Coumadin versus Warfarin?

[MarcoPolo]

I've had trouble with other generics in the past. For example, I found that atorvastatin doesn't necessary work for me like Lipitor.

Anyone have any trouble with warfarin that caused them to require the brand name drug?

 

[clay_from_nj]

There's a great review here: http://www.medscape.com/viewarticle/740268_1. They basically say that there is no real difference; however, one should be careful when switching between them.

 

[RobThatsMe]

My doctors always insisted on using only the name brand after my first surgery at Vanderbilt.
Then, 10 yrs later, I had a 2nd surgery and had that done at Cleveland Clinic.
They used Warfarin with me during my 21 day stay at the hospital. This was over 3 yrs ago.
I have been using the less expensive Warfarin ever since then.
I home test my INR every 2 weeks, and have found no issues, ,and no big swings in my INR.
And, now my wallet is a little fatter.

Personally, I think the doctors get some kind of incentive from the pharmaceuticals for prescribing the name brand in many cases.

 

[dick0236]

Coumadin was developed and patented by DuPont Chemicals who did a good job in making it difficult for patients, like me, to get docs to prescribe generic warfarin. The cost in the '70s thru '90s was in excess of $3/pill, which, back then, was a lot of money. After their patent ran out and they lost a federal anti-trust lawsuit, Dupont sold Coumadin to Bristol Myers and docs began to prescribe the generic warfarin and the cost for the generic dropped to about $.30/pill and as Rob put it my wallet was also fatter.

I had no difficulty in switching from Coumadin to generic warfarin. However, I try to stay with one brand of warfarin as there can be differences between brands due to allowable manufacturing tolerances and staying with a single brand makes INR management easier.

 

[Eva]

I, too, have a sensitive system and cannot use majority og generics. Yet, I've been using Warfarin since my surgery and I'm fine with it.

 

[pellicle]

I have also read on other forums that many people have no problems with generic brands. Personally I use Marevan because there is no practical cost benefit to a cheapie.

So basically I couldn't be bothered to move from the brand I am using.

 

[lance]

Shouldn't have happened

Shouldn't have happened

Following years of stability while taking generic warfarin my INR's became extremely erratic.
The best management couldn't restore the situation to normal until we switched to brand name Coumadin.
It shouldn't have happened, I really can't understand it, but there you have it.
Brand name isn't covered by insurance and is quite costly.

 

[charlieecho]

No difference other than a company name

 

[pellicle]

I have read that the mixes of S and R isomers is not consistent between brands. This would (if correct) explain differences between individual reactions to such, as metabolism of isomers is different.

From mims

Warfarin is a natural product and given as racemic mixture of the R and S stereoisomers of the drug. S-warfarin is 3-5 times more potent an inhibitor of the vitamin K epoxide reductase complex, the target of action, than R-warfarin [Article:3567019]. The stereoisomers are metabolized by different phase 1 enzymes; the predominant metabolism of the S isomer is via CYP2C9 whereas metabolism of R-warfarin is mainly via CYP3A4 with involvement of CYP1A1, CYP1A2, CYP2C8, CYP2C9, CYP2C18 and CYP2C19 [Articles:1581537, 11353757, 8689941, 8723744] as depicted in the Warfarin Pharmacokinetics Pathway. Phase 2 metabolism of warfarin has not been well studied and is not depicted in this pathway representation, although it is known that sulfated and glucuronyl conjugates can be formed [Article:1732719]. Elimination is predominantly renal however warfarin has been shown to interact with the ABCB1 transporter in liver [Article:14676821].

 

[pellicle]

until we switched to brand name Coumadin..

Have you tried another brand name like Marevan? Might be cheaper?

 

[lance]

This is the first time I've heard of Marevan. We did try Sintrom developed in Europe a bit differently than Coumadin. I don't think it contains wheat.
My experience with the generic was so worrisome I'm not about to go back to generic. INR management is just too important to fool around with.

 

[pellicle]

Hi

This is the first time I've heard of Marevan.
...
My experience with the generic was so worrisome I'm not about to go back to generic.

In Australia (and I think Finland too) its not a "generic" but one of the primary recommended brands. So I suggested it because you were worried about generics. I also mentioned it was well priced because you mentioned your brand was expansive.

 

[Bina]

Immediately post op my surgeon had me taking brand name Coumadin, and when i got home my doc also prescribed Coumadin.
It was probably a very good idea in my case because I can be overly sensitive to lower quality colourants and ingredients.
My insurance covers 80% of the cost either way.

Do what works for YOU and try not to switch back and forth.
Best wishes

 

[Protimenow]

A few years ago, when my samples of Coumadin ran out, I had no insurance, and no doctors to prescribe it, I bought generic warfarin overseas. I didn't completely trust it, for obvious reasons, so I tested my INR frequently but found no difference from the patent drug (actually, warfarin was developed by the Wisconsin Agricultural Research Foundation, which licensed it to Squibb). I've used generics from local pharmacies for the past few years - about a dime or so a pill - and have, personally, had no adverse effects. My anticoagulation clinic prescribes generic Warfarin, and also has apparently had no adverse effects in its hundreds of patients.

That said -- if you have great insurance that covers most of the cost of the patented medication, and you feel safer using it, there should be little reason for using generics. For people like me, who are watching costs, and able to test for changes whenever a new manufacturer's version of warfarin is provided by the pharmacy, generics should be fine.