Starting AP today- which Generics are best?

[Nikkoal]

I am starting AP today for new diagnosis of RA. I have read many threads regarding which brands or manufacturers may work better than others. I’m a little confused and would like to get a consensus from anyone willing to share, which brand has worked best for you, and if you have found a brand or manufacturer that you avoid or have not had luck with. My pharmacy carries Actavia (formerly Watson/Tevo). Any suggestions?

[jasregadoo]

Hi Nikkoal, I’ve been on Actavia for a few months and I’m doing ok on it. I did not do well on Aurobindo. I did very well on Ranbaxy, but they were recently taken over by Torrent, and I can’t get either right now.

Best of luck to you!

[Spiffy]

I asked for a refill of Ranbaxy at Target. They special ordered it for me. I told them they might be coming from Torrent or Sun, but my last bottle still said Ranbaxy.

DR4/DQ8 HLA, bio toxin illness
Flare fall of 2014...muscle aches, joint pains, fatigue, hair loss, rashes
Positive RA factor was 71 in January 2015 down to 28 as of September 2016
IGG food allergies wheat, egg, dairy
supplements: C and D, probiotics, milk thistle, Turmeric, cod liver oil, methyl b 12 & folate, digestive enzymes, Moducare, chlorella, berberine, LDN, monolaurin, Triphala, Patriot Greens
MTHFR compound heterozygous
Igenex IGM Lyme positive
Minocycline 100 BID MWF

[Nikkoal]

My pharmacy was able to get the Ranbaxy (torrent now) tabs for me a few days ago. Have you guys had any luck getting them? This is only my 2nd month onto AP, but from all my reading, it seems the general consensus is the tabs are best if generic, and Ranbaxy seems rated best choice. Please let me know if I am wrong.

[jasregadoo]

Nikkoal, no I haven’t had any luck. Did you go to a big pharmacy, or a local one? I’ve been taking the capsules, because I can’t afford the tablets with my insurance. I have new insurance starting this month, so that may change. I’ve not had luck getting Ranbaxy or Torrent for the last several months, at either small local or big pharmacies. I ask in case you were at Walgreens or somewhere like that, I might try again.

[Nikkoal]

I work in a hospital and our employee pharmacy ordered it for me. She said it was in yesterday. It’s not a big hospital system, so I don’t think it would be that reason she was able to get it. I looked online at a Canadian online pharmacy today and saw the price for brand minocycline is around $240.00 for 100 pills by Sigma Pharmaceuticals out of Australia.

[lynnie_sydney]

don’t know whether that is old stock. Minomycin is the brand in Australia (orange coated tabs) which was acquired from Wyeth by Sigma but it was sold to Aspen Pharmaceuticals a couple of years back. The kicker (which will – and should – outrage you) is that the price here for the brand was/is around AU$25. I cannot believe the prices that are being charged in the US, it’s beyond me.

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[CurlyinNC]

Nikkoal,

I was on Watson for many months, than I switched to Teva to see if I had better results. I’ve had the same results with both. Last month, instead of Teva, they filled my Rx with Ranbaxy. I didn’t see any different results there either. My pharmacy was able to get some more Teva from other pharmacies, so I’m back on that now. Sounds like you’ve been lucky that your hospital pharmacy can still get Ranbaxy.

I wish you so much luck with the protocol. Hope you are doing well.

Karen

Diagnosed with RA 10/2014 with very positive anti-CCP. Rheumatoid factor was negative and continues to be negative.
Began abx treatment 12/2014.
Currently taking minocycline 100 mg bid M-F, diclofenac 75 mg as needed, probiotics, various other supplements.

[jasregadoo]

I stopped by my pharmacy today and they said they can now get me Torrent (was Ranbaxy), so hopefully that will be the case. I know others have been told it is available and have not been able to get it, so I’m keeping my fingers crossed. But it seems as though perhaps it will be more available now. 🙂

[Spiffy]

I got excited because Wal Mart said they could still order Ranbaxy…but when it came in…it was PAR. If anyone can get their hands on Ranbaxy using a chain pharmacy, please let us know. Honestly, I cannot tell a difference though. It seems to work the same. I hope heartburn is not going to be a problem. This has never been an issue with me, but I have noticed little feelings that have made me wonder. This is the only change. Question….has anyone else noticed right inside the corners of your mouth…a blue tinge? It does not show from the outside but when I look in the mirror I see some discoloration that I do not think I have always had. I do not mind because my quality of life is so much better than before Mino. Just wondering if this is a common place for “blueing.”

DR4/DQ8 HLA, bio toxin illness
Flare fall of 2014...muscle aches, joint pains, fatigue, hair loss, rashes
Positive RA factor was 71 in January 2015 down to 28 as of September 2016
IGG food allergies wheat, egg, dairy
supplements: C and D, probiotics, milk thistle, Turmeric, cod liver oil, methyl b 12 & folate, digestive enzymes, Moducare, chlorella, berberine, LDN, monolaurin, Triphala, Patriot Greens
MTHFR compound heterozygous
Igenex IGM Lyme positive
Minocycline 100 BID MWF

[Calida]

We’re not crazy!

I had an enlightening conversation with my dermatologist today. He referred to the Hatch-Waxman Act aka The Drug Price Competition and Patent Term Restoration Act.

Three main points I took away from our discussion

1- Bioavailability can vary from batch to batch in one manufacturer of generics, from brand to generic and from generic to generic from 80-125%! Yes, you read that correctly and I confirmed it by reading the act.

