Imagine a patient getting a refill that affects them at 80%, and then a month later getting yet a different brand that affects them at 120%. Then the patient complains about side effects, but both the doctor and pharmacist explain it's all in their head.
I have been a community pharmacist for nearly 50 years. I have never told a patient that Its all in their head. I explain to the patient that some generic equivalents may affect each patient differently. I have many current patients that request a particular generic manufacturer and I keep it in stock for those patients.
This was a really helpful explanation. I knew that generics could be different, but never quite understood why or how they could get approved anyway. I take a very rarely used old medication for a Neuorological condition and started having a lot of side effects and returning symptoms after my pharmacy kept changing the brand of the drug. I had to go through quite a bit of trouble to find a pharmacy that would order the brand name for me, but I felt so much better. Then the company stopped making the brand name version and I had to go through a frustrating process to find a generic version that worked for me. I ended up looking at a pretty technical fda website that listed the fillers and showed a diagram of the chemical structure of all the different versions, and went to my pharmacy with a list of the ones that looked closest to the brand and found one that still worked well.
4:00 difference between concentration and absorption 4:51 different manufacturers can use different agents to produce the drug, and those different agents can make a difference in the side-affects that you experience
Hi Dr. Tracy!! I came here from your video on managing bipolar and I just wanted to hop onto a newer video so that you're more likely to see this I just want to say THANK YOU SO MUCH. I rarely ever find people I enjoy listening to because I always feel like they sound like they're speaking to a child or they just don't have any qualifications to be speaking on the matter and your video is the first video I've watched start to finish, made notes on and even went and did some further research on the things you mentioned to add to my notes and I've just had such a wonderful day putting all my energy into this. I love the way you speak and you have such a soothing yet firm voice. I would do anything to have you as my psychiatrist xD Again, thank you so immensely
Oh thank you so much Jess Bear!! Taking notes. Wow! I'm so glad you find the videos helpful. That give me a ton of satisfaction. Thanks for watching from start to finish. I realize that's a big deal for a youtube video.🙂 BTW - I review the comments on all of the videos in one place on the back end of the channel. So if you ever decide to comment on an older video, I'll still see it.
@Dr. Tracey Marks Your videos really explain concepts. I often tell my therapist that after I listen to your video, I understand what she is trying to teach me. Thank you so much!!!
Really late to the party but one thing I've noticed in my experience (pharmacist) is that it also depends on which country you live in. Generics, produced in my country tend to be of much lower quality due to the poorer QC. I constantly get complaints from patients that their meds don't work well or at all (!) compared to other generics/brand name. I myself was burned while stopping escitalopram and went on a generic (from a Cypriot brand) which was 4 times cheaper than the Lundbeck brand name. The tablet was at least twice as large and I just couldn't stop it without side effects. Switched to brand name and tapering was much easier. These days I try to go for brand name whenever possible or at least find the most reputable company that produces the generics. Sadly not everyone can afford it but *most* generics are of high enough quality (and they should be by law) to be proper substitutes.
Both me and my husband have Concerta and we have tried the generic brands of methylphenidate aswell. Most of the generic types had a huge difference in effect and some of them even gave us huge side effects compared to the main brand. My husband with one type got very angry when the medicine were going out of the system (which never happens otherwise) and another one gave us both the feeling of bad conscience and felt like we were avoiding something very important despite this not being the case. Very strange and interesting how ingredients outside of the active ingredient can affect us so much.
Well done as an introduction. For those allergic to the “inactive” ingredients or the solvents etc used to make different formulations, substituted manufacturers, or generic instead of brand, can lead to serious side effects and DEATH.
Generics medicine regardless of manufacturer is same effectiveness. but sometimes Doctor preferred to prescribe Brand names medicine. why there is a huge difference on the price between Generic medicine and Brand medicine? we are not on the medical field so we can't understand how drugs works and metabolise on the body. we are only ordinary people and sometimes doctors preferred not to discuss important details of a course patients illness and including adverse effects of medications especially "maintenance" medications like hypertensive and diabetes medications. Thank You Doctor Tracey for discussing important details that are not normally talked or discussed in a clinic room. You made every topics clear, now it both saves patients and doctors time and consultations makes it possible because we are now fully aware that our illness is now curable now a days due to advance technology and medical research. Thank You for making This videos to reached out in every patients understanding regarding there scope of illness and how a doctor can help us patients and how a miracle drugs can change and transformed our lives. all your vids is mainly to educate and make public awareness especially People suffering from mental illness and there family. a Doctor can saves a persons life.
very interesting, Tracey. I knew about those differences, but not in detail. Switzerland doesn't insist so much on those. Thanks anyway for your constant teaching. Appreciate it! Have a lovely week-end and splurge on the Omega 3! I will,,,
I have epilepsy. There is a difference between the previous manufacturer of my seizure medication, lamictal. Had many more side effects that the previous manufacturer did. This never occurred to me until the dizziness (which I just figured was from my hearing issues and allergies, I’ve had an increase in seizures since then also. it was brought to my attention that these may be because of a difference in manufacturing of the medicine. Didn’t even know that was a thing, but it’s well now my to be one from doctors and such. Fun stuff.
Very interesting Dr. Marks. I have a medication that will be generic starting later this month. I take other generics, so I’m not concerned. At least now I know what may be different, and look to see if side effects change. Who knows, the side effects may be less. 🤔🙂
Late to the game but I did find a difference with going from name brand to generic lexapro/escitalopram when that released. Kept getting told it was the same as name brand by my PBM. Name brand is on the PBM exclusion list now. I changed rx altogether. Thanks for sharing this information!
