Variances in generic warfarin

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Roger Frank

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Joined
Aug 11, 2008
Messages
208
Location
Manhattan, KS
I'm now using warfarin supplied by my regular pharmacy; previously I was using post release hospital meds. My INR is now drifting upward based on the same doesage. I'm guessing most of this generic stuff is Chinese so I'm quite suspicious/concerned about quality control.

Any thoughts on standardazartion between vendors?

Thanks!
 
I have no idea,,just know that my doctor insisted I be on the brand name Coumadin and not a generic. I figure he had a reason.
 
I'm still taking name brand coumadin. The coumadin clinic I go to(when I have to) said that if the generic brand is from different labs, the ingredients can differ and cause fluctuations in INR. That being said, if you will purchase generic at the same pharmacy every time, you can ask them who their supplier is, etc.

Name brand is more expensive, I pay $50 for a 90 day supply but my health insurance pays the rest. For the peace of mind I stayed with name brand.
 
I switched to generic a few years ago and have had no change in my dosage.

I would try to determine if there is any other reason it could be climbing - less exercise, change in diet, etc.
 
To my knowledge I have never been on anything other than generic unless I was given "Coumadin" in the hospital ... I have never had a problem ... I think everyone has a drift from time to time....that's why we test ....good luck.:)
 
There should be no difference in INR between brand or generic. They both have the same active ingredients, though fillers may be different. If your INR is rising, there is another reason for it, but it's not the warfarin.
 
I'm now using warfarin supplied by my regular pharmacy; previously I was using post release hospital meds. My INR is now drifting upward based on the same doesage. I'm guessing most of this generic stuff is Chinese so I'm quite suspicious/concerned about quality control.

Any thoughts on standardazartion between vendors?

Thanks!

This Question comes up frequently.

At one time, ONE of the (several) owners of the Brand Name Coumadin had their sales people tell Doctors that their product was Better, Safer, More Consistent, yada, yada, yada.

That is UNTIL there was a Law Suit against the (then) owner of the Coumadin Brand Name. It was shown that one of the GENERIC Brands actually had Tighter Tolerances than the Coumadin Brand Manufacturer.

I am NOT aware of a CHINESE manufacturer of Warfarin (and probably would NOT use a Chinese made generic for Warfarin ... or any other drug made in China if I were aware of it...ASK your pharmacist where your drugs were made).

Two the BEST manufacturers of Generic Warfarin are BARR (in the USA) and TARO (in Israel). I have used Both through different Mail Order Rx Services and had NO PROBLEMS with either (ever since my Insurance would no longer pay the difference in Cost between Brand Name Drugs and Generic Drugs).

AL Lodwick has a section on Generic Warfarin on his website www.warfarinfo.com

Bottom Line: It is my understanding that Generic Drugs must meet the same standards and tolerances as the Brand Name Drugs and must have the same amount of active ingredient. (I will ask my pharmacist to confirm this.)

'AL Capshaw'
 
The warfarin I've bought is either from Taro -- an Israeli company -- or Barr -- a U.S. company (trades as BRL on the New York Stock Exchange, per its website) that has facilities in the U.S. and throughout the world.

I haven't seen any variance using generic, from when I switched from name-brand. In fact, I have used Barr one day and Taro tabs the next. No difference with that, or even with coupling 5mg of Barr + 0.5mg of Taro.

As to asking who the supplier of generic warfarin is:
I once asked a Costco pharmacist who that company gets its warfarin from, and I was told it depends on contracts and cost. He could tell me who the current supplier was (Taro).
I'm sure large companies -- such as Target, Wal-Mart, Sam's, Costco, Medco, Aetna's pharmacy, etc. -- get bids on various RXes for X months. Whoever comes in with the best deal gets the contract.
 
I was kept on Coumadin for 38 years because my docs were "brain washed" by Dupont marketing. I finally got "tired" of paying inflated retail for a very old drug and did some reserch. The current owner/manufacturer, Bristol-Myers..., both Barr Labs and Tara, and the FDA all told me that the Brand and Generics are exactly the same in "ACTIVE" ingredients. There is some difference in the "filler" ingredients that sometimes can cause people to react differently between brands. Like the majority of patients, I was able to make the switch with NO problem, except my billfold is a little heavier:p.



As far as where the drugs come from, I have received COUMADIN that the label showed a Bristol, Myers lab in another country. In todays "brave, new world", you just never know:(.
 
As to asking who the supplier of generic warfarin is:
I once asked a Costco pharmacist who that company gets its warfarin from, and I was told it depends on contracts and cost. He could tell me who the current supplier was (Taro).
I'm sure large companies -- such as Target, Wal-Mart, Sam's, Costco, Medco, Aetna's pharmacy, etc. -- get bids on various RXes for X months. Whoever comes in with the best deal gets the contract.

I don't doubt that pharmacies put their drug supplier business up for bid.

FWIW, when I used Merck-Medco for my Mail-Order Rx's, my Warfarin always came from TARO.

