Trouble with discontinued drug

dreoilin

Hey guys, I hope I've posted this in the appropriate place.

My sister suffers from vascular headaches as a result of surgery she had to remove a brain abscess a few years ago. She's been taking Sanomigran daily, which was helping a lot up until this year when it's production was discontinued due to inadequate demand.

After it was discontinued we managed to find a couple of chemists that had some stocks left on their shelves. Once that was gone, she switched to the generic of this drug, which unfortunately just isn't as effective. Her GP is insisting that she stay on the discontinued drug and that a pharmacy will just have to source it from somewhere.

It's a long shot, but is/was anybody else taking this drug and in the same situation, or know anybody that was? Or does anyone know if any local pharmacies around you have stocks left over? I'm thinking less commercial, family run ones.

I'll be needing these tablets for the headache trying to sort this out!

Esel

Might be available from the UK (incl NI). If so I think she could have up to 6 months dispensed at a time.

https://en.m.wikipedia.org/wiki/Pizotifen

Nonoperational

The generic is exactly the same, any difference is purely psychological.

sunny2004

Nonoperational wrote: »

The generic is exactly the same, any difference is purely psychological.

This is in fact incorrect, as generic drugs do not have to contain 100% of the original drug. I suggest you do the research for this urban myth or better still ask a medical professional

Nonoperational

sunny2004 wrote: »

This is in fact incorrect, as generic drugs do not have to contain 100% of the original drug. I suggest you do the research for this urban myth or better still ask a medical professional

If the generic states that is contains Pizotifen 0.5mg then it will contain Pizotifen 0.5mg and be equivalent to the original brand.

This isn't after hours, I suggest you educate yourself before you mislead people.

http://www.ema.europa.eu/ema/index.jsp?curl=pages/special_topics/document_listing/document_listing_000335.jsp&mid=WC0b01ac0580514d5c
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm134444.htm

echo beach

sunny2004 wrote: »

This is in fact incorrect, as generic drugs do not have to contain 100% of the original drug.

No tablet HAS to contain 100% of the stated drug. There are accepted manufacturing tolerances, often 95%-105% but it can be 80% -120%, which apply to BOTH branded and generic drugs. One batch can vary from another within these tolerances because the difference is not clinically significant.

There ARE differences in how a person may respond to a generic version. It is correct to say that this difference in response is 'physiological' because it is caused by the psyche or mind. This doesn't mean that it isn't real. The placebo effect, which is also real, is definitely a psychological effect because no active drug is involved. Both can be measured by the effect, be it on blood pressure, lung volume, migraine attacks or whatever. Telling somebody that what they are experiencing is physiological doesn't mean that you don't believe them.

If a particular company has stopped making a drug then there is no way to access something that no longer exists. Often you will find that they have sold it on to another company who are buying it from the same producer and putting it into their own packaging. With globalisation, it often turns out that all the different companies are buying the same drug from a single source, usually in India. This is particularly the case with lesser used drugs because it wouldn't be economic for many different companies to have separate manufacturing plants for low volumes of the same drug so they all out-source manufacture to a single producer.

Esel

echo beach wrote: »

No tablet HAS to contain 100% of the stated drug. There are accepted manufacturing tolerances, often 95%-105% but it can be 80% -120%, which apply to BOTH branded and generic drugs. One batch can vary from another within these tolerances because the difference is not clinically significant.

There ARE differences in how a person may respond to a generic version. It is correct to say that this difference in response is 'physiological' because it is caused by the psyche or mind. This doesn't mean that it isn't real. The placebo effect, which is also real, is definitely a psychological effect because no active drug is involved. Both can be measured by the effect, be it on blood pressure, lung volume, migraine attacks or whatever. Telling somebody that what they are experiencing is physiological doesn't mean that you don't believe them.

If a particular company has stopped making a drug then there is no way to access something that no longer exists. Often you will find that they have sold it on to another company who are buying it from the same producer and putting it into their own packaging. With globalisation, it often turns out that all the different companies are buying the same drug from a single source, usually in India. This is particularly the case with lesser used drugs because it wouldn't be economic for many different companies to have separate manufacturing plants for low volumes of the same drug so they all out-source manufacture to a single producer.

