Prescribed a brand name but dispensed generic

Unrealistic

I was given a six month prescription for a certain medicine earlier this year that specified a brand name. The first month I had the prescription filled at a pharmacy near my doctor's surgery and I was given the brand name pills. For the second month my partner went to a pharmacy from the same small chain but in another part of town and was given a generic substitute that actually cost a little bit more. The pharmacist did mention to my partner that she was substituting a generic alternative because they didn't have the brand name in stock at that moment. In month three I went to a different pharmacy and was given the brand name drug (at a lower cost). And then in month four and five I went back to the pharmacy that had given my partner the generic substitute and was given the same generic on both occasions.

When I went back to my doctor for a check up he asked me if I was getting the brand name drug each time. When I told him that I wasn't he advised me to reject any generics in the future and insist on the brand name drug. This was the same time that the news stories were running about the implementation of the pending law on generics and I was surprised to read in that context that what the pharmacy did in dispensing generics to me was actually illegal.

I know the likelihood is that the generic tablets I was given were just as effective as the branded products but I'm still extremely annoyed at being taken for a ride by my local pharmacy and I don't want to let it lie. I'm pretty sure my doctor was not contacted by the pharmacist before making the substitute and the pharmacy is in a different part of town to my doctor's surgery so it's unlikely they would have regular interaction in the way that might happen with the doctors located in the same neighbourhood. My doctor suggested that they might be on a 'buy one get one free deal' so they are making twice as much from selling me the generic as they would by selling the branded product they were legally obliged to.

Is this a common practice among Irish pharmacies? Should I be making a complaint to the PSI?

Kurtosis

Unrealistic wrote: »

I was given a six month prescription for a certain medicine earlier this year that specified a brand name. The first month I had the prescription filled at a pharmacy near my doctor's surgery and I was given the brand name pills. For the second month my partner went to a pharmacy from the same small chain but in another part of town and was given a generic substitute that actually cost a little bit more. The pharmacist did mention to my partner that she was substituting a generic alternative because they didn't have the brand name in stock at that moment. In month three I went to a different pharmacy and was given the brand name drug (at a lower cost). And then in month four and five I went back to the pharmacy that had given my partner the generic substitute and was given the same generic on both occasions.

When I went back to my doctor for a check up he asked me if I was getting the brand name drug each time. When I told him that I wasn't he advised me to reject any generics in the future and insist on the brand name drug. This was the same time that the news stories were running about the implementation of the pending law on generics and I was surprised to read in that context that what the pharmacy did in dispensing generics to me was actually illegal.

I know the likelihood is that the generic tablets I was given were just as effective as the branded products but I'm still extremely annoyed at being taken for a ride by my local pharmacy and I don't want to let it lie. I'm pretty sure my doctor was not contacted by the pharmacist before making the substitute and the pharmacy is in a different part of town to my doctor's surgery so it's unlikely they would have regular interaction in the way that might happen with the doctors located in the same neighbourhood. My doctor suggested that they might be on a 'buy one get one free deal' so they are making twice as much from selling me the generic as they would by selling the branded product they were legally obliged to.

Is this a common practice among Irish pharmacies? Should I be making a complaint to the PSI?

This may not actually be illegal. Many pharmacies contacted prescribers in the area to authorise generic substitution unless specified explicitly on their prescriptions. If this pharmacy is part of a small chain with an outlet near your doctor, perhaps this is an arrangement in place despite your doctor not being nearby?

As a matter of interest, did your doctor give a reason why you should insist on receiving the brand name? There is a very small group of medicines where it is important to take the same brand consistently.

mountai

I started a thread a couple of days ago "TRUST YOUR CHEMIST AT YOUR PERIL". Got a fair amount of abuse from the Trade . Lot of support as well from ordinary folk. Just bares out what I said.

Unrealistic

penguin88 wrote: »

This may not actually be illegal. Many pharmacies contacted prescribers in the area to authorise generic substitution unless specified explicitly on their prescriptions. If this pharmacy is part of a small chain with an outlet near your doctor, perhaps this is an arrangement in place despite your doctor not being nearby?

