![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Fred23 on June 11, 2004, at 21:51:05
Several months ago I posted the question here how to ask my GP for Xanax to help reduce the anxiety that I feel is contributing to the high blood pressure he had diagnosed me with. I also posted the Jan 2004 discovery here of the genetic link that the people predisposed to become alcoholics have overactive brain activity due to faulty GABA regulation.
As Xanax is given out rather freely in this area, to people who end up not taking it, I was able to get some to experiment with briefly, and found that simply 0.5 mg per day was "enough" to counteract the gnawing anxiety.
That was several months ago, and at my followup appointment I asked my doctor about something for the anxiety which is a factor in my blood pressure situation. He does not prescribe Xanax, but gave me Ativan (lorazepam), as 0.5 mg tablets, to be taken three times per day. The generic brand I got was Mylan, and I'm aware the equivalence charts say that Ativan has half the strength of Xanax. (Also their half-lives and onset times are somewhat similar.)
So, I figured that 1.0 mg (two tablets at once) of the generic Ativan should have about the same effect as 0.5 mg of Xanax.
But, the effect wears off much quicker.
1. Does Ativan have less actual "power" due to being a different chemical, and this is as expected?
2. Could the generic Ativan be significantly weaker than the name brand, and thus need "more" to have the true effect?
3. Would the approach to test this be to get name brand Ativan on the next refill? Can the patient just request name brand, if willing to pay the difference (insurance co-payments). Or does the doctor have to authorize the switch?
4. Or, should I just ask the doctor for a higher dosage, with the implications that go with that?
In other words, which is the better approach, to ask for the name brand to have a lower dose on record, or ask for a higher dose of the generic to make up the difference, but be seen as someone who wants to bump his dosage?
Posted by chemist on June 11, 2004, at 22:16:23
In reply to Generic Ativan (lorazepam) vs real Xanax, posted by Fred23 on June 11, 2004, at 21:51:05
hello fred, chemist here. if you are seeking alcohol withdrawl, go with ativan, if not valium for short-term. the generic vs. brand name is not an issue. what is an issue is how you feel. you need to understand that the generic and brand-name are bioequivalent. if your insurance covers the brand name, and you feel more comfortable with it, than do it. but it is not a viable remedy. please keep us up to date, all the best, chemist
Posted by Fred23 on June 11, 2004, at 22:33:07
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by chemist on June 11, 2004, at 22:16:23
> if you are seeking alcohol withdrawl, go with ativan,
As I explained in my long ago introductory message, I don't drink, but have the alcoholic genetic makeup. What I had been looking for in the herbal realm for the longest time was the equivalent of one drink, but spread out all day. When I tried a friend's Xanax, I found it.
> you need to understand that the generic and brand-name are bioequivalent.
Your posts about the FDA Orange Book suggest that, but many on this board claim that the generics really aren't as good.
> if your insurance covers the brand name, and you feel more comfortable with it, than do it.
What I'm asking is if *I* can simply ask for a refill to be the name brand, so I can test, on my own say so, or does the doctor have to authorize?
If the name brand is more effective, I'm wondering whether it would be better to pay more to have the record be a "lower" dose, e.g. 1.5 mg/day, or pay the lower co-pay for a "higher" dose, and have it seem like I needed "more".
(There is a post here somewhere where someone did a test like this with Klonopin, I believe, and found a lot less name brand was needed.)
Posted by Fred23 on June 11, 2004, at 22:41:14
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 11, 2004, at 22:33:07
> (There is a post here somewhere where someone did a test like this with Klonopin, I believe, and found a lot less name brand was needed.)
Posted by watergirl on June 12, 2004, at 0:16:15
In reply to Generic Ativan (lorazepam) vs real Xanax, posted by Fred23 on June 11, 2004, at 21:51:05
Hi Fred23,
Speaking from my own experience:
My pdoc wanted to start me on 0.25 mgs of Klonopin. Knowing I was going to buy generic, he wrote my PX for 0.5mg tabs. Different Generics are superior to other generics. You can try a search using the Google Dr-bob.org below to see what some of the other "Babblers" experiences have been. I had been on 0.5 mgs of Xanex. I started out with generic Xanax. Then for kicks, since I had read about the difference between brands and generics, I wanted to try for myself. The first "Brand Xanex" I took, knocked me out, put me to sleep (& Im talking about .5 mgs). Ive finnaly settled on Alprazolam (Xanex) manufactured by Greenstone Labs ; Clonozepam (Klonopin) manufactured by Teva. There is a Benzo equivilant chart on the home page. Check it out.
