Shun Brand Name Drugs With Two Letters After The Name And Save

What do those little letters, CD, ER, SR, etc, after a brand name drug’s name mean? The exact terminology varies, but they usually translate to the same thing: unnecessary ripoffs.

Whether it says CD, CR, ER, LA, SR, XL, XR, or XT, the letters really stand for a version of the drug that releases differently into the body. By coming up with different variations on old drugs, pharmaceutical companies can keep the profits rolling on drugs whose patents have expired. Best of all, if they can get the doctor to write one of these letter sequences after the drug’s name, the pharmacy can’t substitute a lower-priced generic (unless a generic of the extended release version is already on the market).

For example, Wellbutrin (bupropion) came out in 1985 requiring 3 pills a day. In 1996, 36 months before the old patent expired, they came up with Wellbutrin SR, only 2 pills a day. In 2003, 5 months before the SR patent expired, Wellbutrin XL was released, only one pill a day.

A 3 month supply of 300 mg of bupropion per day retails on average for $270. You’ll have to pay $693 and $656 for Wellbutrin SR and XL, respectively. Over the course of a year, that’s $1080 extra dollars. Is it really worth paying 2.5 times as much just for one fewer pill?

There are exceptions where an extended formula works better, like short-acting calcium channel blockers like nifedipine, or Parkinson’s treatment drug Sinemet CR. Luckily, in both cases, the extended release versions are available as lower-costing generics. Furthermore, a certain medication might otherwise be too hard to time correctly if several pills are needed a day at specific intervals. As always always always, any change in your medication needs to be discussed with your doctor.

RELATED: 14 Ways To Save On Drugs Big Pharma Doesn’t Want You To Know

Comments

Edit Your Comment

  1. nicemarmot617 says:

    You shouldn’t be making claims like this about antidepressants. The reason that the extended-release versions are usually prescribed is because they are easier to take and less likely to cause withdrawal problems. For instance, Effexor can cause withdrawal symptoms if a pill is taken even a few hours late. Using old Effexor, you’d have to take multiple pills at the same time every single day. Paxil is the same way. Extended-release versions allow you to take fewer pills, therefore decreasing the risk of withdrawal symptoms – which are what causes the increased suicide risk for many antidepressants. Nobody should try to switch to a different version unless their pdoc agrees they can handle it. (People with mental issues need all the help they can get. I should know. I recently titrated off Effexor XR after taking it for two and a half years.)

    Not to say that most of these – especially the “metabolite” drugs – aren’t total ploys by the drug companies to keep the cash coming. They definitely are. But don’t extend this advice to antidepressants, please, they’re hard enough to take correctly as it is.

  2. jbrecken says:

    Is Tylenol PM still okay?

  3. oldheathen says:

    One glaring exception – migraine medications and similar in which immediate pain relief is a godsend. In these cases, meltable or fast-acting versions are worth every penny.

  4. sven.kirk says:

    Source link broken

  5. jojo319 says:

    @jbrecken:

    classic

  6. SkokieGuy says:

    @nicemarmot617: So what you are saying is that you agree with Consumerist?

    A. Most of these drugs are ploys by the drug companies
    B. Don’t change your prescription without a doctors advice.

  7. samurailynn says:

    Wellbutrin can cause seizures if too high of a dose is given at once. The time release capsules allow a higher dose to be taken because it will be slowly released into your blood stream rather than released all at once (which is what brings on the seizures). For people not at risk for seizures, or for people taking low doses, the SR or XL probably doesn’t matter, but for some people it does.

  8. TheShepherd says:

    I must say, between this and the other article about prescription savings, I am highly disappointed with the Consumerist. These are irresponsible at best.

    While I agree that America as a society is overprescribed, there is usually a reason why Dr’s write the prescriptions they do.

    For example, I take Adderall XR. When I was first prescribed adderall, i was on lower doses, multiple pills per day. There were definite peaks and valleys to my day. At one point I was also on generics, which gave me a headache, so i went back to regular adderall. I then switched to the XR to try and avoid peaks and valleys and I haven’t looked back since.

    It’s not just as simple as fewer pills, the body chemistry is different, that’s why its a different prescription.

    Yes, in the article there was the caveat that “there are a few exceptions” but that is an understatement of the highest degree. These things vary on a case by case basis and to paint with such a broad stroke does not help nor inform consumers, it merely confuses them and in some cases I’m sure has a negative impact.

    There are indeed companies who have some questionable business practices with regards to the medications which they bring to market, but to call that the “norm” when it clearly isn’t is myopic at best and incompetent at worst.

    That being said, any patient should always talk about ALL available courses and methods of treatment and be sure to understand them so that they can WITH THEIR DOCTOR choose the most appropriate treatment plan for them.

  9. krispykrink says:

    @jbrecken: Yeah. But I usually buy Tylenol and Benadryl (or the generic versions) because at certain times I only need 1 of the drugs, not both.

    As for me, I prefer the Ambien CR. Because with regular Ambien I wake up in less than 5 hours. With CR I can get a full 8 hours. Plus, my insurance pays 100% for it, no co-pay.

  10. mrgenius says:

    I won’t take issue with the OP, but, having taken both the regular and the XL versions of Wellbutrin, I can say for myself that the XL version had fewer side effects. The regular pills would sort of spike at first and wear off quicker. The XL was steady. Just my experience.

    Not that it even is relevant since they now have a generic for the XL (budeprion), which I now take and works just fine. And I don’t see Wellbutrin XXL on the horizon, unless they can figure out how to take one a week or something.

    Maybe it’s just me, but I don’t think its a bad thing to have a choice. In 2003 I could choose whether or not I wanted to take 2 pills/day of the generic or just one of the formulary. My prescription plan offers generic drugs for free and formulary for $50 every 90 days. I was willing to pay $200 years to take half as many pills. Others would rather not, and I’m cool with that too.

    I guess I just take issue with the term “unnecessary ripoff” [side note: as opposed to “necessary ripoffs”?]. Is it an unnecessary ripoff flying Virgin Atlantic over American Airlines to Heathrow, even if it’s twice as much?

    You can always ask your doctor for a non-XL, SR, XP or whatever version if you want to.

  11. gorckat says:

    Gotta say that the Consumerist is way off base here, promoting medication changes based on their properties.

    Like was mentioned at least once before me, sometimes this makes the difference between a person functioning normally, or being hospitalized because they want to kill themselves.

    It’s not just “one fewer pill”.

  12. bohemian says:

    The article seems fairly straight forward to me. You might not get any benefit out of extended release drugs other than to lighten your wallet, talk to your doctor to see if older, cheaper non extended release drugs would work for you instead.

    In my case I could pay $100 or I could pay $4 and carry some pills in my bag. I opt for the $4 one.

  13. Jonbo298 says:

    @nicemarmot617: Agreed about Effexor. I too was on it for about 2-3 years and if I missed it by a day or even a few hours, my body would throw a fit. It was a bitch to get off of, but I feel it did help me cope better with my depression because if it was a day or 2 before I got paid and I ran out, I definitely could see a big difference in how I was mentally.

    XR for antidepressants are much more tolerable/easier to remember then the old version(s)

  14. Dresarius says:

    Seriously?

    How to save on prescription medications. By buying this guy’s book?

  15. Caffiend says:

    Umm. No.

    Totally bad advice. I take the Wellbutrin XL, and have since its release. Prior to that, on the Twice a day SR, I would frequently forget – and suffer the consequences. Anti-depressants are less forgiving than other medications. The time release aspect of the XL really reduces the swings even normal doses of SR can cause.

