Costco 'Warfarin'?

[Protimenow]

A few months ago, I switched to Costco Pharmacy and was getting an anticoagulant that was supposed to be warfarin, but had a different name. I'd been taking generic warfarin for years - and it didn't matter which company manufactured it (Teva was the usual one) - but my INR was pretty stable on the same daily dose.
I saw a post on another forum that mentioned some issues with the 'warfarin' that Costco sells.
Perhaps this explains why my INR has been lower than usual since starting to use the Costco stuff. Even when I increase the dose, it still seems to be lower than I want it.

The generic that Costco sells is called Jantoven. It's described as a generic Warfarin. I've checked it on the Internet - some people report issues with this, others don't. For me, it seems like I need to keep increasing the dose to maintain my INR.

Have you had similar issues with the anticoagulant that Costco sells? Do you know of anyone who is taking it and having problems with INR dropping unexpectedly?

I'm thinking of switching my warfarin prescription to a pharmacy that I know uses a generic Warfarin (Taro or Barr), and not whatever Costco is using to fill prescriptions for Warfarin.

I don't mean to denigrate Costco or imply that they're intentionally selling something that really ISN'T equivalent, but if there ARE others who are having problems with the Costco stuff, we should realize that it's OUR LIVES that are being effected, and Costco SHOULD be made aware of this.

Hell -- these things are a few cents a pill now, how much can Costco be saving by switching to something else?

 

[pellicle]

How much are you saving by changing brand?

 

[almost_hectic]

Im on Jantoven. Have been since day one, prescribed by my surgeon. Never been an issue, I take more and my INR goes up. I take less and my INR goes down. Seems like thats how its supposed to work. I dont get my prescription filled at Costco. Ive filled at it both Walgreens and Publix and once at the hospital pharmacy. I know its a generic for Warfarin but it seems widely available at just about anywhere, so dont think its a "Costco" thing. Just coincidence thats what they get in bulk at the best price is my guess. But Im neither a pharmacist or a chemist so I can't say whether theres a difference between it and any other brand name or generic. Just thought id share that Jantoven is the brand of warfarin I take without any issues.

 

[wxman]

My pharmacy switched to Jantoven several years ago...have not had any problems or noticed any change.

 

[almost_hectic]

What if.... and strictly a what if because i dont even know how this works but... what if they buy in mass quantities and their stock gets old sitting in a warehouse? Might that alter the drugs potency and result in mixed results when old and new pills are distributed inconsistently?

 

[dick0236]

I have found that switching brands of warfarin can cause me INR changes because of manufacturing tolerances allowed by the FDA. A pharmacist(chemist) told be that it is always best to stick to one brand and adjust INR to that brand. I recently switched back to Taro after using Barr Labs for several years and had no difficulty with my INR during the change. My reasoning for changing back to Taro was that my pharmacist told me that Barr Labs was discontinuing production of this drug.

 

[Protimenow]

Pellicle: The price really isn't a concern for me. ANY generic warfarin is quite inexpensive. With my current medical coverage, I pay a dollar for a 30 day supply - a 90 day supply would cost the same amount. I don't know if Costco pays less for Jantoven than they did for Taro, but it seems as if my INR dropped when I started taking the same dose of Jantoven as I was of the Taro manufactured Warfarin.

I may switch back to my other pharmacy that dispenses Taro. The price is about the same, and my results seemed to be a bit more consistent. (Also - years ago I was buying Taro from a pharmacy in India - not trusting it at that time, I started using it, testing daily for a week or so, and found that it was consistent with the patented Coumadin that I was taking prior to the switch).

 

[almost_hectic]

A dollar for 90 days! Wow, thats amazing

 

[pellicle]

Pellicle: The price really isn't a concern for me. ANY generic warfarin is quite inexpensive.

Seems a risk not worth taking to me

 

[pellicle]

I have found that switching brands of warfarin can cause me INR changes because of manufacturing tolerances allowed by the FDA. A pharmacist(chemist) told be that it is always best to stick to one brand and adjust INR to that brand..

agreed, switching brands is a recipe for restarting your AC numerics. If you were saving thousands a year then by all means, but cents doesn't make sense.

also (along with tolerances of dose) there is the issue of the racemic mix of .R and S forms (see here) which are likely to be different between brands (but stable within a forumlation by a company. Essentially R and S enantiomers have different half lives and influence INR differently. If all this sounds too technical the answer is simple

"when you're on a good thing ... stick to it"

NB don't change brands without serious provocation.

 

[pellicle]

A dollar for 90 days! Wow, thats amazing

and the strokes come for free

 

[Protimenow]

I didn't switch it, the pharmacy did. They probably figured that all generics were equivalent, and for the hundreds of thousands of warfarin pills they sell, saving them $2.00 a year made sense.

 

[dick0236]

I didn't switch it, the pharmacy did. They probably figured that all generics were equivalent, and for the hundreds of thousands of warfarin pills they sell, saving them $2.00 a year made sense.

This has happened to me. I've learned that if you "push back a little" the pharmacy will order in the brand you request......if not, there is another pharmacy just down the street......but most pharmacies don't want you going down the street.

 

[Protimenow]

That's exactly what I'm going to do. Although I hate Rite-Aid, at least they use Taro, and it was one that gave me reliable results.

 

[dick0236]

That's exactly what I'm going to do. Although I hate Rite-Aid, at least they use Taro, and it was one that gave me reliable results.

I guess this shows the differences between individual stores. I actually have used Rite-Aid for several years with good results. I used to use the Barr Lab warfarin and they ordered it in especially for me since Taro was/is their preferred brand. Earlier this year I switched to Taro since Barr Lab became unavailable due to their discontinuing production of warfarin. There may be more pharmas leaving the warfarin market as the newer anti-coagulants become popular for non-valve patients(tthe largest consumers of anti-coag drugs). Hopefully, since Taro is one of the larger producers of warfarin, they will continue production of warfarin.

 

[Protimenow]

There isn't much money for the pharmaceutical companies who manufacture Warfarin. It's not much of a surprise to see a company or two dropping it. It'll be a shame when only one or two manufacturers are left, so that the competition is gone and the prices can be raised.
I'm hoping that day doesn't come for at least 80 years, or until they come up with an inexpensive, effective, easily reversed substitute.