Prescribed a brand name but dispensed generic

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.

Jumboman

It seems you have no legal come back if you suffer side effects from a generic drug.



http://www.watchlistnews.com/2013/07/16/hope-follows-disappointment-for-those-injured-by-unsafe-generic-drugs/

Consumer advocates were distraught this past June when the United States Supreme Court ruled 5 to 4 that a lawsuit filed against the Mutual Pharmaceutical Company on behalf of an injured New Hampshire citizen was invalid. The decision invalidated a $21 million dollar judgment against the pharmaceutical company.
The situation is detailed in a Los Angeles Times article from June 25 entitled "Supreme Court blocks generic drug liability suits." The opinion of the Court’s majority indicated that they believed generic drug makers are at the behest of the original branded drug when it comes to label updates. With generic manufacturers required not to deviate from the original product or label, the Supreme Court essentially said that the makers are not responsible for instances of patient adversity. Hence, the aforementioned lawsuit, upheld in an appeals court, was overturned.

echo beach

Jumboman wrote: »

It seems you have no legal come back if you suffer side effects from a generic drug.



http://www.watchlistnews.com/2013/07/16/hope-follows-disappointment-for-those-injured-by-unsafe-generic-drugs/

The law in Ireland is different to that in America.
Remember that all drugs have side-effects, they are a part of taking medicine and unless the manufacturer hid details they aren't usually liable. If you suffer because of a quality defect in a licensed medicine and you can prove the manufacturer is at fault you have the same rights regardless of who made it.

Cathy Makes Cards

Very interesting thread. I need to ask a simple question.

I got a prescription from my doctor two weeks ago. On the way back I went to a pharmacy chain, got the usual sealed shop bag with my goods inside and went home. When I opened the bag I discovered that I was given a different brand.

There was no discussion at all regarding the substitution. I assume this is not OK?

locum-motion

Cathy Makes Cards wrote: »

Very interesting thread. I need to ask a simple question.

I got a prescription from my doctor two weeks ago. On the way back I went to a pharmacy chain, got the usual sealed shop bag with my goods inside and went home. When I opened the bag I discovered that I was given a different brand.

There was no discussion at all regarding the substitution. I assume this is not OK?

I would usually make a point of explaining to the patient that the substitution has been made, but that's only as a courtesy, and to avoid the "You made a mistake and gave me the wrong medication" phone call later.

L1011

Cathy Makes Cards wrote: »

Very interesting thread. I need to ask a simple question.

I got a prescription from my doctor two weeks ago. On the way back I went to a pharmacy chain, got the usual sealed shop bag with my goods inside and went home. When I opened the bag I discovered that I was given a different brand.

There was no discussion at all regarding the substitution. I assume this is not OK?

First stage of generic substitution has been introduced since this thread began - albeit the only drugs on it are Lipitor and Seraquel so far.

echo beach

MYOB wrote: »

First stage of generic substitution has been introduced since this thread began - albeit the only drugs on it are Lipitor and Seraquel so far.

There are twenty drugs in the initial list, but only lipitor has had a list of what can be interchanged for it published so far.
The piecemeal way this is being introduced, dragging out what should have happened years ago, makes it next to impossible to have an orderly changeover with proper explanation to Cathy and other patients. Pharmacists and doctors in most areas have come to local arrangements to apply a little common sense instead of tying everybody up in miles of red tape. That way they can get on with doing their jobs.
This affects hundreds of thousands of patients, most of whom will have several changes and as usual it has been left to those in the front-line to do it on top of their other work with no support. There was supposed to be a public information campaign BEFORE the process started but we are still waiting. No doubt when it is all over a PR company will get a big contract to 'inform' us about what is happening.

Cathy Makes Cards

Thank you all very much for taking the time to respond to my question. This morning I went back and spoke to the pharmacist - a very polite young man. My problem was the "morning after" effect of the substituted sleeping pills (a really bad headache) which was never present with the named brand that I've used before. I only occasionally use these and normally wake up refreshed.

The pharmacist was very understanding and explained that while the active ingredient was the same, the non-active ingredient might include something that might not be agreeing with me. He replaced the unused pills with the branded produce without any pressure from me.

Without the help/information I received from this thread I might have been annoyed at the replacement (and him) - so thank you all - from me and him!

Cathy

L1011

Esomeprazole has been added to the sub list with a full set of generics it seems

Jumboman

echo beach wrote: »

The law in Ireland is different to that in America.
Remember that all drugs have side-effects, they are a part of taking medicine and unless the manufacturer hid details they aren't usually liable. If you suffer because of a quality defect in a licensed medicine and you can prove the manufacturer is at fault you have the same rights regardless of who made it.

But all these pharmaceutical companies are based in America. So if want to sue them I think you will need go through the US.

L1011

Jumboman wrote: »

But all these pharmaceutical companies are based in America. So if want to sue them I think you will need go through the US.

No you won't.

All medicines sold in Ireland have an Irish product authorisation holder.