care, htmom
June 19, 2009 - 4:45pm
#18
Lol yes because socialized
Lol yes because socialized medicine=government forced administration of medication
June 19, 2009 - 6:27pm
#19
I saw an article in JAMA
that was looking into that very subject. Specifically Anti-sezuire medication, as they've had many, many reports of this same thing happening all over the country. Kinda scary huh?
Ray
June 19, 2009 - 8:31pm
#20
Oneir
I do not engage in back and forths. I have an opinion and you have an opinion. As adults, let's agree to disagree. The world is not about everyone seeing one way. There are more constructive things we both could be doing. Life is TOO short. htmom
June 19, 2009 - 9:59pm
#21
Woodstock
The agency to contact is the FDA, but honestly, I doubt they would do anything. They are the ones who approved these generic drugs, and they don't like admitting that they were wrong, even though it happens frequently. You could try to contact them, but a better idea is to contact the manufacturer of the brand medication. Why? Because they will do anything to get you to take their drug. So, if you call them up and say "I was taking the generic and it is ineffective, and the FDA won't listen to me when I tried to lodge a complaint. The brand company can do quite a few things, including giving you coupons for money off your copay, free supplies for a year occasionally, or try to push this across to the FDA themselves. Its a difficult situation, and the FDA tends to write these things off as "individual drug differences among patients".
June 19, 2009 - 10:45pm
#22
Woostock-
...you'd at least have to get up to the class action level before any major pharm co. did ANYTHING.
Unless you're involved in litigation, (a threat to their assets,) they won't tell you the time of day.
To Watson, for example, you are viewed not as a human being, but a dollar sign. Unless they're sucking you dry, you mean nothing as an individual.
Your individual "complaint" is on par with calling RJR Reynolds to scream and holler about how their cigarettes gave you lung caner (god forbid.)
June 19, 2009 - 10:50pm
#23
WATSONS
Offered to reimburse us for the money we were out of for the medication, there are concerns of wife s kidneys creatnine being low, thinking possible damage but my wife drinks like 2 1/2 gallons of water a day so that may explain the lo creatnine
I contacted Watsons safety dept. an asked for their labatory data, because they sent me a simple letter stating the medication appeared to be what it suppose to be, an the stability was also intact, but provided no data to back up their findings, siting that information was confidential
I gonna try my Congressman, he once sat on committee for Commerce, maybe he can give me some guidance
take care Woodstock
June 20, 2009 - 6:56pm
#24
Sounds like if the FDA is the
Sounds like if the FDA are the ones that are suppose to be protecting us from these sub par generics then we need another agency to look over the FDA or some kind of internal affairs. I am sure Obama wouldnt have any problem spending more money to make another government agency from our tax dollars..
And about Majic Johnson... of course he is going to get the best treatment... he can afford it and hes a celebrity. I am sure they were using experimental drugs on him before they came out on the market just because of who he is. One thing I think you overlooked is that he was in great physcial condition when he was diagnosed with HIV, I might be wrong on this one but I dont even think he as AIDS yet, which is amazing because its been about 16 years since he was diagnosed with HIV.
I think its similar to the whole Lance Armstrong deal. His cancer was so far spread from his brain, lungs, and testicles that a normal person would have not survived... but since he was in great physcial condition it gave him a better chance to survive.
I am nowhere near Lance Armstrongs or Majic Johnsons level, but I dont think too many people would have survived my wreck. I was 6'3'' 245lbs before my wreck. Worked out 5 days a week and ran 2 miles 3 days a week. I wasted away to 183lbs at the lowest point after my wreck, but now I am back to 215-225lbs.
June 20, 2009 - 6:42pm
#25
In addition to
...the informative post by NJR, this thread has made clear the political affiliations of many of my friends here at Pharmer.
That being said, I almost regret bringing my political views as they relate to U.S. heathcare into this discussion. Any exchange of information that is politically charged is bound to be biased and counterproductive.
