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Do you buy brand-names or generic?

When you go to the pharmacy or big-box retailer do you choose brand-name or off-brand generic over the counter medications and pills even with the same active ingredients?

This kind of thing enthralls me.  I love you NPR. 

Why do people choose what they choose when given the option of the same product in different packaging?  

Some of you are SO. INSISTENT

"I MUST HAVE THIS BRAND!"  

"It is the ONLY ONE!"

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Don't EVEN bring it to crazy-town with mayonnaise.   But we're taking about medication today.

My line of thinking (…when making that choice in the aisle) goes to:

  • Is is *exactly the same?*
  • Does it have the same efficacy?
  • Is the generic brand safe and effective?

When side-by-side store branded pills versus big brands aren't all that different, same active ingredients, similar labeling, the only thing that stands out to many of us is the pricing.  So why do you choose the more expensive product, if you do?

If I am being completely honest, I don't buy off-brand super inexpensive pills from big box retailers like Wal-Mart (…or a Dollar Store, shiver!) because quite frankly I am terrified at the potential of an eighty-eight cent price point and where THAT came from.  It's not that I am a brand snob, but just, no.  I read the packaging of every side-by-side product and if the ingredients match by percentage and you can see the source — I do not mind paying less per pill.

I will admit for some things I have brandsnobbery  (…but even so much less lately and not really. I have even downgraded to generic huge tubs of coffee.  RIP Starbucks at home, entirely.  Thanks to blogging not being so, uh, lucrative, don't quit your dayjobs!)  But not for over the counter medications.  I bought approximately three boxes of generic gas medications, gut-fail medications and the like prior-to and during my trip to Portland last week because of desperation and it worked and kept me from ROTTING ON A PLANE THANK YOU VERY MUCH.

generic tylenol

NPR

Why does anyone buy Bayer aspirin — or Tylenol, or Advil — when, almost always, there's a bottle of cheaper generic pills, with the same active ingredient, sitting right next to the brand-name pills?

Matthew Gentzkow, an economist at the University of Chicago's Booth school, recently tried to answer this question. Along with a few colleagues, Gentzkow set out to test a hypothesis: Maybe people buy the brand-name pills because they just don't know that the generic version is basically the same thing.

"We came up with what is probably the simplest idea you've ever heard of," Gentzkow says. "Let's just look and see if people who are well-informed about these things still pay extra to buy brands."

In other words, do doctors, nurses and pharmacists pay extra for Tylenol instead of acetaminophen, or buy Advil instead of ibuprofen?

Gentzkow and his colleagues looked at a huge dataset of over 66 million shopping trips and found that, "lo and behold, nurses, doctors and pharmacists are much less likely to buy brands than average consumers," Gentzkow says. (Their findings are written up here.)

Pharmacists, for example, bought generics 90 percent of the time, compared with about 70 percent of the time for the overall population. "In a world where everyone was as well-informed as pharmacist or nurse, the market share of the brands would be much, much smaller than it is today," Gentzkow says.

I asked several people who had a bottle of Bayer or Tylenol or Advil at home why they'd bought the brand name. One guy told me he didn't want his wife to think he was cheap. A woman told me Bayer reminded her of her grandmother. Another guy, a lawyer, said he just didn't want to spend the time to figure it out, and decided it was worth the extra couple bucks to buy the brand.

In general, we often buy brands when we lack information — when, like that lawyer, we decide it's easier to spend the extra money rather than try to figure out what's what.

Jesse Shapiro, one of the co-authors of the headache paper, told me he buys Heinz ketchup rather than the generic brand. He likes Heinz. He thinks it's better than the generic, but he's not sure. "I couldn't promise that, if you blindfolded me, I could tell them apart," he says.

Shocked-will-smith

Medication malabsorption?

I do not think I am absorbing my anti-epilepsy medication very well.   I know – surprise, surprise.

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I take two medications –


Topamax

  • Topamax 200 mgs
  • Levetiracetam 2000 mgs
  • Both in divided doses

My blood test results – suck –

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My medication dosages are higher than the "therapeutic levels" suggested above – and my blood lab results don't seem to fit.  

While my grand mal seizures are controlled (thank you Keppra?) I am having multiple complex partial seizures in clusters each week.  My family says they are increased, I can't tell the difference because they happen regardless of my awareness level.

(Side note:  I am also still pushing along toward brain surgery for the removal of the area of the brain that is the trigger area for the seizures, however the neuro team has suggested that it's a very large section – larger than anticipated in earlier scans – and less likely to be a cure… I still have testing to visualize and narrow it down… another post.)

  • My point in posting my medication blood levels was that maybe someone out there has knowledge of this — epilepsy AND gastric bypass AND medication levels or alternative dosing?  

While I am aware that is NORMAL to have absorption issues post gastric bypass – I guess this is some proof – that medication just DOESN'T always work entirely.