You are mixing up physiological and psychological there.

sunny2004

Nonoperational wrote: »

If the generic states that is contains Pizotifen 0.5mg then it will contain Pizotifen 0.5mg and be equivalent to the original brand.

This isn't after hours, I suggest you educate yourself before you mislead people.

http://www.ema.europa.eu/ema/index.jsp?curl=pages/special_topics/document_listing/document_listing_000335.jsp&mid=WC0b01ac0580514d5c
http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm134444.htm

I am educated on the subject, my advice to you is to seek professional help for your attitude and professional advice for your beliefs regarding the guidelines around generic drugs.. or better still get your advice from the internet you know some folk think the moon is made of cheese, my friend..

Nonoperational

You're embarrassing yourself at this stage.

This is the health sciences forum. The standard of discussion should be higher than immature smiley faces and anecdotes about the moon being made of cheese. You are speaking to an educated audience, many of whom are healthcare professionals. If you are educated on the matter then make a coherent argument backing up your point, it is clear you are not able to do this. Generic drugs sold in Europe have to meet certain standards and if marketed as having the same active ingredient as the original brand they have to be within certain tolerances and be bioequivalent.

sunny2004

Nonoperational wrote: »

You're embarrassing yourself at this stage.

This is the health sciences forum. The standard of discussion should be higher than immature smiley faces and anecdotes about the moon being made of cheese. You are speaking to an educated audience, many of whom are healthcare professionals. If you are educated on the matter then make a coherent argument backing up your point, it is clear you are not able to do this. Generic drugs sold in Europe have to meet certain standards and if marketed as having the same active ingredient as the original brand they have to be within certain tolerances and be bioequivalent.

I love your assumptions as to whom I am, and how developed you and the audience here is, bravo..

I find it creepy that before you replied you felt the need to access my profile.. now that deserves a smiley lol

As I stated there are differences between original and generic drugs, I suggest you spend that perceived intellect and superiority complex on finding them out. Instead of trying to bully me like an online moron.. hint, the generic may not have the same fillers. May not contain the same quantity of active ingredient as stated by others..

Nonoperational

sunny2004 wrote: »

I love your assumptions as to whom I am, and how developed you and the audience here is, bravo..

I find it creepy that before you replied you felt the need to access my profile.. now that deserves a smiley lol

As I stated there are differences between original and generic drugs, I suggest you spend that perceived intellect and superiority complex on finding them out. Instead of trying to bully me like an online moron.. hint, the generic may not have the same fillers. May not contain the same quantity of active ingredient as stated by others..

So now you are talking about the inert excipients ("fillers" to you), when I never disputed these could be different?

You made a very different point initially...

sunny2004 wrote: »

This is in fact incorrect, as generic drugs do not have to contain 100% of the original drug. I suggest you do the research for this urban myth or better still ask a medical professional

I won't even bother anymore. Good luck.

sunny2004

Nonoperational wrote: »

I won't even bother anymore. Good luck.

Thank you for trying in an abusive manner it was appreciated, also thank you for not taking anything onboard that was posted by others, thank you for cherry picking your quotes, its truly appreciated, thank you for pointing out the vastness of your intellect, and thank you for making all those assumptions about me.

Without you here we would all be lost.

As for your juvenile remark about making a different point, actually I didn't, I stated they were not the same, and referenced the amount of the active drug, that was also fleshed out by another post, I simply added to my original post regarding the filler, that you assume has zero effect. yet another assumption on your part.

Now run alone to your intellectual friends while I go back to after hours and keep creeping on other peoples profiles before you reply it suite you..

Thanks again, and don't forget to get the medical advice I suggested in my previous post. It might help you..

Kurtosis

Mod note

Can we drop the snarky tone please sunny and Nonoperational? The childish argumentative posts from the two of you do nothing for the discussion.

If you wish to refute a point someone has made, please do that by presenting a flaw, a counterargument, and some evidence to support your position rather than just saying "You're wrong". Condescension and sarcastic smileys aren't welcome in the forum.

Nonoperational

sunny2004 wrote: »

Thank you for trying in an abusive manner it was appreciated, also thank you for not taking anything onboard that was posted by others, thank you for cherry picking your quotes, its truly appreciated, thank you for pointing out the vastness of your intellect, and thank you for making all those assumptions about me.