That may be the case. Thank you for pointing it out.

penguin88 wrote: »

As a matter of interest, did your doctor give a reason why you should insist on receiving the brand name? There is a very small group of medicines where it is important to take the same brand consistently.

He just said it "is not as good". I don't think this is in a category where changing brands can cause problems. I got the impression that he just shared my opinion that a pharmacist charging a customer the same price for a generic as for the brand name and pocketing all the difference is taking the piss. If there is an economic incentive to substituting a generic drug then part of that incentive should be passed on to the end customer. Otherwise where is the incentive to opt for a drug from some mystery company over the household name company that actually developed it and has been making it for a decade or more. (The news about Ranbaxy having marketed sub-standard generics and submitted the brand name drugs for testing as its own compound spooked me on that front.)

nmop_apisdn

Unrealistic wrote: »

(The news about Ranbaxy having marketed sub-standard generics and submitted the brand name drugs for testing as its own compound spooked me on that front.)

The epic inside story of long-term criminal fraud at Ranbaxy, the Indian drug company that makes generic Lipitor for millions of Americans.


TL;DR-->Don't buy Indian Generics.

L1011

When they offered a generic in lieu of the out of stock brand, the dispensed drug would have been recorded on the system. When you asked for your repeat, they would have repeated what had been dispensed. No malice intended, I suspect, but rather a case of not checking the actual prescription and trusted what was on their PMR.

There are a number of doctors who seem to be programmed to assume that generic = innately ineffective, even though in a fair few cases the "brand" version of a drug on sale here isn't the originator in the first place....

gibo_ie

Unrealistic wrote: »

My doctor suggested that they might be on a 'buy one get one free deal' so they are making twice as much from selling me the generic as they would by selling the branded product they were legally obliged to.

Its actually far more likely that your doctor is getting some special treatment from the drug manufacturer reps for prescribing specific named brands! I can attest that this is very common. If the pharmacist had any doubt in prescribing anything that was slightly different in content then they would have immediately checked with your doctor. These people are highly trained and not just picking packets off shelves!

bleg

Unrealistic wrote: »

When I went back to my doctor for a check up he asked me if I was getting the brand name drug each time. When I told him that I wasn't he advised me to reject any generics in the future and insist on the brand name drug. This was the same time that the news stories were running about the implementation of the pending law on generics and I was surprised to read in that context that what the pharmacy did in dispensing generics to me was actually illegal.

Maybe illegal but seeing as they didn't have any of the originator or branded version in stock the pharmacist's code of conduct kicks in and they gave you the generic so you wouldn't be stuck.

Make a complaint if you wish but I wouldn't waste my time. Non issue in my opinion. If the price is what annoyed you then let the pharmacy know and go elsewhere next time.

Some generics are more expensive than branded versions by the way - not just for the consumer but also for the pharmacist.

Unrealistic

gibo_ie wrote: »

Its actually far more likely that your doctor is getting some special treatment from the drug manufacturer reps for prescribing specific named brands! I can attest that this is very common. If the pharmacist had any doubt in prescribing anything that was slightly different in content then they would have immediately checked with your doctor. These people are highly trained and not just picking packets off shelves!

I had considered that but my experience with the doctor is that he is not the money grubbing type. For example, when I had to pick up a repeat prescription a week before an appointment his receptionist charged me a prescription fee but when I went in for the appointment he spotted that and knocked the prescription fee off the fee for that consultation. The pharmacist on the other hand is charging more for a generic than the other pharmacists in town are charging for the brand name product (which in this case is the originator). So I'm sorry but in this situation I think the likelihood is that the pharmacist is trying to push the generic to boost his own margins at my expense rather than the doctor pushing the brand name drug for his own purposes.

