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.

Is Tylenol PM still okay?

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.

Source link broken

@jbrecken:

classic

@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.

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.

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.

@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.

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.

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".

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.

@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)

Seriously?

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

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!

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

@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.

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......

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

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.

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

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.

@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

@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.

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

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.

Still waiting on that generic insulin.......

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

@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.

@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.

@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...

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

@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.

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.

@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.

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.

@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.

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.

@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.

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.

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

@TheShepherd: Shun the nonbeliever! Shuuuuuuuuun

@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.

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

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.

@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.)

@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.

@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.

@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?