Tag Archives: generic synthroid

Generic – It’s NOT the “same thing!”

10 Jan

Many months ago, I posted about my stance on generic medications. Today I read a fabulous article from Fortune magazine that supports my experience with branded medications versus their generic counterparts.

My favorite excerpt:

But generic drugs diverge from the originals far more than most of us believe. For starters, it’s not as if the maker of the original pharmaceutical hands over its manufacturing blueprint when its patent runs out or is challenged. The patent reveals the components, but it doesn’t explain how to make the drug. In reality, manufacturing a generic requires reverse engineering, and the result is an approximation rather than a duplicate of the original.

The FDA’s rules effectively acknowledge that. The agency’s definition of bioequivalence is surprisingly broad: A generic’s maximum concentration of active ingredient in the blood must not fall more than 20% below or 25% above that of the brand name. This means a potential range of 45%, by that measure, among generics labeled as being the same.

There are other differences. The generic must contain the same active ingredient as the original. But the additional ingredients, known as excipients, can be different and are often of lower quality. Those differences can affect what’s called bioavailability — the amount of drug that could potentially be absorbed into the bloodstream. As the American Heart Association recently noted, “Some additives traditionally thought to be inert, such as alcohol sugars, cyclodextrans, and polysorbate-80, may alter a drug’s dissolution, thereby impacting its bioavailability.”

Full article  here.

Fellow thyroid patients – are you feeling poorly on your generic hormone replacement drug? Sometimes the extra copay is a good investment to make.

Why I Hate Generics

22 Feb

I was a pharmaceutical rep for seven years. My closest friend is still a pharmaceutical rep, and we talked today about her struggles selling a branded drug against the onslaught of generics. As a salesperson, I fought the good fight against generics every day. As a disclaimer to everything I am about to say, I am still pro-pharmaceutical industry. But now that I take a daily chronic medication, I feel the need to advocate from the patient perspective.

There are several reasons I refuse generic medication, but here are the most important reasons:

  1. Generic drugs are only required to have between 75% and 125% bioavailability (active drug in the bloodstream). Branded medications are required to have 100% bioavailability at all times. I currently take 125 mcg of Synthroid. That’s less than 1 mg. A variability of 25% either way could absolutely affect my daily life. Read more here.
  2. Generic drugs must have the same ACTIVE drug as the branded medication, but God only knows what they use for inactive ingredients. My guess is that they use whatever is the absolute cheapest. Inactive ingredients affect absorption, and also contribute a great deal to the side effect profile of a medication. Patients also often have allergies to these additives. Read more here.
  3. A large portion of generic medications are manufactured in India and China, where quality control standards are far below that of the U.S. Read more here.
  4. Generic levothyroxine has been PROVEN to be inferior to branded Synthroid in multiple clinical studies. Ironically, I used Synthroid as an example for why doctors shouldn’t switch their Actonel patients to generic Fosamax. Little did I know I would live and breathe that study just four years later. Read more here. 

So you might think this doesn’t matter, because your doctor doesn’t prescribe generic drugs. But guess what? Unless the doctor specifically writes D.A.W. -DISPENSE AS WRITTEN on your prescription, a pharmacist can switch it out with a generic. And you might get a different generic manufacturer every single time you refill…different bioavailability, different inactive ingredients and different quality on a month-to-month basis.

I went into this experience as a very educated patient. I specifically asked for a D.A.W. prescription from the moment I woke up from surgery. Yet on FIVE different occasions over the past six months, I have been harassed at the pharmacy to switch to a generic.

“Sarah – we didn’t fill your prescription because your co-pay is $30. Are you okay with that?”

“We don’t have any Synthroid, but we have levothyroxine, which is the same thing.”

I just want to scream every time. It is NOT the same thing! Pharmacists do this to patients because the profit margin on generic drugs is HUGE compared to their branded counterparts, and inventory costs are much lower. Therefore retail stores incentivize pharmacists to convert to generic drugs. I am all about Capitalism…I really, really am…but at least give me the opportunity to get what I pay for. At least be truthful and say there is a cheaper option, but it might be less effective.

So, fellow thyroid warriors, be educated. Ask questions. And be prepared for one more battle in the war for optimal treatment.

The “After” Life

3 Oct

This weekend I saw 50/50, a new movie about a 27 year-old cancer patient. I couldn’t relate to most of it, except the scene before his surgery. It was so right-on that it was scary. I almost forgot that I had been through it all myself. It’s been seven weeks since my surgery. 53 days, to be exact. I started a new job, and I have been so busy that I dont really know how to measure how I feel. I guess I feel normal…some days I have boundless energy and on all the others I depend on an afternoon coffee to get me through. I have gained two pounds, which is better than many other people in my situation. My TSH is suppressed, and I probably won’t have my scan until 2012. Is the war over? It has certainly slowed down.

