Tuesday, July 27, 2010

Generics and prescriptions

Living here in Massachusetts, there is a state law which mandates the use of prescriptions unless the doctor specifies 'no substitutions'. (I could be wrong, this could be a federal law but since I have no brain I'll just say state law.) All of my prescriptions, of which there are many - they cover the top of my bedside table, are generics except one - Femara which was released just a few years ago.

A recent study says that generics are just as effective as the brand name drugs. But we need to remember a generic is not an identical drug but (as the fancy word implies) are biosimilars - meaning they are close but not quite. Now there is a movement to shorten the 12 years in which drugs are protected from generics in the US. Basically biotech companies say they need the 12 years to recoup their development costs. Now this my be true as many drugs that are developed never make it through the testing process so they do have lots of overhead. I can understand this point.

I can also understand the issue that lengthy drug development allows for time for clinical trials and FDA approval. It is my understanding that the FDA is working on speeding up their approval process but this is not without issue as drugs are released and then recalled - Vioxx for example. If you cut the clinical trials time and speed up the approvals, are more potentially dangerous drugs made available to all? Generic versions make them more affordable - which is important in an era of skyrocketing medical costs.

Perhaps its not the drug companies or the FDA that are the cause of the problems? But perhaps it is the system through which drugs are developed? I am not an expert here but clearly we have some kind of problem. Biotech companies go through lengthy development processes and need to cover their overhead. Can the system somehow be changed to make it less expensive while allowing for safe drugs to be developed? You will note I am avoiding the topic of biotech company profits at this point as they clearly need to take a hit.

Anyway, I called my doctor yesterday to (whine and) discuss my pain issues. The call I got back was one that I really did not want. 'It can take up to two weeks for your hip to get back to normal. The procedure irritated the nerves that go into your hip and the need that long to reduce inflammation.' I don't recall this being mentioned in the pre-procedure information. Grr...

I have found if I take a pain pill and a Tylenol every six hours, the pain is manageable provided I don't do things like stand or walk for more than ten minutes at a time. (I cook dinner in ten minute increments and then take a break.) Sometimes lying in bed gets painful too. I was also told I could add a Motrin to the mix which I will add in this morning. (I just googled it and found out Motrin is a fancy name for ibuprofen.) If I take two pain pills, I am in a coma and can't function. For example, Extreme Makeover: Home edition was difficult to follow and I got the four episodes I watched in a row, all mixed up in my brain.

Today I have to go to work where I will mention I am on medication and I am sure my coworkers will use that knowledge to have a few laughs. Nothing like a bunch of supportive co-workers. Actually they are all very nice and care about me but have a biting sense of humor that is always flying around the office. But in a caring way. Now I am late so I must get moving.


Lauren said...

For not knowing for sure...your spot on, it is a state law to swap to generic. Usually this is fine but in some cases patients respond differently to them.

The drug development system does need improvements. I wish I knew where to tweak it but I'm at a loss. Maybe the FDA could be faster at going through the materials. I wouldn't want the trials themselves to be shorter...just in case. Tough topic.

linda said...

Caroline, since you take tylenol [acetaminophen] and other pain medication regularly, you might read this article published by the fda. http://www.fda.gov/forconsumers/consumerupdates/ucm168830.htm

When I was trying to relieve pain from neulasta, I took vicodin which has a high level of acetaminophen and, thanks to info from M, got a prescription with ibupophren. I think it was 750/250. Regular vicodin has 500 mg of acetaminophen. You might ask your doctor about that.

linda said...

http://www.fda.gov/forconsumers/ consumerupdates/ucm168830.htm

linda said...

http://www.medicalnewstoday.com/ articles/46607.php

You're good at research. Do a google search. There's lots of info.

Ann aka ButDoctorIHatePink said...

I doubt she's taking enough to cause liver damage, and motrin doesn't do that anyway.

It's likely her pain pill has 500 mg of tylenol, and her extra could be less - normal bottle is 250 - but let's say it's not. She's only taking it three or four times a day so she should be fine.

You have to take more than 4 grams of tylenol a day, and more like 7 or 8 regularly to cause liver damage. She is not going to be taking this forever, the doctor said a couple of weeks.

Adding a motrin is a good idea.

So, Caroline,, count it up and be wary - try to stay within that 4 mg guideline - but don't be too worried.

You can ask for a formulation of pain meds with less tylenol. Norco has either 5 or 10 mg of vicodin and 325 of tylenol, as opposed to 500 of tylenol. If you plan to be on them for a longer time, it's a good idea, but it doesn't sound like you'll need it.

As for generics: I got the generic version of ambien and coulnd't tolerate it Somebody else told me that they had the same weird reaction on ambien as I did on the generic, but not on the name brand. I didn't want to go back and get name brand and try it but you are right, it does seem that they are not always identical.

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