All insurance plans are different. When I was on Blue Cross/Blue Sheild, I had the option to choose between Brand and generic, however the co-pay was significantly higher for Brands rather than generics. It depended on the Drug.Best Wishes,
Cindy
Posted by Sad Panda on June 12, 2004, at 0:24:44
In reply to Re: Generic Ativan (lorazepam) vs real Xanax, posted by Fred23 on June 11, 2004, at 22:41:14
> > (There is a post here somewhere where someone did a test like this with Klonopin, I believe, and found a lot less name brand was needed.)
>
> http://www.dr-bob.org/babble/20040510/msgs/345283.html
>Hi Fred,
I think that people favouring the brandname above generic is testament to the brandname's aditional placebo power. I myself struggle to accept substitues even though I know they are equipotent. :)
Alot of people prefer Xanax above all others, but it is harder than all other Benzos to withdrawl from & I would therfore consider it a permanent solution. You should try out other Benzos first to see if your anxiety is kept in check with a continuos dose, or you have a continuos need to escalate the dosage. If you are dose stable on something else like Ativan, Klonopin or Valium, then permanent Xanax might be the best option. If you have a need to escalate the doseage, then you should look at alternatives to Benzos. Do you have an other symptoms besides anxiety?
Cheers,
Panda.
Posted by Fred23 on June 12, 2004, at 0:42:28
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by Sad Panda on June 12, 2004, at 0:24:44
> Alot of people prefer Xanax above all others,
The irony of this is that as Xanax was the only benzo I could "borrow" it was my only reference. I find the effect of the Mylan Ativan preferable, while it lasts, so will settle on Ativan.
> If you have a need to escalate the doseage,
What I want to determine is if the name brand would be more powerful, thus allowing a "smaller" dose, even if it would cost more.
Since the "escalation" of dosage is a sensitive issue, if 1.5 mg of the name brand would work better than, say 3.0 mg of the generic, then it would almost be better to pay the additional money for the name brand to avoid the stigma of "needing more."
Posted by Sad Panda on June 12, 2004, at 2:42:09
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Sad Panda, posted by Fred23 on June 12, 2004, at 0:42:28
> Since the "escalation" of dosage is a sensitive issue, if 1.5 mg of the name brand would work better than, say 3.0 mg of the generic, then it would almost be better to pay the additional money for the name brand to avoid the stigma of "needing more."
>
>If the difference is that much, than it's a fair enough thing to go for the brandname :)
Cheers,
Panda.
Posted by Viridis on June 12, 2004, at 2:55:43
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by Sad Panda on June 12, 2004, at 2:42:09
I have no experience with Ativan (only Klonopin -- clonazepam, Xanax -- alprazolam, and Valium -- diazepam). And, I've never taken the brand-name benzos, only generics. But after having taken Teva brand clonazepam for quite a while, I filled my prescription at another pharmacy and got a different generic (same dose). I'd always assumed that generics are equivalent to brand-name meds and each other, and didn't even think about it. But for that month I noticed a definite difference (less anxiety relief, shorter duration).
Maybe it was coincidental, but when I went back to the first generic (Teva) I felt normal again. I doubt this was "reverse placebo"/placebo effect since it didn't even occur to me for quite a while that it might be the difference in manufacturers that was making me more anxious.
Again, this is just anecdotal, and I don't know much about Ativan (lorazepam), but I suspect that in a few cases generics can be different.
Posted by Fred23 on June 12, 2004, at 9:30:42
In reply to Re: Generic Ativan (lorazepam) vs real Xanax, posted by Viridis on June 12, 2004, at 2:55:43
> Again, this is just anecdotal, and I don't know much about Ativan (lorazepam), but I suspect that in a few cases generics can be different.
What I'm asking is if I can choose which generic, in the way that I could which brand of tooth paste I'd buy, and try a different generic (if it even exists) on the next refill.
And then, on another refill, ask for the name brand and pay the difference myself, on my own say so, or does that need the doctor to approve?
My goal would be to test if there is any real difference before the alloted number of refills is up.
