my wife had avr in Singapore, bustling cosmopolitan city with excellent affordable medical services. She is now on life long warfarin, brand MAREVAN. But we shall be going home to Kota Kinabalu, East Malaysia (northern Borneo island), with reasonable access to reasonable medical services. However, the brand of warfarin is Apo-Warfarin. I wonder whether changing brands will create havoc with INR ?
changing warfarin brands
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Philip B
Well-known member
Brand Names
Brand Names
I never pay any attention to what brand name is on my coumadin. Opinions may vary and others may disagree, but I don't think it matters much. Effective management simply involves adjusting your dosage to stay in range. You do this regardless of factors like brand name of the drug, diet, and exercise.
-Philip
Brand Names
I never pay any attention to what brand name is on my coumadin. Opinions may vary and others may disagree, but I don't think it matters much. Effective management simply involves adjusting your dosage to stay in range. You do this regardless of factors like brand name of the drug, diet, and exercise.
-Philip
ALCapshaw2
Well-known member
I'm not familiar with those brands.
In the USA, two highly regarded generic Brands of Warfarain are provided by BARR (USA) and TARO (Israel).
Several of our members have found NO Difference when switching between Brand Name Coumadin, BARR, and TARO, including myself. When making changes, the best solution is to simply test more frequently (say once per week) until INR is seen to be stable, then go to every 2 weeks, and finally every 4 weeks as long as there are no changes. Many of our Home Testers like to test every week or maybe every 2 weeks, just to be able to catch any variations early.
My internet connection failed while responding to your other thread.
I suggested striving for an INR of 2.5 +/- which gives your wife some 'wiggle room' on both sides before adding green vegetables to her diet. My Dosing Guide (from AL Lodwick, a retired Pharmacist and Certified AntiCoagulation Care Provider) suggests a weekly increase of 10=15% for raising an INR <2 to a Target Range of 2.0 to 3.0. This could be realized by adding 1 mg on two days per week (say 2.3.2.2.2.3.2 for S.M.T.W.T.F.S).
FYI, I remember seeing a graph (on the St. Jude Website I believe) showing the Risk of Bleeding Curve crossses over (i.e. equals) the Risk of Stroke Curve at an INR of 2.5 which is probably the 'best compromise' for an Artificial Aortic Valve Recipient. I suspect this graph *probably* represents their Master's Series Valves.
'AL Capshaw'
In the USA, two highly regarded generic Brands of Warfarain are provided by BARR (USA) and TARO (Israel).
Several of our members have found NO Difference when switching between Brand Name Coumadin, BARR, and TARO, including myself. When making changes, the best solution is to simply test more frequently (say once per week) until INR is seen to be stable, then go to every 2 weeks, and finally every 4 weeks as long as there are no changes. Many of our Home Testers like to test every week or maybe every 2 weeks, just to be able to catch any variations early.
My internet connection failed while responding to your other thread.
I suggested striving for an INR of 2.5 +/- which gives your wife some 'wiggle room' on both sides before adding green vegetables to her diet. My Dosing Guide (from AL Lodwick, a retired Pharmacist and Certified AntiCoagulation Care Provider) suggests a weekly increase of 10=15% for raising an INR <2 to a Target Range of 2.0 to 3.0. This could be realized by adding 1 mg on two days per week (say 2.3.2.2.2.3.2 for S.M.T.W.T.F.S).
FYI, I remember seeing a graph (on the St. Jude Website I believe) showing the Risk of Bleeding Curve crossses over (i.e. equals) the Risk of Stroke Curve at an INR of 2.5 which is probably the 'best compromise' for an Artificial Aortic Valve Recipient. I suspect this graph *probably* represents their Master's Series Valves.
'AL Capshaw'
For 2 years I was on Apo-Warfarin until last fall. For about 3 months my INR was all over the place for no apparent reason. After doing some heavy research I found out that the manufacture of Apo was closed due to cross contamination. It's been a year now and I would think they (Apo) have gotten everything cleaned up by now.
For me, after changing brands from Apo to Taro there some some adjustment to be made with the dosage, which did take a couple of months for my INR to stabilize with the Taro brand.
Sorry, I don't mean to scare you, but is there any chance of you being able to obtain the same prescription/brand that your wife is on at home?
