Warfarin vs. Coumadin -- sheesh!

[catwoman]

This weekend I saw a friend who works in the cardio dept. of a medical school, as best as I remember.
We were talking about generic vs. brand name Rxes. She mentioned that the doctors at the anticoagulation clinic at that med school swear there is a difference between Coumadin & warfarin.
I said, no there's not.
She said, yes, there is. We have patients who insist on switching and they have a stroke even though they've been stable on food, meds, etc. So, the Dr./profs are extremely hesitant to changing from name brand to generic.

I said that no one is ever 100% stable at all times.

This is a decent med school, with profs who have a good reputation. School has several Nobel Prize winners on the faculty, in fact.

I just can't believe the misinformation out there.......

 

[Karlynn]

My cardio won't prescribe generic. She says she's seen the ingredients of generic and won't approve it. It's the one thing she and I disagree on as far as my Coumadin management so I'm letting it slide - for now.

 

[Blanche]

What Karlynn said....Our cardio and his 14 partners are of the same opinion. When either one of us sees him, we have so many pressing concerns that I just can't take the time to argue...and risk ill feelings. I have presented him with articles and the like, but he continues his policy, which is one for most of the heart docs in my part of Arizona. For us, this is one sleeping dog who will remain asleep.
Kind regards,
Blanche

 

[Ross]

Can you say kickbacks?


COUMADIN (crystalline warfarin sodium) is an anticoagulant which acts by inhibiting vitamin K-dependent
coagulation factors. Chemically, it is 3-(-acetonylbenzyl)-4-hydroxycoumarin and is a racemic mixture of the
R- and S-enantiomers. Crystalline warfarin sodium is an isopropanol clathrate. The crystallization of warfarin
sodium virtually eliminates trace impurities present in amorphous warfarin. Its empirical formula is C19 H15 NaO4.

a·mor·phous /əˈmɔrfəs/ Pronunciation Key - Show Spelled Pronunciation[uh-mawr-fuhs] Pronunciation Key - Show IPA Pronunciation
–adjective 1. lacking definite form; having no specific shape; formless: the amorphous clouds.
2. of no particular kind or character; indeterminate; having no pattern or structure; unorganized: an amorphous style; an amorphous personality.
3. Petrography, Mineralogy. occurring in a mass, as without stratification or crystalline structure.
4. Chemistry. not crystalline.
5. Biology. having structural components that are not clearly differentiated, as the nuclear material in certain bacteria.


--------------------------------------------------------------------------------

[Origin: 1725–35; < Gk ámorphos shapeless. See a-6, -morph, -ous]

—Related forms
a·mor·phous·ly, adverb
a·mor·phous·ness, noun


—Synonyms 1, 2. shapeless, undefined; vague, anomalous.



In order to be deemed therapeutically equivalent to brand products, generic drugs must have the same active ingredients, same dosage form, same standards for purity and quality, same standards for manufacturing, and same amount of drug absorbed over the same time as the equivalent brand product. Generics are also required to meet the same stringent government standards for strength, purity and potency as the brand version.

The Food and Drug Administration (FDA) has repeatedly affirmed that the generic approval process is as rigorous and thorough as the process by which brand drugs are approved. When a generic drug receives FDA approval, research and clinical experience indicates that the generic drug is not only bioequivalent but also clinically equal to and as safe and effective as the brand name drug it is a copy of.

 

[sue943]

I would imagine in the UK, and here, it is virtually unheard of NOT to have generic warfarin. What happens here with most prescription drugs is that the doctors prescribe the generic name and the pharmacists dispense generic if they have it, if not they give you the branded drugs.

I just checked my kitchen cupboard where I store my stash of various drugs and see I have two different brands of generic warfarin and a mixture of generic and branded for various other drugs that I take.

 

[RandyL]

For those of you who want generic for price benefits, ask if your Doctor will allow Jantoven, its suppose to be closer to Coumadin than Warfarin is. BTW I use to take Jantoven, now I take Warfarin.

 

[tommy]

My cardio has recently relented and prescribed warfarin after being sure that I understand that warfarin may cause my INR to fluctuate more than Coumadin and I may have to test more often. I suspect that this was face-saving on their part. After over a month, I've been as (in)consistent as always.

 

[Hank]

Jantoven

Jantoven

I have taken Jantoven for over three years now. It has worked perfectly for me. I know because I test weekly and have never seen any difference from when I tested weekly with Coumadin.

Jantoven is a "Branded Generic" which I believe means that it is a generic manufactured with tighter controls by a major pharmaceautical (spelling) company.

Plus its a $10 co-pay instead of $50!

 

[jeffp]

Can you say kickbacks?

Sure I can.

