Crestor, Lipitor...or the Generic

[disneysteve]

This is the sad and dangerous truth. People will not only believe what they want regardless of facts but they will listen to people that have absolutely no experience in the field itself.

Probably the poster child for this is jenny mcarthy and her anti vaccine movement.

She has single-handedly done more harm to public health in this country than almost anyone I can think of. Thousands of moms decided not to vaccinate their children due to her idiocy. Don't even get me started on that topic.

sorry, I should have added--no name brands anymore (on some of the common ones that have been around for ages).

I mentioned this earlier. There are many drugs for which there is only a generic. The brand name version no longer exists. There's no choice to be made there.

As for thyroid medicine, that is one of the very rare cases where brand name might possibly make a difference because the drug has what is called a narrow therapeutic range. Synthroid, the main brand, comes in 11 or 12 dosages and they are measured in micrograms. There is less than a 10% range between some of the doses available so it is possible that if the pill you get this month is off by several percentage points from the one you got last month, it would be almost the same as your doctor changing your dosage.

[Snydley]

Quote:
Originally Posted by creditcardfree View Post
Slightly off topic: the best case would be to avoid taking ANY pharmaceuticals!

Eat whole foods and avoid the processed stuff. You'll be far better off eating food with nutrition to help heal you rather than just treat symptoms.
That's just so, so, so wrong for so many different diseases.

My uncle was a health food nut, but died of cancer at age 58. Would have painfully wasted away many months earlier had we not surreptitiously doped his disgusting health food smoothies with ice cream in order to make them more palatable and boost the calorie count.

Actually, creditcardfree is 1000% right. Consumption of predominantly low nutrient foods (that are also high in salt, sugar, saturated fat) is the major driver of the largest causes of mortality in the US, including cancer and heart disease. There are literally 100s of pubmed (peer-reviewed, scientific) articles to support this, and many of them are listed in Joel Furmann's book Eat for Health.

A diet of predominantly beans, nuts, seeds, fruits, and vegetables is the way to go; dramatic dietary changes in this direction can and will lower cholesterol more than statins. I was just at a seminar where a cardiologist was talking about the "changing face" of heart disease, that statins have shifted plaques from STEM1 to NSTEM1, types characterized by rupture and erosion, respectively. SO...great - heart disease just looks different on statins, but it's blatantly obvious that taking statins without also adopting some dietary changes is not really going to help you all that much.

I am a medical researcher, by the way (with a Ph.D.)

[Nutria]

sorry, I should have added--no name brands anymore (on some of the common ones that have been around for ages).

But that's my point. At some point, they were name brands. And people were afraid of the generics.

Thyroid medicine is a little different. As you must have read from the article that I provided regarding generics only have to get the blood levels within 10% of the name brand. From the article: "the pill needs to get you within 10 percent above or below the blood concentrations achieved with the brand for the FDA to approve the generic"

No drug has an exact therapeutic dosage. There's always a therapeutic window. Always.

For a medicine like levothyroxine (hypothyroidism) with a narrow window, why would the FDA approve a generic if it's dosage left you outside that window?

[Like2Plan]

As for thyroid medicine, that is one of the very rare cases where brand name might possibly make a difference because the drug has what is called a narrow therapeutic range. Synthroid, the main brand, comes in 11 or 12 dosages and they are measured in micrograms. There is less than a 10% range between some of the doses available so it is possible that if the pill you get this month is off by several percentage points from the one you got last month, it would be almost the same as your doctor changing your dosage.

Yep, synthroid is the one. My primary ins coverage has changed so they don't cover the name brand. My secondary ins will only cover it if the script is filled at certain locations (--and I have a feeling the handwriting is on the wall as to where this is headed. )

Something that I don't understand is why the manufacturer of the drug doesn't lower the price of the drug to be more competitive after the generics come on line.

[Like2Plan]

For a medicine like levothyroxine (hypothyroidism) with a narrow window, why would the FDA approve a generic if it's dosage left you outside that window?

That is a good question. It might not even be bad to go from name brand and to generic company A and then get the dose adjusted--if you could always count on getting a refill from company A. But, when it is generic I don't know of anyway to specify.

[Nutria]

Yep, synthroid is the one.