    /And if you’ve never missed a few days of an anti-depressant – it’s a very unplesant experience!

  16. Caffiend says:

    Oh, and Wellbutrin, SR and XL are all available as generics.

  17. mrgenius says:

    @bohemian:

    I am totally with you. I think it really would behoove most folks to try to get comfortable with asking their doctors what they want. Doing your homework beforehand will do wonders too.

    I probably represent the flip side of the coin from you, as I’d rather carry nothing and pay for the convenience.

    I’m sort of troubled by the tone of the post because as evil as drug companies can be, the fact remains that those of us who so choose to buy these new-fangled designer name-brand pills are indirectly allowing for the R&D of newer drugs.

    I shudder to think the progress we’d have made if the pharma companies DIDN’T have a profit motive. And I am a pinko commie liberal too.

  18. SkokieGuy says:

    Gee, not much Consumerist love in this thread! Since we are talking prescription drugs, no one is in danger of changing the drug they take with horrible consequences.

    We ALL have to rely on our doctor’s advice and recommendations.

    Since some people may not know / understand about how drug companies repackage their drugs to extend patent protection, this is an informative article.

    Remember, the drug companies could have offered all the versions at once, but by delaying releases till patent protection is near expiration helps them control the market for many times longer than traditional patent protection would provide.

    And it’s just coincidence that ‘studies’ often surface indicating problems with an aging version of a drug, who’s patent protection is about to lapse, and right around the same time a newer version (with full patent protection) is being introduced. Just coincidence……

  19. Trai_Dep says:

    Luckily, the dealer that lives down the street from me is a firm believer of generic versions of his products.

  20. selectman says:

    I pay $8 for generic 60x 50 mg Ultram pills and $30 for 60x 100 mg Ultram ER for back pain. The full cost of the ER version to my insurance company is over $200.

  21. Echodork says:

    Prescription medication is not laundry detergent or off-brand soda. You shouldn’t be making purchasing decisions based on price.

  22. shorty63136 says:

    I agree – this post (and other Rx posts by the Consumerist) have been a bit irresponsible lately. Sure, you said seek a doctor’s advice first, but how many people are going to COPY-PASTE this and FWD to people who aren’t paying as much attention or who simply don’t know to do things a certain way (especially if they already have psychiatric issues).

    Sure, we should ALL do things this way or that way, but I find it rather disheartening that Consumerist would advise you to SHUN drugs with 2 letters after and then splash a picture of an anti-depressant as an example.

    Stop it Consumerist. Either A) don’t let interns do stories like this (or pick the pics…not saying that’s what you do/did here) or B) put LOTS more thought into it before you do something like this.

    No. No love on this thread. You’ve got to be careful with things like this because not EVERYBODY is a responsible consumer or pharma-educated.

  23. womynist says:

    @gorckat: In all fairness, I don’t think the Consumerist is in any way advocating that people change their medications because of this. I think they’re simply alerting people to the fact that there’s a lot of shady business going on in the pharmaceutical industry. Ever notice the meds that are advertised the most are prescribed the most? And they’re the most expensive, too. Yaz (Yazmin) is a birth control pill that claims it can help you lose weight. However, if you read the fine print on the commercial, you see that it doesnt really do anything. It says something about the average weight loss being like 1/2 lb. a week. I know someone who was on this pill and with health insurance, her copay was $50 a month. You can get a generic of multiple other b.c pills for like $10 a month. And there’s nothing that can help you lose weight like eating healthy and exercising =)

    Advertising = Revenue

  24. selectman says:

    @selectman: Should have added:
    On one hand, I would be all over the place without the ER version, so I appreciate the consistency. However, it’s not exactly “innovation”, so it seems like the problem is in the patent office loophole and not the fact that drug companies are taking advantage of it. Eliminating the loophole would take a profit stream away but I don’t see it crushing innovation.

  25. CaptZ says:

    @nicemarmot617: 2 and half years? Wow……….just wow…..

  26. pantsonfire says:

    This might be somewhat off topic, but does anyone here buy their prescription drugs from Canada? I have noticed that Canadians have access to generic drugs long before we get them. Does anyone have any recommendations for a good online Canadian pharmacy? Somehow I just don’t trust that the unsolicited e-mails I get promising cheap Canadian drugs are on the level.

  27. CaptZ says:

    Still waiting on that generic insulin…….

  28. TacoChuck says:

    If you think I am giving up my morning Robutussin AC you are sadly sadly mistaken.

  29. shorty63136 says:

    @CaptZ: Yeah – not easy to change/come off of something like that. I was on anti-Ds for 5 years (Wellbutrin XL alone for 3 of them – and that XL made the DIFFERENCE for me, might I add) until the last 2 months when I decided to try and get off of them again.

    So far so good.

  30. ionerox says:

    @oldheathen: No kidding.

    I’d happily take a generic version of a pill when it’s available, any doctor I’ve had has always attemped a generic before trying a name-branded version of a medication. What I’m waiting on is a generic version of my migraine medication Imitrex, because $225 for 9 pills (what my health insurance pays, per the pharmacy label)is insane. It’s great when it works, but it’s not a magic pill by any means.

  31. temporaryerror says:

    @Trai_Dep:
    Actually, from what I understand, RX meds that have street value are more valuable with the brand name drug than the generic. Also, if you are abusing them, some brand names have properties that are more desirable than those of the generic counterparts…

    BTW, is Prozac Weekly still around? 1 pill a week, big 90 mg capsule…

  32. temporaryerror says:

    @TacoChuck:
    I think that you need to check the Purple Drank thread…

  33. Ben Popken says:

    @shorty63136: I once read an article about how to dig a hole. The author should probably be ashamed of himself, because someone could fall in it.

  34. arl84 says:

    I think the previous commenters should lighten up a little. They used Wellbutrin as purely an example – and the last paragraph in the article even says, plainly, that there are certain cases where these types of meds are better for you, and to talk to your doctor.

    In these times, every single way to save a penny is needed, and the Consumerist is looking at innovative ways to do that – even if it means moving into territory that is sensitive for some people. I for one appreciate this article, I found it very informative and useful.

  35. @pantsonfire:

    yes, i do. i’ve been buying my wellbutrin xl (speak of the devil!) from doctorsolve.com, a canadian pharmacy. i have to fax or e-mail them a copy of both my prescription and driver’s license, and they always ask when filling the prescription about any other meds i’m taking to be sure there are no interactions. i pay about $150 for a three month supply of the NAME BRAND wellbutrin xl. if i wanted a one month supply here in the u.s., even WITH my insurance i’d be paying that much per month.

    as far as the generic versus the name brand, i have to agree with other posters saying shame on the consumerist. my doctor warned me when the generic xl was coming out that the reason the drug company was fighting the generic so hard was because patients weren’t responding the same way to the drug. apparently the way the generic releases the drug isn’t the same as the original, and she advised me to keep taking the name brand for that reason. she hates the drug companies, so i know she wasn’t telling me that so that i’d keep stuffing their pockets.

    it’s not always about money, consumerist. wellbutrin literally gets me out of bed each day, so to say that all this issue comes down to is money is a load of baloney.

  36. jonthegm says:

    I’ll gladly add to the personal experience club about the (pictured) Wellbutrin XL.

    I couldn’t afford Wellbutrin XL (because my insurance wouldn’t pay for the non-generic), so my doctor switched me to the SL or whatever the generic is.

    I had thought that the headaches, dizziness, and ringing in my ears had been bad before. They got much worse since a more concentrated amount of drug was hitting my system at once. (Not to mention any other differences the inactive ingredients might have had.)

