Recently the FDA announced that Teva’s generic version of Wellbutrin XL (budeprion) was not in fact an equivalent medication, pulling it from the market. This is sort of a landmark thing; all kinds of authorities of various sorts (doctors, pharmacists, regulators, hobos) will insist that generics and brand name medications are the “same.” They are not. They are the same in some respects, but can be meaningfully different in other respects. I’m not going to go into those details at the moment, however, because I’ll go off on a rant and I do have another point to make.
Update: Here’s a great post explaining the US regulations around generics and brand drugs. In particular, check the criteria for FDA approval; the issue with budeprion is that it is not bioequivalent. In particular, tests showed that blood levels of the medicine were very different with budeprion when the FDA finally gave in and looked into it after several years of consumer complaints. I’ll let you draw your own conclusions…
In this case, Wellbutrin has a long history of generics being reported as having more side effects and less efficacy. I was keenly interested in the story from the moment I saw it mentioned on Twitter. I’ve been taking Wellbutrin (a generic version of it, anyway) for about 12 years, and it hasn’t always been smooth going. Perhaps this might explain some of the bumps in the road?
I never realized it, but switching between manufacturers of medications could have caused many instances of breakthrough depression and overwhelming anxiety, leading to increased dosages and increased side effects without increased benefit. In the past, I’ve taken Teva’s and Anchen’s and god knows who else’s bupropion. I never would have guessed that the sort of mood and side effect variability I experienced could have been due to something as seemingly trivial as my pharmacy switching suppliers of my generic meds. After all, the generics are all the same, right? So it was just more depressive symptoms, of course. All in my head.
With somewhat ironic timing, a couple weeks after the announcement of the FDA’s big news, my PNP gave me a month’s worth of samples of brand-name Wellbutrin XL to try. For the first time since I’ve taken bupropion – over 12 years – I’m actually taking the brand-name drug. Insurance has never permitted it because it’s $300/month (or more). The goal of trying the brand drug was reducing anxiety and combating sexual dysfunction from the SSRI (that I’m taking because bupropion wasn’t doing enough for hormonally-triggered depression).
The difference was immediately noticeable, though in unexpected ways. First, it felt almost as if I were starting the drug for the first time or increasing my dose, not continuing at the same 300mg. Except that I didn’t have any of the headaches that I always experienced (with a vengeance) when increasing dosages of bupropion.
Second, I wake up much more readily in the morning, similar to the difference between not being on lamotrigine and taking it. When I started lamotrigine, my ability to function prior to taking my meds in the morning improved by about 1000%. Switching to Wellbutrin XL makes it another 500% better.
The reason is that it’s a true extended release medication; there’s still some in my system 22 hours after taking my last dose, unlike the generics that left me waking up on empty. And wouldn’t you know, one of the problems the FDA found with Teva’s budeprion (ergo probably others) is that it’s not really an extended release drug. That alone is justification for going with the brand name drug – it will keep me more stable, for heaven’s sake! How could that possibly be bad for someone with bipolar disorder? Exactly.
Third, it has reduced my overall anxiety levels, which had been really high lately. Anxiety is sometimes a side effect of bupropion, and it was getting to the point of spawning OCD-like symptoms and disrupting general functioning.
Fourth, my attentiveness is a little better – enough that I can notice the difference, which is meaningful because it can be very hard for me to gauge how distracted I am. This time I’m judging it by the consistent difference over a period of several weeks, which is unlikely to be a spurious correlation. Bupropion can “boost” the (dopaminergic) action of amphetamines for ADHD, and it is also used alone to treat ADHD in some people.
Finally, my libido is back! With a vengeance, in fact. The numbed nethers from sertraline seem to be at least partially offset by the Wellbutrin. It doesn’t fix the rest of the SSRI-induced sexual dysfunction, but we’re finding ways to address that. 😉
So the Real Deal Brand Name medication is working better all around. I’m now quite curious as to how Lamictal proper would compare to Teva’s lamotrigine. According to my prescriber, Wellbutrin XL and Lamictal are the two drugs she most often sees problems with generics compared to the brand drugs.
Changing to brand-name Wellbutrin XL takes the monthly drug price from around $23 to $300, which means extra complications. Among them, I have to wrestle with my insurance company to issue “prior authorization” and then a second authorization so that they will actually pay for it. It also means that the price floor for prescriptions alone to keep me functional on a daily basis will skyrocket to around $7500/year to ensure that I can continue to be a contributing member of society. It might sound like an awfully high price tag, but it’s certainly worth it to me.
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