You get your epilepsy prescription refilled, open the bottle, and see that the pills look different this time. A quick look at the label tells you that instead of the brand-name medication you’re used to, this time you received a generic. Does it matter?
For most people, it shouldn’t. By law, generics have to have generally the same amount of usable -- you might hear your doctor say bioavailable -- medication in each pill as brand names. They can’t have less than 80% of what brand names have, and they can’t have more than 125%.
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But if you have “brittle” epilepsy, in which your body reacts strongly to very small changes in the amount of medication in your blood, the difference between 80% in one bottle of generic medication and 125% in the next bottle of generic can cause problems.
Some people can’t tolerate generics. Others are allergic to something in them. “It’s a sensitive topic because one seizure can set a patient back. It can prevent them from driving for 6 months or it can radically change what they’re capable of doing,” says Linda Selwa, MD, professor of neurology and codirector of the epilepsy program at the University of Michigan.
“Generic-to-generic switching is what makes epilepsy doctors and patients nervous,” says Jacqueline French, MD, professor of neurology at New York University’s Langone Medical Center. It’s most risky for people who need to keep their disease under tight control.
French has other concerns with generics, like how they look and what kinds of extra ingredients (or fillers) are in them. “A generic pill doesn’t look like the brand name. A lot of them are just gray pills. If you’re taking three or four different pills, there’s a greater chance you’re going to get it wrong when filling your pill box,” she says. “Generics also have different fillers, and they may release the medication from the capsule at a different rate.”
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Selwa says the debate about generic epilepsy medications has been around for a while. “This is an old controversy with medications and an old one called phenytoin (Dilantin). There were papers from [about 10 years ago] that indicate some patients who had to switch formulations more had more seizures.”