    Now I’m on generic Celexa, which seems to work ok. Unfortunately, it costs me $20 to get a “pill and a half” for the 30mg, because my insurance refuses to pay for anything but the 20mg or the 40mg.

  37. howie_in_az says:

    @jbrecken: Not according to me and my grandfather; both of us get horrible nightmares if we take Tylenol PM. We’ve both switched to 3mg melatonin tablets for a good night’s sleep.

  38. Cerb says:

    I generally enjoy the Consumerist but posts like this are completely irresponsible, inaccurate, and misinforming. When an epileptic stops taking his extended release medication because the Consumerist told him the evil pharm companies were ripping him off, don’t be surprised when he hires a lawyer. The consumerist should leave the job of dispensing medical advice to those with medical degrees.

  39. camille_javal says:

    @selectman: Good point about the loophole.

    While the posts themselves aren’t so bad – obviously you should talk to your physician – I think it’s just to some of us on medication, who’ve dealt with some of the realities of switching medications, they can come off a bit glib.

    I switched to bupropion SR for a while, after discussing it with my doctor, when my prescription coverage was a joke (wouldn’t fully cover most generics with the monthly cap) and before Wellbutrin XL had a generic. In addition to the general problems of having to make sure you took it at the same time every day, even when I took it at the exact same time every day, I experienced peaks and valleys on a daily basis that became almost dangerous. I finally had to decide that I’d rather shell out $120 every month and be stable.

    Many of those of us on antidepressants are probably a bit sensitive because, when people start talking about the over-prescribing of America, we’re one of the big groups who gets attention. (Doesn’t matter how many of us tried to avoid this route, or for whom going off medication, in the long run, tends to be a very bad thing.)

    Of course, what both this and the last prescription post have in common is the message that people, if they’re going to be on medication, should make an effort to keep talking to their doctors. With HMOs, a lot of them won’t be checking up on you, so you have to speak up.

  40. psychos says:

    It’s not about the nature of the drug, necessarily, thus I don’t think statements to the effect of “you shouldn’t take non-XR antidepressants” are very meaningful. Whether extended release is useful is about a complex combination of the half-life of the drug, clearance/elimination time, time to reach a steady state, time to reach peak plasma concentrations, and how your own body happens to process the drug. I’m not a medical professional, so take this advice with a very large grain of salt. The best advice I can give is: research your drugs thoroughly, talk to your doctor and pharmacist, and ask if it’s worthwhile for you to take a non-extended release version of your drug if it’s significantly cheaper or might have other benefits. (Longer isn’t always better; I take Adderall on a daily basis, and significantly prefer the non-XR version even though it has more of an apparent “crashing” effect, simply because with the XR version I get fairly severe insomnia as it’s floating around my body much longer.)

    Example from a little bit of Googling: Effexor has a half-life of around 4 – 6 hours. This means that for the average person taking it with NO drug in their system, after 4 – 6 hours half of it will be gone. In this case, it is probably a very good idea to take an extended release version. Prozac, however, has a half-life of around 1 – 4 days. When you consider that if you’re on these drugs long term, you already have a decent concentration built up in your body, and there would likely be absolutely no reason to ever take extended-release Prozac on a daily basis.

    (In fact, Prozac stays in your system so ridiculously long that they decided to make an extended release once-a-week Prozac Weekly version.)

    There are other factors here. The suggestion not to take immediately release Wellbutrin because of seizure risk IS applicable whether or not you’ve had seizures. (The Wikipedia article on Bupropion has some good numbers.) Numbers I recall reading in some actual studies showed that at a somewhat high, but “normal” dose of immediate-release Wellbutrin, seizure risk went up to 0.4%, compared to 0.2% for the SSRIs being compared, but actually was lower at 0.1% for the same daily dosage of Wellbutrin but in SR form.

    And of course, some people (especially younger children) will have a harder time remembering to take a drug 2 or 3x a day rather than 1 or 2x a day.

    Bottom line, talk to your doctor and pharmacist, and DO YOUR RESEARCH. They will often try to push much more expensive extended release versions that you might not need and that aren’t available in generic, when an immediate release might be generic-but conversely, there are of course many situations where it is a very good idea to take the extended release.

  41. pantsonfire says:

    @gnappulicious: Thanks for the info, I will definitely check them out.

  42. RabbitDinner says:

    @TheShepherd: Shun the nonbeliever! Shuuuuuuuuun

  43. puka_pai says:

    @Caffiend:

    Oh, and Wellbutrin, SR and XL are all available as generics.

    But they aren’t always cheaper. One of the best ways I’ve found to save money on medications is to find out what your insurance company has on their standard formulary. Ours has three different levels, and they used to be easy to distinguish: generic, brand (co-pay 3x generic) and premium (co-pay 7x generic). Now, however, I’m finding more and more generics are falling into that premium level and so taking brand is actually cheaper. The rules about dispense generic unless brand-only is specified by the doctor haven’t changed, though, and so you can get a nasty surprise at the pharmacy.

    Of course, this is if you’re lucky enough to have insurance. Mine may suck but it beats none.

    @shorty63136:

    how many people are going to COPY-PASTE this and FWD to people who aren’t paying as much attention or who simply don’t know to do things a certain way (especially if they already have psychiatric issues).

    Wow, what an insulting thing to post. We’re depressed, not STUPID.

  44. audiochick says:

    @oldheathen: Hell yes! I’ll keep my Maxalt-MLT, thank you!

  45. And then you run into someone like me, who happens to be allergic to an inert ingredient in the generic version of Wellbutrin. The generic caused me to break out in hives, which really sucked. I’ll pay the extra money for no hives and no chance of an even worse allergic reaction down the line, thank you very much.

    This is rare, and according to my General Practitioner it’s very likely that I’m more prone to side effects than others. I’m not the only one, but I’m sure this advice is sound for people who don’t have this problem. Thankfully, because I had an allergic reaction, my healthcare provider was “nice” enough to cover it at the generic price.

  46. psychos says:

    @gnappulicious:

    What, you don’t expect generics that can theoretically be declared “bioequivalent” simply by having 80 – 125% of the “active” metabolite will work the same? (Hmm, and let’s do a little math here: potent generic A with 125% of that metabolite actually has ~56% more of it than weak generic B at 80% of the original! Imagine, your pharmacy could simply switch generic manufacturers on you and suddenly you’re getting up to 56% more of your drug, or up to 36% less.)

    There are a whole bunch of issues past these that the FDA simply doesn’t seem to care to test for, mainly because most generics do indeed work well. But there is plenty of evidence out there that many do not.

    (And I do think generics are a wonderful thing, if that wasn’t clear, but our standards for them need to be better.)

  47. chaitea says:

    @pantsonfire:
    I’ve been using a Canadian pharmacy ([www.crossborderpharmacy.com]) for my mom’s maintenance drugs for years now. I particularly like Cross Border because they’ll check around the world with their affiliates for the best possible price, and don’t stick us for extra shipping costs.

    I’ve never had a problem with a prescription, or with their billing, pricing, or shipping.

  48. shorty63136 says:

    @puka_pai: I’m not saying YOU – but when people read FWDs, generally they don’t read them thoroughly and all the way through. And I used the words “psychiatric issues” because it’s not limited to depression.

    I’m sorry you were offended, but it wasn’t mean to be offensive. I’m more blatant with mine than that. Thanks.

  49. @psychos:

    i can’t tell if you’re being sarcastic or not, and the concept of metabolites confuses me to be honest. :S

    i would love to take a generic if possible, but you’re right: the fda sucks. i mean, they’ve been in bed with monsanto for years now, so how can we trust them to regulate anything else?

