FDA Finds Not All Generics Created Equal

Generic Drugs Are Actually Not the Same as Name-Brands, Thanks to FDA Malfeasance

ProPublica said:
April 24, 2013 |

Andrew Richards remembers that he had just sat down in front of the TV when the lightning bolt struck. “It was almost like it went through my ear because I could hear it. It was kind of like, ‘fwomp,’ right through my head,” he says.

Stunned and disoriented, Richards tried to get up, he says, but spasms rumbled through his torso and his back; his muscles kept clenching and relaxing. He doesn’t recall falling. “It was almost like a little piece of time was missing, almost like a record skipped ahead a little bit,” he says, “like I was sitting on my couch and time had moved forward and I was on the floor.”

The next thing Richards remembers was calling out to his wife, who scooped him up and drove him to the emergency room. He would soon discover that the lightning bolt that struck him down was an electrical storm taking place entirely in his brain: a seizure. Less than a year later he was in court, contending that his seizure — and the spasms that he says still plague him — were caused by a faulty generic medication.

Generic medications are generally safe and effective, because the Food and Drug Administration mandates tests to show that they are equivalent to the name-brand originals. But in 2011, the Food and Drug Administration determined that a major laboratory had committed such “egregious” research violations that years’ worth of its tests — many comparing generics to name-brand drugs — were potentially worthless. The FDA has required drug manufacturers to redo many of the tests from that lab, owned by the now-defunct Cetero Research. But a ProPublica investigation [4] shows that the agency took little action to prevent consumers from taking medicines the FDA no longer knew for sure were safe or effective.

Richards’ suit involved a drug that was not tested by Cetero. But his case spotlights the possible dangers of a generic medication that isn’t actually equivalent to the name-brand original.

The drug Richards took is Teva Pharmaceutical USA’s 300 milligram version of extended-release buproprion — an antidepressant better known by its brand name, Wellbutrin XL. Shortly after Teva’s generic Wellbutrin was approved by the FDA in 2006, patients began to complain that the drug wasn’t working as well as the name-brand version. Some contended that it was causing more severe side effects.

Richards says he suffered his seizure in March 2008 after his pharmacy switched him to the Teva generic. Within a few days of starting the new pills, he says, he started to experience jolts and jerks. “Sometimes when you’re falling asleep, you get what’s called a sleep start,” Richards says. “Well, I would get that but I was awake.” Then the seizure hit.

Despite having stopped taking Teva’s drug, Richards says he continues to have spasms several times a day. Richards, who was a lead plaintiff in a lawsuit against Teva, contends that it was a direct result of his taking Teva’s generic Wellbutrin. The suit ended in a settlement in which Teva did not admit fault. Teva and Richards won’t discuss the financial terms, but a judge’s ruling approving the settlement suggests that it was for $4.5 million, the vast majority of which went to legal fees and costs.

Neither Teva, nor Impax Laboratories, which manufactures the pill, have admitted that there was anything wrong with the pills. “The product was approved on the basis of the bioequivalency testing that we were required to perform at the time,” said Marc Donohue, Impax’s Senior Director for Corporate Communications. “There had never been a safety issue with the product.” Teva did not answer questions about the Wellbutrin case.

“Just after [Teva's generic] went on the market, within 6 to 8 weeks, first there was a trickle, then half a dozen, then a dozen letters,” says Joe Graedon, a consumer health advocate and author of “The People’s Pharmacy,” a syndicated drug advice column. After writing about the potential problems, the complaints became so numerous that Graedon commissioned his own study to test Teva’s pill side by side with the original. The finding: As the pills dissolved, the generic version wasn’t acting the same way as the name-brand. “The Teva generic releases much faster — much, much faster — than the name brand,” says Tod Cooperman, president of ConsumerLab, the company that performed the test. “There’s this huge burst that occurs right away.”

Faced with doubts from consumers, the FDA first defended the drug. In April 2008, the agency stated that Teva’s generic was “bioequivalent and therapeutically equivalent to… Wellbutrin XL.” [5] The FDA dismissed complaints of ineffectiveness and side-effects as being consistent with the ups and downs of depression.

Still, the FDA asked Teva and Impax to conduct a study to clear up any doubts. Teva terminated the study after recruiting only eight patients. “It was because of slow enrollment,” says Impax’s Donohue, who said that the protocol required subjects to stay in a clinic for 24 days, which likely scared off potential participants.

The FDA picked up where Teva left off, and by August 2012, the agency’s own study showed that the two drugs weren’t equivalent. This forced FDA to reverse its position; in October 2012, the agency declared that Teva’s generic is “not therapeutically equivalent” [6] to the original.

The FDA declined to comment.

The announcement heartens Richards, but one thing he regrets, ironically, is that he’ll never again be able to take even the brand-name version of Wellbutrin, which he says was tremendously effective in treating his depression. “Everything clicked into place. Everything felt normal again,” he says. But, he says, his doctors now warn that taking any form of Wellbutrin is out of the question. “I actually asked them if I could go back on the brand, but the damage was done.”