My wife takes levothyroxine, and her blood level in is the therapeutic range.

[disneysteve]

For a medicine like levothyroxine (hypothyroidism) with a narrow window, why would the FDA approve a generic if it's dosage left you outside that window?

Some patients - not most, but some - are very dose-sensitive. I have dozens of patients on levothyroxine. I only have a couple for whom I specify brand name.

Look at the numbers. Let's say I titrate your dose from 25mcg to 50mcg to 75mcg. You are still symptomatic and your blood test is still out of range so I titrate you once more to 88mcg. At 88, you seem to be doing okay and your blood test results are good. Great, right?

So in April you get generic brand A and it is within the acceptable range of a 10% variance. Let's say it is off by only 4% - pretty darn close. So effectively you are taking 91.5mcg that month. You go for your May refill and get generic brand B. They're also in good shape, only off by 5%, but in the other direction, so now you're effectively taking 83.6mcg, about 8mcg less than last month. Guess what? Certain patients will feel that difference. Again, not many, but there are some.

Coumadin (warfarin) is another drug with a very narrow therapeutic range. A little too much and you can bleed. A little too little and you can clot. 99% of my blood thinner patients take generic warfarin but there are a select few for whom I order brand name Coumadin.

[creditcardfree]

This thread is making my head hurt. The only MD in here is disneysteve unless im mistaken? Anyone else here work for big pharma or does medical research? If thats the case then everyone is blowing steam and throwing opinions around on a topic they know nothing about other than what they read online. Heck the comments I made were regurgitated from stuff my wife who works for the FDA said. No one can even fathom the process/manpower/money it takes to bring a drug to market. You hear things like $2 billion to bring a drug to market and we can kind of register that...but once you start peeling back the layers of what that $2 billion represents...nah...cant do it.

That has to be so frustrating for a doctor or someone on the inside to hear these comments. Thank the internet for everyone now being an expert on everything.

I'm definitely no doctor, or an expert, but I sure have made a point to know what I'm putting in my body and what the side effects are. Primary doctors have very little nutrition training and rarely suggest using foods as medicine, only drugs in my experience.

I completely believe the cost of bringing a drug to market. Drugs are a business. And business will do a lot to hold on to their market share. And foods can't be patented. Something to keep in mind as we make the choices about our health. Just because something is mainstream doesn't make it the right answer for all, or even the right path at all.

[corn18]

I'm definitely no doctor, or an expert, but I sure have made a point to know what I'm putting in my body and what the side effects are. Primary doctors have very little nutrition training and rarely suggest using foods as medicine, only drugs in my experience.

Over the last 30 years of having high cholesterol, every single doctor I ever had recommended a diet and lifestyle change over meds. That didn't work, so they prescribed statins. I blew them off. Then I almost died. Very glad to be taking them now and I hope they keep me alive.

[Nutria]

I'm definitely no doctor, or an expert, but I sure have made a point to know what I'm putting in my body and what the side effects are.

You can't know what the concentration of every kind of chemical in every bit of food you eat. For one thing, they vary by age and growing conditions.

Speaking of growing conditions: an organic food test.

Primary doctors have very little nutrition training

How much nutrition training do TCM practitioners (who think that rhino horn remediates whatever qi imbalance that causes male infertility) have? Or Ayurvedic "doctors" who think that gallstones, arsenic, lead and copper sulfate balance your chakra?

and rarely suggest using foods as medicine, only drugs in my experience.

Because food is not medicine.

Some food has medicine inside, to varying degrees of concentration. That's why drug companies isolate, refine and purify the stuff: so that you're only getting a known quantity of the active ingredient, instead of an unknown quantity, plus a whole bunch of other stuff.

BTW, do you know why we take aspirin instead of drinking willow bark tea?