  50. dangermike says:

    One big exception: Tussin-DM. The DM stands for dextromethorphan which is a highly effective expectorant.

  51. @Ben Popken:

    well, i did sort of get shorty63136’s point (minus the implication of stupidity of those taking antidepressants). consider all of the stuff that gets forwarded around. if people weren’t stupid enough to believe all of it, snopes.com would be out of business. :)

  52. Tmoney02 says:

    @Cerb: When an epileptic stops taking his extended release medication because the Consumerist told him the evil pharm companies were ripping him off, don’t be surprised when he hires a lawyer.

    /Rolls eyes
    Give me a break. A bit Dramatic don’t you think? If that epileptic stops just because this article I would say Darwin is at work, and it was his personal responsibility to make that choice and thus his personal responsibility for the results of his choice. These are prescription drugs which should mean obviously consult with a doctor before making any changes. In fact consumerist says it right in the article – As always always always, any change in your medication needs to be discussed with your doctor.

    @Cerb: completely irresponsible, inaccurate, and misinforming.

    Irresponsible would be reading a 5 paragraph blurb from an internet blog on perscription drugs and making any change without consulting a doctor and doing further research. The point of this article was to inform people what the two letters mean after their prescription and how the industry works. Also to show that in certain cases you may be able to save money by switching to a different version but to consult your doctor (as you would have to anyways since these are prescription drugs). So how is that inaccurate or misinforming?

    I will end by saying that because of this article I am now more informed about prescription drugs and now have something to talk to my doctor about should I need a prescription. How is consumerist or any other media outlet supposed to present basic medical information which may help you without resorting to writing an entire medical journal explaining medications that don’t apply?

  53. malraux says:

    Yeah, the deal with a lot of the anti-depressants like wellbutrin is keeping the bio-availability of the active ingredient at a pretty constant number and that number is actually very close to the toxic level. SR and XL are not just ways to extend patents, but help keep the drug at the right level.

    Oh and the generic version is not the same. The bio-availability of the generic is very different and much spikier than that of the name brand.

  54. psychos says:

    @gnappulicious:

    I was indeed being sarcastic. I think it does suck that you have to import drugs from Canada mainly because the generic available here only has to be “pretty close” to the original. Of course, I don’t expect generics to be 100% identical, but the FDA’s definition of how close they need to be needs to be a lot better than it is in my opinion.

    A metabolite, quite simply, is a byproduct of metabolizing something. Many drugs don’t directly do anything, but need to first be metabolized by the liver and/or kidneys into other substances. The metabolites that actually have a therapeutic effect are called “active metabolites.” Some of these metabolisms are ridiculously complicated, involving 3 or more passes through the liver, and generating multiple active metabolites at different stages of the cycle. I think you can probably see how, in a situation like this, simply testing for active metabolites might not be good enough. Toss things like slightly differing extended release systems in the mechanism and it gets even worse.

  55. pantsonfire says:

    @chaitea: Thanks for the tip, I’ll check them out too.

  56. floraposte says:

    I would just disagree with the direction of the conclusion–I don’t think they all or perhaps even mostly translate to unnecessary ripoffs. So I think instead of “Shun these drugs” I’d agree with a message of “If you’re taking one, you may be able to save money by going with an older version.” Make the investigation the default, not the change.

  57. Rectilinear Propagation says:

    @Echodork: If prescription medications’ prices were similar to the cost of laundry detergent or off-brand soda we wouldn’t have to but medication is too expensive for price not to be an issue.

  58. Consumerist-Moderator-Roz says:

    Folks, if you’re going to post in this thread, make sure you follow our guidelines. Specifically, if your issue is with Consumerist editorial choices, it does not belong in comments. It belongs in an email to the editor directly. Likewise, broken links and the like should be emailed to the editor directly.

    Advising caution (e.g. specific examples where the advice in the post doesn’t apply) is okay. However, we get it – don’t blanketly change prescriptions, talk to your doctor, just as the post says. From here on out, make sure your comments follow the code. Everyone.

  59. CaptZ says:

    Ummm….I was being sarcastic about my Wow…..just wow….for all of you taking antidepressants…..

    Hence the article linked:

    [www.independent.co.uk]

    Go get some excersize, some real life friends in addition to online ones, and maybe even counseling…..you know….an active lifestyle basically.

  60. I used to take Effexor. It treated my depression well, but it also made me perpetually nauseous. Enter Effexor XR. No more nausea, but depression was still treated.

    This suggestion from Consumerist definitely isn’t a one-size-fits-all.

  61. christoj879 says:

    @nicemarmot617: Funniest thing, I wanted to titrate off of Paxil, and as we all know, SSRI discontinuation syndrome is not fun. However, recently my company has seen a tenfold increase in our work volume that I was so busy I forgot to take it. Usually if I forget one or two my body bitch slaps me into taking it, but this time I haven’t had it in over a week and the symptoms are very manageable (only mild headaches every now and then, but everybody gets those), nothing like it has been before. I think my will to get off of it has something to do with it, and I expect to have symptoms for up to a year (I was on it for almost a year), but I’m seeing that all it did was make me a bit more personable.

    The worst side effect was that it made me talk to other people. Yuck.

  62. psychos says:

    @CaptZ:

    I am confused as to your statement of sarcasm. If you are being sarcastic about your “Wow”, then why do immediately, in what seems to be a negative tone, point out that depressed people “basically” just need to exercise, have “real” friends, and seek counseling? A single link to an article in a non-scientific publication really does not prove anything. Now, this is not to say that things like exercise do not help depression; it certainly does, for many people, and there are indeed scientific studies to back that up.

    I, personally, suffer from depression, and do not take medication specifically for depression, as I have tried medication in the past without success. Yet I would consider myself quite fit, would like to think I have a great group of friends (both “real” and “online”), and have tried counseling. So, yes, medication does not necessarily cure depression; but then again, the other suggestions posted may not either.

    However, I know plenty of folks suffering from depression who have done all of the above, as best as they could, and then successfully turned to medication. For some of these people, temporarily being on medication helped their mood enough to actually DO the other things like have enough energy to start exercising more, and to be more sociable. For others, semi-permanently being on medication was the only viable solution.

    I do not personally advocate medication as a first line treatment for conditions such as depression in most cases, but it is certainly an option that has helped many people, both from firsthand experience with these people and from having carefully read many studies involving all of the available treatments. It is, in my opinion, not at all informed to suggest that people on anti-depressants have not bothered to try an active lifestyle, seek out “real life” friends, and so on.

  63. audiochick says:

    @CaptZ: Please do not assume that because someone is taking an anti-depressant they must be living a sedentary, lonely or unhealthy life.Some of us are not on anti-depressants for the obvious reasons but for other things. I’m not depressed, but when I was diagnosed with migraines my doctor prescribed an anti-depressant because it is known for preventing migraines. It didn’t work for me, so I am taking anti-seizure medication now, even though I’m not epileptic, either. Unfortunately, when you are on an anti-depressant, regardless of the reason, you are still subject to symptoms of withdrawl and other side effects if you miss a dose, which is why a lot of people who happen to take anti-depressants are taking an interest in this post in particular.

  64. guroth says:

    do realize that several popular anti depression medications are also prescribed for anxiety, panic disorders, ocd and add

  65. e.varden says:

    @puka_pai: @puka_pai:

    “…we’re depressed not stupid”.

