Same medicine, different brand?

[Tos92]

Good evening.

I take a calcium channel blocker called Vera-Til SR 120mg, also known as Verapamil however, this particular brand is currently out of stock and I have been given an alternative which is Half Securon SR. My GP has advised that I always stick to one brand (Vera-Til SR) and the pharmacist also suggested the same however, due to it being out of stock, I have been given the alternative.

The pharmacist has advised that the medication is the same but, the body might absorb it differently because it’s a different manufacturer and I may, or may not get side effects from it.

My question is that if it’s the same medicine, it should be the same ingredients so why wouldn’t the medication operate in the same way regardless without causing the side effects?

[Milkfairy Heart Star]

I have had the same issue with Diltiazem. There are ongoing issues about supplies of many heart medications at the moment.

I am prescribed Tildiem retard, I take 240mgs twice a day.

I had to switch to another brand for a few months.

For some reason because of the way each manufacturer makes a product it can affect how it's absorbed in the body.

I hope you notice no difference.

You might even find the alternative brand works better.

[Tos92 in reply to Milkfairy]

Thanks for your response Milkfairy .

I have been taking the alternative since Thursday and I have been experiencing nausea and a different kind of chest pain on it, weirdly. I made a call to the pharmacy this morning to see if they could get my original brand in any sooner and he said he might be able to get in for the Monday.

I was going to skip taking the alternative all together tomorrow however, not sure if that’s a wise decision.

[Milkfairy Heart Star in reply to Tos92]

I would suggest that you take the alternative even though you have more side effects.It's better to prevent your coronary vasospasms which the medication is helping to do.

Good luck with getting your hands on an alternative supply!

It's stressful when we can't obtain our usual medication.

[Cat04 in reply to Milkfairy]

Just put in my repeat order for Tildiem 300LA so hopefully will get it as usual as I was told it is very important to always have the same manufacturer. 😕

[Milkfairy Heart Star in reply to Cat04]

I know me too! My Pharmacist is very good at trying to find a supply for me.

Calcium channel blockers are one of my most important medications.

[Etzel]

I had a similar thing with inhalers, same dose, same chemicals but the 'cheap' one gave me side effects that the GSK didn't. My GP concluded that the propellant must be different, you could have the same issue, different binding materials.

[meadfoot]

I have experienced the same thing with different brands of my heart meds. The pharmacist tried to tell me it was all in my mind, yeah right! Do they think we are stupid..

[Steve_G]

Although the active pharmaceutical ingredient, verapamil, is the same in both products, the formulations which includes inactive ingredients, or excipients, are different. A controlled or sustained release (SR) formulation is designed to slowly release the active drug in a controlled and predictable manner into the blood over time. This allows reduced dosing frequency which could mean one or two tablets a day instead of three or four. Although they are required to be bioequivalent in the way the body absorbs and removes them, different SR formulations are allowed to have slightly different rates at which they release the drug, simply because you get natural variability across different people in the way they absorb and handle drugs. So although the active ingredients always act exactly the same way, one formulation might be absorbed slightly faster than another after initially taking the tablet giving higher initial blood levels and potentially causing side effects. Over the course of time, both formulations will maintain a therapeutic level of drug in the blood between doses.

Sorry if this is too much - I spent many years as a scientist in the pharma and biotech industries.

[Hidden in reply to Steve_G]

Good explanation 👍.

However it does beg a question of those who authorise and regulate the production of pharmaceuticals, given that many medications are now made under licence by many suppliers all round the world, when they allow different formulations around a particular active ingredient when it can result in different reactions in those who take it. Why not just have one formulation which gives a uniform predictable result in any one individual or if variations are required label them as such so the prescribing professional can always select the right one consistently for the good of the recipient, which is after all why medications are produced in the first place.

[Tos92 in reply to Steve_G]

This was a great insight. Thank you for explaining it so well.

[Steve_G]

Companies will often extend the patent life of their product by patenting the SR formulation so although there might be multiple generic versions of the active ingredient, the formulation is protected by patent. This is why you get different SR formulations.

Bio equivalence is measured by plotting blood drug levels over time. The area under the curve (AUC) generated by these plots is the critical measure (the science of pharmacokinetics provides the explanation for this) used by the regulators to determine whether formulations are equivalent. It’s many years since I’ve been involved in these studies but recollection is that the AUC has to be within 20% of the original, branded product. For many illnesses, this isn’t too much of a problem but for others it’s a real challenge - for instance epileptic patients could suffer breakthrough convulsions. Of course doctors and pharmacists are well aware of the issue.

[Tos92 in reply to Steve_G]

Thank you for your response Steve_G

[Visitingcat]

I’m normally given Almus (made by Accord) Flecainade in my local boots.I used to get blurred vision in the mornings with it but that happens very rarely now. ( optician was fine with it, I don’t drive).

Once I was given a different brand. My reflux gradually over about ten days went so bad that the pills I was taking in the evening, flecainade, bisoprolol and others, were feeling like they were stuck fast in my gullet. I was drinking so much water trying to shift the feeling that I was up half the night.

 I was also worried the pills would cause harm where they were stuck.

I was a bit ahead with my Persciption orders so could order my next lot early, I asked for my usual Almus and started them as soon as I received them and the symptoms gradually eased off over the next fortnight but took ages to clear up completely.

I had similar recently but nothing like as bad with different lansoprazole. Have had to have notes put on my account at boots and never leave the shop without checking what I’ve been given as if you leave the shop with them they cannot reissue them and have to destroy them.

[Tos92 in reply to Visitingcat]

Thanks for your response Visitingcat . I am generally, sensitive to cardiac meds so slight changes can be bothersome for me.

My repeat prescription orders aren’t issued until 2 days before I’m due to run out by my GP. I might have to start requesting them a bit more ahead of time now to hopefully avoid these issues.

[Milkfairy Heart Star in reply to Tos92]

Can you build up a back up supply?

My Cardiologist gave me an extra prescription to do this and I was given an extra supply of my medication when I was discharged from hospital recently.

[Tos92 in reply to Milkfairy]

I didn’t realise that this was possible, to build up a back supply.

I can ask this question to my pharmacist tomorrow and also my GP - thank you

[Visitingcat in reply to Tos92]

I’ve had sensitivities to a couple of meds in the past, I’ve just had a repeat Persciption changed from apixaban to edoxoban ( told by text message, one chance to reply and objections ignored) despite my saying I didn’t want to change. Apixaban is supposedly much better tolerated.

It’s down to cost, they keep going on about how it’s so much easier to take once a day than twice, lord knows how I’ve managed to take flecainade twice a day as well.

Like Meadfoot says, they think we’re daft!

I will probably do what I usually do and try to get an appointment after a month to get it changed back if it affects me badly.

I order my repeat Persciption through an app my GPs use (tps system online) and do it as soon as it allows you to which is quite early so have managed to get ahead a little with my meds. I hope you can get more in front with yours, I would not like to be cutting it so fine.

[Qualipop]

Whenever my meds are changed to another brand I can react really badly to them. I've been told different manufacturers use different fillers, preservatives or colourings. I take an opiate painkiller which has t o be a specific brand. A few months ago it was unavailable. I'm sure you can imagine the withdrawal effects if I hadn't been able to get some. Thankfully a local pharmacist suggested just one of the cheaper brands that his patients could cope with. He had a lot who also reacted badly to he cheaper ones. When my furosemide was out of stock I found that one of the alternatives was made by the same manufacturer. It was simply packed by a different firm so do read the tiny print carefully to see who actually makes it.

[Tos92 in reply to Qualipop]

Thanks Qualipop