To think that generic unbranded medication is different to the branded one?

[chickenmadcat]

I have been taking an antidepressant medicine for about 18 months. I've taken it in the past and it works brilliantly for me, however it does have rubbish withdrawal symptoms, and I notice it if I skip a day's medication for any reason.

I have always been given the main brand of the product, however in the past 6 months the pharmacy that I get the prescription from changes from month to month between the branded one and a cheaper generic one. This month it is the cheaper generic one.

Each time they change the brand that they give me, I seem to get awful withdrawal symptoms and feel ill for a few days. I didn't think too much into it, but I collected my most recent prescription on Wednesday, and although I've been taking it every day since then, because it's the generic one and not the branded one I had last month, I've felt ill with apparent withdrawal symptoms; nausea, dizziness, feeling like I'm on a boat, tearfulness, etc. I know they will subside in a few days but I hate feeling like this.

I just wondered really whether I am imagining things or reading too much into it, or whether it is possible for the branded and generic products to be a bit different (dosage is the same BTW, I've checked). WIBU to ask the pharmacy to make sure I consistently have one or the other in future? They request my repeat prescription each month for me and have the prescription ready for me to collect. It's easier as the pharmacy is in my village, and my GP surgery is a few miles away. The pharmacists in the local pharmacy are a bit scary and shouty though so I don't want to request anything unless I'm 100% sure I'm in the right....

My mother used various medications, one was a diuretic and if she was given the original one that I think was called Lasixs she could take her medication and catch the 9.15 bus in to town. If however she was given the cheaper generic one she would either have to take it two hours earlier or catch the 11.30 bus into town.

I also see a difference in the medications my son uses and where we live I pay a couple of hundred pounds a month to get him the original one of a particular drug rather than the generic one.

The actual active ingredients will be identical, but the excipients (the rest if the stuff to form it into a tablet) will be different, it might be these you are reacting to.

Kind of like how calpol and un branded liquid kids paracetamol have the same amount of paracetamol per dose, but may taste different.

I work in over the counter medicine, so know quite a bit about branded/generic meds, annoys me when people say lemsip works better than the identical own brand or whatever, but in your case it may be nothing to do with the active ingredients.

My son would know absolutely nothing about the placebo effect of a drug. We however have documented evidence to show very clearly that when he was given a generic version of a particular drug he was very unstable and not well at all. We also notice a difference in his hand tremors if he is given a generic version of an anti tremor drug rather than the real thing - we can't always get the real thing and sometimes we just have to make do. Family can also tell when he isn't on the real Kamadrine for tremors. The other drug isn't as issue anymore as we always pay for the real version as a matte of course now.

I experienced horrific side effects when changed from cerrezete to cerelle, both the same contraceptive according to the gp but I was a wreck!

hiddenhome that's horrific advice to give to crush a medication up before swallowing!!

That completely alters the medication, can render it useless or damage your digestive system and is plans dangerous. Please don't do it.

A generic product does contain exactly the same active component (ie., the drug) as the branded product, however it might well be in a coating that releases the drug at a different rate or combined with a different non-active ingredients used to bind the drug. The difference might be one is a capsule the other a tablet. Although the generic products are required to be interchangeable with the branded product, there is always going to be variation between people.

Do tell your pharmacist as it is also possible that the manufacturing process of the generic product needs to be altered and this could be reported back to the manufacturer. This may be a widespread problem with a particular type of coating they are using, for example. You'd be amazed at the number of pharmaceutical products that get withdrawn due to manufacturing errors.

Forgive me as I can't remember the name of it but a lady on watchdog talked about a code that you should look out for on packaging. The code on a fast acting cold remedy matched up to one for rapid period pain relief etc. The prices were wildly different.

My gp says that crushing tablets can cause a mini overdose (depending on drug obviously).

I'll do what I like thanks. I know my own body

I found this interesting as it explains generic licencing and agrees certain replacments, such as antiepiletic drugs, can cause differences between generic and brand drugs.