For me, after changing brands from Apo to Taro there some some adjustment to be made with the dosage, which did take a couple of months for my INR to stabilize with the Taro brand.
Sorry, I don't mean to scare you, but is there any chance of you being able to obtain the same prescription/brand that your wife is on at home?
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This may sound a bit odd. Al's recommendations for testing weekly until stable, then every other week, etc. are right on target (although he sure didn't need me to confirm that his recommendations are good). Although the manufacturers of Coumadin used to try to scare doctors about prescribing generic warfarin, it's being done more and more. In general, you can probably trust a 2.5 mg to be a 2.5 mg regardless of the country it comes from or the manufacturer - but if you switch manufacturers, it wouldn't hurt to test three or so days after making the switch to make sure that there are no surprises.
Now - the odd part. In the past, before I was able to get Barr or Taro Generics, I used generic warfarin I got from a source in India. I'm not sure if I can identify this source, so e-mail me and I'll give it to you. The results were good - changing from the Coumadin samples that I had used up to the warfarin I got from India resulted in no difference in my INR. I'm pretty certain that this Indian pharmacy uses the same manufacturer for each specific dosage -- right now, the 5 mg and 1 mg warfarin are made by Cipla, and the 2 mg is from Unisearch-- my point here is that if you're concerned about getting a generic from a different manufacturer each time you refill your prescription (and increasing the frequency of your testing, just to make sure the effects are equivalent), an online pharmacy (like the one I used before I was able to get generics locally) may be able to provide you with warfarin from a consistent source, so you won't have to check each time you change manufacturers. (Also - one other thought -- the generic warfarin from some of these online pharmacies is so affordable that you may want to buy enough to last for a year or so and not have to worry about changing manufacturers frequently. The 5 mg warfarin, for example, costs .72 for 10, or $7.20 for 100, and the 1 mg warfarin are $3.60/100. Warfarin is pretty stable chemically, so you may even find that your supply has an expiration date two or more years out).
Now - the odd part. In the past, before I was able to get Barr or Taro Generics, I used generic warfarin I got from a source in India. I'm not sure if I can identify this source, so e-mail me and I'll give it to you. The results were good - changing from the Coumadin samples that I had used up to the warfarin I got from India resulted in no difference in my INR. I'm pretty certain that this Indian pharmacy uses the same manufacturer for each specific dosage -- right now, the 5 mg and 1 mg warfarin are made by Cipla, and the 2 mg is from Unisearch-- my point here is that if you're concerned about getting a generic from a different manufacturer each time you refill your prescription (and increasing the frequency of your testing, just to make sure the effects are equivalent), an online pharmacy (like the one I used before I was able to get generics locally) may be able to provide you with warfarin from a consistent source, so you won't have to check each time you change manufacturers. (Also - one other thought -- the generic warfarin from some of these online pharmacies is so affordable that you may want to buy enough to last for a year or so and not have to worry about changing manufacturers frequently. The 5 mg warfarin, for example, costs .72 for 10, or $7.20 for 100, and the 1 mg warfarin are $3.60/100. Warfarin is pretty stable chemically, so you may even find that your supply has an expiration date two or more years out).
We are planning of getting a Coagucek. Any idea where to purchase the "Dosing Guide (from AL Lodwick)" Can we get online??
ALCapshaw2
Well-known member
AL Lodwick lost his website through which he sold his publications. (Long Sad Story. Apparently all the info is lost).
You might be able to purchase them from him via his e-mail address allodwick([I]at[/I])gmail.com
He used to charge $5 USA for his Dosing Guide (which is Excellent IMO).
If not, there are other Dosing Guides available online that have been posted in the Anticoagulation Forum but I would have to search for them, along with some Dosing Calculators. I can see that I need to make a note of them for future reference!
'AL Capshaw'
EDIT - Here is some more information
Here is a link to a pretty good education on Warfarin, how to dose it, adjust it and what alot of what interacts with it. Read it as part of your deciding process. It's a little outdated, but for the most part, it's pretty spot on:
http://www.aafp.org/afp/990201ap/635.html (Association of American Family Physicians - or something like that)
Online Coumadin Dosing Calendar
http://www.pace-med-apps.com/CoumCalc.htm
There may be others. Try a Google Search for "Coumadin Dosing" or "Coumadin Dosing Guide".