If there is a difference, moneywise I'd prefer a higher dose of the generic, as it wouldn't cost any more. But if the name brand is stronger, then paying more for the "same" dose, and being on record for that lower dose, may be better, perceptionwise.
Posted by chemist on June 12, 2004, at 17:13:25
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 11, 2004, at 22:33:07
> > if you are seeking alcohol withdrawl, go with ativan,
>
> As I explained in my long ago introductory message, I don't drink, but have the alcoholic genetic makeup. What I had been looking for in the herbal realm for the longest time was the equivalent of one drink, but spread out all day. When I tried a friend's Xanax, I found it.
>
> > you need to understand that the generic and brand-name are bioequivalent.
>
> Your posts about the FDA Orange Book suggest that, but many on this board claim that the generics really aren't as good.
>
> > if your insurance covers the brand name, and you feel more comfortable with it, than do it.
>
> What I'm asking is if *I* can simply ask for a refill to be the name brand, so I can test, on my own say so, or does the doctor have to authorize?
>
> If the name brand is more effective, I'm wondering whether it would be better to pay more to have the record be a "lower" dose, e.g. 1.5 mg/day, or pay the lower co-pay for a "higher" dose, and have it seem like I needed "more".
>
> (There is a post here somewhere where someone did a test like this with Klonopin, I believe, and found a lot less name brand was needed.)
>
>
hi there, sorry for the mess. you can request the brand name (from upjohn) BUT your doctor must write the script for Xanax (not alprazolam) and indicate ``Dispense as Written,'' (DAW), otherwise the pharmacy will default to generic because your insurance company goes to generic unless you specify DAW (well, they can't go generic on drugs that are off-patent, of course). so, give it a try.....all the best, chemist
Posted by harryp on June 12, 2004, at 17:59:29
In reply to Generic Ativan (lorazepam) vs real Xanax, posted by Fred23 on June 11, 2004, at 21:51:05
Hello,
I've been using lorazapam for years, and I've never noticed a difference between the different generic forms. Lorazapam is definitely going to feel "milder" than xanax, but it also generally lasts a bit longer.
(On an unrelated note, I do think xanax lends itself to abuse because it "hits harder". It is the pill of choice among people I know who (foolishly) use it as a recreational drug.)
I also have severe anxiety (comes in episodes, though) and I've prefered ativan to xanax because the effect is more spread out over time.
If your anxiety is an all-day thing, I would definitely recommend splitting dosages, since ativan wears off after a few hours, and xanax wears off even sooner.
Posted by Chisoseri on June 12, 2004, at 20:36:57
In reply to Generic Ativan (lorazepam) vs real Xanax, posted by Fred23 on June 11, 2004, at 21:51:05
This may help you out...
http://www.algy.com/pdi/FAQ/BrandvsGeneric2.html
Posted by Fred23 on June 12, 2004, at 21:06:42
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by chemist on June 12, 2004, at 17:13:25
> hi there, sorry for the mess. you can request the brand name (from upjohn) BUT your doctor must write the script for Xanax (not alprazolam) and indicate ``Dispense as Written,'' (DAW), otherwise the pharmacy will default to generic because your insurance company goes to generic unless you specify DAW (well, they can't go generic on drugs that are off-patent, of course). so, give it a try.....all the best, chemist
Clarification: My question is whether *I* can ask for DAW Ativan at the pharmacy, even though the prescription is for generic. I'd pay the higher co-pay willingly, to be able to test the name brand for one refill cycle, to see if there is a difference.
Posted by Fred23 on June 12, 2004, at 21:13:24
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by harryp on June 12, 2004, at 17:59:29
> I've been using lorazapam for years, and I've never noticed a difference between the different generic forms. Lorazapam is definitely going to feel "milder" than xanax, but it also generally lasts a bit longer.
But have you tried the name brand product?
The impetus for my post was that I'm finding that 1.0 mg of the doctor-prescribed generic Ativan wears off *faster* than 0.5 mg of the real Xanax I got from someone to test out. Since Ativan is supposed to have a longer half-life than Xanax, I am wondering why it wears off sooner.