Unrealistic

bleg wrote: »

Maybe illegal but seeing as they didn't have any of the originator or branded version in stock the pharmacist's code of conduct kicks in and they gave you the generic so you wouldn't be stuck.

There are two other pharmacies within walking distance so it wasn't a question of being stuck.

bleg wrote: »

Make a complaint if you wish but I wouldn't waste my time. Non issue in my opinion. If the price is what annoyed you then let the pharmacy know and go elsewhere next time.

I will.

bleg wrote: »

Some generics are more expensive than branded versions by the way - not just for the consumer but also for the pharmacist.

Then why even stock them in the first place? That makes no sense at all. I'm much more inclined to believe that the pharmacist is making a higher margin on the generic in this specific case.

palmcut

It took the UK over 20 years to reach a stage where generics are 68% of dispensing by value. By all accounts generic penetration here is around 18% by value.

One of the reasons why many generics are better value in the UK is because they have 68% generic penetration. As generic penetration in Ireland increases then the price will drop.
In addition the recent passing of a bill to allow generic substitution will help improve generic penetration thus allowing generics to become better value for Irish customers. This change will not be dramatic but it should take less than the 20 years that it took the UK.
Estimates here suggest that we will have our first generic substitution by September or October. (Atorvastatin) The pace will increase after that and within 3 years we should have virtually full generic substitution. (Top 30 drugs)
At that stage most of the generics here will be nearly as competitive as the UK. Prices will not be the same as the UK because the UK is a much bigger market than here.

Icemancometh

gibo_ie wrote: »

Its actually far more likely that your doctor is getting some special treatment from the drug manufacturer reps for prescribing specific named brands! I can attest that this is very common. If the pharmacist had any doubt in prescribing anything that was slightly different in content then they would have immediately checked with your doctor. These people are highly trained and not just picking packets off shelves!

Really? That sounds remarkable. It goes against the Medical Council guidelines for ethical conduct, and could lead to a doctor being struck off. Must be a heck of an inducement to take the risk. Do you have anything to show that this is far more likely than a generic substitution?

Dingle_berry

Icemancometh wrote: »

Really? That sounds remarkable. It goes against the Medical Council guidelines for ethical conduct, and could lead to a doctor being struck off. Must be a heck of an inducement to take the risk. Do you have anything to show that this is far more likely than a generic substitution?

How is it unethical for a pharmaceutical sales rep to hold a training day/seminar/lecture at the K Club etc? That just happens to include a meal and free round of golf for the deligates? It's not cash in hand it's a business meeting! Of course if you're not prescribing the brand name drug then neither you nor your spouse need to attend the event about the brand name drug. Simples! It's probably even tax deductible for the pharmaceutical company involved.

Icemancometh

Dingle_berry wrote: »

How is it unethical for a pharmaceutical sales rep to hold a training day/seminar/lecture at the K Club etc? That just happens to include a meal and free round of golf for the deligates? It's not cash in hand it's a business meeting! Of course if you're not prescribing the brand name drug then neither you nor your spouse need to attend the event about the brand name drug. Simples! It's probably even tax deductible for the pharmaceutical company involved.

Well, that's quite a bit different from what was suggested (although I agree it's unethical). Also, I'm not aware that pharmaceutical companies have any means to monitor which doctors are prescribing which drugs. Again, maybe you have some information here I don't.

Dingle_berry

Icemancometh wrote: »

Well, that's quite a bit different from what was suggested (although I agree it's unethical). Also, I'm not aware that pharmaceutical companies have any means to monitor which doctors are prescribing which drugs. Again, maybe you have some information here I don't.

There are weeks/weekends of this that happen abroad in places like the algarve.
For a relatively brief discussion of the drug. It's not cash in a brown envelope but its certainly dodgey. Where do the companies get the money for this if not from over-inflated profit margins? Why not just hold the one hour lecture in a conference centre for the sake of education?

I don't have the information. But I imagine simple sales/order figures any company keeps - presented in a geographical fashion would show who is prescribing your drug. And a chat with your distributor.

