Do you get used to one generic and can't take another?

[Diandra]

I have been taking generic Norco (hydrocodone 10/325 APAP meaning 10mg of hydro and 325 of "tylenol") for many years, 4-5 per day. It is my base pain medicine. I have tried generics from different companies. Some make me nauseous, some don't seem to have as much hydrocodone, some give me headaches, etc. I finally found one from a company called AMNEAL that was perfect for me so I told my pharmacist that I needed that specific generic and my script insurer was kind enough to write me an override so I can always get that specific generic from AMNEAL. When one pharmacy ran out of it or could not get, my pain doctors office was kind enough to call around to find a pharmacy that did have it(I know, are they nice or what!). Now, I can't find ANY pharmacy that has that specific generic so when I was at CVS I asked them if they could order it for me and they said it was listed as currently not available. So I contacted the company directly but they are being very evasive. One person said it was not being manufactured and another said that they could not get one of the ingredients, etc. So I have asked if they could tell me what pharmacies they sell to and they only sell to big ones like Walmart and CVS yet I get it from my local mom/pop pharmacy so I guess they get it from some distributor. I have really suffered these last few weeks because of the change even though the generic I now have is from a good company(Watson, who I believe is also the maker of the brandname Vicodin) so I don't why there is a problem.

I have these questions:

1. Do any of you find big differences between generics or am I just super sensitive to ingredients?
2. And I guess this is for Steve, do you think writing(snailmail) to the company would be helpful to find out where I could get it?.
I have emailed, called and used their website to contact them about this. I have also called to many pharmacies in the area and they
don't have it.

Thanks and hope you are all doing OK. Sorry I am not around more....just been busy.
Take care, Diandra

[Pharmacist.steve]

@Diandra... I would ask the Pharmacist at the "Mom & Pop" to contact the buyer at the *********r they use... and see what can be found out about supplies from the company. I would suspect that a non-pharmacy contacting the manufacturer asking about supplies is kind of unusual. Personally, I am not familiar with the company... but the generic manufacturing business is pretty cut throat. I checked the FDA listing for drug shortages and there is none for Hydrocodone products... so they could be having manufacturing problems to financing problems to some other issue that is not public information. Otherwise, for some reason .. you may be having some problem with what is otherwise considered a inert ingredient.

[Diandra]

Thanks Steve....that is a good point about a non-pharmacy person contacting the manufacturer. When I asked my MOM/POP pharmacy about it, they said all the generics were basically the same but I will ask them to find out for me. That is good advice.
As always, your info is invaluable.
Thanks, Diandra

[alex44]

Hi Diandra - I had a simaler problem. I finanally got on SSI and Medicaid. My doc took my old bottles and took over my care. Long story short, The M********t that i was getting was upsetting my stomach. I asked my doc. and she said it was most likely the filler, my understanding from my doc is there are about three differant ones. - so she put on the script "do not fill with M********T. the pharmacy had to order it, after an initial hassle with the Pharmacy clerk, I simply asked for the head Pharmacist and it was quickly resolved in my favor. They were able to overnight the order, maybe an extra day but since then they always keep my script in stock and I have no problems since. The E**O brand works much better and faster. Bear in mind though that I am lucky enough to have the pharmacy right there where the doc is - all one building/clinic. Hope this helps and finds you well.
Blessings
Alex44

[Diandra]

Steve and Alex, I did follow your advice and spoke with the head pharmacist and they were able to get me the generic I needed.
I do want to say that the company, called Amneal makes a good generic of hydrocodone that I am able to tolerate better than any of the other generics. Alex, I think you are right on the money about fillers in the generics. Some of them make me feel very nauseous yet the Amneal I don't even have to take with food and I am fine.

Hope you are all well. Diandra

[Boxerlover]

Certain generics I can take and others I have issues with. I get brand on my duragesic patches and have been getting generic on my BT's but they have recently had new generics come out and the taste is terrible. I asked if they could order a specific generic in and they said they basically get what they get. Now for the last 4 months I have gotten the generic I like but if they are not able to get that I will go back to brand. I was just trying to save my insurance company some money.

[Diandra]

Certain generics I can take and others I have issues with. I get brand on my duragesic patches and have been getting generic on my BT's but they have recently had new generics come out and the taste is terrible. I asked if they could order a specific generic in and they said they basically get what they get. Now for the last 4 months I have gotten the generic I like but if they are not able to get that I will go back to brand. I was just trying to save my insurance company some money.

Yep...that is exactly what I am talking about. My pharmacy said if I give them a heads up of a week or so, they will get what I need. Maybe try that with your pharmacy because originially they said the same thing your pharmacy did, I get whatever generic they get, but I think these Mom and Pop pharmacies are trying to do whatever they can to retain customers.