Without you here we would all be lost.

As for your juvenile remark about making a different point, actually I didn't, I stated they were not the same, and referenced the amount of the active drug, that was also fleshed out by another post, I simply added to my original post regarding the filler, that you assume has zero effect. yet another assumption on your part.

Now run alone to your intellectual friends while I go back to after hours and keep creeping on other peoples profiles before you reply it suite you..

Thanks again, and don't forget to get the medical advice I suggested in my previous post. It might help you..

Your fundamental understanding of this is wrong. Let me try and point it out to you. You seem to think that by echobeach posting that generics (and brands) can have varying percentages of active ingredient means you are correct. In fact, for a generic medicine to be licensed by the FDA or EMEA it has to be bioequivalent to the brand leader. In pharmaceutical manufacturing, be it generic or indeed the brand leader, the concentration is never actually 100% of what is stated. It is a percentage that is within acceptable tolerances. This was explained by echo beach above but I believe you misinterpreted is as meaning that generics can have a different percentage of active to the brand leaded. This applies to branded and generic preparations. In fact, different batches of the same medicines will have slightly different percentages of active.

The only allowable difference is in inert excipients. It is very important to be clear that a generic version of a branded medicine will for all intents and purposes be identical to the branded version unless someone has a sensitivity to an excipient.

I have a degree in pharmacy and have worked in an API plant. I simply cannot believe that you can come on here and completely misrepresent the facts based on your misunderstanding of the situation. I have posted references to the FDA and EMEA websites, in fact this information is widely available online. You have posted nothing but anecdotes and smilies to attempt to draw me out.

On the moderators advice, lets drop the childishness and why don't you clearly outline your argument that generics are not equivalent to brand leaders? I would be genuinely interested in hearing it.

This is a nice review article taken from the FDA information page http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm#_ftn1

Kesselheim et al. Clinical equivalence of generic and brand name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA. 2008;300(21)2514-2526

sunny2004

I refer you back to my first post, seek medical advice. I don't think boards is the place for medical advice or legal advice, hence my outline, and nothing more, followed by a suggestion you sought the advice of professionals in the field, I am not here to trawl the internet for cut and paste arguments and links. I have spoken with the relevant people already, I suggest you do the same.

As for your history as outlined above, it adds no weight to the argument at all to me, I'm not the type that believed everything I read or am told, that's assuming your history is REAL, the only real aspect of your posts was in fact your mentality and condescending tone, the abusive nature of your reply, and your general attitude.

Again, I advise anyone to either take this guys word for it, or use your gray matter and actually speak with people in the relevant field. and let me finish on this, Your fundamental understanding of this is wrong. so we agree on something, we both think the other is incorrect.

and I was convinced you "wouldn't be bothering anymore," I am feeling rather special regarding your attention..

If you bothered to actually read the thread, not cherry pick, you would get that I give the original reply, with the suggestion that you sought medical advice.. I didn't include any additional information as I didn't think this was the place for it..

As you seem to think that your alleged background carry any weight, let me just rest your mind that my information comes from a higher source with more experience than yours. so you will appreciate if I don't act on your words, but like your background my source could be a figment of my imagination, which would be odd as they are a family friend and we have discussed this at length.

I wish you all the best and wait with bated breath for any reply

Nonoperational

sunny2004 wrote: »

I refer you back to my first post, seek medical advice. I don't think boards is the place for medical advice or legal advice, hence my outline, and nothing more, followed by a suggestion you sought the advice of professionals in the field, I am not here to trawl the internet for cut and paste arguments and links. I have spoken with the relevant people already, I suggest you do the same.

As for your history as outlined above, it adds no weight to the argument at all to me, I'm not the type that believed everything I read or am told, that's assuming your history is REAL, the only real aspect of your posts was in fact your mentality and condescending tone, the abusive nature of your reply, and your general attitude.

Again, I advise anyone to either take this guys word for it, or use your gray matter and actually speak with people in the relevant field. and let me finish on this, Your fundamental understanding of this is wrong. so we agree on something, we both think the other is incorrect.

and I was convinced you "wouldn't be bothering anymore," I am feeling rather special regarding your attention..

If you bothered to actually read the thread, not cherry pick, you would get that I give the original reply, with the suggestion that you sought medical advice.. I didn't include any additional information as I didn't think this was the place for it..