All theoretical and I'm open to correction. Maybe this practise has changed recently?

Icemancometh

Dingle_berry wrote: »

There are weeks/weekends of this that happen abroad in places like the algarve.
For a relatively brief discussion of the drug. It's not cash in a brown envelope but its certainly dodgey. Where do the companies get the money for this if not from over-inflated profit margins? Why not just hold the one hour lecture in a conference centre for the sake of education?

I don't have the information. But I imagine simple sales/order figures any company keeps - presented in a geographical fashion would show who is prescribing your drug. And a chat with your distributor.

All theoretical and I'm open to correction. Maybe this practise has changed recently?

No, it happens. There's less money involved given the depressed state of the economy. You're more likely to get a few sandwiches, than dinner out, that kind of thing. I know of no freebies on the scale that you're suggesting that are handed out on the basis of known prescriptions given.

L1011

Icemancometh wrote: »

Well, that's quite a bit different from what was suggested (although I agree it's unethical). Also, I'm not aware that pharmaceutical companies have any means to monitor which doctors are prescribing which drugs. Again, maybe you have some information here I don't.

An extremely good guess can be made from distributor figures.

Unrealistic wrote: »

There are two other pharmacies within walking distance so it wasn't a question of being stuck.

Your partner still took the offered generic that time, though. And as I said, this will have had to be accurately recorded on their PMR, leading to someone simply performing a repeat to dispense that drug next time.

Unrealistic wrote: »

Then why even stock them in the first place? That makes no sense at all. I'm much more inclined to believe that the pharmacist is making a higher margin on the generic in this specific case.

Some people will actually request a specific branded generic that they've had before, or go as far as to demand they don't get the originator brand regardless of pricing as "generics are cheaper".

Icemancometh wrote: »

No, it happens. There's less money involved given the depressed state of the economy. You're more likely to get a few sandwiches, than dinner out, that kind of thing. I know of no freebies on the scale that you're suggesting that are handed out on the basis of known prescriptions given.

I've seen a few golfing trips abroad for consultants recently. Lot more margin to be made on drugs that cost a few thousand a month than a hundred...

echo beach

Icemancometh wrote: »

Also, I'm not aware that pharmaceutical companies have any means to monitor which doctors are prescribing which drugs. Again, maybe you have some information here I don't.

There are companies that collect data on what drugs are dispensed in particular areas and sell this information to the drug companies. It can't be tied to individual prescribers but drug reps hold good 'intelligence' on doctors habits, e.g. how interested they are in specific new drug launches and what areas of practice they specialise in, and use that to target their marketing.

I don't think any doctor would take a direct bribe and no company would offer one but there are far more subtle and effective ways to change behaviour and big companies know every trick.

palmcut

The drug data collection companies purchase sales data from the drug wholesalers and from the HSE. They also purchase drug sales information from the drug parallel companies.
The gathered information is then sold to the drug companies (Brand and Generic) in the form of what are called "Bricks".
For example Galway city would be a brick, as would Dunlaoighaire or Waterford city.

The drug companies then use this information to target drug sales in a particular "Brick" area.

The dispensing records of individual pharmacies is never known or sold and in the same way the prescribing habits of individual doctors or doctor's practice is never known.

The main company in Ireland for this type of information is IMS.

Icemancometh

echo beach wrote: »

There are companies that collect data on what drugs are dispensed in particular areas and sell this information to the drug companies. It can't be tied to individual prescribers but drug reps hold good 'intelligence' on doctors habits, e.g. how interested they are in specific new drug launches and what areas of practice they specialise in, and use that to target their marketing.

I don't think any doctor would take a direct bribe and no company would offer one but there are far more subtle and effective ways to change behaviour and big companies know every trick.

I would be suspicious of the motivations of pharmaceutical companies, and certainly think the No Free Lunch crowd have things the right way round. My somewhat disingenuous remarks were a reaction to the ridiculous assertion that docs are on the payroll of Big Pharma to prescribe the right meds.

nino1

Unrealistic wrote: »

He just said it "is not as good"

I would be more worried about my doctor if this was the information he was giving me.
You realise that this is not true, right?

