Circle Of Spite

Surely not Lil Laura-GPs don’t make mistakes!

Even worse than “brand seekers” are those who must have the same brand of generic every month. I have no idea what brand the warehouse will send, or what colour the tablets are.

“But Boots always give me,…..x,y or z” The llast one was Zocor. Zocor costs £30 a box, the generic is about 30p. I seriously doubt Boots are giving out Zocor…

A patient going nuts at me, for something that isn’t my fault, makes me smile. Yes, it’s my fault that nobody in the whole of the UK has Betnesol drops, Atarax or Pregaday in stock :)

Hey TAP,

A question as to the whole generics debate. I guess the whole point is what is written in the individual medicine or drugs data sheets etc. and what actually is in the medicine.

By this I am meaning for generics the active ingredient is the same strength(approxiamately) as the name brand that much may be true but a lot of the incedental ingredients may not correspond. ie the Filler, matrix, or solvent that carries the active ingredient may vary greatly from generic to name brand. This is why some favor it, although many do so due to name brand elitism alone.

So the generic may have the same amount of active ingredient althuogh it may not have identical chemicals other than the PAI. Some name brands use various buffers that facillitate an easier time of exposure or absorption while some generics use just filler that upsets others stomachs, causes gas, or any number of other things.

This is why generics sometimes do not give equivical treatment. Well that or I am completely full of Shit, and many people definitely have a case to prove that gem of wisdom.

If you can take a tablet and tell me that it had methylcellulose in it as opposed to cellulose, I’ll suck your dick and call it chocolate.

Hmm thats a tough one, but the question isn’t if one can find it- just that it’s there and the presence of the methyl group causes irritation of the stomach in many patients hence the difference in name brand vs generic.

Actually as it was spoken as a challenge, there are a number of ways to find that difference. The first is to dissolve the cellulose in a non-methyl solvent and then distill off the methyl and test for the identity at that point. As well there are HP columns that will elute the non methyl cellulose at a faster rate than the methyl. So taking a known methyl cellulose one can measure its elution time and then test both samples to determine if one is a methyl cellulose or not.

For all you just need to crush the tablet into a fine powder and then dissolve it in benzene or any organic as the most likely solvent.

You can do all that within your stomach??? I said TAKE the tablet. I meant PO!

Perhaps it’s not the methyl group making them ill but the benzene and the HPLC equiment they are swallowing. We might have to go back to saying take with a glass of water.

The group of gnereic bashers I like the most are the one who won’t even take the brand name patent bashing generic. It is the EXACT SAME TABLET. Still you can’t help stupidity you just have to laugh.

Doesn’t matter what the carrier is. If it still carries the drug, and the drug gets to do its job, what is the problem?
The MHRA or FDA wouldn’t let them out on the market if they weren’t suitable and you know that.

OZ
“Perhaps it’s not the methyl group making them ill but the benzene and the HPLC equiment they are swallowing”

Sorry I am usually unclear in my responses. What my statement was meaning was that one can use chemical menas to isolate and ID the different compounds even if the compounds varied by a single methyl group. this has no actual relation to the actual drug thuogh as it is doubtful that they are using such technology to isolate such molecules.

As to government agencies and their market control, there are many things that such agencies do well. Researching or substantiating the research of effects of things other than the drug tends to be a very large hole in their “net”. Many of these agencies do a great job in determining the abilities of the API although determining the harmful effects of the buffers, coloring, extraneous other crap included in many pill or tablet formulates tends to not be investigated as stringently.

You’re missing the joke. We meant that by swallowing the tablet, one cannot tell the difference…and it’s bullshit if you think otherwise. Sure, we can run some experiments and find out what’s actually in the tablets, but the common rube cannot. They just have “brand name” stuck in there head associated with “better” and “generic” associated with “junk” — which is not always the case…

Unless they have a really good drug plan, they have to pay for the difference in cost between generic and brand… That usually shuts them up when they start whining…

Along these same lines, I’ve wondered why you or TAP don’t have a running list on your page of a “Hall of Shame” for brand names that docs ought to be ashamed to EVER write for. I was assaulted by a rep about Pristiq yesterday and just now about Treximet (what garbage). I’m also thinking about such gems as Paxil-Cr, Ambien Cr, the whole dose changing Tricor & Antara nonsense and a host of others.
Thanks for the work

Why are you all pharmacists if you hate the public so much? Didnt you realise that you would be dealing with sick and elderly people mostly???