As you seem to think that your alleged background carry any weight, let me just rest your mind that my information comes from a higher source with more experience than yours. so you will appreciate if I don't act on your words, but like your background my source could be a figment of my imagination, which would be odd as they are a family friend and we have discussed this at length.

I wish you all the best and wait with bated breath for any reply

So, after all my attempts at asking you to have a reasonable scientifically based discussion about your comments on generic drugs, the best you can do is tell me to seek medical advice and post anecdotal evidence about talking to a "higher source". I'm not asking for medical advice at all, I am asking you to outline your position on generic medications.

This was an attempt at a reasonable scientific discussion which you continually derailed. Scientific discussion is not only allowed on this forum, it is welcomed.

Your final retort is to question my credibility and imply that me stating I have a pharmacy degree as being a figment of my imagination? I find that comment unreasonable and uncalled for and in fact a little dangerous.

I am a member of the Royal College of Physicians and practice medicine on a daily basis. Could I ask you to elaborate on which "experts in the field" I should consult?

Thanks

sunny2004

Nonoperational wrote: »

So, after all my attempts at asking you to have a reasonable scientifically based discussion about your comments on generic drugs, the best you can do is tell me to seek medical advice and post anecdotal evidence about talking to a "higher source". I'm not asking for medical advice at all, I am asking you to outline your position on generic medications.

This was an attempt at a reasonable scientific discussion which you continually derailed. Scientific discussion is not only allowed on this forum, it is welcomed.

Your final retort is to question my credibility and imply that me stating I have a pharmacy degree as being a figment of my imagination? I find that comment unreasonable and uncalled for and in fact a little dangerous.

Again you have an inability to follow the threads, I explained to you that my personal opinion is not to give either medical advice or legal advice here on boards, as some posters can come across as credible while posting pure poo..

So I explained there was a difference between generic and original drugs, this is the case..

you then went on a repeated insulting illogical, cherry picking exercise and excused yourself from the conversation, the mods stepped in and I hit liked and walked away.. you were unable to do that.

Your sources are in my opinion as credible in your eyes as mine. I cant speak about your sources in my eyes, all I can say is with your background that you claim, if true, is not as specific as my source, this is a fact, based on what you posted or felt the need to post, I am not here at your bequest to prove anything, I possess the facts from someone who is head of a control group for meds, by head I mean national head. not some worker in a plant, or some GP.

But to clarify for you, and I always find repetition good for learning purposes, I suggest you seek medical clarification from a reputable source..

I am replying to an individual that went to my profile to look at my other posts before replying, I think that speaks volumes.

But as you seem to need to reply we can continue this over and over, as pathetic as it is, I'm suggesting people don't take my word for it and seek medical clarification and you are clearly saying your word and the intellectuals here in this forum, are to believed, I am saying that's stupidity and widespread on the internet

As for your assumption, you seem to deal in assumptions, that we should have a scientific discussions over the issue is silly why ? Im not in a position to declare myself an expert on the matter, I am simply not listening to the booby on the beat, and taking my information from the police commissioner

I hope that works for you, if not we can use bill and ben and the flower pot men..

You were given the information, you disagree, that's OK with me lol

Im actually laughing at the futility of this.. GO SEEK PROFESSION CLARIFICATION ON THE MATTER.. or spend your life believing what suits you

Cant wait for the next round.. but apparently if I don't take the route you dictate I'm derailing the conversation..

Keep creeping on others profiles, is says more about you than your words.

WonkyMe

Nonoperational wrote: »

If the generic states that is contains Pizotifen 0.5mg then it will contain Pizotifen 0.5mg and be equivalent to the original brand.

This isn't after hours, I suggest you educate yourself before you mislead people.

]

Absolutely correct.

Some people can however get attracted to the branding and marketing mythology and thus the identical non-branded drug works less well. The opposite of the placebo effect.

Nonoperational

sunny2004 wrote: »

Again you have an inability to follow the threads, I explained to you that my personal opinion is not to give either medical advice or legal advice here on boards, as some posters can come across as credible while posting pure poo..

So I explained there was a difference between generic and original drugs, this is the case..

you then went on a repeated insulting illogical, cherry picking exercise and excused yourself from the conversation, the mods stepped in and I hit liked and walked away.. you were unable to do that.

