Saturday, December 21, 2013

Cymbalta Goes Generic


On December 11th, the FDA approved the use of generic Cymbalta.  The generic version, Duloxetine, delayed release,  became available in the USA four days ago.

Generics generally work just fine and they cost less.  Now and again, some people have side effects or feel the generic is not as effective effective, and for those individuals, it makes sense to remain on the name brand medication.  Generics cost less and the active ingredients are the same.  Oh, but there was a little issue with the efficacy of one pharmaceutical company's preparation of Wellbutrin, XL, 300mg.  See the In The Pipeline discussion of the problem in this blog post, "The Generic Wellbutrin: Whose Fault is It?"

So, generic Cymbalta -- is it okay to take this today?  I have some thoughts.

 I imagine it's probably fine and it's probably cheaper.  In fact, I called one pharmacy, and their out-of-pocket price  for a single 30mg tablet ss $11.73 for Cymbalta, and $8.44 for generic Duloxetine.  So the cost is less, but we're still talking about a very expensive medication, even in generic form.   It's also the holiday season: stress runs high and moods run low.  I imagine it's fine, but for any given person, there is the question with any medication switch as to whether that person might be the person to have side effects or experience less efficacy.

So just to consider :
  --What happens to this person during an episode of depression?  If prior episodes of depression required hospitalization, it might be worth waiting a little and seeing how others who have had milder episodes of depression respond to the generic.
 -- Physicians won't be consulted first, the pharmacy simply makes the substitution.
 -- If there is a problem, the psychiatrist may be away for the holidays and a covering doctor may have to be consulted.
-- It's a preparation of the medication that US physicians have no experience with.  The generic form has been available in other countries.

Medications change to generic all the time, including many antidepressants.  The cost drops and the medication becomes more accessible.  Generics work fine, and I personally have no qualms about taking them.  So I'll leave this as my take away message: just beware that this change has occurred and prescribers may not know about it.  If patients call with problems, it may be worth asking if their medication was changed to a generic, and patients who have problems may want to mention to their doctors that the medication was changed. 

  

13 comments:

Mona said...

Interesting. I was on wellbutrin many years ago. Almost a decade ago. i was fine. Tried it again a couple of years back...totally different experience. The effects did feel like they came on quicker and hit harder. I felt awful. I wonder if I was sensitive to something in it.

Joel Hassman, MD said...

Yay, finally Lilly has no major product to sell without any boundary of responsibility or accountability, and maybe we can see them disappear from view as a distraction and intrusion into responsible mental health prescribing!

They removed their psychiatric subdivision last year, gee, maybe they can remove their pharmaceutical division next?

Think I hate Lilly? You have NO idea!!!

Joel Hassman, MD said...

By the way, per the way Lilly handled ending the samples of Zyprexa, another of their wonderful products, just want to warn both colleagues and patients dependent on those sample bottles at clinics and some private practitioner offices, it ain't gonna be an option past February the latest. So, when patients then get this "Sticker Shock" of what delayed generic decreases in cost are as noted above in the post, it will get ugly, except, who do you think will get the brunt of the ugliness?

Yes, providers, once again thank yourselves for that wonderful double punch of attacking the messenger and also what happens to those good deeds you've been doing!

You gotta love what big pharma does, just like a street corner dealer, get 'em hooked, get 'em revved, and then dump 'em when the money dries up. You think I am really off on this analogy!?

Anonymous said...

For drug prices, it may be prudent to check the cost with more than one pharmacy:
According to the Consumer Reports link below, prices an vary wildly on the same pill. It all depends on which pharmacy you go to:
http://www.consumerreports.org/cro/magazine/2013/05/same-generic-drug-many-prices/index.htm

Consumers need to beware and self-advocate!

Anonymous said...

I have been taking Cymbalta for years. I am now on the generic. I can't speak for others, but my experience with the generic Cymbalta has been awful. I felt like I was going through serious withdrawals within 2 or 3 days of taking the generic. And now I am showing more signs of depression.

I went in to see my doctor and he told me about the problems with Wellbutrin, but said it was too early to tell if there were problems with the Cymbalta generic. I had considered switching back to the name brand, but now that there is a generic available, my insurance wants to ream me. We decided to up my dose of the generic for now and hope for more anecdotal evidence in the near future.

Also, called in to refill the first generic script and was told they are out and having problems getting it from the manufacturer. That's just great.

Anonymous said...

I have been on Cymbalta for 10 years and the only time I relapsed is when I purchased the "Generic" from out of the US for cost reasons (bad choice). I was switched to Generic Cymbalta Jan. 2014 by Insurance Provider and took it 8 days. I had stomach pain and migranes (Gluten Symptoms) and felt once like I was going to have a panic attack. I called my Pharm. to check for gluten and they said "none". I had a backup supply of Cymbalta and have been taking it this week until I see my doctor. All these symptoms went away when I took the "real thing".

Mary Ann C. said...