JJ- No he does not have full blown AIDS yet, that's my point. It would appear to the layman that his disease progression is evidently slowed to the point of dormancy.
Can't continue this post, I'll end up swith something close to The Communist Manifesto...
June 20, 2009 - 6:44pm
#26
I think the FDA is not
I think the FDA is not looking out for our best interest. Like everything else, money is a motivator to get drugs approved. Drug companies develop meds to make money. Health care is a business and not a non-profit. I'm not demonizing making money. Making money is a good thing. Take care, htmom
June 20, 2009 - 7:37pm
#27
The FDA is a joke
They approve all these ridiculus medications, like, I kid you not, Amoxicillin Extended Release (Moxatag). 10 pills of this costs around 70 dollars (AWP) and 10 of the generic costs around 13 cents. Its a joke, very few drugs should be made into extended release forms, mostly for pharmacokinetic reasons (Paxil, Effexor are exceptions). Instead of innovative new drugs, drug classes, etc., we have the same cookie cutter garbage being forced into the market for more money. And, it is cheaper for the industry because they do not have to conduct new drug entity studies, just have to prove availability of the dosage form and safety. I had contacted the FDA on behalf of one of my patients (At her request) to complain about her generic Keppra causing a seizure, and they basically told me to fill out a MedWatch form for adverse reactions. When I told them I did this, they said this was the farthest I could go with the matter. What? This patient almost died because her generic was ineffective. She suffered brain damage from a clip of 10 seizures in a row before her son found her in the kitchen. I was infuriated to say the least. The FDA is run by the same wasteful, corrupt incompetents that run the governments in this country. Its sad, when I think about how it was supposed to be, an agency to protect the public from drugs and make sure our drug supply is safe, and they obviously have grown decadent. I now advise my patients to get all brand when the insurance will cover it, because generics in some cases are a toss up.
June 20, 2009 - 9:13pm
#28
HIV OR AIDS
Is a devastaing disease, the fact that Majic Johnson is doing well or has nt developed AIDS yet may be example that science has been looking for as to why, the multations of certain viruses such as SAR S, or an Influenza can come about.
no matter who, or what the circumstances the goverment should work harder to find the cure for this devastating disease
June 20, 2009 - 9:29pm
#29
Exactly NJRX the government
Exactly NJRX the government can not run the government.
June 20, 2009 - 10:18pm
#30
Its funny how the government
Its funny how the government cant even run the government and then they think they can actually run health care sufficiently.
June 20, 2009 - 10:57pm
#31
Money
in the form of special interests runs the United States government.
Heathcare in this country will never be nationalized simply because of the ungodly profits to be had. That's the bottom line.
June 21, 2009 - 1:51am
#32
sad face :(
sad face :( 
June 21, 2009 - 2:22am
#33
I'm on Medicare and it pays
I'm on Medicare and it pays my pm $15.00 when I see him. When I have a nurse visit it is below $10.00. This is not a pick up script at front desk but I get everything done with the nurse instead of the dr. I think the reimbursement rates are low for Medicaid and Medicare. 2/3 of drs will not accept patients with Medicaid or Medicare. I know they can write stuff off. But what is the breaking point. My previous PCP left because of the amount of Medicare and Medicaid patients he had. No one will buy the practice that is for sale today, some 3 years later. This is what he told my pm. When I worked at the hospital on weekends I was doing an IVP on a patient that had Medicaid. The patient had a stone and needed to be taken to the OR for retrieval. The urologist would not come in to see him and do the retrieval. It was because the patient had Medicaid. The ER dr was furious. He called another urologist that came in to see the patient but would not do the retrieval. He was sent home to pass the stone. The poor patient ended up having the retrieval done, but it was many days later. So if the reimbursement rates were higher the poor patient would not have had to suffer needless. This practice of putting off Medicaid and Medicare patients in the ER happened everyday. The drs hope the patients go to another hospital or a different dr, if came in unassigned. We have always had health insurance. My husband is self-employed and those high premiums we had to pay is no joke. Its not that we could not afford the premium but we could not afford not to have health insurance. For some Americans that can afford health insurance and choose not to because they want something for free just makes my blood boil. Nothing is free. I do not want my kids to have to pay for something that people can afford. So right, left, center, blue, white, black, blond hair, brown hair it really doesn't matter. I agree Felikes why would any dr stay in America.