Thank you! Exactly what you said is what I've spent the last 10 years trying to figure out. 2008 - 2011 Lexapro was an utter Godsend for every single adhd symptom, right down to delayed sleep phase disorder. 2012 & 2013, it was a placebo, so my psych titrated me up to the max dose. By 2017, I was prescribed double the max dose, and it was still nothing. Generic Effexor XR, nothing. Bupropion was great for causing extreme insomnia, intense irritability, zero appetite, and an eating disorder relapse. After that formulation was recalled by the FDA and I learned that it can cause seizures in people who don't even have epilepsy (I do), that scared me away from all reuptake inhibitors forever.
Hi Dr. Marks. I really appreciated the video. I will make sure when I find another good brand of the lithium to request it. As I mentioned before the lithium up north was more potent than the one in Central Florida. They hospital pharmacy that I went to up north a while back has closed so I'm not sure which brand to ask for. Anyway hopefully this new well known pharmacy is just as good. Thanks for the heads up.
Stimulant medication seems to have the most noticeable difference from generic manufacturers. One always gives me a lot of side effects and almost makes my adhd worse. Another works really well with no side effects.
I noticed this as well. I have had generic pain meds and have had little to no difference. But I have had pretty significant changes when I was prescribed generic adderall xr one would come out of. My pores and stink and another would make me so nauseous and wretched it was bad. Seems like every generic had some side effect that the brand did not. I think I had one generic that was nearly as good as the brand. That was the sandoz brand of generic. Almost as good as the brand but not quite
Here UK Some, I say Some Docs insist and bully patients in saying generics are the same thing, they say the effective ingredient is the same, it doesn't work the same
Thank you for the video, Dr Marks. I'm assuming it's possible that the opposite could also be true? That my body might respond better to the generic version, rather than the brand?
I knew my generic Adderall was way different last time when mfg changed to Aurobindo. Nothing but side effects (constipation, headache, rash, sketch), no therapeutic amphetamine ADHD focus, sorta like the crash w no positive effects.
Yeah. I totally agree! I just today for the first time in my life paid for name brand adderall, trying it tomorrow. I used to get good generics and now there are so many and they suck, including aurobindo. That was probably the worst of all of them. If the name brand adderall doesn’t work, I’m switching to Ritalin. I have a federal job now so my insurance paid for part of the my prescription, but 280 every month isn’t sustainable if I’m just too used to having taken adderall for a few years. I’ll keep you updated!
@@Recklessboyz- it was better for sure, but still with insurance it was too expensive. But I switched to Walgreens and now they give me the brand name sandoz, which is great!
I take Effexor XR. The generic does not work and insurance never wants to pay for name brand. I'm currently fighting my doctor and insurance to get back on name brand. I wish there was some way to prove it. Effexor withdraw time for me. Again.
Good info. Pharmacists should send patients to this video when they raise the question. A bit unrelated to this topic, I was wondering what was your opinion on the new trend of online therapy. A step in a good direction?
Hi Markhou. It depends on what you mean be online therapy. There's telemedicine which is just the delivery of care using technology. I do video sessions with established patients and it's great. Very convenient for them and me (worked extremely well in an ice storm which always shuts Atlanta down for at least a week). Then there is the online therapy where you pay a fixed monthly fee for unlimited contact with the therapist usually via email. I have my doubts about the quality of that therapy. Therapy is work and takes training, expertise, etc. I'm not sure what well-trained, experienced therapist is going to want to make themselves infinitely available to do email therapy at a low fee. I assume then it's someone without a lot of experience cutting their teeth. You can still benefit from someone inexperienced, but in this case you get what you pay for and it may still be better than nothing.
@@markhou I had a pretty bad experience with Better Help. They asked me for a lot of money up front when I really needed to talk to someone, but my therapist was unavailable. I couldn't afford their fee, so, they turned me away, even though I explained that I was having a financial hardship and was willing to work with them to find something that would work for both of us. I will NEVER use Better Help again.
Great information. It confirms what I have noticed when taking the brand vs generic of the Proton Pump Inhibitor, Rabeprazole. When taking the brand I can get by with around 2-3 a tablets week, it lasts for ages in my system. I can stop it and I'll only start getting symptoms returning after 2 weeks of stopping it. When taking the generic I have to take it every single day and if I miss a day, I notice symptoms returning pretty quickly. A stark difference for something that is advertised as being "equivalent". Very misleading, but this video clears it all up for me and confirms that I am not imagining things. Thanks for the content.
Thanks Dr. Tracey for this video. I went to the pharmacy to pick ip my medicine and the young guy tried to tell me that the generic is the same. I made this joke that is not what i learned on sesame street. It is not the same. Lol. So i did not take the medicine instead had to go to another pharmacy to get the brand. And another visit to the same pharmacy the manufacture name changed. So i said this is bot the one i have been taking. So they gave me the the medicine from the previous manufacture. I asked them why did they change it. Again. It is not different. Of course. Now i am going to opt out and also get that drug in brand. Yes i am one of those who have sensitivity to drugs. A children Claritin works for me than the adult. If i am going to be on a drug for a long time. I told my doctor. Lets stick to the brand. That away i don't have to go through too many manufactures and i can have fewer side effects. I always ask why was i so sleepy on one med this time and not the other time. My doctor told me it don't make me sleepy. I look at him and said i am not you. And you probably not taking the off brand. He looked at me. Again he put no generics. I am finding it hard to get brand names from pharmacies. Unless it is on line. What do you think about the online pharmacy. It was not my favorite at first. This is the only way i get my brand unless i want to drive to the good neighborhood where my friend tell me to g and then it become a we don't carry it. So i am doing online now. And i am happy with it. Sorry so long.
