Thursday, July 23, 2009

Generic vs Name brand drugs

I'll start by stating that I used to work for big pharma companies, as well as a fairly big generic pharma company. that being said, I have seen both sides and I have no allegiance to one side or the other. I know that there is a very good reason for why the name brand drugs are so expensive, but I also know that, generally, generic drugs are just as good.


I used to take wellbutrin xl. it's an extended release of an antidepressant, designed to release the main ingredient slowly over 24 hours. it worked wonders. i was terribly stressed (my job was very stressful), always highly anxious, stayed awake for days at a time sometimes. then i started on wellbutrin xl, and not only was i more human, i actually had a sexual appetite. i felt normal for the first time in a long time. because i was working for the company that made the drug, and had a great pharmacy benefit for using their drugs, i always got the name brand. when i left the company to go to school full time, however, i didnt make a fuss when the pharmacist switched me to the generic version. when i got home to take it for the first time, though, i should have known something was wrong right away. the name brand wellbutrin xl is a tiny pill, its a high dose, but the formulation used to make it an extended release is from a special process, which i am not sure if i am allowed to get into, so i won't, just to be safe. anyhow - the generic version, budeprion, made by the same generic company i used to work for, was this HUGE horse-pill. i shruged and said well, its the same active ingredient, its the same amount of active ingredient, i guess they just needed to put a whole lot more filler in there? and i just "went with it."

tip #1: if you are ever switched from a name brand to a generic brand, and you see that the pill is more than twice the size of the original, think more carefully before making the switch.

so i went with it, and things started changing back. i was anxious, stressed, full-on depressed, barely holding on and barely worrying about eating. i lost a crazy amount of weight in the fall, then put it back plus some more in the spring! i had days when i did not react at all to the things i hsould be reacting to in the classroom, and days wheni broke down completely. i chocked it up to being in an intense graduate program and figured it would be worse if i were not on my meds.

a year later, i had my first teaching job, so things were different, more calm. but i was still not quite normal. i had just gotten so used to it by this time that i had not thought anything of it. then, due to some extenuating circumstances that i have not quite gotten over yet, i was yanked off the meds, with no step down process. just taken off of 300mg budeprion/wellbutrin without refills. i went through a short period of insanity, as could be expected for being yanked off a mind-altering drug. however, after that initial period of insanity, i was suddenly extremely normal. it was the first time i have felt this normal ina very very long time. 2 things are different here. 1 - i am no longer in the stressful environment that i used ot work in. 2 - i am no longer taking the generic budeprion. i am also not taking wellbutrin, however now that i am no longer working in such stressfuol conditions i do not need it. i am in the same place i was while taking budeprion, however. so really, the only thing I can point to as being responsible for my sudden recovery is the lack of budeprion.

i just read an article (Self, June 2009) that suddenly gave me the "aha!" moment. i hadn't really thought much about all this until i read the article. it turns out that the main difference between the two formulations (welbbutrin xl vs budeprion xl) is the extended release formulation. the big name company has two different patents for the drug, the active ingredient was approved before the extended release (probably because the active ingredient was discovered first, then made into a regular pill, then firther developed into this extended release muc later), so the active ingredient patent was expired before the extended release formulation patent. this means that the generic company could use the active ingredient, but were not allowed to use the same extended release formula, so they had to engineer their own. this explains the huge difference in the size of the pill. the stuff the generic company uses actually releases four times the dose right away, andf then the rest of it very slowly throughout the day. this huge of a dose all at once is what is responsible for making you crazy at times and then the complete opposite at other times.

so where is the fda in all this? well, they approved the 300mg dose based off the info they were given by the generic company. the generic company gave them info that was actually for the 150mg dose, though. so, they approved something not knowing they were not given the correct information for it. yes - the fda should be more vigilant. the fda also used to do on site inspections any time a new approval was sought, no matter how small the change was. now, they dont go nearly as often as they used to. in my ten years in pharma, between generic and name brand companies, i saw fda inspectors on site twice. i can tell you i have seen a greater number of applications than that in ten years.

tip #2: if you are going to try a new drug, lean toward trying the name brand first, this way you know what you are "supposed" to be experiencing. after a couple of months, then switch to the generic brand, if there is one, to save money. this way if there is a sudden change, you ave a better chance of figuring out that its the formulation of your generic pill.

tip #3: ask the doctor if there are reported differences between the generic and the name brand of that medicine. if she says there is, ask her to denote "name brand only" on your prescription. then double check at the pharmacy that the pharmacist didnt miss it.

the differences between the drugs are not so huge for most types of drugs, but for things like heart meds, seizure meds, anti-depressants, and anti-acne meds, keep an eye out and be on top of what you are taking.

Friday, July 17, 2009

Parent Autobiography

as part of the adoption process, we both need to write up an autobiography detailing our childhood: how we were raised, who raised us, what they were like, how they disciplined, how they fought and settled disagreements, etc. if you know me, you might have an idea as to how difficult writing this has been for me. i never thought i was the type of person to hold a grudge, i always said i wasn't. then i read over my writing to do some edits. it wasn't the writing itself that got me thinking, but my thoughts to myself as i did the reading. i thought, with a wry grin, "should i die soon, this should be read as my eulogy, as a reminder to the people who would be there to cry for themselves and their guilt. a reminder of the harm they did me and that they have only themselves to blame for that deep guilt they would be feeling." thats when i caught myself. maybe i am the type to hold a grudge, after all.