Generic Meds

[Miss K]

Has anyone had problems with generic meds being screwed up? With what I am experiencing right now, there is NO WAY that the generic I just started taking is the same as the last one. There's just literally no way. Then I started reading online about how the FDA has pretty liberal definitions about what they consider "identical" to be.

Well I'm really sensitive to medication...and it's great to find out about their liberal definition AFTER starting to take this new batch of pills and have my brain screwed up...grrr.

[Marge]

I am on generic adderal too, and just upped the morning dose to 30 mg from 20 mg. It is hard to guage if I am right in the window. What ever happened with your issue?

Marge

[Miss K]

Andrew - Very annoying when they try to tell you that you are not experiencing what you are experiencing.

Grrr. My docs always have to learn the hard way that I am med sensitive..."oh you'll be fine, nobody's THAT sensitive"...grrrr...

Glad they figured out how to adjust it though...

[Miss K]

Update. Right after I started alternating full doses with half doses I felt felt better immediately...and for about a week afterward, I didn't feel like the first batch made me feel (which was starting to actually make me feel good)...but I felt better. Since then...urgh. I have had increasing anxiety, and then spent three of the last four days in a total mess of anxiety, basically on the verge of a panic attack. I am generally rather anxious, but haven't had a panic attack in...seven years and suddenly I'm just about there again? After this stupid generic started screwing with me? And when I say that I'm on the verge of a panic attack, I mean that for three days I have felt like I was literally going to lose my mind...I always felt like that right before a panic attack, like I'm about to officially cut the lifeline between me and rational thought. Takes me a while to figure out that it's just mounting panic.

In this case, took me until day four, when I felt slightly better to go "oh, duh, I'm riding the ragged edge of full blown panic, and have been for four days straight".

I am going to the NP on Tuesday...either I need a different generic, or I need a different drug altogether because I can't handle feeling like this. Honestly, at this point it's been long enough that I'm ready to kiss citalopram buh-bye, because this is ridiculous. I would rather live with my natural state of anxiety than let a drug make me feel worse.

I'm really pissed at the friggin' FDA again right now. I can't believe they get away with screwing up our brains like this, it's disgusting.

[Dr Charles Parker]

I can report with considerable certainty that generic meds do differ, sometimes considerably. It's tough because your best bet is the time release, and Adderall generic XR Time Release is at the same cost as brand.

For dialing them in correctly please do take a look at this White Paper on your specifics: Precise Solutions for the 10 Most Common Challenges with ADHD Meds It has considerable details and links to further info on how to get them right!

Best,
cp

[Miss K]

I am lucky to have health insurance right now :) So that helps...I can experiment with all these fabulous drug options without having to take a serious hit to my wallet.

Thank you for the link Dr. Parker, I will definitely check it out.

I also want to add...that one of my frustrations is due to the fact that I am a VERY compliant patient. I am the kind of person that follows directions, that takes what I'm supposed to take, at the same times, and checks in with my prescriber when there are issues instead of just stopping my meds...ALWAYS. I knew what I was getting into with playing around with brain drugs. I know it's not a perfect process, and that some tinkering would be necessary--just ask my presciber, I'm more willing to put up with meds adjustment crap than he even asks me to be. AND I trust my prescriber. He's a psychiatric ARNP and not only seems to really enjoy his work with psych patients, but also is very knowledgeable...AND in the tradition of his profession, is very willing to admit when he does NOT know something, and will do research and consult peers to get more information when I need it. He also REALLY takes my opinion into account, and gives me my options, always reassuring me that every decision we make is one made together and that my input is extremely important...which was actually overwhelming to me at first because I didn't know what to expect, but now, as I learn more I REALLY appreciate.

So having a really cool prescriber to work with, and a great therapist, and accepting that the journey may not be perfect, and offering myself up to the process with full interest in finding a possible good fit, and complying with my meds instructions fully...and then having the FDA's liberal policy on bioequivalence SCREW with me like this...? That's just mean. It's so inappropriate...I have been temporarily incapacitated by their definition of "good enough". Grrrrrr! It isn't good enough ya bastards? Do you hear me? (*shakes fist at imaginary bureaucrat*).

Onward then...and I will read your link Dr. Parker. One of the issues I am dealing with, which I'm sure is something you're familiar with, is comorbidity...we're all pretty sure I have some intense anxiety along with my ADHD, so they're trying to figure out if there's a way to treat both, although I have done a lot of work on my anxiety, and managing it without meds. Maybe dropping the SSRI altogether and just trying the Vyvanse (which I do like) and doing some yoga or something for relaxation might be a great solution for me...BUT...tomorrow I visit my NP so I will talk about these things with him before making ANY decisions! :)

Thanks Doc...

[Miss K]

PS Doc...just reading some of your articles, and for me, right now, I feel like I get about 5-6 hours from Vyvanse...and indeed we are still finding my plateau...and I feel like I could use a little more...dang, you'd think you did this for a living! Can't wait for the book.

AND: The article about ADHD and Cognitive Anxiety? Bingo! Bananas...that's me. I notice EVERYTHING, and am always trying to fix it all...drives me nuts...I burn out...start the cycle over and over and over, and am in constant motion. But it makes me very effective at work. Then at home...I have to bring my sister to buy socks with me because I get so into examining all of the potential uses of each sock style, and the fiber content of each sock offering...she'll get exasperated and go "this shouldn't take this long, how about this, do you like the pink or the green"...then I'll pick socks and we pop them in the cart with the 10 pairs she's already picked out. Guess I got the ADHD gene and she didn't...haha...also used to be a compulsive handwasher, am always picking at my skin and a slight eating disorder as a teen...but never diagnosed with OCD. Hmm. Anyway, point? Interesting articles and that one in particular made me go "yup...been there".

