InconLifer said:
Had a bit of a nightmare recently as my medication for neuro issues (duloxetine) stopped working and I was worried it had just given up the ghost. I then saw some comments online about different brands of medication being more or less effective for some people. Still have some of the old brand (lower dose though) and took that today and it's definitely having some effect which is good! The main annoyance is that it's like I've started all over again as it knocked me out this morning and I'm nauseous and have GI issues. I just find it bizarre that a higher dose of ostensibly the same stuff wasn't working but a lower dose of a different brand is. Has anyone else found this with meds?
You may want to look into what are known as authorized generics as well as "dispense as written" prescriptions. I don't know how things work in the UK (going from the location on your profile), but in the US, there are two main types of generic drugs.
Standard generics are drugs that have the same active ingredient, but a company has found a different way to arrive at that final compound, and come up with their own formulation with regard to inactive ingredients and whatnot. The amount of active ingredient can vary significantly, and the inactive ingredients can play a significant role in how things work out for you, including perhaps making you not feel well, or somehow changing how effective the medication is. From a US perspective, these generics require what's known as a New Drug Application, or NDA, from the Food and Drug Administration. They have to go through the entire regulatory process of having their drug approved from scratch.
Authorized generics, on the other hand, use the exact same method of production as the brand name versions, with the same inactive ingredients, and are generally supposed to have the same quantities of ingredients. Authorized generics don't require an NDA, as their production can be authorized using the existing NDA for the brand-name drug. While the company making an authorized generic will likely have to pay the name-brand company to be able to produce their products (assuming they aren't a division of the same company; many authorized generic manufacturers are divisions of the name-brand companies), they save some money by not having to go through the NDA process. The final product's price may vary from other generics as a result. It might be cheaper than other generics, or it might be slightly more expensive.
I've run into medications where a generic I was given made me incredibly sick. I had to track down the authorized generic I'd been taking before, by using the NDC (National Drug Code) number for what I'd been using, and have my doctor write a "dispense as written" or DAW prescription with the NDC number. I also had to find a pharmacy willing to special-order that particular version (that part was easy, but convincing my insurance to allow it, was not).
The US uses NDC numbers to designate every different variation of a drug that's out there. Even different quantities in a bottle will have different NDC numbers. That can make DAW prescriptions a little complicated, though a pharmacist can generally sort it out. An individual 30-day bottle of a particular drug from a particular manufacturer will have a different NDC than a bulk 500-pill bottle of the same thing, meant to stay behind the pharmacy counter, though it's generally just the last few digits that change. Obviously you won't have NDC numbers in the UK, but pretty much every country has a similar system in place, as far as I know. Finding your local equivalent to the NDC number for the pills that worked well, would be a good starting place for making sure you're well taken care of. It's likely on the pill bottle. Otherwise, you should be able to ask your pharmacist. Chemist might be the correct term in the UK?
Back to DAW prescriptions, though. There are three versions that I'm aware of. It's been a long time since I've had to dive into this, so I'm a bit rusty, and might get some details wrong here, so make sure you do your research. You have DAW, DAW-0, and DAW-1. DAW on its own, as I recall, generally has little to no standing outside the US, and is likely to be ignored. DAW-0 and DAW-1 are more or less international standards, as far as I know (it may vary by country, but these seem to be widely used, and I assume there's at least a functional equivalent, anywhere that they aren't). DAW-0, as I recall, is just asking nicely that a specific thing be dispensed. If it's inconvenient for the pharmacy, they are allowed to ignore it. DAW without a number in the US, is basically the same as DAW-0. It's optional. DAW-1, on the other hand, is mandatory. The pharmacy must dispense what's requested, or nothing at all, as far as I know. I could be mixing up the meaning of the 1 and the 0, however. It's been a very long time.
So yeah, finding your NDC equivalent for what you've been taking, and getting a DAW-1 (or 0, if I'm wrong about the meanings) prescription for it will help make sure you get something that works. If you've been taking the brand name medication, you're likely to find that an authorized generic works pretty much the same, and lacks the unpredictability of other generics. If you've already been taking an authorized generic, you might be able to find a different authorized generic that works well for you, or that the brand name will work similarly. Of course, I don't know that the term "authorized generic" exists in the UK (if authorized generics exist, they might be called something else), or that they have similar practices regarding drug production and regulation (as in, authorized generics might not even be a thing), but you can always ask your pharmacist.
I hope this is helpful!
Substitute "name brand" for "brand name" as desired. I'm too tired to go back and edit the whole thing, haha.
Interesting. This article mentions that DAW-2 is also a thing, indicating that the patient, not the prescriber, made the request. I imagine that might be something that's entered into pharmacy records by the pharmacist when a patient makes a request while dropping off the prescription, rather than written on a prescription by the prescriber.
What factors are associated with the dispensing of branded medications in the Medicare Part D program?This cross-sectional study of 169 million Medicare part D multisource prescription drug claims in 2017 revealed that branded drugs were dispensed because ...
www.ncbi.nlm.nih.gov
Anyway, DAW-1 is indeed the true dispense as written. Though a quick glance leaves some things a little ambiguous. It looks as though DAW-1 could be interpreted to mean "please dispense the pricey name-brand stuff no matter what," particularly in the absence of an NDC number or equivalent, or if a prescriber writes the brand name and not the actual chemical drug name (for instance, if they wrote the brand name Cymbalta instead of duloxetine).
