Epilepsy medication

Jacovs

If someone is on prescribed medications for epilepsy such as Topamax (main ingredient Topiramate) and Lamictal (main ingredient Lamotrigine) and they want to move abroad permanently, but those exact generic brands arent available in that country, can they switch to different generic brands with the same main ingredients and dosage?

Obviously this is a question best left to a neurologist, but the waiting time for an appointment right now is about 6 months.

emzolita

Do not substitute generic meds for Epilepsy. There is a huge debate going on in the oireachtas atm about the exclusion of AEDs (Anti-Epileptic-Drugs) from the generic bill. Every other country in Europe that have brought in generic drugs for the public health system has excluded AEDs...except Ireland.

In a generic drug, they only have to have a certain percentage of the main ingredient, to be classed as this generic.
So say "BRAND NAME" has 30% of the main ingredient in it.
"GENERIC 1" may only have 20%
then "GERERIC 2" may have 34%

so if you get prescribed GENERIC 1 after being on the BRAND for years, your dose suddenly drops, unbeknownst to you. (you know how important weaning is, in Epilepsy)

Then if the pharmacist runs out of GENERIC 1 and gives you 2, you have gone up nearly double what you were taking in the same "dose"

this can cause a breakthough seizure, which can effect your life.

If Topopmax and Lamictal are available abroad, I would get them there, if not, maybe try wean onto another drug that is available over there , so you're always taking the brand not the generic.

some Q&A here

Nulty

Can anyone with experience comment on Depakine and its hair loss side effect. My girlfriend has been taking it and its affected her hair growth and she's constantly upset about it. She's asking me about hair extensions and everything. I would like to hear other peoples experience of Depakine and if you suffered hair loss and what you did, if anything about it.

As far as I can tell theres no good epilepsy drugs out there. They all have some terrible side effect but I know very little on the subject.

Thanks!

Ocean Blue

emzolita wrote: »

Do not substitute generic meds for Epilepsy. There is a huge debate going on in the oireachtas atm about the exclusion of AEDs (Anti-Epileptic-Drugs) from the generic bill. Every other country in Europe that have brought in generic drugs for the public health system has excluded AEDs...except Ireland.

In a generic drug, they only have to have a certain percentage of the main ingredient, to be classed as this generic.
So say "BRAND NAME" has 30% of the main ingredient in it.
"GENERIC 1" may only have 20%
then "GERERIC 2" may have 34%

so if you get prescribed GENERIC 1 after being on the BRAND for years, your dose suddenly drops, unbeknownst to you. (you know how important weaning is, in Epilepsy)

Then if the pharmacist runs out of GENERIC 1 and gives you 2, you have gone up nearly double what you were taking in the same "dose"

this can cause a breakthough seizure, which can effect your life.

If Topopmax and Lamictal are available abroad, I would get them there, if not, maybe try wean onto another drug that is available over there , so you're always taking the brand not the generic.

some Q&A here

The issue isn't strictly with the generic meds, it's the switching between brands that's the problem. So if a person was initiated on the generic brand then that's fine, just once they stay on that brand as it's what they are stabilised on.

So if a person does have to change brands due to moving countries then it can be done once they are monitored closely in case there dose has to be adjusted. It would probably be less of an upheaval to potentially have a dose adjustment than have to discontinue one drug and start another. But it really must be done under medical supervision.

It's not ideal and if it can be avoided it should which is why compulsory generic substitution of epilepsy drugs isn't appropriate but sometimes it may be unavoidable.

locum-motion

emzolita wrote: »

...
In a generic drug, they only have to have a certain percentage of the main ingredient, to be classed as this generic.
So say "BRAND NAME" has 30% of the main ingredient in it.
"GENERIC 1" may only have 20%
then "GERERIC 2" may have 34%
...

Quoting this stuff in terms of percentages is utterly meaningless.

What is important is the amount of active ingredient, and its bioavailablity.

Let's take BRAND NAME, like you suggest, but rather than saying it has "30%" of ACTIVE INGREDIENT, let's say it has 1,000mg of ACTIVE INGREDIENT in each tablet.

There will be inactive ingredients in the formulation too, the correct term for these is 'Excipients'. These fulfill various functions: Antiadherents, to make sure that the tablet ingredients don't stick to the tablet die/punch that made it; Binders, to ensure that the tablet does stick to itself and doesn't fall apart in transit; Disintegrants, to make it come apart after you've swallowed it; Glidants, so that the ingredients don't get stuck in the hopper of the tableting machine; and others such as Coatings, Sweeteners, Colours, Flavours, etc.

Now, IF the total weight of the excipients was 2,333mg, then the total weight of the tablet would be 3,333mg, and there would there would be 30% of ACTIVE INGREDIENT, but that's irrelevant. The important figure is the 1,000mg, not the 30%.