June 21, 2009 - 4:07am
#34
I never knew of this htmom,
I never knew of this htmom, now you are even discriminated against by which kind of health care you have? How exactly does medicare/medicaid work? I know at my PM office they have a sign that they dont take Medi-Cal anymore. I was under the impression that doctors and hospitals preferred if you had some form of insurance because they knew they were getting paid. Sorry if I sound really naive. I never thought I would be dealing with doctors and hospitals so much in my 20's.
June 21, 2009 - 5:10am
#35
J
Medical providers are contracted with different insurance carriers at different rates. This means that for a given service, the provider collects x dollars from carrier A and y dollars from carrier B. It happens that Medicare/medicaid/medical etc are contracted at lower rates for government cost control purposes...
Yes its true that, generally speaking, doctors prefer if you have insurance. This gurantees they will recieve payment of some sort. There are doctors that prefer not to take insurance since their contracted rates are often lower than flat rates for non insured patients. In these cases they require payment from patients at the time of service. This gets them the funds quicker and a lot of the time even more money. Doctors would prefer rich patients without insurance to just about any other population I would imagine...
June 21, 2009 - 12:48pm
#36
NJRx242, I know where you
NJRx242, I know where you are coming from. Imitrex went generic so they have to come out with Treximet, which is a joke by the way. What the heck is neproxen going to do for a migraine?
June 21, 2009 - 1:54pm
#37
The hospital I worked at was
The hospital I worked at was very small and that's how I knew so much about the "dirty little secrets". When was young (70-80's) our PCP would only take x number of Medicaid/Medicare patients. So this is nothing new but just thought I would share a different point of view. In my area the hospital will not turn you away, but will a specialist come in to see you is a different story. Take care, htmom
June 21, 2009 - 6:27pm
#38
Reimbursment
The magic taboo word for Medicaid/Medicare is "REIMBURSEMENT". Basically, insurance works like this: A health care provider submits a claim for a service (surgery, office visit, drugs, etc.). This claim is basically a toss up in terms of how much Medicaid/care will pay. For example, say I submit a claim for 30 generic percocet to medicaid. I will submit (automatically, the computer calculates the percentage) usually 50-150 percent higher than what the drug costs, because we never know what the insurance will reimburse. Say those percocet cost me 10 dollars to get from the wholesaler. I will submit a claim for 60-100 dollars to medicaid, and probably will get paid 15-20 dollars. These agencies have a set percentage of what they are willing to pay, rather than pay the asking price. This marginalizes professional services, where I am getting paid only 5 dollars net profit to fill that prescription, when it should be more for a professional service. However, if I were to bill only 13 dollars, they would only pay me that, and not the extra 2 dollars because our claim rate was so low. So, we are forced to bill outrageous prices to the insurance companies, and we usually get only 5-10 dollars on generic and 20-30 on brand. That is why the mom and pop drug stores are being forced out of the industry, because you hardly make any money filling prescriptions, unless you have a high percentage of customers paying cash. Our store has about 10-15 percent cash, of which a sizable number is for Oxycontin, which makes us very profitable in this because we can charge whatever we want. So, for example, we might bill a 90 count Oxycontin 80mg prescription to Medicaid, and make about 50-100 dollars on it, whereas the same cash price would net us 500 dollars. My boss is in Washington right now, lobbying for better reimbursement rates. This works in the same way for doctors, though with different billing procedures.
June 22, 2009 - 12:57am
#39
Because of that billing
Because of that billing practice really s k r e w s the individual without insurance. One of the reasons my PCP who is also my PM doc hasn't moved to OC. He knows it would be too expensive out of pocket. Heck he gives me all of my non schedule meds for BP, cholesterol and hashimoto hypothyroid!
