Generic v Brand Keppra

[Ghormeh Sabzi]

I've been using Keppra in combination with flupirtine to control symptoms of pain which I'm convinced is intertwined with my HPPD. I switched to the generic version briefly because it is a lot cheaper but my symptoms returned and so I had to switch back to the brand Keppra, at which point my symptoms subsided again. 

 

I thought it useful to post this information to demonstrate differences between different versions of levetiracetam.

[StateOfRegret]

It's always disconcerting to hear about differences between brand name and generic. As you know, levetiracetam is enantiopure etiracetam, so there really shouldn't be any room for differences to "emerge".

 

I recently listened to a radio feature on generic medicine. A lot of the generic medicine that enters the US market is produced in India, and some of it doesn't live up to clinical standards. Some was found to contain too little (or, in one case, none) of the active ingredient. I'm not sure if the case is similar in England (and my country, Denmark).

[Ghormeh Sabzi]

Under EU laws active ingredients have to be within certain percentages but there will be slight differences. But effectiveness of medications can depend on other things such as how the tablets are pressed, how the active ingredient is released, what else is in the tablet, etc.

 

I also read some articles that suggest that brand Keppra is more effective than generic for epilepsy.

 

I have a private prescription, but normally you would only pay a small prescription charge in England, with the NHS covering the rest of the cost. The NHS provides the much more expensive brand Keppra rather than the generic version, which says a lot, I think.

[StateOfRegret]

Under EU laws active ingredients have to be within certain percentages but there will be slight differences.

The laws are similar in the US, my point is that some times manufacturers of generic medication systematically fail to live up to them, for whatever reason. The control with overseas pharmaceutical companies apparently isn't as tight as one would like to think.

 

But effectiveness of medications can depend on other things such as how the tablets are pressed, how the active ingredient is released, what else is in the tablet, etc.

Yes, in some odd cases, but generally those things don't make any difference. Inactive ingredients are supposed to be inactive, micro-crystalline cellulose or lactose isn't going to mess with your etiracetam, I believe   As long as we're not talking controlled release, all the different tablets and capsules are equivalent - they all dissolve quickly in your stomach, releasing the active ingredient. I highly doubt that there is anything interacting with your etiracetam in the tablets themselves.

 

By the way, great to see you back, Ghormeh. Have you abandoned talkppd.com? (and, wow, does it have a spam problem or what? ) 

[Ghormeh Sabzi]

I would like to think the published articles I have read will have ensured active ingredient concentrations are reliably within certain parameters, yet they detail significant differences in effectiveness of (multiple?) brand v generic Keppra. I would suggest that inactive ingredients aren't always technically inactive, because tablets can contain substances to allow for better absorption of active ingredients, for example. 

 

I even upped my dosage and my symptoms did not get better, yet very quickly after switching back to generic Keppra my symptoms subsided again, suggesting significant differences, regardless of the reasons for those differences.

 

Yet I confess comments are based on very limited research I carried out when switching between the products, but it is certainly an interesting discussion and something I'd like to research in more detail when time allows, which would also allow me to speak with more authority. As you suggest I'm sure things aren't always as rosy as we think. Here in the UK we like to think things go through strict processes before products can reach the market, but things surely do slip through the net from time to time, as last year's horse meat scandal demonstrates. 

I have temporarily abandoned talkppd.com because it didn't turn out as I hoped and I haven't had the time to push forward with it. But I will revisit in the summer when I have the time and will try and make it successful with some new ideas so that it becomes active. I haven't logged in or commented for a while because I am working a lot and I am also trying to focus on my studies, but I do visit these forums occasionally to see what's going on.