Your sources are in my opinion as credible in your eyes as mine. I cant speak about your sources in my eyes, all I can say is with your background that you claim, if true, is not as specific as my source, this is a fact, based on what you posted or felt the need to post, I am not here at your bequest to prove anything, I possess the facts from someone who is head of a control group for meds, by head I mean national head. not some worker in a plant, or some GP.

But to clarify for you, and I always find repetition good for learning purposes, I suggest you seek medical clarification from a reputable source..

I am replying to an individual that went to my profile to look at my other posts before replying, I think that speaks volumes.

But as you seem to need to reply we can continue this over and over, as pathetic as it is, I'm suggesting people don't take my word for it and seek medical clarification and you are clearly saying your word and the intellectuals here in this forum, are to believed, I am saying that's stupidity and widespread on the internet

As for your assumption, you seem to deal in assumptions, that we should have a scientific discussions over the issue is silly why ? Im not in a position to declare myself an expert on the matter, I am simply not listening to the booby on the beat, and taking my information from the police commissioner

I hope that works for you, if not we can use bill and ben and the flower pot men..

You were given the information, you disagree, that's OK with me lol

Im actually laughing at the futility of this.. GO SEEK PROFESSION CLARIFICATION ON THE MATTER.. or spend your life believing what suits you

Cant wait for the next round.. but apparently if I don't take the route you dictate I'm derailing the conversation..

Keep creeping on others profiles, is says more about you than your words.

So your argument is that a secretive man (the police commissioner as you call him), who is "some one who is head of a control group for meds, by head I mean national head" told you that generics were different and that's that. You won't debate it or elaborate on it any further.

You have told me many times to seek professional clarification on this mystery, but you won't tell me who to speak to.

I think I'll take my queue from your good self here and sign off with a :rolleyes:

Mind yourself.

Nonoperational

WonkyMe wrote: »

Absolutely correct.

Some people can however get attracted to the branding and marketing mythology and thus the identical non-branded drug works less well. The opposite of the placebo effect.

Agreed. And who am I to say that psychology isn't important. It may well be to some people.

sunny2004

Nonoperational wrote: »

So your argument is that a secretive man (the police commissioner as you call him), who is "some one who is head of a control group for meds, by head I mean national head" told you that generics were different and that's that. You won't debate it or elaborate on it any further.

You have told me many times to seek professional clarification on this mystery, but you won't tell me who to speak to.

I think I'll take my queue from your good self here and sign off with a :rolleyes:

Mind yourself.

again you seem to have issues following threads, I never mentioned it was a man, at any point, also you make the assumption that police commissioners are male..

If you actually read the thread, lol

Nonoperational wrote: »

If the generic states that is contains Pizotifen 0.5mg then it will contain Pizotifen 0.5mg and be equivalent to the original brand.

This isn't after hours, I suggest you educate yourself before you mislead people. [/url]

This is the attitude that stared this and this is incorrect, its accepted that drugs can sway from 80% to over 100% this is not something that can be disputed..

So you have a company producing the product as a premium, and a company producing it at a lower cost, which as a rational logic member of society would you think might produce even a marginally lower grade of the drug? Im not suggesting it happens, Im simply saying is tescos corn flakes really the same as the original ? which one is more likely to produce something with 1% lower active agreement ? the branded product or the generic company who are in the business of producing a cost effective product ? and as you stated the fillers do nothing, that's rather odd, I'm assuming you have research this. I was told by my fantasy contact that there is little research on this matter. but I assume you yet again know better. Reminds me of the other conversation regarding the interactive effects of multiple drugs, after about 3 most GPs have no idea what the drugs are doing in combination as again there is no research on this..

Just for your information, when you creep on another members profile, it shows that you visited lol I would have assumed a confident intellectual well read man like yourself would already know that..

As for the assumptions, you continually make, that's a character trait, little you can about that..




I have not put myself out here as the know it all, I have simply stated you seek medical clarification, you seem to be perplexed where to look, I cant help you, as my information comes from a family friend as stated who is in fact perfectly positioned to give said advice. I suppose you could listen to the companies producing the generic versions, they will tell you exactly what oyu want to hear, and may in fact explain why they often use cheaper inert fillers.

