To be shocked at the attitude of this doctor

[ScrambledEggAndToast]

Over the last few weeks my epileptic seizures have started back up with a vengeance after settling right down. I had one today at work at in suddenly occurred to me that this all started when the pharmacist gave me the generic medication rather than the brand name of my medication that I usually have.

Anyway, I managed to get an emergency appointment today at the GP and was pleased to get one with my usual GP. However, as soon as I said what I wanted she started being so utterly rude, I was absolutely shocked. She kept firing all these questions at me which I was unable to answer due to the confusion that I was feeling after the seizure. Normally, the doctor just put the name of the medication and the pharmacist gives me the correct one (different companies make it). However, she kept barking at me, "what's the name of the one you have", "different companies charge more, I need to know"

However, I don't know why she needed to know as I. The 2.5 years I have been going there, the docs have never done this before. They have just put the medication name and the pharmacist has sorted out the rest. She then started saying I was attacking her (verbally, not physically). My mum was there and can vouch I was perfectly polite. In fact, I was so weak from the seizure I didn't actually say much. At one point I didn't think she was actually going to give me the medication

Sorry for the rant. I feel very stressed now and was just so shocked by her attitude. She is normally so lovely and I just couldn't believe it.

[JontyDoggle37]

Log a complaint with the practice manager. She might have been having a bad day, but she doesn't get to take it out in you. You have your mum as backup witness. Don't take crap from people just because they're in a position of power....
And I really hope you feel better now and your new (old) meds kick in quickly. My DP is epileptic and any change to his meds has me anxious and watching him like a hawk to make sure there are no adverse effects.

[ScrambledEggAndToast]

I think I will, I was so upset. She just wouldn't listen to what I was saying. I genuinely think that if mum hadn't been there, I would have left empty handed. I had had the seizure only about 2 hours earlier so my head was wooly and I couldn't think straight.

[InfinitySeven]

My doctor has started doing this. Well, she hasn't accused of attacking her, but she does ask if I know how expensive I am and how much I cost the NHS, and she often asks if I'll give generic medication a go.

I'm glad you got it in the end, and I hope it doesn't take long to kick in!

[LineRunner]

Actually, can you get your mum to ring the practice manager? You don't need the stress.

[milkpudding]

I am confused.
Your doctor should prescribe the brand name for anti epileptic.
If the pharmacist substituted another brand, your prescription must have been in the generic name instead.
Were your previous prescriptions all generic and the pharmacist gave you the same brand anyway? Or only this month was generic?
If your previous prescriptions were all generic then the doctor needs to ask you which brand you were previously taken.
Confused as to the questions about price though.

[Phoenixfrights]

Well, the doctor sounds absolutely awful in her manner and worthy of a complaint.

This said, generic and branded meds should be identical, and generics are cheaper. Are the dosages right?

[Brittapieandchips]

I found I had a lot more side effects with generic lamotrigine than the branded one (Lamactical). It is definitely a 'thing'

[coalscuttle]

It's not unknown for people to react differently to brands and generic. Is it valproate? Agree you should take this to practice manager

[Phoenixfrights]

Ah hang on, is there something special about generic antiepileptics? Think there might be... in which case many apologies.

[JackShit]

Brand names are irrelevant in anti convulsant meds though. Epilim, for instance is the brand name for Sodium Valproate, but generic alternatives contain exactly the same active ingredients.

Perhaps that's what your GP was driving at. No need for the rudeness though.

[JackShit]

Aaahhh, sorry, should have rtft more thoroughly.

Looks like I've been lucky as my seizures have been controlled with both Epilim and generic valproate.

Hope you get it sorted soon OP.

[nobeer]

Anti epileptic generic meds CAN differ to the brand named drugs even though the active ingredient is the same, so the patient should always insist on having the same med, whatever the cost. Sorry you had such a horrible experience with your GP, hope you or your mum does complain. I know how vulnerable and confused you can feel after a seizure.

[confusedandemployed]

Definitely complain in writing to the practicw manager.
They won't be able to discuss your case with your mother, either in writing or verbally. They are also contractually bound to response appropriately to written complaints.
It sounds like a locum doctor or a registrar to me: anyone with knowledge of the practice clinical system would be able to see in a second where the change in prescribing happened, and what those changes were. Totally unnecessary to interrogate you like that.

[WellnowImFucked]

I work slightly in the area, and more and more is starting to come out that yes people can react differently to generics than to branded.

As a nurse we were also told that there was no difference, but as I said above. Sometimes its the ingredient that is used in the capsule that it dissolves faster or slower than you're used to.

Hope you feel better soon.

[Primrose123]

I've had a similar problem with migraine medication. I had a branded one for years, although I can't remember what was on my prescriptions. I asked for a repeat prescription and it just gave the generic named. I queried this with the doctor and she said it would be exactly the same. It wasn't. When I took the branded tablets, they minimised the pain, stopped the sickness and I was able to sleep off the migraine with minimal pain. The new tablets were useless, the pain was terrible and I was violently sick.

I asked the pharmacist if I could have the branded tablets and they said only if the doctor put the brand on the prescription. The doctor wouldn't do this. I was able to get my usual tablets by asking in a few different pharmacies until I found one who would give it to me. I need new tablets soon, so I hope I'll be able to get them.