I'm surprised it's that hard to get the brand. But I guess I shouldn't be since the trend is to substitute brand for generic if generic is available. I've heard that the online pharmacies are fine as long as they are US based. I've had a few patients get Wellbutrin that way.
Yeah it is I’ve used generic medicine forever so had my family. Non generic is just more expensive to make you broke and make greet people more wealthy.
@Dr. Tracey Marks great video, this was the most informative video I've seen so far on the subject of generic vs. brand name prescription medication differences. What about the *potency* and *purity* of the active ingredient? For example, generic fluoxetine 50 mg tablets compared to brand name Prozac 50 mg tablets. If someone tested these two different tablet forms of fluoxetine 50 mg in a chemistry lab using sensitive equipment, would they find the exact same quantity of the fluoxetine molecule inside each tablet, 50 milligrams in both, or is there a molecular purity tolerance range? Does the 80% to 125% range only cover the materials and methods used to package the active drug molecules in a tablet with inert ingredients to change metabolism and blood concentration over time (e.g... Fluoxetine HCl vs. Fluoxetine Bitartrate)? In other words, is the 80% - 125% acceptable range only for blood concentration or does it apply to quantity/mass of the active drug molecule? Thanks!
Hi Anodyne. You've gone a step ahead of me. I'm not sure how quantity /mass are effected by the 80-125 bioequivalency requirement. You need a certain mass/quantity to get the blood levels. It may be that the quantity of the inactive compounds affect how much of the drug is needed to get the level. But this is venturing too far into the woods of pharmacology/chemistry for me to know. 🙂 Thanks for the question though.
@@DrTraceyMarks Thanks for your help, and keep up the great work with your videos! Your work is immensely valuable to the public, including me, around the world. :)
Could there be drastic difference in Buproprion XL from a 300 mg tablet made by Cipla to its 150 mg version? I want to say the 300 mg Cipla pills are noticeably better than the Cipla's 150 mg.
Trigger warner if anyone is a hypochondriac or has anxiety over health. The blood stream one got me for some reason. I guess I don't really think about it going into blood stream. I have terrible health anxiety
Thanks Dr. Tracey, in New Zealand we have had major issues with the generic version of EFEXOR-XR which is now the only version funded by Pharmac, the governing Dept. controlling what drugs are funded. Fortunately the original is still available, for those that can afford to pay for it.
That's interesting...venlafaxine is the me of.the drugs can really cause the brain zaps if you miss a dose or rake it late. Sometimes the brand can make a difference that way
Hi Dr. Tracey, thanks for your response, the generic version we get here is ENLAFAX-XR made by Mylan in Greece. It has caused so many problems here a Facebook support group has been set up and a petition presented to Parliament. I only take 75 mg a day and it had an immediate response, extreme agitation.
I have bipolar 2 which is notorious for being difficult to find the proper combination of medicine. I also receive only generic medication. When a medicine is not effective for me, I can't tell whether the medicine or my condition is to blame.
I take Latuda, and I hope 🤞🏽 a genetic comes out. It is soooo expensive , my insurance won’t cover it 😢. I get samples now till January where my insurance will after I pay $500.00 kickin. But the Latuda 80mg causes my legs to cramp so bad, I have started cutting them in half. Taking 1/2 in the morning, and 1/2 in the evening.
Have you tried using the Latuda copay savings card? It's supposed to bring down your copay to $15 after your insurance pays. If your doctor does not have any, you can get it from the Latuda site. Google latuda copay savings card.
Pharmacy changed generic providers for my lamotrigrine and it became less effective for me. Coincidental? Probably! Ended up going off it all the same.
My doctors okay generic on all my meds, including the ones for my bipolar II disorder, except for my thyroid medication. They specify Synthroid brand for that. Of course it costs a lot more. I need to ask about it. My Lamictal generic recently started coming from a different manufacturer & it freaked me out a little. My lamotrigine has never been that color or that shape. It matched the description on the bottle but it still made me uneasy not being 100% sure I had the correct tablets. Thanks for the information. I think I'm going to watch this video again!
Hi Dj. I'm glad this was helpful for you.Many generics can be just fine but sometimes you can notice a difference in the way it works. So you can pay close attention to changing in your condition whenever you see a different pill/manufacturer.
Just got switched to generic suboxone after taking brand for 4 years and I genuinely notice a difference, they dont work as good My insurance wont cover name brand so I just have to suck it up, have tried 3 different manufacturers and stuck with the one with not as much of a difference, ie mylan generic, tried dr reddys and alvogen and they were horrible.
I have had an experience like this with bupropion. Will a manufacturer ever change its own ingredients and process? My original dose/version (XL) worked very well, but my doctor had me try a few different things (SR, or different doses) to try to manage some side effects. I eventually went back to my original dose and it felt like it barely worked at all, nothing like it did originally. We increased the dose, and still didn't feel any different. I *believe* I've had the same manufacturer throughout, but I'm not sure. But if so, I wonder if it changed at all in that time?
I find the XR never worked well for me. The XR dissolves different to control the release of medication over a much longer time. The SR dissolves much faster and you get the max amount of medication sooner in a sense. I believe, for myself, I don't break down pills correctly in my gut and those XR I don't get my maximum med out of it because I have a similar issue with a PPI. When my script ran out I bought over the counter medication and they come in tablets or capsules full of granules. The tablets do not work the same for me. I have to have the capsules.
