The make of medications?

[Cliff_G]

Has anyone proven to themselves that a particular make of a drug makes a difference to how effective they are?

I'm currently suddenly having more post-ablation ectopics after using up the original supply of 50 mg Flecainides (2 a.m., 2 p.m., so 200/day) and starting a new box, of 100's (1 a.m., 1 p.m., so still 200/day) from a different manufacturer. Of course, there may be other factors, but this change of manufacturer is on my list of things to investigate.

Just interested to hear of anyone's experiences.

TIA

[BobD Volunteer]

In my twenty plus years in this game I have never bothered to even look at who made what and never noticed any difference to how I feel.

[Cliff_G in reply to BobD]

I am fairly sure that the proper Ventolin reliever inhaler acts better on my asthma than the non-proprietary ones. The latter are just about OK though, so I haven't requested the branded one.

[jeanjeannie50]

I insist on certain makes of medication I take and my GP has it written on my prescriptions. Yes a lot of pills have different fillers and they can cause side effects, or the contents can have less effect on symptoms.

With Flecainide, some makes weren't so effective at keeping my AF away.

Jean

[Cliff_G in reply to jeanjeannie50]

Thanks Jean, so I won't take that possibility off my list just yet. Prior to my 2002 ablation I always got the original Tambocor, but I think even that has gone generic, no longer 3M.

Cliff

[mike1961 in reply to Cliff_G]

Cliff,

In my own experience, the original Tambocor chalky white tabs stamped 3M on one side and either 100 or 50 on other other side (ie mg) available up until a couple of years ago were definitely more effective than the cheaper shiny white (not stamped 3M and 100 or 50) generics around now.

When I pointed this out to my Cambridge EP about 15 months ago she didn’t tell me I was talking nonsense but simply commented ‘you aren’t the first I’ve heard say that’. At this time I ordered ‘Tambocor from both Israel and Germany ($50 for 60 x 100mg and €80 for 100 x 100mg respectively) and despite saying ‘Tambocor’ on the box AND showing pics of the actual tabs stamped 3M and 100, the tabs that arrived were shiny rather than chalky and did not have 3M stamped on one side and 100 on the other like the original Tambocor formulation did.

I note that 3M were taken over by Meda AB in 2007. Meda AB were bought by Mylan in 2016. Mylan and Pfizer-owned ‘Upjohn’ merged to form Viatris in 2019. Viatris primarily produce off-patent and generics.

But maybe I’m just talking nonsense and the new generic tabs are just as effective as the old 3M stamped tabs! I hope so as it appears that the old 3M and 100 stamped tabs are gone for good.

[Ppiman]

Having worked in the industry making these, all versions are identical and checked against the same pharmacopoeial standards, rigidly. Changes tend, therefore to be either a psychological response or, more likely, absorption / metabolism issues caused by various bodily changes, often changes in stomach acidity, for example, or different rates of passage through the small intestines.

Steve

[mike1961 in reply to Ppiman]

Steve,

What brought the possibility that generic might not be as good as original on patent was as follows. A couple of years ago I had to start taking generic as couldn’t get 3M and 100/50 stamped tabs anymore. A few months later and having carelessly run out of generic 100s, I hunted around and found a box of 60 x 3M stamped 50s. The 80-90% reduction in ectopics and increase in general heart ‘steadiness’ for the couple of weeks I took these 3M/50s really got my attention and set me off trying to source the 3M and 100/50 stamped ‘originals’ again! I didn’t find the original 50s thinking they’d be better than generics, I just took them as a stop gap until I got my next prescription. I also saw a paper at that time concluding that generic meds had about 30% less effective ingredient than the on patent meds.. plus it’s hardly conspiracy theory territory to think that companies will try to cut corners if they can when making far cheaper (for them to sell) generics. But whatever I hope your observations are 100% correct and thanks for posting them. Cheers, Mike

[Ppiman in reply to mike1961]

That's interesting. If you could send me links to the study showing 30% less effective, I would be grateful as that surprises me, at least for products in the developed world. Also, the actual active ingredient cost is not often that high in many generics compared with the sale price, so reducing it is unlikely to save the manufacturer very much, but who knows?