[Snydley]

High nutrient, anti-inflammatory food is, in effect, medicine. Maybe some of these reviewers of Dr. Furmann's new book have the credentials to convince you of this:

“In the End of Heart Disease, Dr. Fuhrman lays out the science of ending and reversing heart disease using the most powerful drug on the planet; food.” (Mark Hyman, MD, Director, Cleveland Clinic Center for Functional Medicine, Pritzker Foundation Chair in Functional Medicine, author of the New York Times bestseller, Eat Fat Get Thin)

“The End of Heart Disease means exactly what it says. This empowering plan will protect and strengthen your heart and transform your overall health. Dr. Fuhrman draws on a wealth of experience to present everything you need to know and answers your questions along the way.” (Neal D. Barnard, MD, FACC, Adjunct Associate Professor of Medicine, George Washington University School of Medicine President, Physicians Committee for Responsible Medicine Washington, DC)

“The comprehensive information supplied by this book will empower patients and physicians to make healthier lifestyle choices, The End of Heart Disease may just save your life.” (Robert Ostfeld, M.D., MSc., FACC, Director, Preventive Cardiology, Associate Professor of Clinical Medicine, Montefiore Medical Center)

“The gift Dr. Fuhrman has shared with all of us, with the publication of this great work, is [the]descriptions of the seminal clinical work that have helped him... understand which nutritional approaches actually work to decrease the risk of heart disease.” (Gregory S. Weinstein, M.D. Professor and Vice Chair, Director, Division of Head and Neck Surgery, Co-Director, The Center for Head and Neck Cancer, The Department of Otorhinolaryngology: Head and Neck Surgery, The University of Pennsylvania)

“The End of Heart Disease lays out the science and steps to prevent and reverse the epidemic of heart disease. This must read book will be required for every one of my patients and family.” (Joel Kahn MD, Kahn Center for Cardiac Longevity, Professor of Medicine, Author of The Whole Heart Solution)

“Dr. Fuhrman’s new book The End of Heart Disease explains the downsides of conventional medical approaches in treating heart disease, and evaluates the most effective diets designed to promote heart health.” (Naila Khalaf, MD, PhD, MPH, M. Arch, Kaiser Permanente, Los Angeles Medical Center)

“In his latest book, Dr. Fuhrman demonstrates an evidence-based approach, demonstrating the multiple cardiovascular benefits of this whole food, high nutrient, plant-rich diet. If one day, this becomes the mainstream way of eating, society will become way healthier, happier, safer and more productive!” (Aram Shahparaki, MD, FRCPC, Internal Medicine)

“Fuhrman shares the extensive knowledge he has gained via thorough research and more than 25 years of helping patients reverse their disease processes. It’s brilliant!” (Amanda McKinney, MD, CPE, Fellow ACOG, Director of Lifestyle Medicine, Beatrice Community Hospital)

“On page one, Dr. Fuhrman makes the bold claim that this nutritional program can make it almost impossible for you to have a heart attack. He then backs that claim with science. The facts are there, the choice is yours. A must read for anyone interested in their heart health.” (Larry Antonucci, M.D., M.B.A., Chief Operating Officer, Lee Memorial Health System)

“Are you truly committed to the most efffective dietary change to lower your cholesterol, blood pressure and reduce your risk from heart disease? Dr. Fuhrman’s carefully researched book can serve as a guidepost to a natural nutrient (nutritional) life style to help achieve your goal.” (Austin "Ken" Kutscher, M.D. FACC, Associate Clinical Professor, Department of Internal Medicine, Robert Wood Johnson University of Medicine)

“Once again, Joel Fuhrman, MD, has hit the mark with his most recent book. His “nutritarian” diet is supported by clinical evidence and illustrated with clear charts, graphs, and recipes. Many people could reduce their risk of both systemic and eye diseases by adhering to this diet.” (Joshua L. Dunaief, MD, PhD, Adele Niessen Professor of Ophthalmology, Perelman School of Medicine, University of Pennsylvania)

“Another brilliant book by Dr. Fuhrman calling patients and doctors alike to “End Heart Disease” by following a Nutritarian Diet. This is a great read for all those wishing to promote health in themselves and their patients. Thank you Dr. Fuhrman.” (Jaimela Dulaney, M.D., FACC)

“A shot that needs to be heard around the world to empower people everywhere to better understand Dr. Fuhrman’s NDPR diet (Nutrient-Dense, Plant-Rich diet) largely consisting of “foods-as-grown” as a safe and proven reversal strategy for heart disease and other lifestyle-related chronic diseases.” (Hans Diehl, DrHsc, MPH, FACN, Best-selling author, Founder of the CHIP program & the Lifestyle Medicine Institute, Clin. Prof. Prev. Medicine, Loma Linda School of Medicine, CA)

