Switching Between Generic and Brand-Name Antiepileptic Drugs

In this video interview filmed at ECTRIMS 2013, Daniel Kantor, MD, medical director of Neurologique and immediate past president of the Florida Society of Neurology, discusses the risks of switching epilepsy patients between generic and brand-name antiepileptic drugs.
Though going generic can reduce prescription costs, Kantor says sometimes generic medications don’t make sense for epileptic patients with stable response to brand-name medication — not because the generic medication is inadequate, but because of “the fluctuations when people go from one generic to another.”
Kantor cites one study on topiramate that kept one group of patients on Topamax, switched another group to Teva Pharmaceutical Industries’ generic version of the drug, and gave a third group topiramate from different generic manufacturers each day, which is what typically happens at pharmacies. According to Kantor, patients who had that “real world experience” with varying generic manufacturers had breakthrough seizures, while patients who stayed on one version of the antiepileptic drug didn’t have those seizures.
“Breakthrough seizures are dangerous — they can even be deadly — and in many states, people are not allowed to drive after having had a seizure. And so that means that we want to try to avoid our patients with epilepsy having any more seizures,” Kantor says. “Once a patient is stable on a medication, it probably makes sense for them to stay on that.”

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