Posted by chemist on June 12, 2004, at 21:16:03
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 12, 2004, at 21:06:42
> > hi there, sorry for the mess. you can request the brand name (from upjohn) BUT your doctor must write the script for Xanax (not alprazolam) and indicate ``Dispense as Written,'' (DAW), otherwise the pharmacy will default to generic because your insurance company goes to generic unless you specify DAW (well, they can't go generic on drugs that are off-patent, of course). so, give it a try.....all the best, chemist
>
> Clarification: My question is whether *I* can ask for DAW Ativan at the pharmacy, even though the prescription is for generic. I'd pay the higher co-pay willingly, to be able to test the name brand for one refill cycle, to see if there is a difference.
>
sorry, again...the answer is yes you can, just make it clear that you want the name brand. you might get hassled from your insurance company, so you might do the following: tell the pharmacist you do not want to run it through your insurance, and will pay out of-pocket. however, be warned: i am sprescribbed 60 tablets of alprazolam per month, and my doctor writes for the 2 mg tablets. i pay $23.08 for my generics (Geneva, now Solvay), and the savings from the brand name? $173.48. all the best, chemist
Posted by Fred23 on June 12, 2004, at 23:04:31
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by chemist on June 12, 2004, at 21:16:03
> sorry, again...the answer is yes you can, just make it clear that you want the name brand. you might get hassled from your insurance company, so you might do the following: tell the pharmacist you do not want to run it through your insurance, and will pay out of-pocket. however, be warned: i am sprescribbed 60 tablets of alprazolam per month, and my doctor writes for the 2 mg tablets. i pay $23.08 for my generics (Geneva, now Solvay), and the savings from the brand name? $173.48.
Looking in that Electronic Orange Book, I find that the name brand for Ativan is BIOVAL, and the generic lorazepams are MUTUAL PHARM, MYLAN, PUREPAC PHARM, RANBAXY, SANDOZ, and WATSON LABS.
The CVS I went to had the MYLAN I was given, so we can assume they'll also have the BIOVAL, in case they get a DAW, right?
The impression I get from the historical posts is that a particular pharmacy only carries certain generics, so if CVS doesn't have any other than MYLAN, I'd have to look around, it seems.
I'm hoping that I'd only have to pay the $50 co-pay for the name brand, per the insurance company's tiering. (I still have to check into this.)
What are the respective reputations of the companies listed above? It may be practical to try only a few of them.
Posted by chemist on June 13, 2004, at 1:34:52
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 12, 2004, at 23:04:31
> > sorry, again...the answer is yes you can, just make it clear that you want the name brand. you might get hassled from your insurance company, so you might do the following: tell the pharmacist you do not want to run it through your insurance, and will pay out of-pocket. however, be warned: i am sprescribbed 60 tablets of alprazolam per month, and my doctor writes for the 2 mg tablets. i pay $23.08 for my generics (Geneva, now Solvay), and the savings from the brand name? $173.48.
>
> Looking in that Electronic Orange Book, I find that the name brand for Ativan is BIOVAL, and the generic lorazepams are MUTUAL PHARM, MYLAN, PUREPAC PHARM, RANBAXY, SANDOZ, and WATSON LABS.
>
***** bioval is #1, then purepac, sandoz, watson and mylan are tied. go for bioval. all the best, chemist ********> The CVS I went to had the MYLAN I was given, so we can assume they'll also have the BIOVAL, in case they get a DAW, right?
>
> The impression I get from the historical posts is that a particular pharmacy only carries certain generics, so if CVS doesn't have any other than MYLAN, I'd have to look around, it seems.
>
> I'm hoping that I'd only have to pay the $50 co-pay for the name brand, per the insurance company's tiering. (I still have to check into this.)
>
> What are the respective reputations of the companies listed above? It may be practical to try only a few of them.
>
Posted by Fred23 on June 13, 2004, at 8:50:20
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 12, 2004, at 23:04:31
> The CVS I went to had the MYLAN I was given, so we can assume they'll also have the BIOVAL, in case they get a DAW, right?
Maybe not. Looking on the CVS web site shows only the generic, but no name brand Ativan. What happens if they do get a DAW?
Posted by watergirl on June 13, 2004, at 12:35:03
In reply to Re: Generic Ativan (lorazepam) vs real Xanax, posted by Fred23 on June 13, 2004, at 8:50:20
The Pharmacy will order it for you if they dont have it in stock. At least that has been my experience.
