Generic Warfarin versus Coumadin?...

[coffeelover]

Hello all! I've been thinking about switching from generic warfarin (TAVO brand) to brand name Coumadin. I have concerns about generic drugs. I don't know if Blue Cross/ Blue Shield will approve of switch to name drug...any advise?

 

[pellicle]

I would not advise that. Of the things in life you can save money on don't make it warfarin.

The problem is that all drugs are a mixture of entantiomers (mirror images of each other, more or less like your hands), as it happens the two in Warfarin have very different half lives:

From MIMS: ...is a racemic mixture of the R and S-enantiomers. The S-enantiomer exhibits two to five times more anticoagulant activity than the R-enantiomer in humans, but generally has a more rapid clearance.

Normally within a maker they stick to their formula, but it is not identical in mix of S and R from maker to maker.

What this means is that your INR may change significantly and then as manufacturer substitution occurs in the "generic" you will essentially have game of "Chase your tail" going on to stabilise your INR.

My own brand is Marevan, which I have used since I started in 2011.

Search this forum you'll find others have done this and had this problem.

https://www.nps.org.au/australian-prescriber/articles/bioequivalence-of-coumadin-and-marevan

 

[dick0236]

I was on Coumadin for the first 25 yrs after surgery because it was patent protected and many doctors would not permit the use of the generic warfarin even after the patent expired. For the past 25 or so years, I have taken warfarin. I have found both the brand and generic to be about the same. I have found some differences between the various brands of warfarin and suggest not switching between brands. The brand I take is TARO.....they have produced warfarin since it lost patent protection and I have found their drug consistent and easily managed.

 

[LondonAndy]

My UK pharmacist regularly changes the brand of Warfarin I am issued. The only difference that I have noticed is that some brands are in boxes that fit nicely in my bathroom cabinet (where I stack the boxes end on), but others are too long and the cupboard door does not close properly. In other words: no medical difference for me. I don't know if Europe's regulation of generic medicines is different to elsewhere, but if useful my current brands are Almus and Crescent.

 

[user 16827]

but others are too long and the cupboard door does not close properly.

That would play Havoc with my OCD

 

[user 16827]

Same here like @LondonAndy

UK based with no noticeable differences in INR with the brands my Chemist issues

 

[coffeelover]

Thank you everyone for sharing info about generic warfarin.

 

[afraidofsurgery]

I switched from brand name to generic maybe 10 years ago and have not had a problem. Any slight differences would get picked up when I take my INR and adjusted - but my INR rarely is out of range. I enjoy saving lots of money on the generic!

 

[Catie]

For what it's worth, my mom had a need to take brand-name Coumadin. She was on it from 1991 till her passing a few years ago. Her INR absolutely wouldn't stabilize on generic warfarin. She did home testing for years. During the few weeks that I had post-operative afib and was on warfarin in 2016, I mentioned my mom's case to the lab tech who did my blood draws. His wife has a mechanical mitral valve, and he said she had the same experience as my mom with warfarin and had to use the branded drug also.

 

[tom in MO]

Hello all! I've been thinking about switching from generic warfarin (TAVO brand) to brand name Coumadin. I have concerns about generic drugs. I don't know if Blue Cross/ Blue Shield will approve of switch to name drug...any advise?

You need to ask BC/BS about what their coverage is. You can always pay for the prescription out of pocket.

I've never been on the branded drug, but have had no problems with the generics. I've been on at least two different manufacturers (I don't always check) with no trouble. In the US, if a specific entantiomers is required or significantly more effective it is controlled through the drug product specifications.

In the US there was some severe fraud in generic drugs back in the 1980s, but most of this ended with the Generic Drug Enforcement Act of 1992.

 

[Protimenow]

I used to take coumadin until the patent expired. In my case, I did experience some difference in anticoagulation effects from one generic to certain others.

A few years ago, a generic with a different name was substituted for the generic that I was taking. (I forget the brand name for this 'generic'), but I was unable to regulate my INR when I used this stuff.

I insisted on warfarin, instead of the other stuff. My pharmacy gives me warfarin, and I've been able to keep my INR pretty stable on it.

Also - a few years ago there was discussion on this forum about difference between generic warfarin from different manufacturers. There was talk about the binders and coloring agents that were used to make the stuff having impact on the way warfarin reacted in the body. My warfarin is from the same manufacturer (I'm pretty sure, but haven't checked the bottle), and I've been able to manage my INR using it. (Oddly, my dose has changed - and this may be because of differences from one manufacturer to the next - I'll have to check the bottle.)

Here in the United States, my warfarin usually comes in a pill 'bottle' (an amber colored pill container), and not in a box. Occasionally, when I get a LOT of pills (my doctor once wrote a prescription for 240 4 mg warfarin, and it came in three factory sealed bottles).

As far as Insurance coverage -- in my experience, brand name Coumadin is not on most approved drug formularies, meaning that only the generic is covered. I don't know if the price of Coumadin was reduced because of competition from generics, of they've increased the price because they KNOW that generics don't work for everyone and the patient has no choice.

On a slightly different topic - Ketoprofen, an NSAID that is supposed to have less effect on the platelets than other NSAIDS - is NOT on formularies, but should be an important pain reliever for people who take warfarin. Maybe it will lose its patent soon, or the insurance carriers will realize that it's a better alternative than NSAID for people taking warfarin/coumadin.

 

[QuincyRunner]

After my OHS in 2011 I could not stabilize my INR while taking generic warfarin, although I do not know what brand it was. After about six months it was suggested to me (by either my pharmacist, doctor, or someone on this site - I do not recall) that I should try Coumadin, which I did. Soon after my INR stabilized and I have been in range over 90% of the time since then. My HMO insurance requires a copay of $50.00 per month versus a couple of bucks for the generic but I feel very strongly that the extra money is well spent.

 

[Bina]

Coumadin--brand name---for me. Since 2005.
Not expensive in Canada, $20 for 60 pills. And my insurance pays 80 %

 

[Protimenow]

QuincyRunner -- I have been taking generic warfarin for at least 13 years. Jantoven (another generic warfarin) didn't work for me - I was unable to regulate my INR with it. Some generics seem to work for me - if you ever decide to give generics a try, you should know pretty quickly whether or not they work for you. Having your own meter makes it easy to verify whether or not you can control your INR with a generic.

However, if $600 a year isn't an issue for you, staying with Coumadin is undoubtedly best (although generics may still be an option if the money is something of an issue).

 

[stephenismycopilot]

Coumadin--brand name---for me. Since 2005.
Not expensive in Canada, $20 for 60 pills. And my insurance pays 80 %

O CANADA!!