See more stories tagged with:
generic [7],
name-brand [8],
drugs [9],
fda [10],
pharmaceuticals [11]
Source URL: http://www.alternet.org/drugs/generic-drugs-are-actually-not-same-name-brands-thanks-fda-malfeasance

Links:
[1] http://www.propublica.org/
[2] http://www.alternet.org/authors/charles-seife
[3] http://www.alternet.org/authors/rob-garver-0
[4] http://www.propublica.org/article/fda-let-drugs-approved-on-fraudulent-research-stay-on-the-market
[5] http://www.fda.gov/AboutFDA/CentersOffices/OfficeofMedicalProductsandTobacco/CDER/ucm153270.htm
[6] http://www.fda.gov/Drugs/DrugSafety...ormationforPatientsandProviders/ucm322161.htm
[7] http://www.alternet.org/tags/generic
[8] http://www.alternet.org/tags/name-brand
[9] http://www.alternet.org/tags/drugs-0
[10] http://www.alternet.org/tags/fda
[11] http://www.alternet.org/tags/pharmaceuticals
[12] http://www.alternet.org/+new_src+
http://www.alternet.org/print/drugs...y-not-same-name-brands-thanks-fda-malfeasance

Anyone have any experience with generics that don't have the same effects (whether it's lower efficacy or different/more pronounced side-effects or whatever else) as their supposed Brand equivalent?

I've heard of, and I think I've actually experience this myself iirc, how certain generic(s) of clonazepam) are less effective (medicinally and recreationally speaking) their the Brand Klonopin. As I've switched recently onto a few new generic meds (Subutex - generic Buprenorphine 8mg pills; Prozac - generic fluoxetine 20mg/5mL suspension; and Inderal - generic Propranolol 40mg), this has got me thinking about this whole subject again.
 
Yeah i've always been a bit suss when the pharmacy workers tell me that the generic drugs are exactly the same as the name brands without the same packaging and cheaper, I'd love to know if it's true or not.
 
This has to do with differences in the prep, that is, the inactive ingredients and how they break down to deliver the active molecule. I have a hard time believing that the actual active molecule is different or impure, at least in countries with as strict industry standards as the US.

I think one of the problems here is that while "a pill for oral administration containing 300mg of bupropion as its only active ingredient" can be patented and have its patent expire, the actual nano-mechanics governing the engineering of the inactive ingredients, and therefore the drug delivery at the molecular level, still remain industrial trade secrets. I'm sure corporations as rich and powerful as Big Pharm have the bargaining power to cede as little information as possible about their "secret sauce", when the government forces them to allow lesser companies to copy their work. So what do these generic manufacturers do? They make preps with the same doses of the same active molecules, but packaged in inactive delivery chemicals that are familiar to them from other drugs they've made. The problem is that if the new drug has a narrower safety and/or therapeutic window, time release and other sorts of preps are not one size fits all, and the generic formulation is highly likely to hit the wrong peak levels or last the wrong duration.
 
This is not a new story; the Teva buproprion XL has been the poster child for "why generics suck" ever since it happened.

The whole reason this fiasco happened is because the 150mg formulation got rigorously approved and the 300mg formulation was deemed close enough to the other in terms of its composition that it wouldn't have to be rigorously tested. It's by no means a sign that "all generic medications are garbage" - no instant release medication has had this issue.

I've heard of, and I think I've actually experience this myself iirc, how certain generic(s) of clonazepam) are less effective (medicinally and recreationally speaking) their the Brand Klonopin.

This is stoner folklore. It's a meme that spreads between benzo users and makes them dissapointed with whatever they're taking. 100% bullshit with no truth behind it, excepting the case where you buy your meds from a shady Indian pharmacy.
 
This is not a new story; the Teva buproprion XL has been the poster child for "why generics suck" ever since it happened.

The whole reason this fiasco happened is because the 150mg formulation got rigorously approved and the 300mg formulation was deemed close enough to the other in terms of its composition that it wouldn't have to be rigorously tested. It's by no means a sign that "all generic medications are garbage" - no instant release medication has had this issue.



This is stoner folklore. It's a meme that spreads between benzo users and makes them dissapointed with whatever they're taking. 100% bullshit with no truth behind it, excepting the case where you buy your meds from a shady Indian pharmacy.

Good to know with so much street BS out there. Thanks sekio!
 
This is stoner folklore. It's a meme that spreads between benzo users and makes them dissapointed with whatever they're taking. 100% bullshit with no truth behind it, excepting the case where you buy your meds from a shady Indian pharmacy.
I've definitely had different brands of pills that were supposed to be the same dose, but felt a little weaker or stronger. It could be for a variety of reasons.

Why do you think the XR version of this pill is what caused this to happen? I think the guy suffered a seizure from bupropion most likely.
 
^I think the issue in that case was that, yes, it was the bupropion was the cause, but the problem was the time release mechanism in the pill, if there even was a legit one, but it didn't work for whatever reason and all the active drug that was supposed to be released over X amount of time ended up getting released all at once - so yea, overdose, a la ineffective extended release mechanism.
 