Well, I thought I was losing my mind on a whole new level. I have experienced nausea, headaches, extreme lethargy, panic attacks, feelings of dread, crying jags. Then at times I'm perfectly alright, only to be hit again with the crazy symptoms all within the same day.
I was about to ask my internist for a referral to a psychiatrist, when a good friend of mine told me about her experience with a switch to a generic drug and the hell it put her through. She encouraged me to search for online cases like my own. Bingo, I found this blog (as well as a few others), and I knew what had been the problem all along. This medication (Cymbalta 60mg) has been out in generic form for what, less than 2 months? I even called my pharmacist after reading the online blogs and she confirmed that she had been hearing of many of the same complaints.
I know my insurance company is going to make me pay a fortune for brand now that generic is out, but I cannot go through what I've been through the past 2 weeks. I was in an emotional nightmare and truly thought that there was something that had gone horribly wrong with me.
Did this company not do any testing on this drug? Do they not realize that people take this for a reason, and it can be dangerous for the patient to suddenly be thrust into a nightmare of emotional havoc with no knowledge of why? My fear is this could cause drastic results in people. It was that bad.
I spoke to my doctor's office today and they are going to call in the brand for me. I hope and pray that the weeks I have taken the generic have not in some way ruined the compatibility I have had with this medication for many years. I would hate to think I have to start over from square one!

Mary Ann C. said...

Well, I thought I was losing my mind on a whole new level. I have experienced nausea, headaches, extreme lethargy, panic attacks, feelings of dread, crying jags. Then at times I'm perfectly alright, only to be hit again with the crazy symptoms all within the same day.
I was about to ask my internist for a referral to a psychiatrist, when a good friend of mine told me about her experience with a switch to a generic drug and the hell it put her through. She encouraged me to search for online cases like my own. Bingo, I found this blog (as well as a few others), and I knew what had been the problem all along. This medication (Cymbalta 60mg) has been out in generic form for what, less than 2 months? I even called my pharmacist after reading the online blogs and she confirmed that she had been hearing of many of the same complaints.
I know my insurance company is going to make me pay a fortune for brand now that generic is out, but I cannot go through what I've been through the past 2 weeks. I was in an emotional nightmare and truly thought that there was something that had gone horribly wrong with me.
Did this company not do any testing on this drug? Do they not realize that people take this for a reason, and it can be dangerous for the patient to suddenly be thrust into a nightmare of emotional havoc with no knowledge of why? My fear is this could cause drastic results in people. It was that bad.
I spoke to my doctor's office today and they are going to call in the brand for me. I hope and pray that the weeks I have taken the generic have not in some way ruined the compatibility I have had with this medication for many years. I would hate to think I have to start over from square one!

Anonymous said...

Thank you all for posting this. I have been on Cymbalta for 10 years and they switched me to generic a week ago and I am slowly getting depressed and the nerve endings on my body are driving me nuts. My teeth even hurt so bad I feel like asking the dentist to pull them all. I called my doctor and he said it's the same drug but he would go ahead and switch me back. I feel like I am having a panic attack. I am hoping insurance company doesn't give me crap. Thanks for sharing your stories.

Anonymous said...

I have been switched by insurance co. to generic Cymbalta after being on non-generic Cymbalta for the last few months. I have had two episodes of severe headaches, nausea and vomiting in the last few weeks. At first I thought it was food poisoning, but after the second episode I am questioning my assumption. I am wondering if anyone else is having these symptoms?

Anonymous said...

I was placed on Cymbalta 60 mg approx. 2.5 years ago for suspected fibromyalgia (pain in legs). It helped tremendously, but I also reaped the benefits of the anti-depressant (had been depressed for years and didn't realize it)! Finally felt like "me" again! Due to loss of insurance, had to get generic in February 2014 (still paid approx. $300). My restless legs syndrome kicked into high gear, had "weepy" days, trouble sleeping, headaches. Finally got insurance and doctor was able to have name brand approved. Been taking it for just a few days now and already feel SOOOO much better. Make me very wary of generics, even though they're supposed to be as "effective." Glad to know I'm not the only one who experienced an issue (thought I was losing it)!

Kimberly W said...

I have been on many meds over the years both generic brands and the real thing. Though.. I've never been on Cymbalta (lucky me). I am on five meds at this time including a recently added one called Fetzima... so far it's a god send! My pdoc gave me samples two weeks ago to try so I'm not sure how much the actual prescription will cost yet.

Btw I'm also wary of generic anythings... ��


Jules said...

Thank you for posting comments regarding generic Cymbalta/Duloxetine. Although I have been on the generic brand for this past year, recently I have had similar symptoms: chest pains, difficulty sleeping and worsening hip pain. Main reason I am taking the drug is for depression. Added benefit is that it helps with pain from cervical stenosis. I am going to request that my psych Dr advise no substitutions. I may have to pay out of pocket to find out whether the brand name helps with these new symptoms.