Methadone question from former Rockhound

[gracie05]

I have been on this pain med for years and was always able to get Roxane brand which worked great. All of a sudden everyone is carrying this new brand called Ascend. It's horrible! I constantly feel like I'm having withdrawal! According to my pharmacy everyone is complaining and Roxane is nowhere to be found. Is anyone else having this problem? I suspect it's way cheaper and is connected to the government insurance, but this is horrid! Does anyone know anything about this previously unknown substandard brand that has suddenly taken over the market? I'm actually scared! Mallinckrodt is also substandard and gives me a stomach ache but even it is better than this stuff! And absolutely no one carries the non-generic dolophine! I haven't been able to take other meds successfully and methadone has always worked well. Now I don't know what to do.

For those of you who have been around awhile, I originally joined here in 2000 as Rockhound.

[tortoisegirl]

Sorry you are dealing with this. I hadn't paid attention to what brand my Methadone is, but I looked now and it is Ascend. I believe I've had this brand for the last couple years. I previously had the more oblong squarish ones with a pronounced break line.

I can say though that even if you were getting a lower dose (and there isn't too much leeway in the mg per pill it can vary from the listed amount), any withdrawal would stop once your body gets used to the "new" dose. ie. your symptoms wouldn't continue indefinitely, as the "new" dose would be holding steady, not decreasing. So, in the long term, this should be easier to deal with than getting more side effects from a specific brand.

Pharmacies often get reimbursed by insurance for the average generic price of a med, so they typically buy whatever is cheapest for them. On a couple of my meds I get the brand switched back and forth almost every month just based on what they have in stock. I hope things improve for you soon. Best wishes.

[gracie05]

Kate, the squarish ones are Mallinckrodt. People were complaining about that brand being substandard 10 years ago. I think Ascend is new. It looks a lot like Roxane brand, so you may have had Roxane before. I'm finding I need more of the Ascend and even then it doesn't work as well like it has a blocker or something in it. Maybe I just don't absorb it because of one of the fillers they use. I don't know. I do know a friend who takes methadone says the Ascend gives him horrible headaches. He has complained to his pharmacy about it, too. The Roxane has numbers on the back. One is 54. Can't remember what the other is. I do know from what 2 different pharmacies have told me customers are really complaining about Ascend. I'm glad it works for you but you are definitely in the minority. But I did ask how people are reacting to this brand and I appreciate your input.

[gracie05]

By the way, Kate, you comment in your profile that you have new daily persistent headaches. You might ask your pharmacy if they changed to Ascend about the time your headaches started because as I said, Ascend has been giving my friend headaches.

[tortoisegirl]

By the way, Kate, you comment in your profile that you have new daily persistent headaches. You might ask your pharmacy if they changed to Ascend about the time your headaches started because as I said, Ascend has been giving my friend headaches.

Thanks for the idea, but I've had the constant headache (singular not plural by the way) for 9 years, and it is the reason I started the Methadone, not the other way around.

I also see posts online about the Ascend brand of Methadone going back to 2012 so I'm not so sure it is new. I'm assuming that is what I have been getting the past couple years since the pills have looked the same and I haven't gotten the sticker on the bottle that says there has been a manufacturer change, but I could be wrong.

If you think there is a real problem I would be contacting the manufacturer and/or FDA, but even if a pharmacy had received several complaints, it probably wouldn't be a significant percent of the folks at that pharmacy on the med. How long has it been since the switch? If you are having issues after a month, then I'd discuss your options with your doctor. Your body should be able to adjust to any slight change in dose, release mechanisms, fillers, etc. Best wishes.

[alex44]

having been on Methadone a long ago - and having to detox rapidly (not pretty p as in it sucks) I thnk both mallencroft - I always hated their Morphine - the binders -and filler. even my Doc could not get an override for a different brand. Yea , my understanding is that they can go 10% either way on the active ingredient - in my case Morhine - in yours Methadone - same diff - I would bet Mallinckrodt on the minus side, of course . does this as well as this new manufacturer and knowing how a simple drop in my methadone of 2Mg HURT like heck, yeah a 10% difference would be noticeable. I am doing my best to use alternative Medicine. I wish you all the luck in the world and Blessings and prayers. may you be as pain free as possible.
Blessings
Alex44
Skypilot

[tortoisegirl]

Here is an FDA website page describing a study where from 12 years of bioequivalence data they found on average the absorption differences between generic and brand varied by 3.5%: Only registered and activated users can see links., Click Here To Register...

A generic must be shown bioequivalent to brand, which is when the rate and extent of absorption is not significantly different from the rate and extent of absorption of the brand when administered at the same dose under similar conditions. There is a 0.8 to 1.25 confidence interval (not dosage) variation allowed for 90% of the samples.

It will vary each time slightly, but the dose variance is close to 4%, nowhere near a 20% or even 10% different from brand (or another generic). Unfortunately there is a lot of misinformation on this topic online. Generics can however have different binders, fillers, and other inactive ingredients than effect the absorption and side effect rate for some folks. I would guess the absorption rate differences and any misconceptions & preconceptions are what account for most reports of perceived differences between brand and generic (or two generics).