UIC College Of Pharmacy

The Roux-en-Y gastric bypass is most commonly performed in the United States and produces a more profound and sustained weight loss than the other two methods.2,5 This procedure uses a combined restrictive and malabsorptive approach to induce weight loss. During this procedure, a 30- to 60-mL portion of the stomach is sectioned off in an effort to limit food intake. The small intestine is then cut from the base of the stomach, and the lower intestine is connected to the pouch at the top of the stomach. The narrow opening to the small intestine slows the emptying of the stomach and produces a sensation of early satiety.By circumventing the lower portion of the stomach (90% to 95%) and much of the small intestine (the entire duodenum and part of the proximal jejunum), the surface area for absorption is greatly decreased and malabsorption can occur.2

Drug absorption and bariatric surgery

The mechanism of altered drug absorption depends partly on the type of procedure done-restrictive or malabsorptive. In general, drug absorption is affected by drug disintegration and solubility and the surface area available for absorption, all of which can be affected by restrictive procedures. 5,7 Disintegration of the dosage form is the first step needed for drug absorption. The smaller volume of the stomach with restrictive procedures may prevent adequate tablet or capsule disintegration due to reduced gastric mixing.Solubility of a drug is dependent on pH. Drugs that are more soluble at a lower pH are absorbed in the stomach, while those that are soluble in more basic environments are absorbed in the small intestine. Changes in the stomach volume after bariatric surgery result in a decrease in gastric acid production and a higher pH compared with the stomach as a whole. The change in pH may cause a decrease in the absorption of medications that rely on an acidic pH for solubility or absorption. A reduction in the surface area of the stomach may further decrease drug bioavailability. These changes may be especially important for drugs that are slowly absorbed, such as sustained-release formulations. Use of liquid formulations or chewing or crushing solid dosage forms (if appropriate) may help overcome some of these factors.

Malabsorptive procedures bypass much of the small intestine.7 This technique not only decreases intestinal length but also limits mucosal exposure of drugs and alters intestinal transit time. Mixing of highly lipid soluble drugs with bile acids may be reduced, with a loss of enterohepatic recirculation and decreased absorption.

In addition to drug absorption, drug distribution can also be affected following bariatric surgery.Obesity-related factors that can influence drug distribution include increased blood volume, cardiac output, lean body mass, organ size, and adipose mass. After bariatric surgery, these factors are expected to change and, therefore, may necessitate drug dosing adjustments.

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Not today brain.

Complex partial seizures are often preceded by a seizure aura.[2] The seizure aura is a simple partial seizure.[2] The aura may manifest itself as a feeling of déjà vujamais vu, fear, euphoria or depersonalization.[3] The seizure aura might also occur as a visual disturbance, such as tunnel vision or a change in the size of objects (macropsia or micropsia).[4] Once consciousness is impaired, the person may display automatisms such as lip smacking, chewing or swallowing.[3] There may also be loss of memory (amnesia) surrounding the seizure event.[2] The person may still be able to perform routine tasks such as walking. Witnesses may not recognize that anything is wrong.

Complex partial seizures might arise from any lobe of the brain.[2] Complex partial seizures most commonly arise from the mesial temporal lobe, particularly the amygdalahippocampus, and neocortical regions.[5] A common associated brain abnormality is mesial temporal sclerosis.[3] Mesial temporal sclerosis is a specific pattern of hippocampal neuronal loss accompanied by hippocampal gliosis and atrophy.[6] Complex partial seizures occur when excessive and synchronous electrical brain activity causes impaired awareness and responsiveness.[7] The abnormal electrical activity might spread to the rest of the brain and cause a secondary generalized tonic–clonic seizure.[8]

This morning I was sitting here with Bob and Tristan after the big kids had gone off to school, and we were talking about Christmas presents.  

I remember stating out loud, "Not today, brain."  This statement is obviously part of a pre-seizure aura, and comes very frequently.  

A few minutes later, I seized.  My husband and youngest daughter saw, and my husband grabbed my phone and video-taped what happened mid-way through, caught the END and uploaded it to my Facebook page, unknown to me.  I apparently just got up after this, walked away and laid down on my couch.


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I suppose, after seeing the 86+ 42 comments to this video on Facebook (that I didn't know I uploaded, beacuse Mr. did it, because I have NO MEMORY OF THE EVENT… because I NEVER DO…) it's caused a reaction.  

I guess you could say I am surprised by the feedback from the internet.

I appreciate and understand the safety concerns, as I would be equally concerned, and perhaps maybe now my concerns make more sense to you?  I live in this body.  I have lived in this body with seizures since at least … 2006.  I know many of you have always understood it — but many don't.

I have been sharing posts, snippets, videos and updates about living with epilepsy for more than five…six… years, and I have had people complain, some unsubscribe, some ask me not to discuss it, some suggest that I have Munchausen's disorder, and that I "fake" it, or receiving comments along the lines of… 

"OMG I AM SO SORRY for YOU HOW CAN YOU LIIIIVE THAT WAYYYYY I would just DIIIIEEEEE," I don't really respond well.  "OMG, I cannot IMAGINE not being able to…."  "You're getting WORSE, you know!"  "How are you NOT 300 pounds again?  I would just EAT MYSELF to DEATH!"

And, it goes on.  I get some seriously shit comments sometimes.

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Yeah.  I have seizures.  I. have. them. all. the. time.  So what?  I have polymicrogyria.  I am considering brain surgery.   It is likely that I have a lot more seizures than we know about.  It seems like I only notice them when there's an adult home.  

I figured that particular pattern out on the last three days the Adult Was Home.  

Oops.  

I suppose now you understand why I don't take well to those making light of the disease — it's not something you can "get over."  I can't medicate it and go about my day, though I try, the medication makes me a bit uh… where were we?  

I have zero short-term memory left, which is likely a permanent neurological condition.

I cannot work, I have been denied disability twice, and I continue to appeal.