Toprol XL vs generic

[Praline]

Hello everyone. I have not been here in a while, just so busy with work. All these new toys to learn are too much for this old lady.

About 3 months ago, my Toprol was switched to a generic, can't remember the name. I did not think anything of it since I have taken generic brand meds before , including warfarin, with no problem. But then I started noticing that my BP was fluctuating a lot. And I was getting headaches. I have never been one to get headaches except when I have sinus problems. At first I thought it was the change of weather playing with my sinuses.
After 2 months of this, one day I sat down and analysed what I was doing and eating. The only change I could come up with was the generic med. By then I was having almost a constant mild headache.
I called my cardiologist and he wrote a prescription for the name brand Toprol and I switched. After my second dosage, my headache was totally gone. My BP is also stabalizing. I have been back on the Toprol for a month now. My insurance is covering the brand name meds because my cardiologist said that the generic does not agree with me. I pay $30 a month for the Toprol instead of $10 for generic.
We had an insurance meeting this past Friday. We are changing insurance carrier. The new carrier, Blue Cross Blue Shield of Louisiana, will not take in consideration that you may have problem with the generic. With this new coverage, my Toprol may cost me $60.00 a month.
Anyone else out there having problem with the generic Toprol?

 

[Bina]

Hi Praline
I take the generic, metoprolol, without problem.
However, my father is on another heart med (brand name), which the drugstore switched for generic...the next day he had angina and lots of problems. We had the RX re-written for the name brand and since then he has been just fine. You must also be one of the special rare exceptions.

 

[leecrowley]

There is a difference between metoprolol and the generic Toprol XL. Metoprolol is the generic for Lopressor. The generic for Toprol XL is Metoprolol ER (extended release). One is called metoprolol tartrate (generic Lopressor), and one is called metoprolol succinate (generic Toprol XL). I switched from Toprol XL to Metoprolol ER 4 or 5 months ago. I didn't notice any difference in my BP, but my heart rate went up about 5 beats per minute. My surgeon said this was fine. I have had a few more minor headaches since the switch, but they haven't been bad enough to switch back.

I'm sorry you had so much trouble with the generic. Make sure you were given Metoprolol ER.

Good luck.

Lee

 

[Bina]

In Canada, Lopresor SR, 100 mg, is metoprolol tartrate....and there is no generic for the SR formula only the regular formula available in 25mg, 50mg, etc. We don't have Toprol at all.

 

[Turkey Hunter]

I too had issues with metoprlol.
I refuse to take it.
I also used to have Blue Cross and am going back to it and when I had it 1.5 years ago, they had no issues with name brands. Just cost a bit more & I don't recall the increase being anywhere what you have mentioned.

 

[Jkm7]

Blue Cross is ceasing to cover toprol xl. They are requiring substituting metroprolol succinate after January 1.

 

[Praline]

If I understood the insurance rep correctly, the Blue Cross policy that we are getting will not cover any brand name meds that have a generic available. So I will have to buy the Toprol XL without insurance benefit. I think it runs about $50-$60 for what I take for a month. I am going to check the discount pharmacy and see if I can buy it cheaper there.

 

[Jkm7]

I wonder if there is any chance BlueCross would pay the amount they would have paid for the generic and not make us pay the full amount ourselves? Would be good if they at least gave us the value of the generic.

 

[tobagotwo]

One thought - try another pharmacy (not the discount one).

Generic Atenolol bought at a particular food-store chain caused a great number of side-effects. Bought from a Legend Pharmacy, the generic caused no problems. Why? They buy their generics from different manufacturers.

The lowest-price pharmacies are not always the bargain they seem. Just so you know, there was no difference in price for the consumer between the two pharmacies, so it's the discount pharmacy that's often getting the difference, not always the consumer.

Shop around. It can make a big difference.