Great response, I've been asking myself this question for ages! Please tell us why half life matters? I mean, why do some medications like Effexor only exist (I believe) by prolonged delivery?
Half life dictates how long the drug stays in your system. Drugs with a long 1/2 life wear off slowly and you tend to have less withdrawal effects if you miss a dose. Drugs with a short half life, like Effexor, wear off quickly and you can have more withdrawal when you stop taking it. Original effexor was twice a day because it didn't last long enough to work for the whole day. The extended release version makes it last the whole day, but it still wears off quicker than medications like Prozac that have a very long 1/2 life.
What are the different antidepressants that do not make if taken together. Example can you take a tricyclic antidepressant with an SSRI or a SSRI with a tricyclic antidepressant?
Well now I know why the bupropion I was prescribed doesn’t work how it’s supposed to. I’ll probably throw away the rest of the bottle until I can find a pharmacy that sells actual Wellbutrin. Does anyone know what the good generics are incase I can’t find the name brand?
Hello Dr. Tracey When i take SSRIs after a while they make my feelings numb this feeling made stop taking it and stop seeing a doctor and keep switching meds and doctors.. when i discuss this with my doctor they deny that this meds made this feeling. . I've been on prozac, celexa, lexapro and now zoloft. Why SSRIs make me lose my feelings and motivation and make me dull? Right now I'm barley holding my self not to quit therapy again.
Some of these meds can make people feel this way as a side effect. you may be a slow metabolizer of drugs and have more side effects in general. If you seem to be sensitive to most meds, sometimes taking lower doses is neccessary
Anyone had experience with generic vs seroqel brand. I tried the 'Accord' generic and it was awful. I always have to get seroquel, but is so expensive. Anyone know of any generic that is very similar to the brand?🙏
I have only ever used generic medications at home. However in hospitals, I always received brand name medications. I can ALWAYS notice a difference. Generic psychiatric drugs DO NOT work for me. I can’t afford brand name prescriptions though, not to mention my insurance doesn’t want to pay for them.
I'm having a hard time understanding (for the majority of simple tablets) how different manufactures would really make that much of a difference to the AUC... I've never heard of any drugs that include medical ingredients other than the main bioactive, unless the additional ingredients are an intended part of the treatment. I thought that most manufactures should basically being using the same non-medicinal ingredients (like fillers, the casing around the tablet, etc). To me these seem like simple ingredients that break down easily in the digestive system so that the medicine is released. How can these ingredients cause significant adverse effects (altering the AUC)? Can anyone explain it in a different way than the lady explained in the video? Thanks
The active ingredient of a generic drug is chemically identical to that of a name brand drug. So said a pharmacist who I personally knew. The only thing which might be different are the binding chemicals used to manufacture the pill. If the milligrams are different between different manufacturers, then there of course exists the possibility that some brands have inferior and/or careless manufacturing, or else they cheat and are dishonest.
![Gunna - HIM ALL ALONG [Official Visualizer]](http://i.ytimg.com/vi/HiCxoDeo0hc/mqdefault.jpg)
Imagine a patient getting a refill that affects them at 80%, and then a month later getting yet a different brand that affects them at 120%. Then the patient complains about side effects, but both the doctor and pharmacist explain it's all in their head.
I have been a community pharmacist for nearly 50 years. I have never told a patient that Its all in their head. I explain to the patient that some generic equivalents may affect each patient differently. I have many current patients that request a particular generic manufacturer and I keep it in stock for those patients.
@@visualedtech
My pharmacist is similar to you but TBF I’ve heard many bad stories in our small city.
Find a new pharmacy and or MD.
I hadn't understood all of these differences you described. Thanks for making the video Dr. Marks!
You're welcome Matt. I hope this makes it easier to understand.
This was a really helpful explanation. I knew that generics could be different, but never quite understood why or how they could get approved anyway. I take a very rarely used old medication for a Neuorological condition and started having a lot of side effects and returning symptoms after my pharmacy kept changing the brand of the drug. I had to go through quite a bit of trouble to find a pharmacy that would order the brand name for me, but I felt so much better. Then the company stopped making the brand name version and I had to go through a frustrating process to find a generic version that worked for me. I ended up looking at a pretty technical fda website that listed the fillers and showed a diagram of the chemical structure of all the different versions, and went to my pharmacy with a list of the ones that looked closest to the brand and found one that still worked well.
4:00 difference between concentration and absorption
4:51 different manufacturers can use different agents to produce the drug, and those different agents can make a difference in the side-affects that you experience
Thanks for the notes. That’s helpful for others.
Hi Dr. Tracy!!
I came here from your video on managing bipolar and I just wanted to hop onto a newer video so that you're more likely to see this
I just want to say THANK YOU SO MUCH. I rarely ever find people I enjoy listening to because I always feel like they sound like they're speaking to a child or they just don't have any qualifications to be speaking on the matter and your video is the first video I've watched start to finish, made notes on and even went and did some further research on the things you mentioned to add to my notes and I've just had such a wonderful day putting all my energy into this.
I love the way you speak and you have such a soothing yet firm voice. I would do anything to have you as my psychiatrist xD
Again, thank you so immensely
Oh thank you so much Jess Bear!! Taking notes. Wow! I'm so glad you find the videos helpful. That give me a ton of satisfaction. Thanks for watching from start to finish. I realize that's a big deal for a youtube video.🙂 BTW - I review the comments on all of the videos in one place on the back end of the channel. So if you ever decide to comment on an older video, I'll still see it.