We've had issues at work recently as we have a patient whose mental state deteriorates when he's on the cheaper brand of his medication. It's dispensed for him and looks the same as the branded stuff so he shouldn't be getting any placebo effect as he doesn't know it's any different. It is really bizarre.

You shouldn't crush the enteric coated tablets due to how they get released in the body. They get released in the intestines rather than the stomach.

hiddenhome any risks you take with your body are entirely your choice. However if you know it's a risky behaviour maybe when you post the idea online as something that you have found helpful you should point that out.

Unless of course you are going to tell me you are a pharmacist and then I'll take advice from you with pleasure.

I have never advised anybody to do it, merely said that this is how I manage my medication

If people want to take this as 'advice' then they need to learn to take responsibility for their own health.

I think that the difference you are experiencing is likely to be due to one of three factors, which are all related to rate of dissolution and absorption:

1. Capsule vs tablet
2. particle size of the active ingredient
3. vehicle or packing substrate

A drug which has large particles and packed densely (like a tablet) will be released more slowly, will be metabolised to some degree while it is still being absorbed, and consequently, although you will have the same exposure over the 24 hour period, the maximum concentration will be lower and the time to maximum concentration higher. For drugs with a CNS effect particularly there may be a threshold at which you feel the clinical effect and therefore you are more likely to have a period of no clinical effect (like the withdrawal you describe) if you are used to a drug with higher Cmax/lower Tmax.

No pharmacist should be changing you between capsule and tablets for the same short half life neuro-active. It just shouldn't be done. Your GP can specify capsules or tablets if you are being dispensed either/or for the branded or generic, though I suspect that the format wouldn't change for the branded.

As for the other factors, which may be the difference between the generic and branded medication, you can minimise the effects by being absolutely meticulous on how and when you take them, and by making sure that you drink enough water with each tablet/capsule: absolutely no less than 1/3 pint of water with each one, ideally 1/2 pint.

However you do really need to talk this through with your GP: you wouldn't be prescribed the meds if you didn't need them and your Dr and pharmacist are beholden to make sure that you actually get maximum benefit from the treatment. Good luck.

My drugs are not enteric coated either.

Rubber, we have the same with my son who has very serious mental health problems as well as Autism and Tourettes.

And I would also advise against breaking a tablet to make swallowing it easier. We did this with one of my sons and he was being hit by a very powerful release of the drug into his system instead of it being released in a sustained manner over a certain period of time. No blooming wonder his moods were still all over the place despite the medication. I can't believe we were so naive but we really didn't think we were doing anything wrong.

There shouldn't be any noticeable difference between generic and branded antidepressants as the drug companies have to demonstrate that the generic is equivalent to the brand (within specified limits) to get a license in the first place.

You can ask your local pharmacy to give you the same brand each time though. They may agree but it might depend on whether their is a big price difference.

People experience the same problem with thyroid medication. YANBU.

Regarding crushing tablets, whether or not it's okay depends on the tablet. Don't ever do without seeking advice from the prescriber or pharmacist first.

PrimalLass - not sure which medication you mean but thyroxine tablets don't have to be prescribed by brand.

This isn't about brands, it's about efficacy within generics.

I don't think people are understanding the issue.

I understand the issues Hiddenhome thanks. When I used the term "prescribed by brand" I meant prescribed by name (different generics have different names).

Op i was going to say it was most likely a placebo affect as i thought my painkillers weren't as good as i didn't have my usual brand, but i knew it were in my head.
However the two weeks ago for few days i had severe anxiety, was down bad headaches, and was hot and sweaty.
Iv just reliesed that that was the day i started on my generic antidepressants. Same name, same dosage. I'm now fine now they've settled in my system, i'm actually feeling better than i usually do, so i'm now wondering!

Yes, very different. Three weeks ago, I was prescribed my usual epilepsy meds but went to a different pharmacist who have me the generic medication saying it would be fine as the drugs have the same active ingredient. In the last three weeks, I have had four seizures after being stable for months. I went to the doctor's on Friday for another prescription and now have my usual branded stuff, still not feeling 100% but hopefully will start to feel better soon.