From the article below
Bioequivalence determined by single dose blood level studies, with the test and reference products determined to be bioequivalent if Cmax and AUC meet confidence interval requirements of 80%–125% at the 90% level. AUC measures the extent of drug absorption (or exposure), and Cmax is a surrogate measure of rate of absorption (that is over what time period the drug is absorbed).

2- The inactive ingredients (filler) can affect tissue penetration thus different fillers affect bioavailability.

3- The major pharmaceutical chains are de facto “kingmakers”. “Since these major customers control so much of the prescription drug market, they are essentially acting as de facto “kingmakers” in the generic manufacturing marketplace87.” (See article)

I apologize for the length of this reply but I included excerpts from the article for those who don’t have time to read it or the act itself. The article is dated and doesn’t account for the recent growth of pharmaceutical monopolies.

http://www.sciencedirect.com/science/article/pii/S2211383513000762

The often stated standard is that equivalent generic products have the same safety and efficacy profile as the RLD to which they are compared. This is probably true in virtually all cases44. However, when considering how generics products are dispensed in the USA, the standard is that they must be “switchable”, essentially identical. Patients can be switched from the brand to a generic or from one generic to another by the dispensing pharmacist with no input beyond that the switched products are rated as interchangeable in the Orange Book20. Switchability is a higher standard than “same safety and efficacy profile”. Even from the beginning there have been complaints that some generic products are not switchable41, 45 and 46. In the early years, there was a strong campaign by some brand drug companies to discredit generics and complaints concerning switchability were dismissed as just part of the campaign to discredit41, 42 and 47. However, while the brand-name company anti-generic tactics have largely subsided, the complaints concerning switchability of some classes of drugs, and of some specific drug products have continued and gained more credence in recent years45 and 46. Some groups believe that antiepileptic drugs (AEDs) have switchability issues and claim that break-through seizures occur following switching and are resolved upon switching back to the original medication48 and 49. One physician group advises switching with caution when patients are stabilized on a particular AED drug therapy48.

The issue of switchability remains unresolved. It is clear that FDA and its Advisory Committee feel that much of the switching complaints are “placebo” effect and not grounded in any real differences between bioequivalent products67. There is a lack of well controlled studies in this area and the question of switchability is likely to remain unanswered until such studies are performed. From a public health perspective this is an important question regarding the approval and use of generic drug products. Given the complexity of disease states and the diversity of the patient population, it would seem improbable that all generic drug products would be switchable based solely on the bioequivalence criteria. While it may be considered expedient to continue to maintain that all bioequivalent generic drug products are switchable, it would seem from a scientific view to be an unlikely situation.
The debate on switchability has focused on possible differences between brand drugs and generic drugs that might occur within the constraints of the bioequivalence statistical range, however that involves an assumption that commercial batches of generic products perform exactly as the exhibit batch(es) subjected to bioequivalence studies. Many of these generic products are scaled up for commercial manufacture and changes might occur as a result of the scale-up, for example changes in drug substance particle size or changes in dosage form properties. If this kind of product change does occur at some level, then individual generic drug products might have an altered bioavailability profile and so possibly present switchability issues.

9 The generic marketplace, a generic “oligopoly”, and drug shortages
A large proportion of the generic drug supply can be in the hands of only a few large generic companies87. In calendar year 2009, nearly 50% of the generic drug supply was produced by the top 4 generic companies. This can create a fragile drug supply situation where production problems at one generic company can rapidly lead to critical drug shortages that can take weeks or months to resolve. This is most often an issue for mature generic products where the major market share has been ceded to one manufacturer and the other manufacturers, including the brand company, reduce manufacturing capacity for the product or even cease manufacture altogether.

This oligopoly situation is largely the result of major purchasers preferring to deal with only a few well known and well established generic manufacturers. Since these major customers control so much of the prescription drug market, they are essentially acting as de facto “kingmakers” in the generic manufacturing marketplace87.

A recent review of FDA’s drug shortages list shows that there are a number of shortages attributable to “manufacturing issues” in generic drug companies88. Many of these “issues” are themselves attributable to FDA compliance problems faced by some of the companies. The point, however, is that over time following the introduction of generics, much of the drug product supply comes from a single generic manufacturer, most often from a single manufacturing plant. If problems occur, other suppliers cannot react quickly enough to prevent a drug shortage.

Dx: Diffuse Systemic Sclerosis/SLE overlap, Raynaud's June 2013, Lyme August 2013
AP: Azithromycin (Teva) 250mg BID, May 2014, Clindamycin 600mg every 8 hours for 2 weeks July 27, 2015 - Aug 10, 2015
Minocycline (Teva generic) 100mg BID November 20, 2014
Meds: LDN 3.5 mg, Prednisone 5 mg (discontinued), Aspirin 81mg, Liposomal Artimisinin 50mg QID x 3 weeks, 4th week off, rotating (discontinued May 2015, restarted 2016 7 days per month), Daily Nystatin, 2 tabs BID, as a preventative measure
Supplements

[jasregadoo]

My local CVS said they could get me Torrent, but then they called and said it’s on back order, so no go for now. Every small pharmacy I’ve called says the same thing. So not yet.

[richie]

Hi There was a convoluted deal i9n which Sun has to supply Torrent with the Ranbaxy product –but ony 3 of 5 plants have been FDA certified –this may account for so called shortage !!!

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