@Dr. Tracey Marks Your videos really explain concepts. I often tell my therapist that after I listen to your video, I understand what she is trying to teach me. Thank you so much!!!
Thanks for the video. Dr, I hope you have time to talk to us about grief and psychological impact of grieving. Thanks again.
Thanks simplyme. Thanks for the suggestion. I'll try to work that topic in.
I swear you have videos on every subject I need info on. Thank you!
Wow! I'm an RN and I never heard this before! Thank you!
Really late to the party but one thing I've noticed in my experience (pharmacist) is that it also depends on which country you live in. Generics, produced in my country tend to be of much lower quality due to the poorer QC. I constantly get complaints from patients that their meds don't work well or at all (!) compared to other generics/brand name.
I myself was burned while stopping escitalopram and went on a generic (from a Cypriot brand) which was 4 times cheaper than the Lundbeck brand name. The tablet was at least twice as large and I just couldn't stop it without side effects. Switched to brand name and tapering was much easier.
These days I try to go for brand name whenever possible or at least find the most reputable company that produces the generics. Sadly not everyone can afford it but *most* generics are of high enough quality (and they should be by law) to be proper substitutes.
Both me and my husband have Concerta and we have tried the generic brands of methylphenidate aswell. Most of the generic types had a huge difference in effect and some of them even gave us huge side effects compared to the main brand. My husband with one type got very angry when the medicine were going out of the system (which never happens otherwise) and another one gave us both the feeling of bad conscience and felt like we were avoiding something very important despite this not being the case. Very strange and interesting how ingredients outside of the active ingredient can affect us so much.
Well done as an introduction. For those allergic to the “inactive” ingredients or the solvents etc used to make different formulations, substituted manufacturers, or generic instead of brand, can lead to serious side effects and DEATH.
Great video as always, Thank you!!
Finally I knew the reason why some meds haven’t worked as good as before and we thought it’s about tolerance. ❤️
Generics medicine regardless of manufacturer is same effectiveness. but sometimes Doctor preferred to prescribe Brand names medicine. why there is a huge difference on the price between Generic medicine and Brand medicine? we are not on the medical field so we can't understand how drugs works and metabolise on the body. we are only ordinary people and sometimes doctors preferred not to discuss important details of a course patients illness and including adverse effects of medications especially "maintenance" medications like hypertensive and diabetes medications. Thank You Doctor Tracey for discussing important details that are not normally talked or discussed in a clinic room. You made every topics clear, now it both saves patients and doctors time and consultations makes it possible because we are now fully aware that our illness is now curable now a days due to advance technology and medical research. Thank You for making This videos to reached out in every patients understanding regarding there scope of illness and how a doctor can help us patients and how a miracle drugs can change and transformed our lives. all your vids is mainly to educate and make public awareness especially People suffering from mental illness and there family. a Doctor can saves a persons life.
Thank you. I’ve learned so much from your videos since I subscribed!
You're welcome, Jen I'm glad they've been helpful. Thanks for subscribing.
A huge number of generics made in India. Less FDA oversight.
Your anxiety videos help me a lot. Thank you Dr!
very interesting, Tracey. I knew about those differences, but not in detail. Switzerland doesn't insist so much on those. Thanks anyway for your constant teaching. Appreciate it! Have a lovely week-end and splurge on the Omega 3! I will,,,
You’re welcome Christine. Enjoy your weekend as well in Switzerland. That sounds so exotic! 😊
Thank you for pointing out the manufactuer on the bottle.
I have epilepsy. There is a difference between the previous manufacturer of my seizure medication, lamictal. Had many more side effects that the previous manufacturer did. This never occurred to me until the dizziness (which I just figured was from my hearing issues and allergies, I’ve had an increase in seizures since then also.
it was brought to my attention that these may be because of a difference in manufacturing of the medicine. Didn’t even know that was a thing, but it’s well now my to be one from doctors and such. Fun stuff.
Very interesting Dr. Marks. I have a medication that will be generic starting later this month. I take other generics, so I’m not concerned. At least now I know what may be different, and look to see if side effects change. Who knows, the side effects may be less. 🤔🙂
Yes Mark the side effects could be less. I hope so.
Late to the game but I did find a difference with going from name brand to generic lexapro/escitalopram when that released. Kept getting told it was the same as name brand by my PBM. Name brand is on the PBM exclusion list now. I changed rx altogether. Thanks for sharing this information!
You’re welcome. I’ve seen a big difference with escitalopram. It’s still a good drug but I have more patients tell me they are tired with it.
Thank you! Exactly what you said is what I've spent the last 10 years trying to figure out. 2008 - 2011 Lexapro was an utter Godsend for every single adhd symptom, right down to delayed sleep phase disorder. 2012 & 2013, it was a placebo, so my psych titrated me up to the max dose. By 2017, I was prescribed double the max dose, and it was still nothing. Generic Effexor XR, nothing. Bupropion was great for causing extreme insomnia, intense irritability, zero appetite, and an eating disorder relapse. After that formulation was recalled by the FDA and I learned that it can cause seizures in people who don't even have epilepsy (I do), that scared me away from all reuptake inhibitors forever.
Hi Dr. Marks. I really appreciated the video. I will make sure when I find another good brand of the lithium to request it. As I mentioned before the lithium up north was more potent than the one in Central Florida. They hospital pharmacy that I went to up north a while back has closed so I'm not sure which brand to ask for. Anyway hopefully this new well known pharmacy is just as good. Thanks for the heads up.