    Lucky you, Bucko. I have a couple of post-graduate degrees and a history of being known as a sharp wit, and clever marketer in the world of play-spaces for children. Yet when I’m in the “black jaws of despair” I am functionally stupid. I am incompetent, and the sight of a form-to-be-filled-out washes me into a sea of panic and fear.

    Without a simple, dependable SSRI (like Effexor Extended) that I take like rote every morning, I would be a ward of the state.

    Contrary to your good fortune, severely depressed people can be severely stupid people; incompetetent, and dangerous to themselves and to others who (unfortunately) may depend upon them.

    Take grace in your luck to be depressed and functional; we are not all like you.

    Sincerely, e.varden – way less likely to be scarily stoopid when medicated….can even write a letter like this one.

  66. parnote says:

    @jbrecken: Tylenol PM may be ok, but you’ll save a TON of money buying generic acetominophen and generic diphenhydramine (Benedryl), instead of them already mixed and sold under an expensive brand name.

  67. parnote says:

    There’s no argument that the “advanced” time-release/extended release/sustained release drugs are a lot more expensive and tried-and-true ways for drug companies to prolong patents and to reap (rape?) more profits from an already gouged health care consumer.

    But, as a health care provider, there is also no argument that it is easier for health care consumers to remember to take only one pill a day, versus three or four a day. And the fewer they have to remember to take, the greater the chance that the health care consumer is going to be more compliant regarding their medication regimen.

  68. almk says:

    The prescription I take is ER (extended release) and it is already in generic form, so it doesn’t cost any more. AND because it is extended release, I get two benefits:

    1. the drug releases slowly into my body so it is active at a regular level for a long period of time

    2. the side effects of the ER version are drastically less than in the regular version

    This story is BS

  69. MunkyBoi says:

    Time-release isn’t just for convenience. I’m stuck taking a couple different meds for malignant blood pressure, and over the years, the extended release versions of the same meds I started taking have proven to be a lot more effective than the scheduled doses they came out to begin with. I can see how pharms can benefit from re-releasing the same meds over and over again, but I think that Consumerist is way off base by posting what’s here. I take what is said here at face value, but from here on out, I’ll tread more carefully. I think it was more a matter of opinion than fact.

  70. psychos says:

    @parnote:

    I’d have to say that your second point is actually somewhat subjective. These are just random examples with no scientific backing, but I think they’re worth considering. For one, if someone is occasionally forgetful about their medication but usually takes it, being on, say, a 2x daily dosing regimen means that a single missed dose is less of an issue than if on a similar medication 1x daily (with certain obvious assumptions about drug durations and such made.) To further conjecture, I would propose that, for some subset of the population, it might actually be EASIER to remember to take a drug twice a day instead of once a day, since you’re doing the action on a more regular basis.

    And to wildly conjecture again, let’s take a hypothetical example of a patient who MUST take drug A only in the evening. This same patient is on drug B which can either be taken once in the morning as an extended release, or taken in the morning as an immediate release and then again in the evening as another immediate release along with drug A. Again as above, missing drug B will be less of an issue if one dose is missed on a 2x daily schedule than missing a single daily extended release dose.

    To further the above argument, take one of the following scenarios. Let’s say the patient is responsible, but just not a morning person, and will sometimes forget to take the morning drug-but will not almost never forget to take the evening drug(s). In that scenario, I’d say the likely missed amount of dosage is LOWER with a 2x daily dosage than if it’s just taken once in the AM. A second scenario, let’s say drug A, the required evening-only medication, is something like an anti-arrhytmic drug that the patient knows might save his or her life, whereas drug B (the morning-only or 2x daily one) is an anti-psychotic that the patient thinks makes him or her feel better, but that a missed dose of isn’t potentially fatal. In this case, again, I would argue that a 2x daily dose is likely to provide more consistent average dosing.

    Now, these are again just extreme examples with absolutely no scientific backing; however, I do believe that they are likely to be possible, and that healthcare providers should evaluate the patient in situations such as these to determine what sort of dosing might be better, since they MAY actually be superior to a single daily dose of an extended release drug. I would agree that the average patient is likely to do better and be happier with taking a single daily dose rather than 2 – 3x doses a day.

  71. psychos says:

    @almk:

    I believe both of your points are only valid for some drugs, and that those points also depend on the patient.

    To address point 1, many extended release drug actually have an initial peak that is comparable with taking an immediate release form. (This tends to be in the form of an immediate release over-coating over an extended release pill, or something like that.) So the initial release is NOT any slower. However, it will generally be active for longer, but this may or may not actually be a desired effect. I gave the example somewhere above about Adderall (which I take) vs Adderall XR. I like the non-XR because it clears out of my system faster, and leads to significantly less insomnia. On top of that, I don’t need the anti-ADHD properties of the drug past an 8 – 10+ hour workday, which is what I take this drug for. The non-XR lasts long enough for me to cover 10 hours fine, and be somewhat effective if I’m working late, thus I feel it is superior (for me) since it’s not in my system as long since I don’t need it for more than part of the day. The tapering off of this specific drug IS actually noticeably a bit more for non-XR than XR, but it doesn’t cause me any ill effects past just noticing it. Additionally, I need to have a certain amount of this drug in my system to be effective; if the drug lasts for longer due to an XR form, that would mean the total dose I would have to take each day would be greater, and for any drug (and especially something like Adderall) I like to minimize my total exposure.

    As for your second point, the side effects being less are HIGHLY dependent on the drug. Again, some drugs have a higher initial peak; some extended release forms DO allow you to have a lower peak concentration of the drug in your blood and keep a better average concentration, which may indeed lower side effects.

    Now, I do agree with you that the general headline of this article is BS. One should not shun these “two letter”-suffixed drugs, but simply be aware of what the extended release mechanisms are, what the alternatives are, what the costs are, and how the effects of the drug might vary between the two.

  72. psychos says:

    @psychos:

    Just have to point out another minor thing here, flexible dosing on non-extended release drugs. I can take either a half or a quarter of a 2nd Adderall non-XR later in the day if I either am really low on focus, or need to work very late. (The manufacturers, at least of the generic I take, were kind enough actually double-score the tablet so it can be split in half in both directions.) This actually closely mimics the effects of the XR version, as shown by the peak plasma concentration curve in the XR PI sheet. So I have the option to either select taking a regular shorter-duration dose (as I do 80 – 90% of the time), or taking a second, lower dose to extend the duration of the drug when I feel that I need the drug to either be more effective or last longer (without taking a higher dose every day, since most days the dose I’ve standardized on is fine; and also lower than the XR dose I’d have to take for the same benefit for the usual 8 – 10 hours.)

    And on top of that, on the few weekend days that I need to do something that calls for my mind to actually focus on a difficult task, I can just take half my regular dose for the entire day, since the non-XR can, again, be quite handily split. With an XR version, I’d be stuck either taking the entire dose, or taking nothing.

  73. crypticgeek says:

    The consumerist should NOT be giving medical advice like this and then say “oh, but make sure you check with your doctor first!” Well duh, but the information you are giving can be widely inaccurate for a variety of different people. I think it’s irresponsible. A simple bit of advice to talk to your doctor and your pharmacist about any ways to lower your drug costs is where I would draw the line. Anything else is speculation, and dangerous speculation at that.

  74. puka_pai says:

    @e.varden:

    Take grace in your luck to be depressed and functional; we are not all like you.

    Depressed and functional? What a concept. I wish I knew what that was like. I suppose you could consider me functional since I did take a shower today, but that’s not always true. Some days are better than others.