Unrealistic

nino1 wrote: »

I would be more worried about my doctor if this was the information he was giving me.
You realise that this is not true, right?

It seems down right odd to attempt to state that so definitively when you don't know what I was prescribed or what was substituted for it, especially in light of the Ranbaxy scandal.

penguin88

penguin88 wrote: »

This may not actually be illegal. Many pharmacies contacted prescribers in the area to authorise generic substitution unless specified explicitly on their prescriptions. If this pharmacy is part of a small chain with an outlet near your doctor, perhaps this is an arrangement in place despite your doctor not being nearby?

As a matter of interest, did your doctor give a reason why you should insist on receiving the brand name? There is a very small group of medicines where it is important to take the same brand consistently.

Your doctor does not know what he is talking about.

steddyeddy

There can be a difference in the bioavailability of the generic drugs to be honest. They're not exactly the same as some people make out.

palmcut

steddyeddy wrote: »

There can be a difference in the bioavailability of the generic drugs to be honest. They're not exactly the same as some people make out.

There is a difference in the bioavailability of some of the generic drugs.
The anti-epileptics for example.
Lithium would be another example.
For most drugs there will not be a bioavailability problem.

Kurtosis

steddyeddy wrote: »

There can be a difference in the bioavailability of the generic drugs to be honest. They're not exactly the same as some people make out.

True, but most are bioequivalent, so any difference in bioavailability will make no clinical difference.

nino1

Unrealistic wrote: »

It seems down right odd to attempt to state that so definitively when you don't know what I was prescribed or what was substituted for it, especially in light of the Ranbaxy scandal.

No it's not odd, you said yourself that your medication was not one where changing brands was a problem!
The Ranbaxy scandal has nothing to do with it. Branded drug companies can also be guilty of poor standards

Nonoperational

bleg wrote: »

Maybe illegal but seeing as they didn't have any of the originator or branded version in stock the pharmacist's code of conduct kicks in and they gave you the generic so you wouldn't be stuck.

Make a complaint if you wish but I wouldn't waste my time. Non issue in my opinion. If the price is what annoyed you then let the pharmacy know and go elsewhere next time.

Some generics are more expensive than branded versions by the way - not just for the consumer but also for the pharmacist.

Pharmacists dispense generics because, in general, they make far far more profit than on the original brand. To say otherwise is just untrue. The bonus is huge on some lines and a pharmacist could be getting 5+ free packs with each 1 purchased.

The legislation to allow generic substitution really needs to ensure the costs of generics genuinely come down. The currant situation where they supposedly cost pretty much the same as the brand on paper but the pharmacy gets a load of free bonus stock, is ridiculous.


That said, your GP should no better than talking nonsense about generics not being as good as branded products is very unprofessional and frankly if he was my GP I'd be looking for another.

drzhivago

Theer was a very interesting link here regarding one of the worlds largest generic manufacturers and their attitude to bioavailability, drug breakdown etc

Frightening tos ay the least
Until I can be assured of regulation that is tight in the area I will not be taking generic drugs from manufacturers I do not know

nesf

Nonoperational wrote: »

That said, your GP should no better than talking nonsense about generics not being as good as branded products is very unprofessional and frankly if he was my GP I'd be looking for another.

On one hand I think you can't say this without knowing what drug the OP was taking, on the other I can't see a pharmacist substituting for a brand with something like a high maintenance dose of lithium or any other drug where there's a known difference between generic and branded, or even between brands. They'd know it could go badly wrong and in this case seriously mess with the person's lithium levels.

echo beach

drzhivago wrote: »

Until I can be assured of regulation that is tight in the area I will not be taking generic drugs from manufacturers I do not know

Good point but what level of regulation would put your mind at ease? I thought the quality of the food I bought was tightly regulated until we found out what was in products made by well known and long established companies and sold in major supermarkets. Horsemeat was found in both branded and own-brand products. Paying a higher price didn't always buy any better quality. Our problem is that we have no way of knowing. Unless you have some means of having products independently tested you have to trust the fact that it has been licensed by the IMB.