Seriously, it's not a matter of kickbacks, but more of the way doctors were trained years ago. Much of the continuing education is sponsored by the pharmaceutical industry and their job is to market their product (subtly as they might, it's still marketing). When the makers of generic warfarin lost their lawsuit against the maker of Coumadin seeking to end the practice of calling Coumadin superior to warfarin, it cost the Coumadin folks quite a bit of money. The case was evidence based but there is painfully little evidence based medicine in the marketing of pharmaceuticals. Docs still go alot with anecdotal studies all wrapped up in nice statistics like med A is twice as effective than med B. The nice bar chart we get to see shows the huge difference and the marketing dept predicts the $10/day new pill will reduce the overall cost of care over the $1/day old pill. (As docs we're guilty of too easily buying into this because we're too busy to dig deeper. In reality often it's a case of "In both patients studied, med A improved symptoms by 1/10% vs 1/20% for med B". Sample too small and effect too insignificant enough to be valid, etc.)
Fortunately, the younger docs are more cynical (when did I become one of the older docs?), and less likely to buy into this type of marketing. Some I know have basically banned sales reps from the office!
Personally, I've found I have been more stable (at least predictable) with the generic than with the name brand. Just proves how variable INR maintenance and testing really are. But it's the best we got.
<End of long-winded rant >

 

[Ross]

Sure I can.

Seriously, it's not a matter of kickbacks, but more of the way doctors were trained years ago. Much of the continuing education is sponsored by the pharmaceutical industry and their job is to market their product (subtly as they might, it's still marketing). When the makers of generic warfarin lost their lawsuit against the maker of Coumadin seeking to end the practice of calling Coumadin superior to warfarin, it cost the Coumadin folks quite a bit of money. The case was evidence based but there is painfully little evidence based medicine in the marketing of pharmaceuticals. Docs still go alot with anecdotal studies all wrapped up in nice statistics like med A is twice as effective than med B. The nice bar chart we get to see shows the huge difference and the marketing dept predicts the $10/day new pill will reduce the overall cost of care over the $1/day old pill. (As docs we're guilty of too easily buying into this because we're too busy to dig deeper. In reality often it's a case of "In both patients studied, med A improved symptoms by 1/10% vs 1/20% for med B". Sample too small and effect too insignificant enough to be valid, etc.)
Fortunately, the younger docs are more cynical (when did I become one of the older docs?), and less likely to buy into this type of marketing. Some I know have basically banned sales reps from the office!
Personally, I've found I have been more stable (at least predictable) with the generic than with the name brand. Just proves how variable INR maintenance and testing really are. But it's the best we got.
<End of long-winded rant >

Oh ok. Chalk another up to the truly misinformed physicians then.

 

[Marty]

My cardiologist,is arguably the best at our hospital. He did my pre-op cardiac cath. He saves lives day in day out.......BUT when I asked him about going generic he said stay with Coumadin.....His patients taking generic are "all over the place". I'm sure he neither gets or wants a kickback so go figure! I took coumadin for eight years but when we signed up for Part D Medicare the pharmacist asked if I would go generic. I did and there has been no problem.
There are many situations in medicine where a doctor hangs on to old ideas or past teachings. Sometimes this is a good thing....but not always.

 

[Granbonny]

March 25th..I will be 5 years post-op.. I have been on 5 mg of Warfarin...Never coumadin.... Never a change in doseage (I home-test)...Same Cardio...He scrips my Warfarin....He signed off for me to home-test 2 months post-op...........I know he just turned age 50..because they had one of those cute signs outside his office a few months back.. Dr. Marshall is fifty, nifty..type things.. So, that would have made him age 45 when he found my aneurysm.....I know he was at Emory in Atlanta before he came up to Gainesville, Ga.( Now, heads the Ronnie Green Heart Center at the Northeast Ga. hospital..in Gainesville, Ga.).......He told me last month they are now doing valve-surgery......My point..I got lucky with a Cardio that was up to date..on Coumadin/warfarin......home-testing.. ......He stills likes to see me every 6 months..(His group has now grown to about 15 Cardios)I don't think he takes new patients?) ..Just his older ones like me.. Maybe he is using me for a guinea pig .........Back to Warfarin.....I am most in the 3.0-3.5 range.. I can never remember being lower than 3.0.. in 5 years?..If I test above 3.5....I just drink a V8 juice..eat cabbage, ect....................test in a week ..back into the range. Bonnie

 

[Guest]

I am in Tucson right now and it is 53 degrees F and raining. I was in London once when it was 92 degrees F.

My conslusion is that Tucson is much colder and rainier than London.

Do you understand why personal experience is the worst thing to base medical jusgements upon?

 

[Persianlady05]

To Sue943

To Sue943

Hello Sue, my name is christine I live in us.I too had lithotripsy for kidney stones and since then I have had problems with hemoroids ,do you have any problems at all ?if so what do you do to help that.waiting for your reply chris