    Still, you’re not stupid even when depressed and panicky. If someone sent you something in e-mail that encouraged you to make a drastic change in your meds you wouldn’t just do it. That’s what I mean by not stupid. You’d talk to your doctor about it, even if, like me, it took you weeks to work up the nerve just to pick up the phone.

    I envy you your multiple degrees. I’m hoping to fight my way clear of The Pit to finish my first one some day.

  75. varro says:

    @jonthegm: I’m also a generic Celexa taker – and Lexapro is a *scam*.

    I went from paying $60 co-pay for Lexapro to $7 for a month’s supply of generic Celexa at Costco, and the generic worked *better*.

  76. mmmsoap says:

    Unnecessary profits? Show me your medical or pharmaceutical degree, then we’ll talk.

    As many comments have noted, XR, CR, SR (extended release, continuous release, sustained release) tend to be letters at the end of the drugs that are pretty darn important, particularly for drugs that people take daily, as a long-term regimen. This includes diabetes meds, anti-depressants, various treatments for ADHD, anti-anxiety medications, and many many others. For many people, these turn out to be significantly cheaper, whether it’s just a monetary value, or a overall quality of life calculation (maybe the drugs cost $1000 more in a year, but if it means you feel better enough that you’re not calling out of work constantly, you’re going to earn more money over that same period.)

    What many drug companies ARE guilty of, it is true, is combining known formulas to extend the patent. Claritin-D is claritin + a decongestant, for example. Some of the new cholesterol drugs have been combined with old-school vasosuppresors and given a new name, etc.

    However, to call ALL drugs with “extra letters” a scam (“unnecessary profits” my ass) is incredibly irresponsible. There’s no way the average consumer, without a LOT of education and research, could possibly make an informed decision about which option (extended release or “regular”) would be appropriate for them. Frankly, I’d rather pay someone to be informed for me (ie – my doctor and my pharmacist). If you’re not on board with what your doctor thinks you should take, get a new one. I’ve had very open discussions with my doctor about the pros/cons of extended release or regular, and which fits into my lifestyle, my tendency towards side effects, and my particular diagnosis best.

  77. unpolloloco says:

    @Tmoney02: The American judicial system would disagree with you.

  78. psychos says:

    @mmmsoap:

    I do not believe that you can count on your doctor and pharmacist to simply be informed on your behalf. You need to research the drugs ahead of time, figure out WHAT the exact extended release mechanisms are, figure out how it will compare to taking multiple doses of an immediate release version of the same drug, and have a decent idea of how your body will process the drugs. (Which will, quite likely, entail trying both the extended release and immediate release versions of the drugs, when it’s safe to do so.) If my doctor does not think I should try both versions of the drug, when I’ve done plenty of research and it seems that it might make sense to do so, then I would certainly get a new one as you suggest. But I do think that it’s very common that doctors will just prescribe what they think is the most convenient drug form without thinking twice about your circumstances, or even your condition. (I again bring up my own reasons for taking regular Adderall over Adderall XR, even though I do think the XR is better for many people; but it took me a few psychiatrists to find one who was savvy enough to work with me on trying various dosages of both versions to figure out which would work the best while causing the least side effects.)

    And suggesting that you are paying your pharmacist to be informed for you? I’m sorry, but the average retail pharmacist does NOT do that. I would not dispute that they actually know the issues there, certainly better than I do, but they simply oversee the dispensing in most cases, and the tech who takes care of you at the register doesn’t really care if you have a question for the pharmacist or not. (And the few times that I HAVE tried asking a retail pharmacist a question, always when I knew the correct answer, they did not give me a very good answer.)

    ALL drugs with “extra letters” are certainly not a scam, as you note. However, many are, and nobody will tell you about them unless you perform due diligence, figure out for yourself that they MIGHT be, and then talk to your doctor and pharmacist (after having a somewhat informed opinion) and find out what they think about the matter. There are, as I’ve previously noted, many drugs that ARE better in extended release form-but not necessarily for everyone, yet many doctors will prescribe what’s most common.

    What hasn’t been noted here much are the stupid patent-busting drugs that are just modified versions of existing drugs. A very good point is brought up by varro a few posts up; Celexa vs Lexapro is often a scam. Celexa is citalopram, with half of it (the R-citalopram) not really doing much as far as most studies can tell. Lexapro is a “purer” form of the other half, pure S-citalopram (“escitalopram”.) It has been VERY heavily marketed as having less side effects than regular citalopram, yet it’s hard to find studies that actually prove that. When I was trying out various anti-depressants (including foraging off into the less-socially acceptable anti-epileptics, anti-psychotics, and so on under the guidance of a rather knowledgeable psychiatrist), the very first thing I was given to try, by a GP and not a psychiatrist, was Lexapro. It cost me a ton at the time. An ideal trial, now that I’d consider myself a more informed consumer, would have been to try both citalopram, which was available as a cheap generic, and escitalopram, which was only available as brand-name Lexapro at the time. But this was not the case, as my GP at the time had been heavily plied by the marketing companies; and she was quite happy to give me a free trial of Lexapro (which was just long enough of a trial to determine that I wouldn’t have horrible side effects, and should get at least one month filled at the pharmacy.)

    I’ve since often challenged pharmaceutical reps when they’ve shown up at my psychiatrist’s office (which seems to happen about every monthly visit), and asked them exactly what manufacturer they’re representing, then knowing that which drugs they’re representing, what the differences are between the former drugs (if they’re selling things like stupid cut-in-half stereoisomers), and what the pricing and reasons would be for me to take the newer version of the drug. I have yet to come across a pharmaceutical rep who has given me a cogent argument to take a cut-in-half stereoisomer, a “new” version of a drug that my liver just has to process back into the cheap old generic drug, or an extended release version of a drug with a half-life that doesn’t warrant more than daily dosing, yet still exists. (And I ask these question for many drugs that I’d never take, simply because I’m a bit obsessive about the topic and tend to do research on random psychiatric drugs for fun.)

  79. renegadebarista says:

    I don’t like paying out the nose for prescriptions more than anyone else, and with one month of my MS meds costing over $1400 I think I have a little room to complain, but this and the previous post are just out of line. I understand wanting to save money on meds, especially each month when I have to try and come up with the cash for mine. But the recommendations here and in the previous story can be dangerous. Cutting or changing your dose can have horrible effects. I know others have said this, and I know that I’m probably going to get nailed for saying it again, but I really don’t care.

    Ben stick with what you are good at, there have been many many good items that have helped consumers here, this is not one of them. Stick with the grocery shrink ray appearances please don’t try to play a doctor here or on tv.

  80. psychos says:

    @renegadebarista:

    Final comment here. I must strongly agree with your comment; The Consumerist is where I come to find out about things like the Grocery Shrink Ray, or the Worst Company in the World.

    This may perhaps be a bit out of line with your editorial policies on comments, but I do not think that a site like this, with non-medical folks running it, should be dispensing medical advice of this nature.

    The very premise of the “Shun Drugs With Two Letters After The Name” concept is basically flawed. Unfortunately, many people will simply read the main article, and not read the comments. I would say that the majority of the people in the comments have been quite on base as far as recommending that extended release drugs might be good, but then there seem to be quite a few trolls suggesting things like anyone who is taking anti-depressants just needs a bit of exercise and “real-life friends.”

    There are a ton of very good sites where one can read about the ins and outs of medication, and I do not think that this is one of them. Please, please, stick to things like the Grocery Shrink Ray.

  81. pharmchick says:

    The comments on this post got the pharmacist nerd raging inside me a bit impassioned.