You're welcome Natahsia.
Just what I always wanted to know! Thank you.
You're welcome Debbie!
Excellent explanation of the differences between a generic and the original brand name drug.
Great information, thanks for the video!
You’re welcome Ben!
This was really helpful. Thank you
Stimulant medication seems to have the most noticeable difference from generic manufacturers. One always gives me a lot of side effects and almost makes my adhd worse. Another works really well with no side effects.
I noticed this as well. I have had generic pain meds and have had little to no difference. But I have had pretty significant changes when I was prescribed generic adderall xr one would come out of. My pores and stink and another would make me so nauseous and wretched it was bad. Seems like every generic had some side effect that the brand did not. I think I had one generic that was nearly as good as the brand. That was the sandoz brand of generic. Almost as good as the brand but not quite
Here UK Some, I say Some Docs insist and bully patients in saying generics are the same thing, they say the effective ingredient is the same, it doesn't work the same
Thank you for the video, Dr Marks. I'm assuming it's possible that the opposite could also be true? That my body might respond better to the generic version, rather than the brand?
Great information. Thank you.
I knew my generic Adderall was way different last time when mfg changed to Aurobindo. Nothing but side effects (constipation, headache, rash, sketch), no therapeutic amphetamine ADHD focus, sorta like the crash w no positive effects.
Yeah. I totally agree! I just today for the first time in my life paid for name brand adderall, trying it tomorrow. I used to get good generics and now there are so many and they suck, including aurobindo. That was probably the worst of all of them. If the name brand adderall doesn’t work, I’m switching to Ritalin. I have a federal job now so my insurance paid for part of the my prescription, but 280 every month isn’t sustainable if I’m just too used to having taken adderall for a few years. I’ll keep you updated!
Adderal is very different cause it's a racemic mix, and some manufacturers will use different levo/dextro ratios
@@sarahbearah9434 so how was your experience with brand name adderall?
@@Recklessboyz- it was better for sure, but still with insurance it was too expensive. But I switched to Walgreens and now they give me the brand name sandoz, which is great!
@@sarahbearah9434 tbh at this point I’m willing to pay if I have to because the generic ones I had were horrible lol
I take Effexor XR. The generic does not work and insurance never wants to pay for name brand. I'm currently fighting my doctor and insurance to get back on name brand. I wish there was some way to prove it. Effexor withdraw time for me. Again.
Good info. Pharmacists should send patients to this video when they raise the question.
A bit unrelated to this topic, I was wondering what was your opinion on the new trend of online therapy. A step in a good direction?
Hi Markhou. It depends on what you mean be online therapy. There's telemedicine which is just the delivery of care using technology. I do video sessions with established patients and it's great. Very convenient for them and me (worked extremely well in an ice storm which always shuts Atlanta down for at least a week). Then there is the online therapy where you pay a fixed monthly fee for unlimited contact with the therapist usually via email. I have my doubts about the quality of that therapy. Therapy is work and takes training, expertise, etc. I'm not sure what well-trained, experienced therapist is going to want to make themselves infinitely available to do email therapy at a low fee. I assume then it's someone without a lot of experience cutting their teeth. You can still benefit from someone inexperienced, but in this case you get what you pay for and it may still be better than nothing.
@@DrTraceyMarks
Thanks for your reply.
I was thinking of online services like betterhelp.
It's a bit like fast food vs having a chef cook for you :)
@@markhou I had a pretty bad experience with Better Help. They asked me for a lot of money up front when I really needed to talk to someone, but my therapist was unavailable. I couldn't afford their fee, so, they turned me away, even though I explained that I was having a financial hardship and was willing to work with them to find something that would work for both of us. I will NEVER use Better Help again.
Great information. It confirms what I have noticed when taking the brand vs generic of the Proton Pump Inhibitor, Rabeprazole. When taking the brand I can get by with around 2-3 a tablets week, it lasts for ages in my system. I can stop it and I'll only start getting symptoms returning after 2 weeks of stopping it. When taking the generic I have to take it every single day and if I miss a day, I notice symptoms returning pretty quickly. A stark difference for something that is advertised as being "equivalent". Very misleading, but this video clears it all up for me and confirms that I am not imagining things. Thanks for the content.
You're welcome Ben. Thanks for this example.
Thanks Dr. Tracey for this video. I went to the pharmacy to pick ip my medicine and the young guy tried to tell me that the generic is the same. I made this joke that is not what i learned on sesame street. It is not the same. Lol. So i did not take the medicine instead had to go to another pharmacy to get the brand. And another visit to the same pharmacy the manufacture name changed. So i said this is bot the one i have been taking. So they gave me the the medicine from the previous manufacture. I asked them why did they change it. Again. It is not different. Of course. Now i am going to opt out and also get that drug in brand. Yes i am one of those who have sensitivity to drugs. A children Claritin works for me than the adult. If i am going to be on a drug for a long time. I told my doctor. Lets stick to the brand. That away i don't have to go through too many manufactures and i can have fewer side effects. I always ask why was i so sleepy on one med this time and not the other time. My doctor told me it don't make me sleepy. I look at him and said i am not you. And you probably not taking the off brand. He looked at me. Again he put no generics. I am finding it hard to get brand names from pharmacies. Unless it is on line. What do you think about the online pharmacy. It was not my favorite at first. This is the only way i get my brand unless i want to drive to the good neighborhood where my friend tell me to g and then it become a we don't carry it. So i am doing online now. And i am happy with it. Sorry so long.
