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ImageAnti-epileptic drugs: Generic versus brand name Feature Article

Drugs that are used to treat epilepsy are called anti-epileptic drugs (AEDs for short). Epilepsy is a disorder that has been mentioned in ancient texts; hence, it is no surprise that the ancient Greeks and medieval Europeans used a variety of plants and herbs to cure epilepsy. In the 1800s, potassium bromide was found to be effective in seizures, and this marked the advent of modern AEDs. Today, there are a number of AEDs in the market. AEDs treat or curb seizures, they do not cure epilepsy. For this reason, some researchers say that perhaps a more accurate term would be ‘anti-seizure drug’ instead of ‘anti-epileptic drug’.  Different AEDs are used for different epilepsy syndromes. The good news is that for two-third of people with epilepsy, their seizures will be effectively stopped with one AED. For the rest of the patient population, this is not the case, and a combination of AEDs may be necessary. 

This brings us to the topic of generic medications - this subject is usually surrounded in controversy and confusion. What are generic drugs? Are they the same as brand-name medications? Are they safe? Why is there a cost difference between generic and brand-name drugs? Navigating the world of generic vs. brand-name can be very challenging. To learn more about generic medications, Sloka Iyengar, PhD sat down with Dr. Marcelo Lancman, Medical Director of the Northeast Regional Epilepsy Group for this issue of the NEREG newsletter. To learn more about the various commonly used AEDs, check out Dr. Lancman’s book – ‘What you need to know if epilepsy has touched your life’. This book explains in simple English the science behind seizures and epilepsy, drugs available and other special issues that people with epilepsy face, and how to navigate them. In order to support epilepsy scholarships and education, Dr. Lancman and co-authors donate all royalties from the book to the Epilepsy Free Foundation.  To purchase:

http://www.amazon.com/What-need-know-epilepsy-touched-ebook/dp/B00BK5WLGA/ref=sr_1_3?ie=UTF8&qid=1407758346&sr=8-3&keywords=lancman

What are generic drugs? Why is there usually a price difference between generic and brand-name medications? 

Simply speaking, a generic medication is a copy of a brand-name medication. The way drug discovery works is that a pharmaceutical company spends substantial time and resources to discover a new drug that would benefit people. The company receives a patent for a certain number of years on the drug – this means that they have the exclusive rights to market that drug. Once this period expires, the drug can be manufactured by any company, as long as it conforms to the FDA standards. These drugs are called ‘generic’ drugs. Hence, the intended use, side-effects, routes of administration etc for a generic medication should be exactly similar to the brand-name medication. Since a pharmaceutical company doesn’t have to invest in years of research and development, generic drugs are usually cheaper than their brand-name counterparts.  

How can I tell what is the generic name, and what is the brand-name? What are a few generic AEDs that are out in the market? 

If you look at a container of an anti-epileptic drug, the generic name is the one in lower case (e.g. acetazolamide), and the brand name is capitalized (Diamox). The generic preparation of the commonly used brand-name drug Dilantin is phenytoin. Topiramate is the generic ingredient of Topamax (another commonly used brand-name drug for epilepsy).  

What is the controversy regarding generic medications?

To understand this, we must first understand how a drug produces its effects. When you take a drug (orally, for example), it has to be absorbed, distributed throughout the body and get eliminated. A generic medication should ideally, do the exact same thing as a brand-name medication. However, one should remember that a generic drug is similar, but not necessarily equal to its brand-name counterpart. This could be a potential problem, because depending on the way the generic drug is manufactured, absorption could be more or less than the brand-name medication. If more is absorbed in the body, you will need a lesser amount to produce the same effect. If less is absorbed in the body, you will need more of the drug to produce a similar function. This is also the reason why switching from a brand-name to generic drug should be done with caution. 

We cannot forget the side-effect profile of drugs. Just as we can expect differences between brand-name and generic drugs in terms of their therapeutic action, there can be differences in the side-effect profile as well.   

Can one brand-name drug have more than one generic counterpart?

Yes – once the patent on a drug expires, in theory, a number of companies can produce the same drug. It is important to remember that two generic medications of the same drug can show differences in the way that they are absorbed. 

If I buy generic drugs from the local pharmacy, can I be assured that they will sell me the same generic medication every time?

Unfortunately, this is not the case. Pharmacies usually buy the medication that happens to be cheaper at a given time. Hence, it may be that the generic medication you are getting is not the same from one time to the next.  

Should I take generic medications for my epilepsy? 

The answer to this question is not simple, and there is no one-size-fits-all answer. Your doctor may decide that generic medication is good for you if it is safe i.e. it doesn’t pose a risk to you; or if you cannot afford current medication. Epilepsy is a unique condition. For example, if your blood pressure goes from 125/85 to 135/95 from one checkup to another, the consequences are probably minor. This is not true with epilepsy, as a breakthrough seizure can have major detrimental effects. If you (in consultation with your doctor, of course) decide to take generic medications, make sure to ask the pharmacist if you’ll be getting the same drug from the same manufacturer every time you place an order. If this is not the case, it is advisable to ask around, and switch pharmacies. 

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