Posted by Fred23 on June 17, 2004, at 20:41:10
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by chemist on June 13, 2004, at 1:34:52
> > Looking in that Electronic Orange Book, I find that the name brand for Ativan is BIOVAIL, and the generic lorazepams are MUTUAL PHARM, MYLAN, PUREPAC PHARM, RANBAXY, SANDOZ, and WATSON LABS.
> ***** biovail is #1, then purepac, sandoz, watson and mylan are tied. go for bioval. all the best, chemist ********CVS still lists it as from Wyeth. I had realized that a change of hands had occured. E.g. the news
"Biovail Acquires Ativan and Isordil from Wyeth" seen at
http://www.biovail.com/english/Investor%20Relations/Latest%20News/default.asp?s=1&state=showrelease&releaseid=417652A related question would be if I could only get 1/3 of the refill with Wyeth, and the remaining 2/3 of the order the generic?
If the name brand is found to be more powerful, I almost wouldn't want to have a full refill worth, if I was going to decide to stick with the generic, possibly. But that might make the order too complicated....
Posted by Fred23 on June 25, 2004, at 18:46:35
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 17, 2004, at 20:41:10
> > ***** biovail is #1, then purepac, sandoz, watson and mylan are tied. go for bioval. all the best, chemist ********
> A related question would be if I could only get 1/3 of the refill with Wyeth, and the remaining 2/3 of the order the generic?
No, CVS has to fill the order with one or the other, so I have to get all 60 as name brand.
I guess if I can establish the most useful dosage with the name brand, if I have to "up" it due to the generic, I'll have a clear case that the name brand is better, so if I go with generic for insurance reasons, I can make a strong footnote that the "higher" dosage needed is due to the difference in strength.(This is the plan. No tests have yet been done, nor conclusions drawn, other than the Mylan lorazepam seems very weak.)
Posted by Fred23 on June 26, 2004, at 20:43:05
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » Fred23, posted by chemist on June 13, 2004, at 1:34:52
> > > sorry, again...the answer is yes you can, just make it clear that you want the name brand. you might get hassled from your insurance company, so you might do the following: tell the pharmacist you do not want to run it through your insurance, and will pay out of-pocket.
> ***** bioval is #1, then purepac, sandoz, watson and mylan are tied. go for bioval. all the best, chemist ********
Yesterday I ran a test with the CVS supplied Mylan generic, then today paid in full for a refill of name brand Wyeth Ativan, and re-ran the same experiment.My initial conclusion is that there is a *big* difference in quality between the two, with the name brand Wyeth far superior to the generic Mylan.
I'll give the details as the days go by.
Posted by Fred23 on June 27, 2004, at 22:08:58
In reply to Re: Generic Ativan (lorazepam) vs real Xanax » chemist, posted by Fred23 on June 26, 2004, at 20:43:05
> My initial conclusion is that there is a *big* difference in quality between the two, with the name brand Wyeth far superior to the generic Mylan.
These are my initial impressions on the "day after" the first test of the "real" Ativan.
What was puzzling about the generic Mylan lorazepam is that it didn't seem to have any half-life at all, though it is supposed to be longer than Xanax.
With the real "borrowed" Xanax I found that 0.5 mg/day taken with breakfast would have anxiolytic effect lasting until at least the next morning, with no sedative effect. I would have more energy in the evening after coming home from work as my energy had not been frazzled away.
The doctor-prescribed Mylan lorazepam didn't seem to have much anxiolytic effect, just some sedative effect.
The name brand Wyeth Ativan has anxiolytic properties, with very little sedative effect, and has that same energy leveling property so I can easily stay up "past my bed time" if wanted. And it has enough of a half-life that at least a large dose is still in effect the next day.
So there is really no comparison, as just taking more of the generic would just result in more sedation, with little anxiolytic effect, so paying the increased copay for the brand name is definitely worth it.
(I haven't told my doctor this yet, and doubt that he will even care.)
Posted by 1980Monroe on June 28, 2004, at 22:37:45
In reply to Re: Generic Ativan (lorazepam) vs name brand, posted by Fred23 on June 27, 2004, at 22:08:58
Suprinsingly placebo's are powerful, but still your could very much be right and i dont want to argue. Anyways, well, could the drug structure be alred somehow, cheap*** companies dont know how to make it.
Anyways,im going to check out somemore on this, i gt me a good research cookin....
LaterMatt
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.