My intent with this information is not to discredit anyone who experiences increased pain and/or more side effects when switching to another generic, but to correct the misconception that generic dosages are allowed to be double digit percents off from one another. Great discussion! Best wishes.

Only registered and activated users can see links., Click Here To Register...
Only registered and activated users can see links., Click Here To Register...

[Pharmacist.steve]

There is something called the "Orange Book" which rates all approved medications by the FDA.. Only registered and activated users can see links., Click Here To Register...
I could not find Methadone being listed being made by ASCEND
I also checked for the manufacturer ASCEND and what meds they have approved and a company called Ascend Therapeutics makes a estrogen gel.
Here is a FDA website to report what they determine as a Therapeutic Failure... Only registered and activated users can see links., Click Here To Register... which seems to describe what you are experiencing
If this particular Methadone medication is not rated/listed in the Orange Book... it is ILLEGAL to dispense.

[alex44]

I have the same problem except with Morphine ER. I get mine from the good ol VA I USED to get brand - Now i get soe generic that is not worth a doggone. I found some old 15MG. i had about 10 - I only took 3 and that worked much better then the 60. I am going to try to get my Nurse provider to give me the 15MG. strenght as when i called the VA pharmacy to inquire, I got HUNG UP ON. that or another Med. This has been an issue before, both me and my partner have a hard time with the fillers and other crap they put in the 60's are like 4 times normal (brand and I suspect by Mallencroft (I have never gotten any real relief from their products - they are crap but something is better then nothing and I hurt too much. I will try to be here more as we all need to support the forum and maybe get some members back that have gone elsewhere. I am not sure under terms of my contract. Methadone - Have been on it, NEVER AGAIN , Same with Suboxone - Too many horror stories. took me 6 MO to get off methadone and it was miserable Morphine detox was easier. Good Luk and I will pray for you.
Alex44
Blessings
Skypilot
Skypilot

[tortoisegirl]

Alex: Could you have been switched from Methadone to Morphine or something else to taper down? Thankfully Methadone is a great med for my pain...the only one to significantly consistently help. The side effects are there, but manageable. Suboxone wasn't a good for for me though...I only lasted a week, and had no pain relief, a constant migraine, and continued withdrawal. Everyone is different.

As far as generics, very little active ingredient dose variation is allowed. They must be shown bio equivalent not within a certain percentage, but within a statistical measure. The 90% confidence intervals for the ratios of the geometric means (brand vs. generic) of the AUC and Cmax must fall within 80% and 125%. This is what commonly gets misconstrued as -20% to +25% being allowed for a generic. To get an idea of what the typical percent dose difference is, there was an FDA review of 2,070 human studies between 1996 and 2007 which found the average difference in absorption into the body between the generic and brand name med was 3.5%.

However, the differences in the inactive ingredients and the time release can be significant for some patients. You can ask for a certain generic (or at least to avoid a certain generic). However, pharmacies often aren't able to accommodate the request. Insurance typically reimburses the average generic cost (not the actual cost), so they aim to order the cheapest option to maximize profit (as the profit margins are quite small). Chances are better at independent pharmacies than chains, as often a chain has no control over what generic their order is filled with. Similarly, if a rarer medication isn't in their system, they can't even order it. Best wishes.

[alex44]

Rockhond = Sorry it took so long - i am not able to be as active 0n the boards. Having been on methadone 80mg. daily. i was rapidly de-toxed due to a bad U/A as in 2MG a day. talk about withdrawal. If you find relief in this medication, but only if you plan to spend the rest of your life on it, that's great. if you would be more comfortable on something else, Talk to your Doc. I wish you the best of luck.
Alex44
Skypiiot

[gracie05]

Alex, I had to do a rapid titrate at one point and was sick as a dog!! So I can definitely empathize with you (and I was taking only 20mg/day at the time!). I have never been so miserable!! As for brands, Ascend is made in India where both Mallincrockdt and Roxane (now Westford) are made in the US. I reacted so badly to the Ascend that the next time I accidentally got it my doctor disposed of the entire bottle and replaced my prescription rather than put me through weeks of withdrawal again! For people who start methadone with Ascend it's all your body knows, but if you were to get the Westford/Roxane you would definitely feel the difference!!

[alex44]

cme across this old post had to reply - I was much younger then - withdrawel was hell - I got through it by doing things best left unsaid - it was not pretty - both me and my partner were rapidly -detoxed at the rate of 2Mg. a day - hell on earth - I would not ask my worst enemy to get on it or go what we went through. I don't know of the drugs you speak of - I am old school and proud of it - you sucked it up and did what you needed to do - It will be unspoken but it got us thru - suboxone is NO better - from what I have heard - it [s worse - I do not think that is possible. the same - very possible
Blessings
Skypilot Steve