Hi, I have been using C/L 25/100 with the inscription 539 on the upper half of it and a kind of fish/ribbon on the either side.This is mostly what I have used. I got a 3months supply of CL 25/100 with the m721 branded onto each tablet. Using the latter has made me feel like I ave Parkinson’;s squared. It is NOT the same formulation. Has this happened to anyone else?
My pharmacy (CVS) has not been helpful, saying that they are made by the same company.. Any thoughts and experiences appreciated. Thanks!
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Tryguy
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I have no experience with it. I'm guessing the 539 and 721 refers to the batch number.
Being made by the same company means little. The reason they number different batches is to account for differences (in the manufacturing process.) If you're absolutely certain that one creates a clearly diferent response, then it would not surprise me, if you had them analyzed, they'd be different.
Hi Tryguy, I have encountered this. I was using R 539 and it was replaced by M 721. These are not different "batches" but rather different manufacturing facilities. I noticed a difference immediately. I found that the R 539 have a greater half life (i.e., they are effective for a longer period if time), and for me, the R 539 were much better than the M 721.
CVS is also my pharmacist, and after many weeks of them trying to get my prescription filled with R 539 pills, they finally told me that the R 539 pills are no longer available.
And as I understand it, Mayne Pharma bought the company (Actavis) that made the R 539 pill (along with many other meds), and I presume they eliminated it since it was "redundant" with the M 721 pill which they already offered... Btw I believe that the R 539 pill was made in the US, and the cynical side of me makes me think the the M721 pills are made overseas... I can imagine that manufacturing what is supposed to be the "same" medicine (c/l 25-100) in different factories, and maybe half way around the world, with different levels of quality control, and potentially different inert ingredients, could be very challenging...
IMHO, this is very bad for us PWP... but I don't see that there is anything I can do about it, so I am getting on with my life, and adapting my doses to the crap M 721 pills... (I only have a small supply of R 539 left!)
I have another story. Ever since I have been takingCL 25 / 100 mg ER it was made by Sun Pharma. It's marked with 450 on the tab. And by the way, now they don't give you a 3-month supply just 30 days. In the drugstore I looked at the pills on the counter and they seem to be little bit off in size but I thought I was imagining things. So anyway I get home and they are different manufacturer and slightly different size of the pill with different markings. I called the pharmacy and told the pharmacist that I heard horror stories about people getting different generic and the generic is not working, especially the ones that are Time released. he called their supplier and I was able to switch to my old brand of the pills. I gave back the other ones so I have no idea what they were now. Hopefully, they'll be able to get my old generic brand. The idea of only getting 30 day supply is ridiculous, you have to expose yourself when you go out and get the prescription filled.
I thinkI am going thru the same thing. My symptoms are worse and my latest batch of c/l are 721. I don't have any of my old pills and I doubt if my HMØ pharmacy would get them for me even if they are available. I was taking two 25/100 three times a day and one at bedtime (total 7). My nuerologist told me my new symptoms were dyskinesia. She prescribed Amantadine and suggested that maybe my previous doctor had prescribed too much c/l so I've been taking the Amantadine and cutting my c/l back to 1 1/2 pills 4 times a day (total 6). Still lots of "big" tremoring and wobbly legs. How are you adjusting your dose? Should I try more, not less?
If my theory is correct a lower 721 half life will mean a higher 721 peak concentration, and what you are seeing is probably peak dose dyskinesia, so reducing your dose may help... you might also have to adjust your interdose interval...
Anyway, you can see the resulting blood concentrations with this tool:
- introduce entacapone, which will extend the half life of the 721 IR and lower the peak concentration
- change to stalevo which will not use 721 IR and it includes entacapone which will extend the half life of the non-721 IR and lower the peak concentration
- changing some of your dose to CR (ie using less 721 IR) which has an increased half life and lower peak concentration
- find out if there is another C/L IR manufacturer beside the 721
(I have not investigated this route)
- try Rytary (it's expensive, but I understand if you have a financial need you can get assistance from the company)
No matter what you, should get familiar with the tool I mention above to see what the doses are doing to your levodopa blood concentration, and play with the dose size, interdose interval, and involved medications to see what will give you the most consistent levodopa concentration with the lowest peaks... I.e, this tool provide the path out of the weeds...
FYI, I currently take a combination of IR, CR, and entacapone. The introduction of the 721 pills required me to lessen my inter-dose interval from 4 hours to 3.25 hours...
FYI, here is the dosing plan I currently use:
Dose @ Duration CR IR LED Opt LED'
1 6:30 AM 3.25 1.0 1.0 240 e 319.2
2 9:45 AM 3.25 0.5 1.0 170 e 226.1
3 1:00 PM 3.25 0.5 1.0 170 e 226.1
4 4:15 PM 3.25 0.5 1.0 170 e 226.1
7:30 PM total:997.5
columns are dose #, time of day, interdose interval in hours, # of 50-200 CR tables, # of 25-100 IR tablets, Levadopo Equivalent Dose w/o Entacapone, Entacapone option flag, Levadopo Equivalent Dose w/ Entacapone
Yes, last year. Here is another story. It started in Dec '18. My symptoms started getting alot worse, it seemed like overnight. And they kept in getting worse. Some of it was stress from needing to put my dad in a nursing home, but things got so bad I was tremoring all over & didn't even want to go out of the house for about 4 months (and that's not like me). Before I started getting worse I happened to look at the manufacturer & it was different. This happened about 4 years ago, but I didn't get near that bad. I called the doctor then & she changed it to the old mfg
& everything went back to "normal". This time it was because the mfg. was closed by the FDA. So I kept calling the pharmacies & I even called the mfg several times. They kept saying it would be the next month, etc.... finally 11 months later I received the correct one. I'm much better now but it was definitely a struggle. The doctors & pharmacists said sometimes that can happen. I was on Parcopa which is an ODT of C/L . (Orally dissolving tablet). The good one was made by Mylan(M C52) & I actually tried several different ones during that period, one was made by Sun & one by Mayne 187. I also tried a regular C/L, not ODT, & none of them worked near as well. Good luck to you!
You might try to get your pharmacist to clarify what he means by " not available." others here have implied that the formula from that plant is no longer manufactured, and that is the reason it is not available. if such is the case then you are screwed as far as getting an equivalent generic, see the comments others above have made. Each generic formulation made at a specific plant is unique and different from all others. Thus, if that plant is closed, then if it was 539, that's it. The same happened to me with a medication I was extremely specifically adapted to, chlor-trimeton.
However, you may be able to do all right if you can obtain, and can afford, the brand not a generic. To do so, you ask your prescriber to use the name of the brand in the written prescription along with the phrase "dispense as written."
Of course, that would require that the brand is available in the formulary used by your insurance company or pharmacist, ie the suppliers the pharmacist uses, and that your insurance company will pay for the brand or that you can afford the cost of the brand yourself. One would think about getting the original brand would be the way to go because the original brand probably is going to be the exact original brand formula regardless of what plant specifically manufactures it.
Generics are allowed very wide individual variation in their ingredients and amounts and that has been true for decades.
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