The pharmaceutical industry isn't divided into manufacturers of branded medicines and generic medicines. The same companies sell both. The same plants manufacture drugs for different companies. All are overseen by the same regulators.

nino1

drzhivago wrote: »

Until I can be assured of regulation that is tight in the area I will not be taking generic drugs from manufacturers I do not know

How much do you know about the practices of branded drug manufacturers?

Nonoperational

nesf wrote: »

On one hand I think you can't say this without knowing what drug the OP was taking, on the other I can't see a pharmacist substituting for a brand with something like a high maintenance dose of lithium or any other drug where there's a known difference between generic and branded, or even between brands. They'd know it could go badly wrong and in this case seriously mess with the person's lithium levels.

The OP pretty much said this wasn't the case. There are only a very small number of drugs this applies to anyway.

drzhivago wrote: »

Until I can be assured of regulation that is tight in the area I will not be taking generic drugs from manufacturers I do not know

Your probably taking "generic" drugs anyway if you take any OTC paracetamol or ibuprofen etc, or indeed the majority of prescription antibiotics. Millions of people in Ireland and the UK are taking generics manufactured by Clonmel, Pinewood, Activas, Teva etc etc every day with no problems. Very rare you get the branded product now in the UK. For a GP to go around telling people they should ask for the branded product on safety grounds, well frankly that's unbelievably ignorant. If they want to tell them to get branded products because pharmacists are ripping them off well that's a different matter, but not really something the GP should be concerning themselves with.

locum-motion

nesf wrote: »

On one hand I think you can't say this without knowing what drug the OP was taking, on the other I can't see a pharmacist substituting for a brand with something like a high maintenance dose of lithium or any other drug where there's a known difference between generic and branded, or even between brands. They'd know it could go badly wrong and in this case seriously mess with the person's lithium levels.

Lithium in Ireland is available as Camcolit 250mg or 400mg, or as Priadel 200mg or 400mg (note differing strengths)

99+% of prescriptions for Lithium in Ireland are written by brand name. On the very, very rare occasion where they're not, it is usually apparent from the total dose which the patient is on: a total dose of 1,000mg means Priadel 400mg x2 + 200mg x1, while 1,050mg means Camcolit 400mg x2 + 250mg x1.

I'm fairly sure that I've never ever seen a prescription for Lithium 800mg or 1,200mg (ie a dose that could be made up by either brand), but if I did, I would make damn sure I found out which brand the patient gets before I dispensed anything.

Anyway, Lithium is a bad example to use in a discussion about generic substitution - there isn't a "generic" as such available for it, and of the two "branded" products that are out there, everyone knows not to swap between them.

nesf

locum-motion wrote: »

Lithium in Ireland is available as Camcolit 250mg or 400mg, or as Priadel 200mg or 400mg (note differing strengths)

99+% of prescriptions for Lithium in Ireland are written by brand name. On the very, very rare occasion where they're not, it is usually apparent from the total dose which the patient is on: a total dose of 1,000mg means Priadel 400mg x2 + 200mg x1, while 1,050mg means Camcolit 400mg x2 + 250mg x1.

I'm fairly sure that I've never ever seen a prescription for Lithium 800mg or 1,200mg (ie a dose that could be made up by either brand), but if I did, I would make damn sure I found out which brand the patient gets before I dispensed anything.

Anyway, Lithium is a bad example to use in a discussion about generic substitution - there isn't a "generic" as such available for it, and of the two "branded" products that are out there, everyone knows not to swap between them.