Best wishes,

 

[Praline]

Tobagotwo,
The generic I had problems with was not bought from a discount pharmacy. It was bought at the Walgreens where I normally have my prescriptions filled. My cardiologist and also my Primary Care Physician said that I was not the only patients who had problems with the generic Toprol XL. The metropolol succinate does not seem to agree with several people.
I am so sensitive to meds to begin with. I will just buy the Toprol XL. The pharmacy I want to check out , Marjoria drugs , has been around for years and years. They have a very good reputation around here.
I checked with Walgreens. The cost of my prescription would be around $60.00.

 

[Jkm7]

Praline...... I, too, have decided to buy my own Toprol xl. The risk is too great to risk, I think. My valve has stayed stable for the last 3 or so echos and I don't want to risk a change of medications. I am very close to being 'over the edge' and needing a second OHS that I intend to do everything possible, for as long as possible, to stay stable. I'd never forgive myself if I failed to pay the $60 and have the drug that is working for me. (My co-pay on the Toprol xl has been $25 all along so it appears, it just went up. )

 

[tobagotwo]

Differences in Generic Drugs

Differences in Generic Drugs

What I was suggesting was not that you not get the brand name from a discount drug store. The brand name is, after all, the same anywhere you buy it within the US. Note that imported versions may be different formulations that are allowed in those countries.

(To our non-US membership, that's not intended to imply superiority of one to the other: only to point out that there may be perfectly legal differences in formulation in different jurisdictional markets, which may affect the potency or tolerability in either a good or bad way, which a US doctor or pharmacist would not anticipate when discussing a drug with a patient.)

The brand name of the extended release version, Toprol XL is formulated as metoprolol succinate by Astra Zeneca. In its conventional-release form, it's formulated as Metoprolol tartrate, and they market it as Lopressor.

What I was suggesting is that there are often multiple companies making generic versions of popular off-patent drugs, and that these generics are not all made the same way, nor have even the same formulations.

In fact, some drug manufacturers manufacture "generic" versions of their own, original drug. The generic is the same product, comes off the same production line. It's packaged in a different wrapper, and sold through a different marketing operation. There may be distinguishing characteristics to the shape, color, or markings on the pills, but they can otherwise be the exact, same product as the original.

Not for every drug, of course, but you can ask at the pharmacy what the formulation is. If it's different from the official version's, then you are aware that there may be differences in tolerability or effectiveness.

Another issue is time-release, continuous-release, or extended-release medications (like yours). They often have initials after the name, like TR, CR, ER, XL, or XR. These are often exisiting drugs on which the patent protection can be extended, due to the change in formulation to achieve extended release. The benefit to the patient is often once-a-day dosing and fewer pills to take.

There are a number of mechanisms available to make drugs release over an extended time in the body, any of which can reasonably be used. They are usually multiple coatings that are only dissolved by distinct chemical processes that are located in the stomach, small intestine, large intestine, and then colon, releasing more medication each time a new section (and chemical process) of the tract is reached. As such, they are usually tied to a relatively normal digestive tract and process to allow the proper span of release time, and may not always work for people who have had other work done to their digestive tracts. They may also work unevenly in those who are taking poppy-derived painkillers like morphine, which can interfere with the digestive process.

On a simplified level, the main requirements for generics are that they achieve an effective release of the active ingredient equal to that of the original manufacturer, and that their manufacturing processes ensure that the pills or capsules are uniform in their dosage and composition.

However, original manufacturers often take pains to create an even distribution of the drug over time, to achieve the greatest effect. Generic drugs sometimes create spikes of drug release at some stages, so there may be a peak of rather high potency, then a period of low availability before the next release phase kicks in. This can heighten side effects and create uneven relief, depending on the product's purpose.

Similarly, a non-extended-release medication taken daily may peak in four to six hours, delivering its required dosage, and have only residual blood levels and effectiveness for the remaining 18-20 hours. This is another reason why differences in the formulations used by manufacturers of generics can make a large difference in tolerance for those who are sensitive to these medications.