[Padthai]

It is widely known that the different brands of anti epileptic drugs have a completely different bio availability. As you know it is really important to never change brands, the Dr is an idiot and is putting probably very small amounts of money ahead of your wellbeing. Some of the older drugs such as Epilim and tegretol are very cheap. Make a complaint and if possible contact your neurologist and ask them to write to your GP stating which brand you take. You might need to remind the doctor of her responsibilities when prescribing
www.gmc-uk.org/guidance/ethical_guidance/14325.asp
This is a link to the General Medical Council guidelines on repeat prescriptions .
She might also be interested in the NICE guidelines on Pharmacological treatment of epilepsy that states
Consistent supply to the child, young person or adult with epilepsy of a particular manufacturer's AED preparation is recommended, unless the prescriber, in consultation with the child, young person, adult and their family and/or carers as appropriate, considers that this is not a concern. Different preparations of some AEDs may vary in bioavailability or pharmacokinetic profiles and care needs to be taken to avoid reduced effect or excessive side effects. Consult the summary of product characteristics (SPC) and 'British national formulary' (BNF; available at bnf.org) on the bioavailability and pharmacokinetic profiles of individual AEDs, but note that these do not give information on comparing bioavailability of different generic preparations[11],[12]. [New 2012]
Link to NICE here www.nice.org.uk/guidance/cg137/chapter/1-guidance#pharmacological-treatment.
My daughter has epilepsy and we have found that there is incredible ignorance about the illness even amongst the medical community. One thing that has helped us immensely is finding a pharmacist who fully understands what medication my daughter needs. She orders the repeat prescriptions and if a doctor makes an error she will chase them up until the prescription is right. I hope your feeling better, good luck.

[LatteLady]

Doctors are under a lot of pressure to prescribe generics as they are very much cheaper than the original. However there are known issues with generic epilepsy drugs, I expect you will have noticed that they taste and feel different as you swallow them. Go back to your GP and ask for the drug that worked for you, explain that the generic has exacerbated your epilepsy rather than help control it. You may also have issues with the pharmacist, put them in the picture too. You are not on you own.

As to your GP, ride it, she was trying to help albeit awkwardly for you at that time.

[Phoenixfrights]

I think it might be useful to cite this in your complaint.

This MHRA document suggests that patients on phenytoin, carbamazepine, phenobarbital and primdone should keep taking the same manufacturer's drug. There is a second category, where they say that repeat prescribing decisions should be based on clinical judgement and patient history and a third category of drugs (including gabapentin and pregabalin) where there is unlikely to be any difference for most patients between maintaining the same brand and switching to generic/ another brand.

[becominglessofalurker]

I would definitely log a complaint. I wouldn't want to think she was gonna treat someone even more vulnerable the same way.

[iwaly]

My daughter's consultant recommended in writing that we stick with the brand which has been working for her epilepsy. I made sure the GP had a copy of that letter on file and always check it is prescribed properly for her. If you ever have cause to see a consultant for a review or anything, it might be worth asking for it to be noted for the record.

[DoJo]

I asked for a specific brand of a medication for my son as he flat out refused to take the one I got from a different pharmacy, and was given a prescription which had the manufacturer on the prescription, which had just been for the generic medication name until that point. So I can kind of understand her needing to know which brand it was to specify if you needed one which would otherwise not usually be given, but there was no need for her to be so rude about it and haranguing you when she knew you had just had a seizure is wildly inappropriate.
However I would get the issue with your meds resolved first, if it hasn't been, and then worry about a word to the practice manager as your health should be your primary concern.

[offtoseethewizard64]

phoenixfrights I was going to say that there is a published list of which anti-convulsants can be switched and which should not, but didn't know where I had seen it.
DD is on 3 anti-convulsant meds - one from each of those categories. So far her GP has not tried to change any, but our surgery dispenses it's own drugs so we are not beholden to the random choices of a pharmacist. Whenever DD goes into hospital, however, the hospital pharmacy always switches her Cat 3 drug to the generic version, but leave the other 2 (in Cat 1 & 2) alone.

OP check out your medication against the list on that link. That is not to say, however, that even if your medication is in Cat 3 the swap has not caused your increased seizures. Drugs work differently for different people.

[ScrambledEggAndToast]

Thank you for your replies. I will write my letter of complaint tomorrow when my head has cleared and I will also look at the suggested sites, thanks to the posters who have suggested them. My head is a bit too fuzzy right now to have a proper look.

[mumbanator]

Hi I work in general practice. Antiepileptics are in the list of medications that we should prescribe by brand name, yes it does matter because although generics are supposed to be bioequivalent it is recognised that levels of drug in the bloodstream can differ which can be crucial in getting control of seizures. The GP's behaviour sounds bizarre, hopefully a one-off, sounds like she was having a bad day and perhaps didn't register that you were post-ictal. Agree, discuss with the practice manager and state you are normally happy with your GP and would like the usual relationship to continue!

[Writerwannabe83]

I had a letter about 18 months ago from my GP surgery to say they were no longer going to be prescribing my branded epilepsy medication and would instead be having a genetic version and I "shouldn't notice any change in my seizure control".

I absolutely hit the roof!!

I wrote a letter to the practice manager with copies of the NICE guidelines surrounding treatment of epilepsy and copies of research carried out regarding generic/branded epilepsy medications and also a print out of a letter that a neurologist had purposefully wrote for GPs to read about how patients should not be switched from branded to generic medications!

I also threatened to write to the paper about the appalling way the surgery thinks it can treat people with epilepsy by showing such disregard for our health and thinking it's ok to 'Play God' with out lives by risking our seizure control for the sake of cost.

Within two days of handing my letter in (delivered by hand) I received a letter back from the Practice Manager to say he'd discussed my case with the GP Partners and that they have decided to allow me to continue with the same medication. I have not had any issues since.

It's really bad though - we shouldn't have to kick up such a fuss just so we can have the treatment we need.