When my company switched Mail Order Suppliers to CareMark, they have always come from BARR.

I've been very pleased with my INR stability with both suppliers. My (small) variations have always correlated with other factors, mostly seasonal and / or activity level.

I've only asked my Local Pharmacies who their supplier(s) once (each) so I don't know how often they switch.

'AL Capshaw'
 
Thanks everyone for your help! My generic Warfarin says BARR, which is very comforting, (Thanks ALCapshaw) especially considering all the bad press around the Chinese Heparin. (which about did me in)

BTW - I recently read something in the NY Times which stated ALL generic aspirin and Acetaminophen is now sourced from China. Not good...
 
there's nothing wrong with medicines exported from china, assuming all the proper
procedures, especially those for testing and hygiene, have been followed. but given
the current system, i would not make that assumption.

meds for domestic consumption are another, very scary, matter. the problem is that
our pharmaceutical companies are outsourcing to the lowest bidder and are not fully
aware of the way business is done in other cultures. despite the government, the
chinese at heart are extreme capitalists. anything for a buck (or a yuan). the
business mindset can be summed up by one of the many many many many many
sayings: "if you're not cheating your customers, then you're cheating yourself."

that applies to the guy in a cheap suit with the 6" pinkie fingernail who won the
contract, and to the 47 tiny factories spread out over 13 provinces that he farms
the work out to, and to the suppliers of those factories, and to the local inspectors,
and the workers as well. signing a contract does not signal the end of negotiations.
it just means you've won the first skirmish, with more battles to come. it's not
uncommon for a factory owner to change suppliers several times over the course
of a production run, never reporting this to the contract holder. his suppliers,
and the suppliers' suppliers are doing it, too. imagine trying to maintain quality
control in this kind of environment.

unfortunately, the mindset also applies to the major pharmaceutical companies, who
would be doing the same thing in western countries but for
government inspections and enforced health and safety standards. so they
outsource to third-world countries to save a buck (does that saved buck ever
show up in lower consumer costs? didn't think so.) in labor and material costs,
but they're also saving even more in lower testing and inspection fees, running
a sampling system that would be appropriate for a single factory in a western
country turning out large lots of homogeneous product.

for the time being, i mail-order my meds from india or england or canada, or sometimes
have friends in the states send a small parcel of whatever med along with a case
of little debbie snack cakes.
 
Even though I was only on coumadin for 3 months, when my gp wrote the prescription for it for the first time, he told me to be sure and ask the pharmacy if they used the same supplier every time for generic. If the answer was no, then he said get the brand coumadin.

Kim
 
From what you said about using hospital-supplied drugs and what my (ailing and failing) memory is telling me, you are not long out from surgery. Shortly after surgery, about the 4-week mark or so, your appetite improves, you eat more "real" food as opposed to snack stuff, and you are probably also more active than immediately post-surgery. This can have a huge impact on your INR. You may also be starting/stopping drugs, getting over the stress of having your rib cage broken open and everything else they do to you. That too can have and effect on INR.

I am no expeert, but feel that fluctuations are not a "problem" until your lifestyle settles back down into a regular daily routine, maybe even not until you go back to work.

I could, of course, be wrong - it's happened before, last time was 1964, I think :D
 
Hi---one more reply

Hi---one more reply

I was on Coumadin for several years after which my insurance decided to only pay for generics if one was available. I decided to go generic. I can honestly say that nothing changed whatsoever....except it didn't cost so much! Good luck!
 
Hi,
I'm a new pharmacist in Canada.
I found your forum very interesting. In Canada, we have only one generic option for Coumadin and it is the Taro one. I know that Taro made his warfarine in the exact same place that Coumadin is done. So it's the same place that does Coumadin and Taro-warfarine. In Canada, we switch a lot of people to Taro because Coumadin was back order in summer 2007 if I remember well. Actually there is no evidence base that people on Coumadin could not switch to Taro. It's more a personal choice.

Have a good day!
Alanis
 
Hi,
I'm a new pharmacist in Canada.
I found your forum very interesting. In Canada, we have only one generic option for Coumadin and it is the Taro one. I know that Taro made his warfarine in the exact same place that Coumadin is done. So it's the same place that does Coumadin and Taro-warfarine. In Canada, we switch a lot of people to Taro because Coumadin was back order in summer 2007 if I remember well. Actually there is no evidence base that people on Coumadin could not switch to Taro. It's more a personal choice.

Have a good day!
Alanis

Hi Alanis and welcome to the forums. I remember the great back order of Coumadin also. People here were frazzled about what they were going to do because some of them will not switch to generic because they insist there is a difference and so do their Doctors. Can't prove it by me. I've tried them all, Coumadin, Jantoven, Barr generic, Taro generic, mixed and matched, so on and so forth, and none of them made a difference.

Glad you stopped by. Our resident pharmacist, now retired, Al Lodwick, is busy giving Warfarin seminars in the U.S. You might want to see his site at www.warfarinfo.com :)
 

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