I'm surprised it's that hard to get the brand. But I guess I shouldn't be since the trend is to substitute brand for generic if generic is available. I've heard that the online pharmacies are fine as long as they are US based. I've had a few patients get Wellbutrin that way.
Interesting!
Thanks Authentic mental health!
That was a good video. Good information to know.
Best explanation everrr🎉❤❤
Yeah it is I’ve used generic medicine forever so had my family. Non generic is just more expensive to make you broke and make greet people more wealthy.
As long as they are working for you, no need to insist on the brand.
Could the “ fillers “ or added components to bupropion go as far as to cause anxiety or paranoia ?
@Dr. Tracey Marks great video, this was the most informative video I've seen so far on the subject of generic vs. brand name prescription medication differences. What about the *potency* and *purity* of the active ingredient? For example, generic fluoxetine 50 mg tablets compared to brand name Prozac 50 mg tablets. If someone tested these two different tablet forms of fluoxetine 50 mg in a chemistry lab using sensitive equipment, would they find the exact same quantity of the fluoxetine molecule inside each tablet, 50 milligrams in both, or is there a molecular purity tolerance range?
Does the 80% to 125% range only cover the materials and methods used to package the active drug molecules in a tablet with inert ingredients to change metabolism and blood concentration over time (e.g... Fluoxetine HCl vs. Fluoxetine Bitartrate)? In other words, is the 80% - 125% acceptable range only for blood concentration or does it apply to quantity/mass of the active drug molecule? Thanks!
Hi Anodyne. You've gone a step ahead of me. I'm not sure how quantity /mass are effected by the 80-125 bioequivalency requirement. You need a certain mass/quantity to get the blood levels. It may be that the quantity of the inactive compounds affect how much of the drug is needed to get the level. But this is venturing too far into the woods of pharmacology/chemistry for me to know. 🙂 Thanks for the question though.
@@DrTraceyMarks Thanks for your help, and keep up the great work with your videos! Your work is immensely valuable to the public, including me, around the world. :)
This is so true. I am on effexor xr and the generic gave me ups and downs.
my question is - as a consumer - where or who can you send yur generic medicaiton to - and have it tested against the FDA rules?
Could there be drastic difference in Buproprion XL from a 300 mg tablet made by Cipla to its 150 mg version? I want to say the 300 mg Cipla pills are noticeably better than the Cipla's 150 mg.
A couple days ago I was prescribed the generic version of wellbutrin (75mg) and the side effects are terrible. I might get off of it soon.
Trigger warner if anyone is a hypochondriac or has anxiety over health. The blood stream one got me for some reason. I guess I don't really think about it going into blood stream. I have terrible health anxiety
Thanks Dr. Tracey, in New Zealand we have had major issues with the generic version of EFEXOR-XR which is now the only version funded by Pharmac, the governing Dept. controlling what drugs are funded. Fortunately the original is still available, for those that can afford to pay for it.
That's interesting...venlafaxine is the me of.the drugs can really cause the brain zaps if you miss a dose or rake it late. Sometimes the brand can make a difference that way
Hi Dr. Tracey, thanks for your response, the generic version we get here is ENLAFAX-XR made by Mylan in Greece. It has caused so many problems here a Facebook support group has been set up and a petition presented to Parliament. I only take 75 mg a day and it had an immediate response, extreme agitation.
A facebook support group? Wow that's serious. I hope it makes enough of an impact and you see some change.
I have bipolar 2 which is notorious for being difficult to find the proper combination of medicine. I also receive only generic medication. When a medicine is not effective for me, I can't tell whether the medicine or my condition is to blame.
Doc thanks for info 👍
That was interesting. Great vid :)
yes they are the same thing the only difference is that the non brand ones are cheaper and more accessible driving the prices down for everyone!
I take Latuda, and I hope 🤞🏽 a genetic comes out. It is soooo expensive , my insurance won’t cover it 😢. I get samples now till January where my insurance will after I pay $500.00 kickin. But the Latuda 80mg causes my legs to cramp so bad, I have started cutting them in half. Taking 1/2 in the morning, and 1/2 in the evening.
Have you tried using the Latuda copay savings card? It's supposed to bring down your copay to $15 after your insurance pays. If your doctor does not have any, you can get it from the Latuda site. Google latuda copay savings card.
Dr. Tracey Marks Yes I have but because I have insurance they won’t do anything for me.
My doctor has been good enough to keep me with samples until the first of the year
Oh well, it was worth a try.😕
My Insurance says there is no way they are paying for a name brand which is way over the cost of generics by hundreds.
Pharmacy changed generic providers for my lamotrigrine and it became less effective for me. Coincidental? Probably! Ended up going off it all the same.
Very interesting!
Thank you
My doctors okay generic on all my meds, including the ones for my bipolar II disorder, except for my thyroid medication. They specify Synthroid brand for that. Of course it costs a lot more. I need to ask about it. My Lamictal generic recently started coming from a different manufacturer & it freaked me out a little. My lamotrigine has never been that color or that shape. It matched the description on the bottle but it still made me uneasy not being 100% sure I had the correct tablets. Thanks for the information. I think I'm going to watch this video again!
Hi Dj. I'm glad this was helpful for you.Many generics can be just fine but sometimes you can notice a difference in the way it works. So you can pay close attention to changing in your condition whenever you see a different pill/manufacturer.
Generic levothyroxine works just fine for me, and it's free.
Just got switched to generic suboxone after taking brand for 4 years and I genuinely notice a difference, they dont work as good
My insurance wont cover name brand so I just have to suck it up, have tried 3 different manufacturers and stuck with the one with not as much of a difference, ie mylan generic, tried dr reddys and alvogen and they were horrible.