Who the fuck are you? Who would’ve known that the ‘public’ would call me a “stupid motherfucking cocksucker”? If it weren’t for that type or rudeness and disrespect, none of us would have a problem with your so-called public. So, piss off as you’re on the outside looking in.

I have to agree with Regina, I am on the inside looking out, i wish i was fortunate enough to be on the outside because it is so fucking boring coming to work everyday to listen to all you bitter individuals moaning about your jobs, you are so much more important than everyone else, you know so much more, blah blah blah. Lighten up!!!!

Piss off.

Kerry, There is the matter of FDA rating on drugs that you are overlooking. If 2 tablets contain the same active ingredient and have the same bioavailability and bioequivalency they have an AB rating - signifying that they are generically equivalent and therefore substitutable.

Your AB rating is plus or minus 20% on AUC and plus or minus 3% on Cp (concentration in the plasma) if my memory serves me correct. That’s a pretty wide margin — especially when we’re dealing with drugs like Synthroid(Levothyroxine) and the tablet is 100 micrograms as the initial dose. That’s the only example where I give a shit.

The FDA is understaffed and underfunded. They are ill-equipped to deal with anything going on in the United States other than saying every drug causes children to want to think about killing themselves (suicidality).

For those of you who are saying Pharmacists didn’t realize they’d be working with the sick and elderly…All I can say is this.. I am a Tech and my pharmacy has primarily elderly and people with Medicaid and some rich people here and there ( I do work on the nicer side of town and my city has like 6 diff. rite aids alone not to mention a CVS and walgreens every other street…But I digress, we in the pharmacy know we’re going to work with the sick and the public and we’re often not treated as the professionals we are. Pharmacists went to school for a very long time and I have just taken the PTCE (pharmacy tech certification exam) and spent a lot of money for that and am in school myself. So just a thought, the next time we’re ranting about the patient who wanted their scripts filled yesterday and ran out of refills or called and wanted us to “loan” them some adderall XR just remember we’re people too…. Thank!!!

Not sure what happened to previous postings, so am hoping this response is readable. After a period of symptoms which included shiveringly coldness, sluggish thinking, aching feeling of heavy limbs (more heavy than usual!), fatiguel, occasional palpitations, etc., I gave my list of complaints to my GP who promptly diagnosed me with hypothyroidism with corroboration of labs, and prescribed thyroid hormone supplementation. It was the very devil to try to remember to take a dose on a moderately empty stomach, never mind to take it at all. (If the drug manufacturers can come up with Depo-Provera, why don’t they think about Depo-Thyroxa?) When I started with the nose-dripping chills again, it occurred to me that I’d forgotten to take the drug for a while and put the prescription vial in a different location where I’d more likely see it and remember to take it. Of course it was the first time I had to take a regular medication, so I was a little shocked that Walgreen’s expected me to pay for 3 regular fills as if it were three individual prescriptions when I wanted a 3 month supply, never mind the cost of Synthroid, so I ordered it from the pharmacy I work after the dose was figured out. With the initial hassles of getting the dose and the quantity and fixing how to take it correctly, I make sure that it’s ordered from the same generic manufacturer from hereon in. Next time there’s some problem, say the company’s products are recalled or no longer accessible from our wholesaler, I’ll prepare to adjust for a change in drug biopharmaceutics ahead of time. But, yes, there’s a few of narrow therapeutic window drugs that are the exception to okay generic substitution. Otherwise, if the Tylenol doesn’t work for as long as it needs, take the next dose a little sooner in that acceptable dosage frequency range. There is an FDA sanctioned Orange Book here in US after all! (Indicating that the bioequivalency testing was done and decisions made.) I do a lot of ( helpful) self-talk when I see what appears to be a haughty expression directed toward me from some who ‘demands’ brand name Vicodin. As a matter of fact, I caught myself replying to a patient who’d called to inquire the cash price of Lortab 5, (in the middle of two people at the window, a tech who needed a little instant knowledge boost, and bagging up 3 scripts), hmm, you said #30 Vicodin? The patient replied ‘Lortab not Vicodin’, and I said, ’same dif’.

I wonder if patients ever thought of MONOPOLY when they thought of brand names taking full control of the prices. They should be thankful generics are there to help them. Who cares if the pill is in a different shape or color, if the pharmacist says it is the right pill and even shows you the bottle, trust the damn pharmacist. Ever though of different manufacturers?

ooh, but Pristiq sounds so pretty, and the pens right well also.
I did enjoy outshining a Xyzal rep when I showed him that it wasn’t on a patient’s insurance perferred product list. Hmmmm… what you gonna say to that?