I don't know how to roll my eyes, so I will go with a few simleys you seem to like them.

Kurtosis

penguin88 wrote: »

Mod note

Can we drop the snarky tone please sunny and Nonoperational? The childish argumentative posts from the two of you do nothing for the discussion.

If you wish to refute a point someone has made, please do that by presenting a flaw, a counterargument, and some evidence to support your position rather than just saying "You're wrong". Condescension and sarcastic smileys aren't welcome in the forum.

sunny2004 wrote: »

Your fundamental understanding of this is wrong.

...

I wish you all the best and wait with bated breath for any reply

Mod note:

You were asked not to engage in debate where your point is "You're wrong" and to drop the sarcastic smileys, you failed on both counts. Please do not post in this thread again. PM me if you have any questions.

Just to add as well, discussing similarities/differences between generic and branded medicines is neither medical nor legal advice and is a welcome topic of discussion.

RobFowl

Mod Note
Let's all calm down
Thanks
Rob

rhabarbarum

If you cannot get the original drug or its generic version, than you may consider switching to other medication after discussion with your doctor
http://www.nhs.uk/Conditions/Migraine/Pages/Treatment.aspx

Mod edit as medical advice not allowed
Rob

nua domhan

sunny2004 wrote: »

So I explained there was a difference between generic and original drugs, this is the case..

Wrong - what's your source on this?

UsedToWait

Entertaining and all as the to-and-fro of the thread has been so far, I'd like to add my tuppence worth and see if there are any opinions.

I take esomeprazole 40mg for reflux.

I'd consider myself to have a fairly jaundiced view of marketing, and I'm aware that generic esomeprazole contains the same 40mg of active ingredient as the more expensive Nexium 40mg.

That's a way of saying that I don't think I'd be susceptible to a placebo effect influencing the fact that the Nexium is, for me, much more effective.
If I take the generic, I wake in the night choking on the acid from my stomach.
If I take the Nexium, I don't.

Is the placebo effect so strong that it would cause this physiological reaction?
Or is it possible that, in my individual case, there is some other factor influencing the efficacy of each product?

My own theory is, given the Nexium comes in tablet form and the generic in a capsule, that this must be the cause, but I'm prepared to bow to the medical knowledge of the forum if you can convince me that my subconscious brand bias is causing the generic version to not work for me...

Edited to add:
Having studied marketing, and also having seen first hand different branded products being rolled out on the same production line, which only stops to change the packaging being used, I would consider myself fairly immune to the 'power' of branding, but maybe at some deeply unconscious level, I'm not?

Edited again to add:
I should also say that I take other generic drugs (antihistamines mostly) and have found no subjective difference in their efficacy over branded versions..

Kurtosis

UsedToWait wrote: »

Entertaining and all as the to-and-fro of the thread has been so far, I'd like to add my tuppence worth and see if there are any opinions.

I take esomeprazole 40mg for reflux.

I'd consider myself to have a fairly jaundiced view of marketing, and I'm aware that generic esomeprazole contains the same 40mg of active ingredient as the more expensive Nexium 40mg.

That's a way of saying that I don't think I'd be susceptible to a placebo effect influencing the fact that the Nexium is, for me, much more effective.
If I take the generic, I wake in the night choking on the acid from my stomach.
If I take the Nexium, I don't.

Is the placebo effect so strong that it would cause this physiological reaction?
Or is it possible that, in my individual case, there is some other factor influencing the efficacy of each product?

My own theory is, given the Nexium comes in tablet form and the generic in a capsule, that this must be the cause, but I'm prepared to bow to the medical knowledge of the forum if you can convince me that my subconscious brand bias is causing the generic version to not work for me...

Edited to add:
Having studied marketing, and also having seen first hand different branded products being rolled out on the same production line, which only stops to change the packaging being used, I would consider myself fairly immune to the 'power' of branding, but maybe at some deeply unconscious level, I'm not?

Edited again to add:
I should also say that I take other generic drugs (antihistamines mostly) and have found no subjective difference in their efficacy over branded versions..