    @mmmsoap: You’re completely right about already paying your pharmacists and doctors for their free (and hopefully unbiased advice) as well as the point you brought up about the overall quality of life cost. I don’t think people always stop to think about the grander scheme of things, especially with prescription costs being as ridiculous high as they are.

    I haven’t read the book this post links to, but any good pharmacist should be able to provide you with free advice to save quite a bit of money. Regarding “extra letters tacked on” drugs, many of them are losing their patents within the next few years, which will provide cost savings. It’s important to remember that a brand name drug is not always better – generic means older, and older means a larger body of evidence regarding efficacy and side effect profiles.

    To step away from this extended release debate a bit, I feel as if this is only one small issue in the larger realm of medication cost. Some points I like to bring up to my patients:

    1. No prescription is worth the money you’re spending on it unless you are using it correctly. Make sure you are a well-educated patient and consumer – using appropriately prescribed drugs in an appropriate manner will almost always be cost-effective.
    2. Pick your pharmacists’ brain. We know more about drug costs than anybody, which often means we will know about a discount program you can sign up for, or have suggestions for talking with your doctor about less expensive, equally effective alternatives. If you’re nice, many of us will even offer to consult with them on your behalf.
    3. If you’re taking 100mg of Drug X, see if it comes as a 200mg tablet. Sometimes they cost exactly the same amount, and you can cut them in half and have twice the supply for the same price. If you’re taking a brand-name combination drug, find out if the components are available separately for a lower total cost (it happens more than you’d probably assume).
    4. And finally, if you’re shopping around to different pharmacies for the best price, make sure each pharmacy knows all the drugs you take. Drug interactions at their worst can be dangerous, and in less serious cases can cause some of the drugs you’re on to not work as well. Your pharmacist genuinely wants you to be safe and healthy and paying for drugs that are working optimally for you.

    ::Hopping off my pharmacist soapbox now::

  82. Charlotte Rae's Web says:

    Yikes. This seems like an area consumerist shouldn’t be getting into.

    My child is on a med that is extended release. It is far easier to keep her on a level dosage, it also means she doesn’t have to leave class to get more meds nor do we have to rely on school staff to give her meds correctly. Furthermore, she’s a kid and hates to take meds. It is simpler to manage one dose than several.

    Also I took a drug called Metformin for glucose issues and the XR version made me much less sick than the regular version.

  83. ironchef says:

    never underestimate the sheer greed of big pharma.

  84. Meathamper says:

    I remember paying for pills with XR because it sounded badass.

  85. goodywitch says:

    How about talk everything with your doctor and ask if there’s a cheaper alternative? The end.

  86. TangDrinker says:

    @thnkwhatyouthnk: I had this happen to me on generic b/c. The filler in the generic was lactose derivative – and I’m lactose intolerant. Not fun.

    The PDR is your friend.

  87. nadmonk says:

    I’m agreeing with a lot of what I’m seeing here. If generics are an option, go with that. But the exact form of the medication you are taking should be a medical descision between you and your doctor. Those letters do make a difference. I’ll be the first one to complain about drug companies ripping us off and over charging. But if your doctor is good, there will be a reason for them prescribing these specific meds.

    Yes, the drug company probably released those versions of Wellbutrin on that schedule to maximize profit. However, that doesn’t mean the XL version isn’t better than SR or standard. I know someone who tried both the standard, SR and XL. The XL provided the most consistant med level for them and the best experience. That will not be true for everyone, and I feel that underscores the importance of consulting your doctor more closely than your pocket book when selecting meds…as much as that sucks financially.

  88. INTPLibrarian says:

    @CaptZ: Original article instead of dumbed down summary: [dx.doi.org]

    And unless you’re a doctor, why are you telling people to stop taking their meds? Even if you were a doctor, you’re not any of the posters’ doctor.

    Basically, ditto what psychos said.

  89. termitehead says:

    It’s like a game! Let’s see….

    ER = Extended Release
    XR = eXtended Release
    XL = eXtended reLease
    XT = eXTended release
    SR = Sustained Release
    CR = Controlled Release
    CD = ControlleD release
    LA = Long-Acting ?

    did I miss any?

  90. Tmoney02 says:

    @unpolloloco: Which would point out one of the many problems of said judicial system if I believed you. If I blog saying that aspirin maybe be a cheap substitute for heart medication but you should speak to a doctor, and some one ignores my warning and switches their medication and has a heart attack should I be held liable for their ignorance? I never claimed to be an expert and I have no credibility in medical subjects just like consumerist. I just posted something I heard. It was their choice to switch and their choice to believe the article written by someone with no medical experience (and never claimed said experience) and without any personal research, and their choice to ignore my disclaimer/warning. So how exactly would I be liable? Considering this is pretty much what consumerist did and they actually have a lawyer in the gawker network and this article is still up I would say no the judicial system doesn’t disagree with me, or at least I have a strong case.

  91. Wow, crazy commenters — maybe shills, or just a little jumpy from being over-medicated?

    Okay, okay, that was a bad joke. But still, READ the POST, people. Nowhere in there does it say “run out and start taking drugs you weren’t prescribed! grab a pencil and change your Rx to save some dough!” It says…TALK TO YOUR DOCTOR. It gives a useful tip, that in some cases the more expensive version may not be needed. ooOOOoo, how controversial!

    Most of you who are freaking out end up giving exactly the same advice that the article gives, and it’s making you look more than a little kooky.

    Take a chill pill! They’re free. ;)

  92. ChootinDaChit says:

    Oh my, it’s amazing to me how people are so defensive about their medications. Ben’s post is not attacking you personally, folks. If you’ve done your due diligence and are fully informed about your prescriptions, then just move on to another topic.

    One thing I haven’t yet seen mentioned in this post, however, is the heavy cost of prescription drugs on society in general (especially non-formulary drugs without a generic equivalent). A consumer may see that there is only a $X per month out-of-pocket difference between a generic and brand-name medication, and make their decision based on that (I’ve seen that logic already posted in this thread). What people may fail to realize, however, is that there is a large hidden cost for the brand-name drug that’s being picked up by insurance. These costs, added together, are a big part of why health insurance is becoming less and less affordable for everyone.

    Get generics, whenever possible. By law, a generic version of a drug must have exactly the same active ingredient as the brand-name version. Even if it doesn’t personally save you a whole lot of money to go generic, chances are it is saving a LOT of money for your insurance company, and by extension, everyone else being insured by them.

  93. Phexerian says:

    Bleh, so many posts on this issue going back and forth. Some are pretty crazy and some are right on.

    The industry standard for this scheme is, when your drug is about to lose its patent, you come out with the new extended release version, and at the same time, start blasting your old drug that just went generic saying how bad it is and how much easier it is to take the NEW extended release version.

    Many drugs that are in XL form are just thrown out there to keep the drug company’s market share up in value, but some of them that come out are needed. I see reasons for having the depakote ER, Wellbutrin XLs possibly, but certainly not the Coreg CR, Seroquel XR, and Ambien Cr…

    Much of the time, they are reducing the frequency of the dose from twice daily to once daily. Most people can handle twice daily. Not really much of a need. Take Coreg for example. Right after it went generic, they came out with Coreg Cr. However, just taking Coreg generic twice daily is just as good as once daily Cr. Ambien Cr is another. Most people just need to get to sleep. All they would need is am ambien pill. Ambien Cr is supposed to keep you asleep? Honestly, if you are waking up after taking an ambien, which is a pretty strong drug, there are probably other issues at hand. Want to know what that CR really stands for? Try Continued Revenue.