June 22, 2009 - 6:34am
#40
Correct me if I am wrong, but
Correct me if I am wrong, but from what I gathered its the health insurance people that are to blame and not the pharmacy. They dont pay what the price is, they only pay what they want to pay? It almost seems like it would be better if there wasnt these health insurance providers and everyone just paid cash at a reasonable price where the pharmacist still made money and the drug company. Then the people that dont have insurance dont get screwed for making up for all these people that do have insurance. I am not sure if I am right on this theory.
Basically pharmacists like having cash patients. They get their money right away, and get more money than someone with health insurance. I think thats why they have this savers club at walgreens to keep the drugs at a somewhat reasonable price so I will keep coming back with cash.
June 22, 2009 - 8:52am
#41
There have been times where
There have been times where my insurance copay was a higher price than just buying the Rx without insurance. Good stuff
June 22, 2009 - 10:01am
#42
oneir
lol...that's funny cause it's true. It's happened to me....
June 22, 2009 - 11:59am
#43
when
I worked out insurance problems for co-workers, the health insurance paid either the healthcare provider or the pharmacy, what is called a reasonable , customary, an usual fee, meaning for the cost of living in the region you live dictates the cost of service
a person in alaska or hawaii would pay more, because of shipping costs
this is why its very important to save all EOB S, from the insurance company (explaination of benefits), very useful in solving a disputed claim where provider still trieds to bill over what insurance allows
WOODSTOCK
June 22, 2009 - 4:27pm
#44
Smaller Pharmacies are different
Because we are a small chain, the pharmacists can override the prices if they are too high. We do this all the time. From what I hear, the chains like CVS, Rite Aid, and Walgreens cannot do this ever. Whatever they charge the insurance is what they charge the cash customer. For example, generic 30 generic Ambien costs around $1.73. Brand is around $106.00. Our computer is set to charge 85% of the brand when billing the insurance for the generic. That is around $85, which is a huge mark up. So, we settled on $1 a pill as reasonable for the cash customer. It is the same for generic roxicodone 30mg. The brand costs around $3 per pill. For 90, it would cost around 270 dollars. The computer wants us to charge 200 dollars for 90 of the generic, when they cost around 28 dollars to get from the manufacturer. So, again, we set up $1 per pill as a reasonable price. We make a decent profit, without gouging patients when they don't have insurance. As long as the the prices are the same for everyone, we can charge whatever we want. I know some pharmacies that totally gouge patients for all cash prices. Our price for brand Oxycontin 80mg for 120 tablets is 1330 dollars (which some people pay) and a CVS down the road charges 2100!!! That is insane, I'm sorry. They are charging 200% over cost!! And some people pay it there! Unbelievable.
June 22, 2009 - 9:30pm
#45
Yup NJ, pain as we may all
Yup NJ, pain as we may all know sure can be a #&$#$, some of us would sell our children to get rid of it. Funny how some of the more potent pain meds cost so much money. It's insane where my script for #120 10mg Percocet cost only $66 from costco. But how much would a script for 10mg Oxycontin cost from the same place? It sure won't be $66!
June 23, 2009 - 3:12pm
#46
Its all the pharmaceutical industry
Oxycodone is a very cheap medication to manufacture. However, Purdue, who makes Oxycontin, charges a huge amount for it. Some drugs cost a large amout of money to make due to the complexity of the chemistry involved, but that list is very small (Mostly the newer anti-psychotic meds, Abilify, Seroquel, etc.) Most of the medications are expensive because the companies just charge a huge amount to make a bigger profit. Generic oxycodone, hydromorphone, etc. are very cheap to make, and the prices are low. Drugs like Oxycontin, Opana, etc. Are very expensive because they are brand only (Generic oxycontin from Maillincrokt was expensive because they had a deal with Purdue to manufacture it for 6 months at a fixed price, so they couldn't undercut Purdue. When there are several companies making oxycodone ER, the price will basically bottom out because it isn't expensive to make.