This is stoner folklore. It's a meme that spreads between benzo users and makes them dissapointed with whatever they're taking. 100% bullshit with no truth behind it, excepting the case where you buy your meds from a shady Indian pharmacy.

I don't know if you are talking about clonazepam in particular, but at the university clinic here they do not use generics because of quality control issues and cheaper fillers which can lead to some GI difficulties.
 
Definitely noticed a difference between Core and Barr adderalls. No doubt, 100%.

My ex used to be on seasonique. then the generic came out, was only a little cheaper. she tried it and started spotting, having side effects etc.

It's bullshit they sell you the same product at a different price. something's gotta be different.. cheaper made. companies don't just give away shit.
 
Its pretty much all about extended release mechanisms. Buproprion is buproprion. Amphetamine is amphetamine, etc. However, the generics pills may be made with different binders, fillers, and coatings, that change how the pill and its contents disolve in the digestive tract.The pill may disolve slower or faster. Perhaps the filler may alter the ph of the stomach, though I would be skeptical of this. With instant release, it doesn't really matter. It's much less complicated than an extended release formulation, especially if its just a gel capsule that dissolves within seconds anyway.
 
Its pretty much all about extended release mechanisms. Buproprion is buproprion. Amphetamine is amphetamine, etc. However, the generics pills may be made with different binders, fillers, and coatings, that change how the pill and its contents disolve in the digestive tract.The pill may disolve slower or faster. Perhaps the filler may alter the ph of the stomach, though I would be skeptical of this. With instant release, it doesn't really matter. It's much less complicated than an extended release formulation, especially if its just a gel capsule that dissolves within seconds anyway.

Trust me, CorePharma Adderall IR's are much better and consistent than Barr. I usually do sublingual, half the time Barr feels like they got skimpy on the amps...
 
^I could see consistency also being an issue with generics, esp regarding reducing cost (as that's what draws their customer base anyways, their lower cost). Like how a lot of folks I know have had shitty experiences with ordering drugs from overseas pharmacies in India and Pakistan (etc), such as diazepam, that are either bunk or different signficantly in active ingredient from pill to pill, or just have something totally different (another benzo or barb in this case) in them.

I mean, this is only anecdotal, but whenever I used to get Teva clonazepam and Roche clonazepam the Teva didn't seem to have nearly anything like the sedating or anxiolytic efficacy that the Roche product.

Of course, I wouldn't be surprised at all if a component of what we hear about generics being inferior to brand (not the case for many drugs though - such as the generic SSRIs/Prozac I take and the generic buprenorphine I take, both of work just as well as the brand, no diff whatsoever as far as I can tell) is in fact either junkie folklore or pharmaceutical propaganda or a combo of both.

But, in certain cases, it seems there is something to be said for this phenomenon, where the generic is not truly equivalent (for whatever reason) to the brand product.
 
Trust me, CorePharma Adderall IR's are much better and consistent than Barr. I usually do sublingual, half the time Barr feels like they got skimpy on the amps...

Do you think this is due to lower doses, different balances of enantiomers, or poor absorption? Basically is it qualitatively different, or just weaker? Even assuming the same dose of active ingredient, there can be variations. On XR its just more obvious how.
 
The drug companies don't have to complete the same clinical trials(none, to be exact), in order to gain approval to release generic drugs. They only measure the level of drugs in the blood of a few people, not sure how many, and I don't know the tolerance in variation either. When spread out over the general population, it's not really a great wonder that different people will have different levels of absorption, and thus effects, from the drugs, due to the unproven formulations, binders, etc.
 
when I was getting my pain medication 100% reimbursed by my insurance I always went for the more expensive named brands, they definitely seem to have more oooomph than the generic ones.
 
Sometimes I wonder why more IR medications aren't simply the pure compound in a gel cap...
 
The drug companies don't have to complete the same clinical trials(none, to be exact), in order to gain approval to release generic drugs. They only measure the level of drugs in the blood of a few people, not sure how many, and I don't know the tolerance in variation either. When spread out over the general population, it's not really a great wonder that different people will have different levels of absorption, and thus effects, from the drugs, due to the unproven formulations, binders, etc.

This makes sense... It's not like the FDA has super duper rigorous standard or lots of money to devote to this shite. They seem more like a part of the political apparatus, as opposed to a mechanism of public health, but what's knew (*sigh*)

when I was getting my pain medication 100% reimbursed by my insurance I always went for the more expensive named brands, they definitely seem to have more oooomph than the generic ones.

I used to do that too. I now prefer generic 'tex/bupe to any brand buprenorphine+naloxone (can't say I've tried brand buprenorphie - Temgesic?), but I too used to be like yourself (although waaay back when I was using hydrocodone/oxycodone at low doses for legit reasons it never seemed like it made a difference). Maybe this issue with generics is less common with certain opioids because they have such a long history/well understood pharmacologically speaking? (that is nothing but my mere speculation for the record)...

But when it comes to buprenorphine, the cheap-o generic 'tex is the best I've ever had imo (although it's been a long time since I had any bupe+naloxone orange stop sign tablets, or the new super expensive generic that is supposed to replace it, but for now I'll take my bupe w/o naloxone thank you).
 
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