Warfarin VS coumadin

[SHerrin Hutt]

Hey Al,
Do you think that I would be better off on coumadin. Since I have been on warfarin I have not been controled. I talked to a guy the other night that had the same problems that I have had and he told me he couldn't take warfarin .
Also today I went to pick up my new scrip of Lovenox needles and the last scrip was for 20mg. Twice daily when I went to pick the new ones up the new Pcp changed it to 80mg. twice a day. Also I would like to know how long does it take for your body to process the lovenox out of you system?
Thanks a head of time for any advice.

 

[Blanche]

I'm not Al, my name is...

I'm not Al, my name is...

Sherrin:
I'm sure Al Lodwick will respond as he makes his rounds here. Thank heaven for Al.

The consensus here and in much of the literature is that there is no substantial difference between Coumadin and its generic equivalent, Warfarin. However, all four of my Al's doctors are quite specific when they state that Al is not to switch to Warfarin. The cardiologist told me that if cost was a problem, I should mortgage the house. Our internist is a bit less passionate, but still urges that Al not make a change. He says that he has seen patients who have had problems with see-saw INRs after changing to the generic and he is convinced that, although generics work well for most people, there are some people who do have serious difficulties. He told me about a young, healthy person who had no problems for three years on Coumadin. When this person changed, apparently his INR was all over the place. According to the dr., when the patient was changed back to Coumadin, his problems stopped.

I've had total success with generics as have my friends. But, I don't have heart problems. Albert has so many problems that I just want to stay with what has worked for so long, Coumadin. My feeling is that if you can bear the additional cost and you want to try changing, why not!!!

I'm really sorry that you are having these problems and the added concern about changing meds. Hope your concerns are resolved very soon.

Kind regards,

Blanche

 

[Karlynn]

Al has said that for most people, there is no difference. And I trust Al's opinion. But my cardiologist still refuses to let me "go generic". She says she has seen what is in the generic. And I asked her this after the makers of Coumadin lost a law suit related to them spreading bad information about the generic. So like you, I'm stuck paying the higher cost.

 

[SHerrin Hutt]

Well,
The cost is not a big problem since my husband is retired from Ford Motor Co. We pay 5.00 for generic and 10.00 for name brand. And you can mail order and get three months for the price of one.

 

[Guest]

Get the generic and try it. You have had so many problems - who knows.

I wonder what the doctor saw in the generic --leftovers from making Spam maybe. For some of you younger, non-farm folks, the old saying about Spam was that it contained everything from the hog except the squeal. There were no leftovers after they were done making Spam.

 

[Karlynn]

Get the generic and try it. You have had so many problems - who knows.

I wonder what the doctor saw in the generic --leftovers from making Spam maybe. For some of you younger, non-farm folks, the old saying about Spam was that it contained everything from the hog except the squeal. There were no leftovers after they were done making Spam.

I don't know what she saw. But my wallet would like to find out!

 

[ALCapshaw2]

I had NO problems after switching to TARO generic warfarin (made in Israel). INR was stable before and after the switch. (Wonder if I could collect an endorsement fee ). I've heard that BARR also makes a good generic warfarin.

FWIW, I have / had several heart issues*, all compounded by radiation exposure from treatment for Hodgkin's Disease. (*MI, Bypass surgery, AVR, MV Stenosis)

'AL Capshaw'

 

[Blanche]

Sherrin:
The issue here is not that one, two, or 2,200 people did NOT have any problem switching to generic Warfarin. Most people have no problem. The issue here is that some people have had problems. Who's to say who falls beyond the 3 sigma limit. We do know that some people do. If there is any question in your mind that you did better on Coumadin, you might consider
trying it again. I'm a big Dr. Phil fan. He says, "If what you're doing doesn't work, try something else."
Regards,
Blanche

 

[LUVMyBirman]

My card only approves the brand Sherrin. With all of your past issues....sounds like there is a good chance you may be reacting to the Warfarin.

I would switch to the brand!

 

[catwoman]

My PCP approved my switching to the generic because I home-test. Said if there was any INR changes, I'd be able to detect them more quickly than other patients.

However, my question is:
How can you pin an INR change merely on changing from Coumadin to a generic? After all, every other factor is not 100% consistent from day to day -- you do not eat exactly the same thing, exactly the same amount, get exactly the same amount of exercise, etc. ...

Guess it's just easier to blame it on the generic if there is a change in INR?

 

[ALCapshaw2]

Sherrin:
The issue here is not that one, two, or 2,200 people did NOT have any problem switching to generic Warfarin. Most people have no problem. The issue here is that some people have had problems. Who's to say who falls beyond the 3 sigma limit. We do know that some people do. If there is any question in your mind that you did better on Coumadin, you might consider
trying it again. I'm a big Dr. Phil fan. He says, "If what you're doing doesn't work, try something else."
Regards,
Blanche

OR, the issue could be that SOME manufacturers of generic warfarin are less consistent than others. TARO and BARR seem to be quality producers. I don't know about any others.

Close monitoring of INR for several weeks seems the prudent course of action to take when switching between ANY suppliers.

'AL Capshaw'

 

[SHerrin Hutt]

I looked at the bottle and the manfacture is Barr. I have been on this generic form since my stoke in 3/26/02 and I have had problems with my PT from the very start. That is why the insurance payed for the protime machine, which I am very thankful for. It really helps when you travel and you don't have to go to the Dr. office every week or more in my case.