You might be able to purchase them from him via his e-mail address allodwick([I]at[/I])gmail.com
He used to charge $5 USA for his Dosing Guide (which is Excellent IMO).
If not, there are other Dosing Guides available online that have been posted in the Anticoagulation Forum but I would have to search for them, along with some Dosing Calculators. I can see that I need to make a note of them for future reference!
'AL Capshaw'
EDIT - Here is some more information
Here is a link to a pretty good education on Warfarin, how to dose it, adjust it and what alot of what interacts with it. Read it as part of your deciding process. It's a little outdated, but for the most part, it's pretty spot on:
http://www.aafp.org/afp/990201ap/635.html (Association of American Family Physicians - or something like that)
Online Coumadin Dosing Calendar
http://www.pace-med-apps.com/CoumCalc.htm
There may be others. Try a Google Search for "Coumadin Dosing" or "Coumadin Dosing Guide".
This is interesting. When doing my research into APO and where it was made, no one could tell me or my pharmacist. It's my/our understanding the Apotek-Canada is just a distributor and does not know exactly where the drug comes from.
Where exactly did you get your information in regards of APO Canada making generic drugs?
Hi there! I've been on Coumadin and Warfarin (different brands) for almost 11 years and found no differences in the medicines. As a sidenote: my son will most likely be working in Brunei in the near future, so you'll be neighbors! All the best to you and your wife, Dorothy..
I take the name brand Coumadin as prescribed by my doc and my insurance covers 80% of it anyway.
When I was taking coumadin -- before the patent ran out and generics became available, I was paying about $1 a pill, if I recall correctly. I don't know what they get for it now.
I get my generic warfarin - 90 pills for $10. IF coumadin is still around a buck a pill, then the 20 cents you're paying now is roughly double what the generic costs. I realize that the difference is slight -- for a year's worth of pills (assuming that you take one a day, and pay a 20 cents a day for the pill), the difference should be only about $36 or so a year - and if the name brand stuff has dropped in price so that they can compete slightly against the warfarin generics, it may be worth the extra peace of mind to pay the slight difference (as long as insurance picks up the other 80% and doesn't require that you use generic)
I get my generic warfarin - 90 pills for $10. IF coumadin is still around a buck a pill, then the 20 cents you're paying now is roughly double what the generic costs. I realize that the difference is slight -- for a year's worth of pills (assuming that you take one a day, and pay a 20 cents a day for the pill), the difference should be only about $36 or so a year - and if the name brand stuff has dropped in price so that they can compete slightly against the warfarin generics, it may be worth the extra peace of mind to pay the slight difference (as long as insurance picks up the other 80% and doesn't require that you use generic)
It took me almost 40 years to get my docs to allow me to try warfarin. My experience with warfarin over the last 6 years has been as good as my experience with coumadin. I have used both Barr Lab and Tara manufactured tablets. DuPont Chemicals, the original patent holder, did a very good job in marketing (brainwashing) coumadin over the years and many of the older docs are convinced that the generic is inferior to the brand name. According to the USA FDA, many pharmacists and YOUNGER docs I have talked with, this is absolutely not true. The "active ingredients" of warfarin and coumadin are identical. There may be some difference in the "inactive ingredients", such as the dies used, and some patients may find they don't do as well because of these ingredients.
I am of the "old school" that believes "why pay the difference, if you can't tell the difference":biggrin2:.
I am of the "old school" that believes "why pay the difference, if you can't tell the difference":biggrin2:.
Dick is right. DuPont did a great job convincing prescribing physicians that, for a drug with such a tiny margin of error, the generics weren't as safe. I don't know that dyes or other inactive ingredients would have any effect on INR.
Also - from what I understand, the FDA wouldn't allow a generic manufacturer to label a warfarin pill's strength to be FUNCTIONALLY different from that of patented Coumadin.
Still, when I switched, I confirmed that my INR didn't change as a result. I can't imagine a switch from a specific dose of Coumadin to the same dose of warfarin to make any dramatic differences on INR -- but it still wouldn't hurt to confirm, with a test 3-7 days after switching, just to see if there is any change that can be attributed to the switch to generic.
I'm glad that generic warfarin is finally available -- so far, they're working just fine for me (and probably for most others who take the generic)
Also - from what I understand, the FDA wouldn't allow a generic manufacturer to label a warfarin pill's strength to be FUNCTIONALLY different from that of patented Coumadin.