The placebo effect can actually have a physiological impact, and this can persist even when people know they are taking a placebo. This is a really nice study that demonstrates the placebo effect associated with branded and generic medicines. Participants were given a dummy tablet and were told it was an original brand to treat anxiety by lowering blood pressure. When measured, both their blood pressure and anxiety had decreased. Some people to a generic brand (although they were still taking placebo tablets). When their measurements were taken again, those that had switched had higher blood pressure and anxiety levels and reported more side effects compared to those who were left on the original brand placebo tablets.

echo beach

UsedToWait wrote: »

Is the placebo effect so strong that it would cause this physiological reaction?
Or is it possible that, in my individual case, there is some other factor influencing the efficacy of each product?

My own theory is, given the Nexium comes in tablet form and the generic in a capsule, that this must be the cause, but I'm prepared to bow to the medical knowledge of the forum if you can convince me that my subconscious brand bias is causing the generic version to not work for me...

While I agree with Penguin regarding the strength of the placebo effect, my own experience of large numbers of people switching to various generic brands over the last few years suggests that your experience with esomeprazole may be due to the different formulations. There is a generic tablet form that might be worth a try if only to see if you notice a difference.

UsedToWait

Thanks for your suggestion.
As it happens, my pharmacist suggested sourcing a tablet rather than capsule version also, so I certainly will give it a try.

While I appreciate that any perceived improvement in efficacy may not be separable from the placebo effect, that in itself would be no bad thing if it stops the horrible sensation of waking up essentially choking on your own stomach acid..



Slightly off topic, but in a roundabout way addressing the reaction that the OP received from certain healthcare professionals to the original query on the thread I'd like to broaden out the discussion slightly if I may..

I've had regular dealings with numerous HCPs in relation to a number of different medical conditions over the years, and I've noticed vast differences between the way they practice.

I think some are very orthodox, and empirical in their approach - disinclined to listen to the patient's input and insight into conditions they live with daily and the treatment thereof..

However I believe the medical literature can only go so far in proving the efficacy or otherwise of different treatments.

- Firstly, the work of the likes of Ben Goldacre shows that the validity of the research papers many doctors rely on can range from questionable to downright fraudulent

- Secondly, the range of reported side effects listed on must of the meds I've been prescribed should serve to highlight that there is no one size fits all solution - each patient can react differently to a certain medicine (and perhaps to different formulations or roa's of that medicine)
-- is it not the case that cutting edge research is now looking at formulation treatments individualised to the patient's own genetic sequence? That in itself should be instructive..

I have though found that some HCPs are very willing to listen and discuss treatment options, and in my opinion, they are better clinicians.

In all the time I've been interacting with the medical profession, I've rarely been asked:

- any question about my diet in relation to an inflammatory condition I have, when anecdotally many patients feel diet has a huge effect on their condition..

- any question about / any investigation of environmental factors triggering an allergic condition I have, just prescription upon prescription until the symptoms are stabilised..


All of which is a long winded (thanks if you've taken the time to read this far!) way of asking:

Do you agree that some HCPs take a medication-centred approach to their practice, when they'd be better served taking a more holistic, patient-centred approach?

Esel

UsedToWait wrote: »

....

Apologies for truncating your post, and I am not a HCP.

Regarding generic versus original - and apart from capsule versus tablet - could it be about inactive ingredients? Method of absorption? As I said, IANAD.

I don't think that the placebo effect applies here.

L1011

As far as I remember Nexium is a 24 hour sustained release format (using a somewhat complicated method of variable thicknesses of gasto resistant coating on bulked up molecules) whereas some of the generics are not. I'm not sure which are and aren't (or if Nexium still or always is XR).

echo beach

UsedToWait wrote: »

Do you agree that some HCPs take a medication-centred approach to their practice, when they'd be better served taking a more holistic, patient-centred approach?

In a word -Yes but in fairness the alternatives are difficult and sometimes impossible. Really listening to patients and getting to the bottom of their problem, which often isn't whatever symptom they present with, requires a great deal of skill, experience and TIME. Most consultations with a HCP last a maximum of 10-15 minutes and that simply isn't long enough, no matter how well intentioned the practitioner is. In alternative and complementary medicine a consultation is never less than 45-60 minutes.

There is also the problem of increasing specialisation which means a HCP has a very narrow focus and the patient is sent to somebody else if there is another, possibly related problem. You become a collection of body parts and disease states.