People sensitive to blood pressure medications may find this particularly problematic, as the roller-coaster blood levels of the product may exacerbate effects like dypsnea (dizzyness). These side effects may not be evident when using the brand name versions, if the release is more carefully controlled by them.

Different generic manufacturers (including original manufacturers producing off-label) often use different release mechanisms, so a generic from one source may easily not show the same issues as a generic from another. Some pharmacy companies buy strictly by price, others purchase generics based on both price and what they perceive to be product quality differences. This is why switching pharmacies for generic prescriptions may help.

Generics are often not the same as the brand name, only cheaper. And generics are often not the same as other generics either. Caveat emptor.

Best wishes,

 

[Praline]

However, original manufacturers often take pains to create an even distribution of the drug over time, to achieve the greatest effect. Generic drugs sometimes create spikes of drug release at some stages, so there may be a peak of rather high potency, then a period of low availability before the next release phase kicks in. This can heighten side effects and create uneven relief, depending on the product's purpose.

Tobagotwo,
Thank you for a most informative post. What you are saying in the above quote is what my PCP said seems to be the problem with the generic Toprol XL. She also said that the headache could be caused by an ingredient used as a filler. I am SO sentive to EVERYTHING.

 

[Praline]

However, original manufacturers often take pains to create an even distribution of the drug over time, to achieve the greatest effect. Generic drugs sometimes create spikes of drug release at some stages, so there may be a peak of rather high potency, then a period of low availability before the next release phase kicks in. This can heighten side effects and create uneven relief, depending on the product's purpose.

Tobagotwo,
Thank you for a most informative post. What you are saying in the above quote is what my PCP said seems to be the problem with the generic Toprol XL. She also said that the headache could be caused by an ingredient used as a filler. I am SO sentive to EVERYTHING.

 

[tobagotwo]

As you point out, lots of things can affect the product. Not just the active compound or the digestive coatings already discussed.

And not just fillers. Also the binders used in the product. And the type of empty capsules supplied, and even what is used to seal the capsules.

There is at least one medication whose characteristics may have been changed by the purchase of rubber vial stoppers used in production from a different supplier. The slightly different rubber composition may have been enough to cause a minute variation in the finished product's action.

Variations in product quality for one of the tissue valves years ago were caused by the variability of the solubility of a particular compound that was obtained through differing sources, which was causing crystallization of the compound on the valves that could only be seen under high magnification.

I don't disagree with going back to the original brand name product at all. It has the highest likelihood of success.

However, I would like to again point out for those who may not be able to afford to pay for the original version, that switching to a drugstore who purchases their supply from a different generics manufacturer may have as good an effect as going back to the name brand.

Another pathway for the financially challenged to name brand drugs may be through TogetherRX, which is an attempt by a consortium of pharmaceutical companies to make some of their products available to those who would not otherwise be able to afford them. Your doctor would need to evaluate whether their available products are appropriate for you, and you would need to decide if that would be an appropriate vehicle for your circumstances.

Best wishes,

 

[Jkm7]

Thank you, Bob, for your excellent posts. Very, very helpful.

My unease about switching to any of the generics is that Toprol XL has kept my valve regurg stable and it makes me uneasy to think of any changes in medication that could result in less stability with my mitral valve.

The only way for me to know the generic has been less effective for me is when the damage will have been done, so to speak. I have low sensitivity to medications and can take almost everything I've ever been prescribed with no adverse effect so it would not be likely I'd have dizziness etc What I could have is a more severely leaking valve. I'd never forgive myself if that resulted because I switched to a drug which was less effective for me. A second OHS that possibly could have been avoided?

My pharmacist is extremely helpful and willing to take the time to answer questions. I think I will speak with her to determine which of the generics may mimic Toprol XL (...maybe Astra Zeneca's own). If there is an exact formulation, I am sure she would order that brand for me (and other customers in the same position.) My pharmacy will order a specific generic for a customer even though it is not the brand they usually stock.

You have been a huge help to me and I greatly thank you.