Then take GENERIC 1. It too will have 1,000mg of ACTIVE INGREDIENT in it. (If it didn't, it wouldn't get a Product Authorisation from the IMB.)

There will of course be Excipients in this formulation too. Let's say, though, that the company that makes this one uses a different Glidant, of which you only need half as much for it to do the same job. maybe it uses a different Disintegrant too, and for that you only need a quarter as much. If the final weight of the excipients in this case is 2,000mg (not 2,333mg), then the total tablet weight is 3,000mg, and there would be 33% of ACTIVE INGREDIENT. However, there's still 1,000mg of it.

Finally, let's take GENERIC 2. Let's just say that its excipients tip the scales at a whopping 3,000mg. Total tablet weight = 4,000mg. Amount of ACTIVE INGREDIENT expressed as a percentage = 25%. But it's still 1,000mg.


These are extreme examples. Apart from anything else, in real life, the amount of excipients in a tablet with 1,000mg of active ingredient would actually be a fraction of the weight of the active, not a multiple of it. The figures I've quoted here are merely plucked from the air to illustrate the point of this post: quoting dosages of medications based on their 'percentage' in a tablet is completely meaningless.

Later this evening I shall post again on the subject of 'bioavailabilty', but right now, I've work to do.

locum-motion

Sorry, I said I'd post again last night, but I didn't get 'round to it.

So; Bioavailability: What is it?

In layman's terms, it is a way of measuring how much of a dose of medicine reaches the patient's bloodstream. But it is slightly more complex; One also needs to take account of how rapidly the medicine reaches the bloodstream, how long it stays there, and how long it takes to leave the bloodstream.

We've already seen in my last post how our three hypothetical products (BRAND, GENERIC 1 & GENERIC 2) all contain the same amount (1,000mg) of the same medicine (ACTIVE INGREDIENT). But are they the same? Do they have the same Bioavailabilty? In fact, and even more importantly, are they Bioequivalent? Two (or even three) products are Bioequivalent if all of the factors I mentioned above are the same. Or close enough to the same not to matter. These are the sorts of things that the IMB will look at when determining if a new generic product is going to be given a Product Authorisation or not. If the above factors are not close enough to the original, no Authorisation will be granted.

In the vast majority of cases, any minor variations that might exist between two products will be exactly that; minor. They'll be so small that they won't matter. If "ACTIVE INGREDIENT" is a blood pressure medication, and if there's a tiny variation, it won't matter. As a pharmacist, I have absolutely no problem in recommending a generic be substituted for the originator brand in the vast majority of cases. It is perfectly safe to switch.

Why are antiepileptic medications different?

Epilepsy is a very complex disease, and there is considerable variation between patients. The main goal is to keep the patient seizure-free. And having a seizure makes it more likely that you'll have another. One patient might be seizure-free with Drug A, whereas the next patient might not respond to it at all. On the other hand, the second patient's epilepsy might be perfectly controlled with Drug B. Then perhaps a third patient might need both A and B before their seizures are controlled.

Once a patient has been stabilised, it is very important to maintain that stability. If control is lost, it can have massive implications for the patient. As I said before, seizures beget seizures. And it can also have implications on things like work and holding a driving licence.

Another thing is that some antiepileptics have what is called a 'narrow therapeutic window'. For any med, there's a minimum concentration of it that must be present in the bloodstream for it to work. This is the bottom of the window. There's also a concentration above which the likelihood of side effects is increased. This is the top of the window. The difference between the two is the 'therapeutic window'. If a med has a narrow one, one has to be very careful about how one manages it.

So, while that theoretical, possible, tiny little difference between the original and the generic won't matter in the case of a blood pressure medication, in the case of an antiepileptic, it can be crucial.

Basically, as OceanBlue said above, changing can be problematic. Once a patient is stabilised on one product, leave well enough alone as far as possible. Whether that's the original or the generic, doesn't matter. But chopping and changing is not a good idea.

Bouncy11

Hello I was prescribed fycompa roughly three weeks ago for epilepsy and am curious to see other peoples views on it because I seemed to have put on a bit of weight since, there doesn't seem to much on the internet. Does anyone else take this medication and know other side effects? Thanks

wretcheddomain

Bouncy11 wrote: »

Hello I was prescribed fycompa roughly three weeks ago for epilepsy and am curious to see other peoples views on it because I seemed to have put on a bit of weight since, there doesn't seem to much on the internet. Does anyone else take this medication and know other side effects? Thanks

Fycompa, or Perampanil, is, relatively speaking, a new class of drugs in the treatment of a type of epilepsy. I assume you're referring to partial onset seizures? As for side-effects, results from trials have shown a preponderance for aggressive and irritable thoughts, but other effects such as headache, dizziness, vertigo and weight gain have also been reported as the most common. However, as always, you should consult your prescriber should you have any concerns with any of the above.