I just changed that to Zyrtec. Period. Didn’t call. Didn’t ask. Just told the patient I saved them a ton of change. Call me unethical. Thanks!

Somebody brought in an insurance card, which changes the price of a brand name birth control to the price of the generic… Which brought on the conversation with my pharmacist about how generic-Alesse is possibly 10% less effective then brand name (according to the drug rep)… No offence to the provincial formulary, but if ODB will only cover the generic, it sounds like they want more children in the system… (I wonder if the drug rep was being untrue?)…

I’m sure she had a “quality” study performed by a “reputable” team of physicians paid for by Cerner Multum. I can’t believe that you would take that for fact - especially about the competition. That’s like Coke saying Pepsi has arsenic in it. The only thing that comes out of a drug rep’s mouth that I would believe is, “I’m bringing you shakes. Do you want chocolate, vanilla, or strawberry.”

PS - I want chocolate!

You are so bad dude.. but I love it! hehe :)

I am NOT a member of the public and have probably worked in Pharmacy longer than most of you!!!! Pharmacists are not God! Although most of you seem to think you are it would seem!

What the fuck does time spent have to do with anything? Actually, what the fuck are you talking about???

There is one instance in which generics differ from brands. I have Celiac Disease which means I cannot ingest gluten (comes from wheat, barley or rye). Many drugs use either wheat or corn as a filler and if it is wheat I will pay dearly for weeks, literally spending my days and nights hugging the toilet. Unfortunately it is difficult if not impossible to find out which drugs contain gluten, often requiring days/weeks of research and many calls to the company who makes the drug. Most pharmacists do not seem to be aware of this problem and I have had many bizarre scenarios with them. For instance when I was first diagnosed I asked my pharmacist if he could check and he literally started screaming at me that I was wrong as gluten was AN ANIMAL PROTEIN and there was NO WAY it could be in pills! When I moved to PA I asked my new pharmacist if he knew of Celiac disease and he didn’t. I tried to explain and told him that I would often have to request a specific brand of a drug. However he refused to do that. I would call and tell the tech that I had to have such and such a brand this month as it was the only gluten free brand available and the pharmacist would ignore that and fill with the usual generic anyway! Once when I got pneumonia the doctor carefully researched an antibiotic that was gluten free and wrote ON THE PRESCRIPTION that I had to have that particular brand and the pharmacist filled with a glutened generic ( I live in PA where that is legal). However there are a few in the know. Rite Aid in particular seems to be aware and even has a special number they can call to check. The reason generics tend to be glutened is because they use the cheapest filler they can, which is usually wheat these days thanks to ethanol and corn prices. This is not always the case however, just a general tendency. So pharmacists, PLEASE, PLEASE, PLEASE, be aware that sometimes, when a patient calls and asks for a specific brand, or changes that brand around from month to month, they are not doing it to spite you or in a mistaken belief that “brand name” is automatically better, but because they have a disease that makes it dangerous for them to ingest gluten.

This is possibly the best comment I’ve ever received on the blog. You make an excellent point. In addition to your concerns of gluten with Celiac Dz (of which I am remotely aware of), Vegans also have concerns when it comes to glutenated tablets — since it is an animal protein as you say. However, for me, this is a VERY simply problem to research and correct. Clinical Pharmacology is a great resource to research inactive ingredients in ALL medicines. It does require a subscription, and due to the fact of it’s excellent inactive ingredient lists, I gladly pay that money for my patients. It takes no time to find that information and even print it for patient’s ease of mind. Thank you for this excellent, eloquent comment.

Hey, I think it is important that patients be given the same brand that they have been taking. Its not the same, no matter what you learn in pharmachology school. Studies show that two brands of the same drug can vary as much as 20% in concentration. That is a big deal if your epilepsy dosage is a carefull balance of seizure control and side effects, or if you are taking psychiatric medications whereby flucutating concentrations can lead to mental instability. 20% can be a big deal and patients diserve reliabaility. Taking the same brand may at least lessen the likelyhood of dosage differences or drug release patterns in the case of XR formulations.

[...] this guy flew off at the mouth in the comments on Circle of Spite by my former accomplice, Lil Laura. Here’s his comment and below that is my [...]

My rebuttal to Bill — http://www.theangriestpharmacist.com/2008/08/12/we-got-a-hotshot-here/