Once in awhile, I still have to fight. I picked up my Synthroid prescription last week, and glanced at the bottle before the pharmacist put it in the bag. Oval pills. Not the perfect circle ones that I’ve been taking. My face got hot when she asked me if I’d like anything else.

“I’d LIKE the drug that my doctor prescribed for me. But YOU switched it out with a generic.”

She apologized and gave me my Synthroid, and I walked out feeling a little embarrassed by my overreaction. After everything I’ve been though on this journey, I should just accept medical errors and continue to watch my own back. But I still get angry. I am still having the imaginary tell-off to Dr. P in my head, where I point at my scar and say, “Who was the one who didn’t know where my thyroid was again?” Or maybe, “How are your other cancer patients doing on the Zoloft that you gave them?” Will I ever get to say my peace? Will it even make a difference?

At the end if the day, I am a survivor. But I don’t feel much like a cancer survivor. As I sit in the U of M Cancer Center waiting room, I am humbled. I am so grateful that this happened to me and not to one of my children. As much as I would like to fit into my old jeans, I am grateful I am not sick from chemotherapy. If not for my scar, you would never know that I belong to this club. Most days, I feel GOOD. I am happy in my life. I can still run 3 miles (a little slower now), and I keep up in TurboKick and Zumba. I am loving the new challenges in my job, and meeting brilliant people from all over the world. I am present in every moment…savoring every hug from my girls and every laugh with my husband. I made it to “after.” Still alive. Still working. Still running. Still singing. Still eating ice cream and watching TV in my recliner. Still me.

7 weeks post-thyroidectomy…my scar fading into a crease.

Point B

26 Jul

Today I met with Dr. E in Endocrine Oncology at U of M Comprehensive Cancer Center. It was a good appointment…not Point A, and not yet Point C. I am calling it Point B on My Journey.

U of M is a well-oiled machine. They provided me driving directions that took current construction into account, I got my own “Blue Card” so I don’t have to re-register at every appointment and I was in an exam room in less than 5 minutes. Dr. E spent more time with me than any other doctor I have ever seen. We discussed my log road to Point A (diagnosis), and she shared with me that the U of M pathologists diagnosed cancer on the FIRST biopsy slides that they received from Covenant (yes, the biopsy I had way back in April 2010!). That should make me really, really mad. But I am kind of past that point. Now I am just grateful. It’s probably been there for a long time. The good news is that over the course of a year, it didn’t grow any bigger!

Dr. E did a long physical exam, which was great. She even checked my reflexes, which all doctors looking at thyroid issues should do. She had me drink water while she checked my neck, and she said my thyroid isn’t even that enlarged. Then she did an ultrasound to check my lymph nodes…right there in the exam room. It was a whole new world! She said my thyroid looks pretty darn normal aside from the small calcified spot. The nodule is actually toward the middle, so removing half is really not an option. I had already decided I wanted the whole thing out and done with anyway. She said my lymph nodes look perfectly normal on the ultrasound, but she didn’t give me any promises that I was in the clear until after the surgery pathology report comes back. If all is as it look to be (just a small cancer spot, encapsulated, no spread) then no RAI (radiation with radioactive iodine) treatment for me! If you happen to be praying for me, please pray for that!

Before I left, we discussed my aftercare a bit. She said she only writes synthetic replacement hormone. I guess I kinda expected that. And she seemed taken aback when I asked about combo therapy (T3/T4 Cytomel/Synthroid). She said she was open to it based on my needs after trying Synthroid alone first. I guess I can live with that…as long as it’s BRANDED. Maybe that’s the drug rep in me, but there’s no way anyone is putting me on generic ANYTHING.

I liked Dr. E very much, and it seems she takes it one thing at a time. This is what I know today:
* Everything looks positive for a stage 1 diagnosis with no radiation
* I may qualify for robotic surgery, but I need to get that answer at my surgery consultation
* After my total thyroidectomy (TT), I will know if I need to have a body scan or if we can just follow up with labs (watching my thyrogloblin levels). I really don’t want to have a scan, because it means going on a horrible low-iodine diet and possibly getting off thyroid medication for 6 weeks (this is what thyroid patients call “Hypo Hell”).
* My surgeon will manage my meds for the first three months, and I will follow up with Dr. E in December
* I will get a phone call within 48 hours to schedule my surgery date and my surgery consult, and it will likely be sometime in early September
* After my surgery (Point C), the goal of my medication treatment will be normal thyroid function. This is quite different from suppressive therapy, which I assumed I would need. Since everything is so early in diagnosis, I might actually be able to get back to my old self before Christmas!
* I have a really, really great friend who comes through with unsolicited support every time I need it. You know who you are. Thank you. This whole experience has made me want 100 more of you in my life.

So here we are. Point B means I have some information, but no resolution. I am feeling really good about everything, and ready to focus on my sister’s wedding on Saturday. We’ll worry about Point C later!