What can happen, I think, with generics, is less good QC testing, as that is an expensive part of the process. Sometimes, over-compressed tablets are produced and, if these get through QC unnoticed, then there's a chance the ingredients won't be released into the right part of the intestines and so might not be absorbed.

But... in this world today, anything is possible. Standards seem to be on the way down.

Steve

[Cliff_G in reply to Ppiman]

Agree with all of the above. Though I think there's a fair degree of being ruled by "received wisdom" without proper full consideration, e.g. has anyone actually tested the hypothesis that all generics are the same as they contain the same stuff?

I saw a video on manufacture of vaccines where the expert concerned said that while the active ingredient of a vaccine is important, it cannot be divorced from the process used. He gave a very old example of a change in vaccine manufacture process which was apparently quite famous, caused a lot of problems, and led to withdrawal of the product concerned. I'm sure (as a chemical engineer familiar with knowledge of reaction kinetics, purification processes, etc.) that the product yield and purity can indeed change between processes and therefore probably manufacturers, especially as off-patent provides an incentive to identify cost savings. Hence, speculatively, the stages of purification from the whole reaction mass containing the active molecule could be different. QA and QC should test the final outcome is as per spec and prove that the drug is what it should be, but as you say, who knows. I'd hope they adopt proper statistical process controls methods to ensure adequate sampling.

[Cliff_G in reply to Cliff_G]

Plenty of evidence online of efforts to find more economic processes to manufacture Flec!

[Ppiman in reply to Cliff_G]

I was astonished by the 30% figure to be honest. Generics are tested to formulary and pharmacopeial standards for submission to FDA, EU, UK, etc. Failure to do this will result in licence suspension and large fines.

Increasingly so, cynicism is a character trait of most of us these days, fanned into an uncontrollable fire in a few by social media, YouTube and the like. My dear brother is an example, lost now forever to reason, obeisant to Icke as his mentor, and seemingly thoroughly enjoying his newfound wisdom. I try to stay realistic and my experience is that generic drugs are of high quality.

Steve

[Qualipop]

The main problem people seem to have with the generic brands is bad reactions to some of he fillers or preservatives used rather than the main ingredient which works just as well in any brand. There's only one specific brand of painkiller I can use as , having tried all the cheaper ones, I either get a bad rash or have stomach problems. My chemist is very good at trying to stick to just a couple of brands of my other meds for he same reasons. I keep a list of the brands that don't have horrible side effects but the main ingredient works just as well regardless of brand

[stargazer52]

I have found a couple of my drugs have to be the original make. It is the fillers that make the difference. My doctor also has it down on my prescription now. Don’t give up. You know your own body. Good luck

[Cliff_G]

Thanks everyone. My weekly Wellue ECG (since my recent ablation) showed things were not quite as bad as they "felt". I think I'll just bear the possibility in mind, note the current make and any future changes, and ask my EP on folow-up, which will probably be January

[Moose09]

Not cardiac related, but I have an adult son with a severe cognitive disability, and he depends on a couple of medications to control seizures and behavioural distress. This past winter (Feb 2024) he was suddenly very agitated and aggressive, and self injuring (biting his arm etc) and we could not pinpoint any cause. Until the day program provider noticed that one of his medications appeared to have a slightly different colour. We called the pharmacy and found out that indeed the brand had changed because the original brand was having supply chain issues. His psychiatrist said that this doesn’t usually make a difference, and it’s rare to see such a dramatic change, but there is a different preservative or carrier in each brand. It’s unknown if this affects the metabolism of the active ingredient, or if the preservative is having the effect. As soon as we were able to get the original brand again, our son’s issues were resolved, confirming that they were due to the medication. So after that experience, my belief is yes, brand might be making the difference.