I'm on 1200mg, I was on 800mg whilst titrating up.

sam34

locum-motion wrote: »

Lithium in Ireland is available as Camcolit 250mg or 400mg, or as Priadel 200mg or 400mg (note differing strengths)

99+% of prescriptions for Lithium in Ireland are written by brand name. On the very, very rare occasion where they're not, it is usually apparent from the total dose which the patient is on: a total dose of 1,000mg means Priadel 400mg x2 + 200mg x1, while 1,050mg means Camcolit 400mg x2 + 250mg x1.

I'm fairly sure that I've never ever seen a prescription for Lithium 800mg or 1,200mg (ie a dose that could be made up by either brand).

"lithium 1000mg" could be camcolit 250mg x 4 as well as priadel 400mg x 2 plus 200mg.

locum-motion

nesf wrote: »

I'm on 1200mg, I was on 800mg whilst titrating up.

Fair enough, I stand corrected on that; but still, I bet the Dr prescribes it by brand name, doesn't s/he?

And the main thrust of my argument: (

locum-motion wrote: »

...Anyway, Lithium is a bad example to use in a discussion about generic substitution - there isn't a "generic" as such available for it, and of the two "branded" products that are out there, everyone knows not to swap between them.

) still stands.

nesf

locum-motion wrote: »

Fair enough, I stand corrected on that; but still, I bet the Dr prescribes it by brand name, doesn't s/he?

Of course, it'd be quite mad of her not to. I did have an issue with a GP script which said 1200mg Lithium but since I was filling it at my usual pharmacy it wasn't an issue since what I said I was on and the records agreed.

Vorsprung

Lithium and the anti-epileptics are ones I've heard of that shouldn't be written in generic form, are there others? Insulin?

angeldelight

Warfarin is another that springs to mind

palmcut

Probably Theophylline, Carbamazepine, Phenytoin and Sodium Valproate.

locum-motion

Vorsprung wrote: »

Lithium and the anti-epileptics are ones I've heard of that shouldn't be written in generic form, are there others? Insulin?

palmcut wrote: »

Probably Theophylline, Carbamazepine, Phenytoin and Sodium Valproate.

Nifedipine, Verapamil, Diltiazem (if over 60mg).

angeldelight wrote: »

Warfarin is another that springs to mind

Warfarin is controversial. There are very many things that can affect an INR test; a couple of pints, some broccoli, other meds etc. If a patient's INR is different on a given test day, it is much more likely that one of these factors is responsible than any substitution of brand. The BNF, for example, has nothing to say on the subject of swapping Warfarin brands, but on the other hand its entry on Nifedipine specifies "Different versions of modified-release preparations may not have the same clinical effect. To avoid confusion between these different formulations of Nifedipine, prescribers should specify the brand to be dispensed."

Dingle_berry

locum-motion wrote: »

Nifedipine, Verapamil, Diltiazem (if over 60mg).



Warfarin is controversial. There are very many things that can affect an INR test; a couple of pints, some broccoli, other meds etc. If a patient's INR is different on a given test day, it is much more likely that one of these factors is responsible...

Technically incorrect, it's not the INR that they change its the metabolism of Warfarin or Vitamin K that they would change.

bleg

locum-motion

Am I missing something?
Why is a photo of Tina Fey relevant?

bleg

"Oh brother"

locum-motion

Sorry, Bleg, I'm none the wiser!

Edit: Actually, scratch that. She's moving now (which she wasn't before) so I can see what you mean.

locum-motion

Dingle_berry wrote: »

Technically incorrect, it's not the INR that they change its the metabolism of Warfarin or Vitamin K that they would change.

Technically, you're right. Doesn't chage my point, though!

Dingle_berry

locum-motion wrote: »

Technically, you're right. Doesn't chage my point, though!

My bad, thought this was the health sciences forum!

Vorsprung

Mod note

Put the handbags away there lads, thanks.

Xeyn

Generics are allowed to be within 80 - 120% bio equivalent of a drug and does not need to undergo as stringent a course of testing as the original drug. So is it really fair to say this GP doesn't know what he's talking about without knowing anything more. Some people seem very quick to judge and criticise on here.