Patients also contribute to the problem by being very passive and have unreasonable expectations of instant cures without having to make any changes to their lifestyle. There is no easy answer but current practice with its poor communication is far from the optimum.

Nonoperational

A holistic approach is essential in my opinion. Yes it is hard to get the time, but I have found talking something out can be as effective as medication in many instances. Some brand leaders have different release profiles, and that is a completely reasonable point.

UsedToWait

Nonoperational wrote: »

Some brand leaders have different release profiles, and that is a completely reasonable point.

With that in mind, would you be prepared to reconsider your initial dismissal of the OP's sister's complaint?

Nonoperational wrote: »

The generic is exactly the same, any difference is purely psychological.

jh79

UsedToWait wrote: »

With that in mind, would you be prepared to reconsider your initial dismissal of the OP's sister's complaint?

A generic would have a similar formulation to the originators and be bioequivalent.

The poster is referring to drugs with the same active ingredient but within a different formulation not generics as such.

UsedToWait

jh79 wrote: »

A generic would have a similar formulation to the originators and be bioequivalent.

The poster is referring to drugs with the same active ingredient but within a different formulation not generics as such.

Sorry, you're going to have to break this down for me, as I'm not a medic..

I thought we had established that the same drug, delivered in a different manner, can have differing degrees of efficacy.

Is it not possible that the generic version of the drug prescribed for the OP's sister comes in a different formulation?

jh79

UsedToWait wrote: »

Sorry, you're going to have to break this down for me, as I'm not a medic..

I thought we had established that the same drug, delivered in a different manner, can have differing degrees of efficacy.

Is it not possible that the generic version of the drug prescribed for the OP's sister comes in a different formulation?

If the formulation differs enough that it is not bioequivalent then it is not a generic.

UsedToWait

jh79 wrote: »

If the formulation differs enough that it is not bioequivalent then it is not a generic.

Sorry, I'm not being awkward here - genuinely interested..
If it is the same drug, with a different formulation which precludes it from being called a generic, what is it called then?

jh79

UsedToWait wrote: »

Sorry, I'm not being awkward here - genuinely interested..
If it is the same drug, with a different formulation which precludes it from being called a generic, what is it called then?

Formulations can be different and still be a generic as long as it behaves in a similar manner ie is bioequivalent .

If it is not bioequivalent then it is a different dosage form.


https://www.sciencebasedmedicine.org/generic-drugs-are-they-equivalent/

UsedToWait

Thanks for the link - very informative..

In the section on bioequivalence, the author points out that in regards to the extent of absorption of the drug:

"Most regulators worldwide have decided that a 20% variation is generally not clinically significant". [my italics]

That suggests that it is possible that there will be outliers - patients for whom this difference is in fact clinically significant.

I came to this thread because I was annoyed at the way the OP's query was shot down without any consideration that there may be, however slight, the possibility that their sister's reaction to the substitution of her medication was indeed as a result of the medication, rather than of the placebo effect.

I'll restate my point that I feel that some clinicians are disinclined to listen to patients because of a blinkered, empirical approach that favours (often flawed) research over first hand patient feedback.

jh79

UsedToWait wrote: »

Thanks for the link - very informative..

In the section on bioequivalence, the author points out that in regards to the extent of absorption of the drug:

"Most regulators worldwide have decided that a 20% variation is generally not clinically significant". [my italics]

That suggests that it is possible that there will be outliers - patients for whom this difference is in fact clinically significant.

I came to this thread because I was annoyed at the way the OP's query was shot down without any consideration that there may be, however slight, the possibility that their sister's reaction to the substitution of her medication was indeed as a result of the medication, rather than of the placebo effect.

I'll restate my point that I feel that some clinicians are disinclined to listen to patients because of a blinkered, empirical approach that favours (often flawed) research over first hand patient feedback.

In this case patient feedback is less reliable than even flawed research as the patient is aware of a change and confirmation bias is inevitable.

UsedToWait

jh79 wrote: »

In this case patient feedback is less reliable than even flawed research as the patient is aware of a change and confirmation bias is inevitable.

Fair enough, but that implies you are dismissing out of hand the postulate that for certain patients, the generic will simply not be as effective as the original formulation (per my post above yours).

What is to happen to such patients if doctors simply dismiss their complaints as 'confirmation bias'?