June 23, 2009 - 11:36pm
#47
NJRx242:
this would be a good question to pose to You, do you think that Big Drug Manufactors, like Big Tobacco tinker with the design of a medication to addict you to certain medications.
everyone found out that Big Tobacco, not only adds more nicotine, but approximately close to a 100 addition additives to tobacco to make kicking the smoking habit hard.
whats Your opinion in regards to suspected tinkering.
WOODSTOCK
June 24, 2009 - 11:21am
#48
Woody
...while we wait for NJR's take one this one, I can tell you this much, No "tinkinering" is necessary to produce dependence (sometime leading to addiction,) when it comes to opiates/opioids. The same can be said for many other medications that must be taken daily, like BP medications that can have lead to severe adverse effects if abruptly discontinued (Lopressor/ Clonidine.)
It's widely known that anxioltics and many other medicines, once they've been administered daily for a given period of time, you're "hooked," like it or not. One cannot just discontinue drug therapy (w/ certain classes of medication) without any adversde effects...
Choo Choo (That's the money train)
June 24, 2009 - 11:22am
#49
Woodstock
Waiting g for NJR to chime in; ask yourself why Purdue hasnt produced a less abusable form of Oxycontin? Where you could not crush it and insufflate it? The six month generic was good and waxy when it was crushed, making it less desirable for those who abused it. With all the billions purdue has made on oxy they could easily make a tamper resistant version of it. Of course there are other motives at work.
June 24, 2009 - 10:25am
#50
All that is needed
To make Oxycontin impossible to abuse is to add 2-10mg of naloxone to the tablet. That simple, and naloxone is cheap as anything. It would be inactive if taken orally, as it is supposed to be, and active if abused. Just that simple. The reason Purdue won't do it is because it will hurt sales in eliminated all the people abusing it. They knew this when they settled the lawsuit with the FDA. In my opinion, alot of drugs produce some kind of dependency. Feliks is right, if you discontinue some BP medications, you can get a huge spike in BP, sometimes to dangerous levels. Those medications are lifetime meds. Most antidepressants, with the exception of Prozac (due to a long half life) result in a "discontinuation syndrome" when abruptly stopped. The docs always neglect to mention this one to patients when starting them on this line of therapy. Most painkillers result in addiction as an offshoot, probably as an evolutionary method of the poppy plant to ensure proliferation at the hands of animals (i.e man). There are some interesting theories that some plants have these chemicals that result in euphoria, and hence dependency to promote harvest and increased planting by animals. Cocaine comes to mind, as well as opiates, Khat (an illegal stimulant) and several others. Most drugs are tested for dependence when approved by the FDA. Lyrica produced euphoric effects in over 10% of study subjects, hence its federal scheduling as CDS V. Honestly though, addiction is a desirable effect of drugs, from the standpoint of the pharmaceutical industry, because it ensures a steady stream of customers. The only barrier to this is professional ethics, which we know big business doesn't have. So I would have to say yes, they desire addiction and dependency, but not purposefully. It is a bonus with some medications. Which is a sad commentary on the industry (as if the ludacrus prices on drugs weren't sad enough)
(edited)
interesting...
posting via mobile so excuse the grammar...
i work with psych patients and their meds. a guy here takes a generic keppra and still has seizures problems. i dont know that he was fine on the name brand as he is new to my facility so i wont comment much there..
BUT regarding the depakote generic, divalproex...
i definitely have a comment to make. one of our patients recently decompensated and became extremely unstable, making several suicide attempts and eventually assaulting my coworker then coming after me. he has returned to a more controlled and restrictive setting. as we tried to figure out what changed this man from a calm, friendly and generally fun guy to be around into a raging, psychotic and violent person the only thing we can identify that changed was the depakote from name brand to generic.
we dont know for sure if this caused it but there were no other med changes and there were no significant life events. if i had to place a bet on what caused the change i would put my money on the depakote change. our pharmacist said others have reported a difference in the generic as well...
anyway. this is worth considering...