Still, when I switched, I confirmed that my INR didn't change as a result. I can't imagine a switch from a specific dose of Coumadin to the same dose of warfarin to make any dramatic differences on INR -- but it still wouldn't hurt to confirm, with a test 3-7 days after switching, just to see if there is any change that can be attributed to the switch to generic.
I'm glad that generic warfarin is finally available -- so far, they're working just fine for me (and probably for most others who take the generic)
Try this website:
http://www.apotex.com/ca/en/products/search.asp?qt=All&qs=&t=All Products
Apotex is a Canadian Company
Since I am hyper sensitive and more likely to react to cheap dyes etc., I will stick to paying a few cents more per pill and take the name brand Coumadin.
cjune1961
Well-known member
Hello, I just switched to Walmart's pharmacy for the cost of 20.00 for 180 5 mgs supply,have been taking barr brand of warfarin mostly for three years,but this presciption says Zyd,and asked the pharmacist,he also said Zyd. Does anyone here take that brand?Thanks, Carla.
You're probably not in California. The generic for the 5mg warfarin is considerably higher -- something like $23 for 100. There's some kind of quirky rule saying that you can't pay less for a generic than the STATE pays for its MediCal users (or something). I wind up getting the 10 mg (90 for $10) and breaking them in half.
Sorry - I'm not yet familiar with Zyd.
Which manufacturer's warfarin are you switching from? If you're concerned about different effects on your INR, it probably wouldn't hurt to test 3-5 days (and maybe even a week) after you make the switch. (Of course, diet, activity and other things could also make the INR change, so even if you get differences in your INR, it may still NOT be due to the Zyd warfarin).
Sorry - I'm not yet familiar with Zyd.
Which manufacturer's warfarin are you switching from? If you're concerned about different effects on your INR, it probably wouldn't hurt to test 3-5 days (and maybe even a week) after you make the switch. (Of course, diet, activity and other things could also make the INR change, so even if you get differences in your INR, it may still NOT be due to the Zyd warfarin).
Protimenow wrote: You're probably not in California. The generic for the 5mg warfarin is considerably higher -- something like $23 for 100. There's some kind of quirky rule saying that you can't pay less for a generic than the STATE pays for its MediCal users (or something). I wind up getting the 10 mg (90 for $10) and breaking them in half.
I live in California and get warfarin for $4 for a 30-day supply or $10 for 90-days from the pharmacy at the local Ralph's.
I live in California and get warfarin for $4 for a 30-day supply or $10 for 90-days from the pharmacy at the local Ralph's.
Luana:
You're lucky. I get mine from Ralphs Pharmacy and THEY want to charge me $23 for 90 5 mg tabs. Perhaps your Ralphs Pharmacy ignores the State's rule. I'm 'stuck' getting 10 mg and breaking them in half. (Of course, this way it's HALF of what you're paying for your generic 5 mg, so I'm not complaining.)
I take 49/week - I've been consistently at this dose for quite a while. I get 7 mg/day by breaking a 10 mg in half, and a 4 mg in half -- so it's still costing me $10 for 90 days. If I was able to get a 5 mg for $10 for 90 and a 2 mg at the same cost, my daily cost would be twice what it costs me now. (Still going from about a dime a day to twenty cents a day isn't a big deal). I could probably get to 49 by taking six 7.5 mg and a 4 mg, but the consistent 5+2 every day is a bit smoother and still comes out to two half-pills a day.
You're lucky. I get mine from Ralphs Pharmacy and THEY want to charge me $23 for 90 5 mg tabs. Perhaps your Ralphs Pharmacy ignores the State's rule. I'm 'stuck' getting 10 mg and breaking them in half. (Of course, this way it's HALF of what you're paying for your generic 5 mg, so I'm not complaining.)
I take 49/week - I've been consistently at this dose for quite a while. I get 7 mg/day by breaking a 10 mg in half, and a 4 mg in half -- so it's still costing me $10 for 90 days. If I was able to get a 5 mg for $10 for 90 and a 2 mg at the same cost, my daily cost would be twice what it costs me now. (Still going from about a dime a day to twenty cents a day isn't a big deal). I could probably get to 49 by taking six 7.5 mg and a 4 mg, but the consistent 5+2 every day is a bit smoother and still comes out to two half-pills a day.