Thaznks hun great advice
You're welcome Randy!
I have had an experience like this with bupropion. Will a manufacturer ever change its own ingredients and process? My original dose/version (XL) worked very well, but my doctor had me try a few different things (SR, or different doses) to try to manage some side effects. I eventually went back to my original dose and it felt like it barely worked at all, nothing like it did originally. We increased the dose, and still didn't feel any different. I *believe* I've had the same manufacturer throughout, but I'm not sure. But if so, I wonder if it changed at all in that time?
I find the XR never worked well for me. The XR dissolves different to control the release of medication over a much longer time. The SR dissolves much faster and you get the max amount of medication sooner in a sense. I believe, for myself, I don't break down pills correctly in my gut and those XR I don't get my maximum med out of it because I have a similar issue with a PPI. When my script ran out I bought over the counter medication and they come in tablets or capsules full of granules. The tablets do not work the same for me. I have to have the capsules.
Great response, I've been asking myself this question for ages!
Please tell us why half life matters? I mean, why do some medications like Effexor only exist (I believe) by prolonged delivery?
Half life dictates how long the drug stays in your system. Drugs with a long 1/2 life wear off slowly and you tend to have less withdrawal effects if you miss a dose. Drugs with a short half life, like Effexor, wear off quickly and you can have more withdrawal when you stop taking it. Original effexor was twice a day because it didn't last long enough to work for the whole day. The extended release version makes it last the whole day, but it still wears off quicker than medications like Prozac that have a very long 1/2 life.
@@DrTraceyMarks thank you!
What are the different antidepressants that do not make if taken together. Example can you take a tricyclic antidepressant with an SSRI or a SSRI with a tricyclic antidepressant?
What if the same excipients of brand are used in generic products, will the efficacy be same.
Well now I know why the bupropion I was prescribed doesn’t work how it’s supposed to. I’ll probably throw away the rest of the bottle until I can find a pharmacy that sells actual Wellbutrin. Does anyone know what the good generics are incase I can’t find the name brand?
Hi doctor.. looking forward to watch video on a anxiety symptom" feeling like loosing mind/ going crazy" . Please
Hi Saritha. Are you referring to the one on health anxiety that came out last week? If so, here's the link ruclips.net/video/W4-hhWqi2rg/видео.html
Thanks doctor.. yes I am hypochondriac.. and when my head pains.. I have fear of loosing mind ? I don't know how to overcome from this ?
Hello Dr. Tracey
When i take SSRIs after a while they make my feelings numb this feeling made stop taking it and stop seeing a doctor and keep switching meds and doctors.. when i discuss this with my doctor they deny that this meds made this feeling. . I've been on prozac, celexa, lexapro and now zoloft. Why SSRIs make me lose my feelings and motivation and make me dull? Right now I'm barley holding my self not to quit therapy again.
Hi Hadeel. Emotional blunting with antidepressants is a real thing. I did a video on this very topic ruclips.net/video/40wbhck0JKo/видео.html
Have to ever heard of Gene Site Testing? It's a genetic test to see which ones you are predisposed to be sensitive to.
Okay so my meds don't feel right. When I take it(lamotrigine) it makes me feel like I'm floating and weak and dizzy. Kind of like I'm high.
Some of these meds can make people feel this way as a side effect. you may be a slow metabolizer of drugs and have more side effects in general. If you seem to be sensitive to most meds, sometimes taking lower doses is neccessary
Anyone had experience with generic vs seroqel brand.
I tried the 'Accord' generic and it was awful.
I always have to get seroquel, but is so expensive.
Anyone know of any generic that is very similar to the brand?🙏
I cannot notice a difference in my anti depressant, by using generic, but I won't use generic for my anti convulsant.
I use generic medicine which is sertraline and it works just fine.
I've have transitioned from name brand vyvanse to generic vyvanse and I have ADHD.
From my experience, your best bet is to just stay with the same one you choose at the start.
Why you say that pls???
Are there differences or is it bad to change???
Damn even big pharma sells Mid
I have only ever used generic medications at home. However in hospitals, I always received brand name medications. I can ALWAYS notice a difference. Generic psychiatric drugs DO NOT work for me. I can’t afford brand name prescriptions though, not to mention my insurance doesn’t want to pay for them.
Yes many insurances will charge you much more if your doctor says you need brand when there is a generic available. 🙁
I'm having a hard time understanding (for the majority of simple tablets) how different manufactures would really make that much of a difference to the AUC... I've never heard of any drugs that include medical ingredients other than the main bioactive, unless the additional ingredients are an intended part of the treatment. I thought that most manufactures should basically being using the same non-medicinal ingredients (like fillers, the casing around the tablet, etc). To me these seem like simple ingredients that break down easily in the digestive system so that the medicine is released.
How can these ingredients cause significant adverse effects (altering the AUC)?
Can anyone explain it in a different way than the lady explained in the video?
Thanks
👍👍
The active ingredient of a generic drug is chemically identical to that of a name brand drug. So said a pharmacist who I personally knew.
The only thing which might be different are the binding chemicals used to manufacture the pill. If the milligrams are different between different manufacturers, then there of course exists the possibility that some brands have inferior and/or careless manufacturing, or else they cheat and are dishonest.
Easy fix is to take the generic from the very start..
As she explained there are different generics and one may be fine but the other may generate a different response.
This was so helpful! Thank you
You're welcome, Justina.