    Other drugs like Depakote which is a narrow window drug, really do help patients from the extended release as it keeps the drug levels workable for the patient and not in dangerous spikes.

    Now, some drugs that require a 4 or 3 times a day dosing, yes a XL version could be used I would think. It is very difficult to take a medicine 4 times daily, and compliance is very low with that dosing schedule.

    Regarding Celexa and Lexapro. Lexapro is the S isomer of citalopram. IN THEORY, you get more of the active drug with less side effects because you don’t have the R isomer. There are studies, probably by the drug company, that state Lexapro works better, but in all honestly as I have been taught, the studies are very weak and biased. If you take Lexapro, ask your physician about switching to generic celexa and trying it for a while to see how you do on it.

    Of course, asking your physician is a good idea. Generally they will work with you and try and get you on a drug that works for your body and your pocket book.

    A Pharmacist is also a good idea, as they can give you all the information you need to know about each drug, how they react in the body, their pricing, and their honest thoughts on whether the drug is a sham or not.

    As for the person, physchos, who thinks its not worth the time to ask a Doctor of Pharmacy about a drug, if you want to think you know more about drugs than a pharmacist, you go on and keep thinking that. It makes you look pretty damn arrogant. And honestly, I have to deal with that same attitude in my pharmacy quite often, and 99 times out of 100, the person who thinks they know more about drugs than the pharmacist winds up looking like an idiot. Perhaps you should go to another pharmacy if you think you are getting bad answers from your pharmacist. Other than that, your post was fairly accurate.

    Good post pharmchick.

    Side note, there seem to be quite a lot of people that post here that are taking antidepressants. I wonder if you all actually started on something like prozac, or, did you start with the name brand effexor XR or Wellbutrin XL?

    -Phex
    -3rd Year PharmD / MBA Candidate

  94. mizmoose says:

    I take two “extended-release” drugs. One IS available as a generic – and yes, I buy that version.

  95. Crazytree says:

    great article.

  96. mizmoose says:

    @Phexerian: if you want to think you know more about drugs than a pharmacist, you go on and keep thinking that. It makes you look pretty damn arrogant.

    Except that when I’m prescribed something I’ve never taken before, I read up all the details I can on (at least) rxlist.com, and yes, I speak more than enough medicalese to fully understand what it says (and I can research the meanings of what I don’t).

    And just doing that research and looking things up on my own has saved my behind more than a few times, because the Pharmacist, whether from ignorance, stupidity or simply being too busy, either made a mistake or did not give me critical information.

    I may not know *more* than a pharmacist about all drugs, but I’ll be damned if I don’t find out as much as I can, because it’s just as arrogant to think the Pharmacist is automatically going to do The Right Thing.

    (And I don’t trust Doctors, either; I’ve twice caught them prescribing me drugs that you DO NOT give to diabetics without caution and warning, neither of which I was given. Better to find this stuff out yourself before you die from hypoglycemia.)

  97. mstevens says:

    jonthegm, there’s no way you should be paying more than $6/month for 30mg citalopram. This drug is on the $4 generics program at Wal-Mart and Target pharmacies, so since they think 30 tablets is a month’s supply they’d charge $6. Most pharmacies will match their prices IF YOU ASK THEM. In this case, it’s cheaper NOT to use your insurance.

    If your dose is stable, they charge $10 for 3 month’s supply, so for the $20/month you’re paying you could get a 4-month supply.

  98. mstevens says:

    Phexerian, if we’re being precise, R- and S-citalopram are enantiomers, not isomers. When Lexapro was the same price as Celexa, it was often better due to very slightly lower side effect risk. Now that citalopram is, essentially, free, it’s very hard to justify the cost differential.

    For anyone thinking of switching, it’s important to keep in mind that the rough conversion ratio is 4:1, not 2:1. The R-enantiomer still occupies binding sites but does nothing, so in addition to making up half the bulk of racemic citalopram, it reduces the efficacy of the other half. This is hardly ever a really big deal, but if you’re on 40mg of Lexapro, 80mg of citalopram is not likely to cut it.

  99. Bix says:

    I usually defend this blog but this is a ridiculously irresponsible post. It’s totally case by case situation and there are many, many cases where the extended release version is better.

  100. Phexerian says:

    Excuse me, Enantiomer was the correct word. Isomer is something completely different that regards the same molecular formula with a different arrangement of the atoms.

    “When Lexapro was the same price as Celexa, it was often better due to very slightly lower side effect risk.”

    That side effect profile being lower was never proven with strong evidence, only weak biased evidence. The drug company succeeded and now sells ridiculous amounts of Lexapro, even though it has not been proven to be any better than Celexa.

    @mizmoose: It is good when you look up the info yourself, but when someone states that..

    “And suggesting that you are paying your pharmacist to be informed for you? I’m sorry, but the average retail pharmacist does NOT do that. I would not dispute that they actually know the issues there, certainly better than I do, but they simply oversee the dispensing in most cases, and the tech who takes care of you at the register doesn’t really care if you have a question for the pharmacist or not. (And the few times that I HAVE tried asking a retail pharmacist a question, always when I knew the correct answer, they did not give me a very good answer.)”

    I am not capable of being informed about drugs even with a pharmD, then I think the person has a complex. The average retail pharmacist knows a lot about 95% of the drugs that they dispense and can give you the main problems with each one. We simply oversee the dispensing? We also deal with the insurance, check for drug interactions with your other medications, try and call the physician to get you cheaper drugs if it is too expensive or your insurance doesn’t cover it, warn patients of major problems with ALL drugs, counsel on all OTC problems and drugs, act as a mini poison control center, and much more. We do not just dispense the medication. Quite honestly, most techs do care if you have a question. When you have a question, they get the pharmacist for you. We don’t ask you everytime you pick up your prescription if you have a question. I’d assume one would have the nerve (intelligence?) to do so on their own.

    The few questions this guy asked, I would assume, were probably off the wall and probably asked the same pharmacist for each one. If he happened to get a lazy pharmacist (yes some people can be lazy and be a doctor), he may have given the simplest answer. Perhaps the pharmacist was busy and didn’t have much time. One pharmacist and a “few” questions is not enough to state that we are not informed. Quite honestly, I take offense to it.

    -Phex
    -Ranting 3rd Year PharmD / MBA Candidate

    P.S. – Rxlist.com is not a good site IMO. Then again, I use clinicalpharmacology.com and Micromedics which one has to pay for. I suppose for general information, rxlist is ok, but certainly doesn’t give good specefic info for some drugs. PS is also what the alphabet would look like without Q and R (Mitch Hedburg).

  101. Consumerist-Moderator-Roz says:

    @Bix: As I posted earlier in the thread, if you have issues with the editorial choices of the Consumerist, it doesn’t belong in comments. You then posted a near identical comment. Gone.

  102. DoctorMD says:

    This is more BS from Big Pharma. The one company that invented the stabilizer should only be able to patent the mechanism of slowed release. Repackaging the same drug is nothing new and should not be issued a patent. But thats when you get when the patent system thinks it is still 1790 AD.

    To the people who mentioned side-effects from standard release dosing. Seems like the original release was a defective product. That’s a consumer safety issue to me. With NO increased cost they could have made the product extended release. Just try to sue them for improper formulation if you have a side effect from missing a dose.

  103. civicmon says:

    @TheShepherd: Same here.. I take Adderall XL and would rather pay the extra $$ to take the pills once a day vs. 3x.

    The savings, after insurance, are minimal at best.

    I don’t have to carry pills around. I don’t have to try and remember to take them, either. With ADHD, that’s much more of a benefit than one may imagine.