[Marge]

Dr Parker,

Your site introduced me to a lot of things including your preview podcast of the virtual conference online today - but I believe there is an error on accessing the white paper Precise Solutions for the 10 most common challenges with ADHD meds.

Thank you for your attention to this.

Marge

[David Willey]

Hello Doctor Parker,
You sir have hit the nail right on the head - "Time Released" - my doctor wrote a scrip for generic Corgard on a Friday afternoon, and by Monday morning I was going nuts with my blood pressure 150/100.......went to his office and he gave me the "DAW Corgard". My personal impression was that the generic released a full dose in the morning and by two in the afternoon the med stopped working altogether. Some people claim that it's all in your head - because they insist that both the brand name and the generic come off the same production line - except one goes to the left to be packaged and the other goes to the right.
The same thing happened with my prozac - the generic was worthless while the original stayed working the entire 24 hour period.
I moved from the States to Germany - January of 2002 - my meds were perfect back home, but here everything is written as DWG Despense With Generic (my own interpitation). I now feel like a piece of shit most of the time, and my doctor seems to think that I'm crazy - he hasn't a clue why I can't take the subsitute prozac florintine (spelling) and why it doesn't work for me - but the doctor only gets a limited amount of money for the scrips he writes for original brand name drugs - for example he gets only 90 euros for prozac when the price is 175.00 - the doctor was taking a beating so he only would write for generic brand....and then sent me to a shrink if I wanted the real deal in my meds. You see here, you need a shrink to write for prozac - when back in the States, it was my GP who was able to do that. Clinical Depression is not a mental disorder I try to explain to these professionals - but they just don't understand the concept......but I'm starting to figure it out - just another scam - everyone gets a piece of the pie.
By the way - went to the shrink - a six month waiting period - he said I didn't belong there and my doctor should have his head looked at. The shrink gave me a list of meds to look up on the internet and told me to order them online. Thanks for nothing!

[Miss K]

Wow...can of worms, these discrepancies in med dispensing. On top of everything, it's not fair that we have to deal with this. The pharmaceutical companies have strong lobbyists...are there any groups working for the benefit of the consumer in the same capacity? I would love to know.

[Stacey L]

I completely agree with your dissatisfaction with generic medications....

I am taking Adderall and have run into a couple of situations where I could literally have pulled my hair out from sheer frustration....
They JUST came out with a generic version of Adderall XR recently -- before they did however, my doctor never had to specify "NO SUBSTITUTIONS" on my prescriptions.... well NOW he has to, but of Course we didn't realize this until I had already traveled the 40 minutes to my pharmacy to find out that now they have a generic and I can't have the regular because my doctor didn't specify.... so if I wanted to pick up my medicine I was gonna have to get a NEW script saying the no subs thing.... meaning I would have to drive the 40 minutes BACK to my doctors office, pick up the script, drive the 40 mins BACK to the pharmacy... all because adderall is considered a class 3 drug and can't just be fixed over the phone... UGH!!!

On top of that I have tried different medications' generic versions and they are absolutely NOT identical to my regular medicines... at least they don't work the same way for Me.... and I know it's not just something in my head because I actually didn't even realize I was taking the generic version for one of them at one point and definitely felt . . . off. I asked about it and was told I was taking the generic version.... my reaction??
--> THAT EXPLAINS IT!!

I have to be honest.... I am not a fan of the whole generic version THING.... aggravating.

[Miss K]

As if we're not going to notice that the drugs are different! It's our freaking brain chemicals! Ha! I have never found a more appropriate situation for the term "crazymaking"...these stupid inexact drugs ARE making us crazy...grumblegrumblegrumble.

Here's what's hilarious too about you having to drive all over for that script...do they seriously think that all of that effort is going to keep actual drug addicts from getting drugs? Do they think that an addict on a mission, who has found a sucker doc to write them a prescription is going to care about all that driving? I work as a paralegal in a criminal defense office, and I can tell you with absolute certainty, our addict clients--and that would be MOST of our clients, and for the record MOST of them are addicted to some kind of prescription drug, not the illegal kind--will do ANYTHING. They will drive. If they don't have a car or money they will find someone who does. They will trade sex for gas money. They will hitchhike...they will WALK if they have to. They will even call their court-appointed attorney's office to ask if they can sue their doctor for cutting them off when their doc gets wise to their addiction. The legality or illegality of the drug at hand is not the issue, the only thing that matters to them is that they have a route to getting it.

So while the legal system is clogged up with prosecuting addiction...which as I've made clear, is probably pretty futile because an addict's mind isn't even thinking in those terms...people trying to get their ADHD drugs are driving all over creation trying to get prescriptions for GENERICS that don't work. And having to make reminder notes to remind themselves to remember to ask the doc a week ahead of time for a mail prescription--and the last thing I need is more reminder notes and more things to remember!

Now that I just typed that out, it looks even more screwed up than I thought it was when I first started typing. This system is seriously messed up.

[Cathie]

I do use the generic of Aderall XR and it works as well as the name brand for me (and with my insurance is $25 cheaper a month!).

I do know that the active drug itself in name-brand and generic drug's is the same chemically. However, there is more in your medication than the active drug. These other fillers and binders are often what is different between brand name & generic drugs and can effect the way the medication is metabolized in your system.....and can be different from person to person.

It's all about finding the right fit :-)