Is it Safe to use Generics For Epilepsy?
You get your epilepsy prescription refilled, open the bottle, and see that the pills look different this time. If you look closely at the label, you will notice that you have received a generic version of the medication instead. It matters?
Most people don't think so. Generics must have the same usable medication as brands. You might even hear your doctor call it bioavailable. Generics can have no less than 80% and not more than 125% of the brand-name medication.
They aren't for everybody
If you suffer from "brittle epilepsy", in which your body is sensitive to even small adjustments in medication levels, the difference in generic medicine in one dose and the generic in another bottle can result in problems.
Some people can't tolerate generics. Other people may be allergic to the ingredients. "It's a sensitive topic because one seizure can set a patient back. It can prevent them from driving for 6 months or it can radically change what they're capable of doing," says Linda Selwa, MD, professor of neurology and co-director of the epilepsy program at the University of Michigan.
"Generic-to-generic switching is what makes epilepsy doctors and patients nervous," says Jacqueline French, MD, professor of neurology at New York University's Langone Medical Center. People who have to control their condition are most at risk.
French is also concerned about generics. He wants to know how the pills look, and what extra ingredients are (or fillers). Generic pills don't always look the same as brand names. Many of these generic pills are simply gray pills. She says that if you are taking more than four pills at once, it is likely you'll get the wrong dosage. Generics can also contain different fillers and may release medication at different rates.
New News Is Good News
Selwa states that the topic of generic epilepsy medication has been debated for some time. "This is an ancient controversy regarding medications and an anti-epileptic medication called Phenytek, Dilantin. There were papers from [about 10 years ago] that indicate some patients who had to switch formulations more had more seizures."
More recent research is encouraging about epilepsy drug alternatives. Bioequivalence in Epilepsy Patients, a study that was published in 2015, examined differences in lamotrigine generic and brand-name Lamictal. It examined three methods of how medication were absorbed into the bodies.
From brand to generic (different Lamictal versions) Genric to generic, patients were subject to frequent blood tests in order to determine how much medicine was present. The researchers saw that while a few people had trouble going back and forth between drugs, only one patient had major problems with seizures.
Their bodies would process the drugs the same. That was the question. They did, says Barry E. Gidal, PharmD, division chairman and professor of pharmacy and neurology at the University of Wisconsin-Madison School of Pharmacy.
Gidal said that there was one unexpected result. They also found that brand-name drugs can have a lot of variability.
This means that the medicine will not be the exact same each time you refill it, regardless of the brand. If your epilepsy is brittle, you could react to the difference and have a breakthrough seizure.
Selwa states that the reassuring thing is that generics switching has been found to have very low risks. However, it's unclear how to make individual patient predictions.
Gidal also participated in another study called the Equivalence between Generic Antiepileptic Medicines (EQUIGEN) which examined how generics compare to one another. The results were similar: Patients didn't have any major changes in how often they had seizures or side effects.
Selwa advises that it is possible to stick with what you love, and Selwa agrees. It seems that the best advice is to stay with one formulation, regardless of whether it's brand or generic.
You might find that your insurance company won't pay you for a certain brand-name medicine if you take it. Then what?
For an exception, ask. French states that if your doctor believes your epilepsy may be brittle, and you would suffer from harm if you switched to generics, they can appeal the decision to your insurance company.
You can always refuse. French suggests that you talk with your doctor about having your blood levels monitored if you need to change to generics. Ask your doctor to do a test of blood levels before and after you switch. You can switch to a generic drug if you're satisfied with the results of a blood test.
Be consistent after that. Establish a good working relationship with your pharmacist to ensure that they always have the same generic. Gidal suggests that you don't jump from pharmacy to pharmacy trying to find the best price.
When you receive your prescriptions, make sure to check them right away in the pharmacy. Gidal states that if your pills look different than the one you received last month, it is worth asking your pharmacist. The pharmacist can write down the name of the medicine, and the lot number. If the pharmacy doesn't know, you can ask your doctor.