 

[geebee]

I have taken both Taro and Barr (taking Barr right now) depending on insurance carriers with no notable change in INR. I used to be concerned about switching also because I thought Coumadin was such an important drug to keep consistant.
I finally decided that ALL drugs are important (especially those that keep our hearts going) and I had switched from Lasix & Inderal to generics without any problems.
However, I never break pills because I am not convinced the medicine is equal throughout the pill but I felt that way about the brand also.
Then, of course, there is always the money issue. I simply cannot afford to buy Coumadin anymore and I am not going to mortgage my house to pay for it. It makes no sense to want a longer life if it is going to put me into bankruptcy or living on the street. An exaggeration, of course, for me but not maybe for some.

 

[John & Joann]

This is the only issue that we have a different opinion that Al. Cleveland Clinic has recommended that Joann NOT use the generic. The principal reason is that the supplier may change and that there MAY be a difference. We are now 33 + years.

You can beat the prescription by having your coumadin clinic state "Take one or two as needed". Since your IRN will vary, there is no guarantee what amount you will need in the next 3 months, therefore this is a honest statement. This MAY give you 6 months supply for 3 months cost. It MAY also eliminate cutting the pills.

 

[Guest]

In the last 10 years the company that makes Coumadin has changed 3 times. Only the name has remained the same. I wonder how many times the name Coumadin ahs been sold since the 1950s and how different the equipment that makes is now from what it was then. I don't that the doctors said Coumadin was better. It is just that the doctors have believed the advertising and not the studies in journals. These are the same doctors who are training new doctors to go with what the studies in journals show and forget about advertising. I'll agree that prior to 1990 it made sense to say that Coumadin was better. I said it back then. However, the technology is so different now that all manufacturers make excellent products. In fact one study showed that Barr exceeded Coumadin in uniformity of tablets.

 

[Rich]

This is a subject discussed many times on this forum.
I have to agree with John and Joann about this one.
When my wifes ankle was in a cast for several months, she had to take Coumadin. They accidently switched her from the brand to the generic and a few days later she had internal bleeding. Got her back on the Coumadin and never had another problem. I felt pretty stupid since I was the 'expert' on this stuff and never caught the switch.
As a retired engineer(like Al mentioned) I know there are tolerances on everything, nothing is perfect.
Though the ingredients are the same,the tolerances from one manufacturer to another could vary enough to cause problems for some people.
Plus I don't think most prescription plans will let you specify what company the medication come from.
I have nothing against generics and do take one myself but as far as the Coumadin goes, I won't switch.
Sherrin,
You guys are getting a great deal on your medications, I'm retired from GM and while generics cost $10.00 for a three month supply, brand names are now up to $37.50.

 

[tobagotwo]

I don't know if it would be an issue with warfarin, but the binders and other "non-active-ingredient" components of pills can have a great effect on the way the contents of a pill are absorbed and the timing of the absorption.

This is a factor in people having problems with generic blood-pressure pills, where a large amount may be absorbed up front, instead of a slow, steady release from the name brand. Some generics have been found to have elements in the pills that actually block the active ingredient's effect.

For example, certain coatings (such as used on "enteric" aspirin tabs) can keep the stomach from absorbing most of the ingredient until it reaches the colon. As an example, this is a problem for anti-stroke aspirin therapy, because aspirin is not effectively absorbed in the colon by many people. Other pills or capsules may crumble right away and allow the full dose of compound to be absorbed immediately. Some can actually bind to the product and inhibit release of part of the product entirely.

My understanding is that generics are required to prove active ingredient content of their pills, not efficacy. This can mean that the product may be poorly absorbed from one brand, and highly available from another.

Consistency would likely be the safest policy: if possible, pick one brand or generic and stick with it. If you're having trouble with the one you're on, you might want to switch to the Coumadin brand or a different generic and stick with the new one for a while.

If you still can't keep your INR happy, look to other factors: unrealized vitamin K sources, unexpected warfarin boosters (e.g. grapefruit juice), erratic physical activity, green vs. blue tabs (i.e. accidentally mixing different strengths), or other medications you take that might affect warfarin levels or uptake. If you can find the wild card, you should be able to simplify your life.

Best wishes,

 

[SHerrin Hutt]

I know I am thankful everyday for my husband insurance. I went and got my lovenox needles yesterday and two vboxes of 20 preloaded needles wouldn't have been 1500.00 but I payed 10.00. Being on SS disabilty I would be up a creek if it wasn't for my husband insur.

 

[Guest]

There is a third choice in this controversy. There is a warfarin product with the brand name of Jantoven. www.jantoven.com It is made by Upsher-Smith, an long-established pharmaceutical company in Minnesota. They take many generic products, make them to exacting standards, give them a brand name and have a small sales force to promote them, and sell them at generic prices. If your doctor writes a prescription for Jantoven and specifies that brand name only then you must get that product. That way you have a consistent manufactured product and still can get it at generic prices. Because it is cheaper than Coumadin, most insurance plans will require that you only pay the generic co-pay. If you don't have insurance, then you can save money etc.

 

[Emma]

????

????

well i must be very thick about this then 'cos i always thought that you all over there said coumadin and i said warfarin but that they were one and the same thing. I had no idea they were 2 different drugs! AND there were all sorts of brands of them too. Over here - it's warfarin and thats it - plain and simple and no choice. I guess thats what paying for your treatment gets you - it's sooo different over here - seems theres nowhere near as much choice (not to say we don't have excellent medical care in case someone questions what i just said!!!).

(a very confused!) Emma
xxx