Generic drugs contain same ingredients as brand-name
DEAR DR. DONOHUE: I am concerned about your advice regarding generic drugs. My family’s experience with anticonvulsant generics was alarming. The mail-order pharmacy that we use switched our son’s Depakote to the generic medication valproic acid. He immediately began having seizures again and did not stop until we got him back on Depakote. I enclose an article from this month’s epilepsyUSA, published by the Epilepsy Foundation. The article cautions about the risk in using generic anti-epilepsy drugs. Breakthrough seizures are apparently common when the switch is made. You may want to caution your readers about this. — N.F.
ANSWER: Generic drugs contain the same ingredient as the brand-name drugs. For most patients, the generic equivalent of the brand-name drugs works well. The great benefit of generic drugs is their reduced cost. For a few, generics don’t work. It can be a matter of the filler material used in the drug’s production or a slightly lower rate of absorption with the generic prescription.
Prescribing doctors have the right to insist that the pharmacy dispense the brand-name drug. They write that direction on the prescription. The prescription can say something like “dispense as written — DAW,” which tells the pharmacist not to make a switch. In many states, pharmacists are allowed to make a switch if no instructions to the contrary are indicated.
Some drugs have a narrow therapeutic index. The therapeutic index is the amount of drug that controls illness without causing dangerous side effects. With a narrow therapeutic index, the amount of effective drug is quite close to the amount of drug that leads to complications. These drugs are the ones that most often cause trouble when a change is made. Anti-epilepsy drugs like Dilantin, Tegretol and others are examples. Some thyroid preparations have a narrow therapeutic index. Lanoxin — a digitalis (heart) drug — is another drug with a narrow index. So do Coumadin, the medicine prescribed to prevent clot formation, and theophylline, a medicine used for asthma control.
DEAR DR. DONOHUE: Please repeat your comments on naps. I find that I sometimes have to take a nap so I can function effectively or safely. I recall you making recommendations on the length of naps. Will you please repeat such advice? — J.M.
ANSWER: People are often warned not to take naps because they will throw off their biological clocks and not be able to get to sleep at night. Naps truly do refresh many people. Anytime between noon to 2 p.m. is a good time to take a nap if you’re feeling groggy. Twenty to thirty minutes invigorates people without making it hard for them to fall asleep at bedtime.
For about 10 minutes after taking a nap, people may feel a trifle befuddled, but they make no more mistakes than they would if they had not taken the nap. (Someone actually studied this.)
DEAR DR. DONOHUE: Will you tell me about the drug Lamictal and its side effects. I take it for bipolar disease, and it works well. I have taken it for the last 3 1/2 years. I am clumsy and drop many things. I sometimes turn into walls because I am not steady on my feet. My mind does not seem to process well. I realize I am 56 and those changes do happen. Do you think they could be related to Lamictal? — H.S.
ANSWER: Lamictal (lamotrigine) is prescribed for two quite different conditions — seizures and bipolar disorder. Its most serious side effect is rashes, which sometimes require hospitalization. It can cause dizziness, headache, trouble with muscle coordination (including walking) and blurred vision. A few report memory difficulty and confusion.
You must have a heart-to-heart talk with your doctor. This drug has regulated your bipolar condition very well. If you and the doctor want to try a period without it, the drug must not be discontinued suddenly. Furthermore, stopping it could bring about a relapse of bipolar disorder. If your symptoms are severe enough to interfere with your functioning, then a trial of not using it might be worth the risk of experiencing a relapse. It’s your decision and your doctor’s.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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