“As an orthopedic surgeon, I look for evidence - based treatments, results that can stand up to the scrutiny of research. [Dr. Fuhrman’s] program is solid science and should be a mainstay of preventative care for the young and old.” (George Tischenko, M.D., Muir Orthopaedic Specialists)

“Dr. Fuhrman has written a Magnum Opus about nutrition and the heart! Reading this book and following the dietary recommendations with delicious recipes he prescribes may save your life!” (Jill R. Baron, MD, Integrative and Functional Medicine Physician)

“Dr. Fuhrman’s 25 years of clinical experience, extensive research and knowledge of nutrition has resulted in this book that outlines an eating plan that will make patients not just survive, but thrive.” (Ashwani Garg, M.D., Family Physician and Lifestyle Medicine Specialist

“Dr. Fuhrman is able to shine a light on the true role of food in our lives, which is to sustain us, keep us healthy, and not to promote disease. Simply said, food is medicine, and in this book, Dr. Fuhrman provides us with a perfect prescription.” (Suzanne Steinbaum, D.O., Director, Women's Heart Health, Heart and Vascular Institute, Lenox Hill Hospital)

“Finally, a scientific compilation of studies proving that food is medicine as well as an excellent alternative. In fact, just to be sure this eating plan was do-able, I tried it myself and my LDL cholesterol went from 120 to 65 in 6 months.” (Connie Hahn, D.O., Family Physician, Bozeman, MT)

“Dr. Fuhrman clearly lays out how a healthy enough diet can not only be cheaper and safer than pills and procedures for heart disease and high blood pressure but, critically, more effective.” (Michael Greger, M.D. FACLM, Founder of NutritionFacts.org)

“In The End of Heart Disease Dr. Fuhrman points us toward a solid, scientific path for dealing with heart disease by treating its cause with nutritional excellence.” (Marc Braman, MD, MPH, FACLM, FACPM, President, The Lifestyle Medicine Foundation, Former President, The American College of Lifestyle Medicine)

“If you are a patient with heart disease, you owe it to yourself and loved ones to follow Dr. Fuhrman’s advice. If you are a physician treating patients with heart disease, you owe it to your patients to share Dr. Fuhrman’s information with them.” (Dennis J. O'Connell, D.O. Ophthalmologist and Retina Specialist)

[Nutria]

High nutrient, anti-inflammatory food is, in effect, medicine. Maybe some of these reviewers of Dr. Furmann's new book have the credentials to convince you of this:

Some of the doctors specialize in cardiac care, but flooding us with plaudits from people with lots of suffix acronyms only works until someone takes the time to actually look at them:

• Four woo-woo "integrative medicine" doctors. If there were actual science to back it up, it would be "allopathic", not "integrative".
• E.N.T. surgeons don't specialize in cardiology.
• Naila Khalaf, MD, PhD, MPH, M. Arch - a medical doctor and an architect??
• Two hospital administrators.
• Eye doctors don't specialize in cardiology either.
• Do we have to mention non-medical doctors?
• Nor orthopedic surgeons.
• An osteopath.
• What's the American College of Legal Medicine? (Not the same as the American Board of Legal Medicine.)
• An osteopath who's also an opthamologist.

[Snydley]

Well, if you want to insist that the sky is green that is your choice.

[Nutria]

Well, if you want to insist that the sky is green that is your choice.

Doctors have been saying for decades to eat our vegetables.

[ESMonitor]

I have a status update about the Crestor coupon. I printed it out and took it to my pharmacy. They told me I already had the coupon. I knew I had a coupon, but I didn't know I had the same one. I was hoping for a credit with my $32 purchase and $3 buy each month moving forward. Unfortunately, the maximum discount is $3. My insurance won't cover Crestor now that it is generic, so I will continue to have to pay $32 a month; $32 is net amount with coupon discount applied to the price.

Or I could take the generic.

Does anyone know what is the generic for Crestor, how much does it typically cost with insurance and does anyone have any feedback about it such as side effects etc?

Thanks in advance.