How have you been, by the way?...is your pain being managed OK. Take care, Donna

[alex44]

Good info for all of us. There are a number of fillers they can use (according to my doc.) and it is also my understanding that generic Manufacurers can deviate on the active ingrediant up to 20%. P. Steve, could you clear this up for us? I cannot tolerate m---------t, but have no problem with e--o - My S/O got changed over and is having thre same problems I had - So I do believe the filler as well as the Manu. has a lot to do with the Quality of the product. Thoughts?
Blessings
Alex44
Skypilot

[tortoisegirl]

The FDA quotes the average difference between generic and brand bioavailability is 3.5% (Only registered and activated users can see links., Click Here To Register...), but its allowed to be between 80% and 125% (Only registered and activated users can see links., Click Here To Register...). I assume due to cost they would want to tend towards the 80%. I've read some folks need to increase their dose when switching from brand to generic (in something you can feel effectiveness of, such as a pain med). Some meds you wouldn't know if you are getting less active ingredient. I very rarely ever use brand name meds due to cost, so starting with the generic I wouldn't know if I was missing out on anything.

Also agree its often the fillers in different manufacturers that can be causing different side effects or even severe reactions among folks who are med sensitive. I however haven't had any issues to date with one generic vs. another.

From my reading, in the pain realm, it seems the Fentanyl patches in particular get a lot of complaints about having different generics be quite different in effectiveness (especially reservoir vs. matrix ones). Some even say their doctors told them to only use X brand, or to never use X brand. Between the allowed difference in percent of active ingredient, the possibility of the filler affecting absorption, and the possible different physical design of patches affecting absorption, I can definitely see how this can be true. I just started on the patch and plan to try out different generics (as well as placement on the body, although I read that is less true).

But no, in my opinion I don't think you get used to one generic and can't take another, but I think when switching its quite possible to have it work better or worse. Best wishes.

[alex44]

Alex here - My S/O/ got M.........t instead od her E... band - two ays in - withdawels, changes in pesonality - she hates them. Is thee a shotage of E...? Her egula phamacy said they ae on backorder - the chain said that moe is coming online, We went to a chain where we used to go, good to be fiends with a phamacist or two and was able to get a differant generic - the clinic phamacy was like "take it or leave it - long stoy short, we left it and went to the chain. I do not undestand how a phamacy that KNOWS you takea specific drug that cannot be suddenly stopped cannot take the time - like call the distributer and get the ode in instead of waiting until the last minute - tho that might be copoate policy. We will now take ALL ou scripts to the chain - the geneic is much better on the pain meds and i Don't need two stops since both stoes take about an hour or so
we can do our grocery shopping and lunch while waiting. I guess like all things, there ae good and bad, bad and I take my bussiness elsewhere.
Blessings
Alex44
Skypilot

[Pharmacist.steve]

Good info for all of us. There are a number of fillers they can use (according to my doc.) and it is also my understanding that generic Manufacurers can deviate on the active ingrediant up to 20%. P. Steve, could you clear this up for us? I cannot tolerate m---------t, but have no problem with e--o - My S/O got changed over and is having thre same problems I had - So I do believe the filler as well as the Manu. has a lot to do with the Quality of the product. Thoughts?
Blessings
Alex44
Skypilot

My understanding is that ALL DRUG ..must have 95%-105% of what mgs that are on the label... and that all generics are tested as to their bio-equivalence to get a AB rating in the FDA "orange book". Unless a pharmacy is dispensing a generic brand that is not rated in the book... which is ILLEGAL.... any difference -other than some abnormal reaction to what is considered inert fillers - should be at a minimum.

[RustyBonz]

The conversation used to be about brand vs. genric. Now it's down to crappy generic vs. reasonable generic. There is a reason that President Lincoln has tears running down his face. Pinching that penny puts percentages in profit margins over customer satisfaction. The quality of products and ultimately quality of customer service is a joke to the 'profit-seeking' behavior exhibited by too many stores. Their battle cry is "Shut up and love it". That's really not how competition is supposed to work. Competition is the justification for substitution.

How's this for a valid point?

Double blind tests and testimony have documented the "placebo effect". If a person in pain feels that they receive more effective pain relief from a generic product that distingushes itself by using quality ingredients, then why not use that perception to help the patient?

Pharmacists, doctors, and scientists will go to the mat arguing that the lump of white crumbs and powdery pills is every bit as good as the yellow hard pressed pill that happens to be made by the same mfg that produces the brand. If the stubborn poorly educated 'drug seeking' pain patient thinks that they get better pain relief from a particular mfg generic- why not let themselves go off and delude themselves. If it doesn't matter- than why does it seem to matter??

RB

[RustyBonz]

P.S. Steve I didn't mean to insult you or your profession. I apologize

[Pharmacist.steve]

A large part of that "profit seeking behavior" is because of that little "drug card" that 90%+ of the people use. These PBM ( Prescription Benefit Managers) offer "take it or leave it contracts".. and every 2-3 yrs... the lower the amount they will pay.. that is why Walgreens doesn't accept Express Scripts (ESI) anymore... their last contract offered... offered Walgreens 7% of the profit that ESI was going to generate from a transaction.. and ESI provides not much more than a charge card does. Generally speaking the Pharmacy staff has a "shut up and love it" attitude... because that is the attitude that are getting from upper management when they tell management that they need more help. The PBM doesn't care what you want.. they say they will only reimburse for the least expensive product available...so that the PBM.. can maximize their profits...