T2D - Glucophage (name brand) > Metformin (generic) ?
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KetoGirl83 wrote: »KetoTheKingdom wrote: »Does anyone know:
- whether the same holds true for other generic - name-brand combinations, such as anti-hypertension medications or statins?
- are there reliable web sites that publish reviews of generic equivalents? Is the FDA a good source of information?
Thank you.
Generics are supposed to be the same active ingredient as name brand. Metformin is used by so many people and its results shared in so many fora that a pattern for less reliability of the generic form emerged.
I trust the FDA when they say something is bad, not so much when they say it's safe. Bingo.
::flowerforyou::
@KetoGirl83 and @KetoTheKingdom. Here's my armchair take on it.....
Most of the metformin-bashing I've seen has been aimed at the whole ball of wax, not merely the generic - possibly because Glucophage has been off-patent for so long that most folks don't have a basis for comparison. Dr. Bernstein, however, can compare the two across a large number of patients.
For statins and blood pressure meds, I think the scene is a little different. If there are passable substitutes, many of our US insurance policies won't cover drugs under patent without several rounds of mud-wrestling. And of course, win or lose, the pig still enjoys it......
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I took Metformin 500mg for 2 weeks and I thought I was dying. Rushing to the bathroom, gas pain that was unbearable. Stopped that and a week later started Metformin XR 500mg. Been taking that for 1.5 weeks and I am having muscle pain. First I thought it was electrolytes, I'd been slacking on potassium a bit, added another cup of broth, upped my magnesium. Just today it hit me - it's gotta be the med. I think I'm over trying medications.
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Rainqueen77 wrote: »I took Metformin 500mg for 2 weeks and I thought I was dying. Rushing to the bathroom, gas pain that was unbearable. Stopped that and a week later started Metformin XR 500mg. Been taking that for 1.5 weeks and I am having muscle pain. First I thought it was electrolytes, I'd been slacking on potassium a bit, added another cup of broth, upped my magnesium. Just today it hit me - it's gotta be the med. I think I'm over trying medications.
1. Start with name-brand Glucophage XR, 500mg only, for as long as necessary to have tolerable GI effects.
2. Increase your dose of Glucophage XR to 1500 mg gradually, only as tolerated.
3. Spread the Glucophage XR over the course of the day. It takes 4-8 horse to reach peak blood levels.
4. Evaluate your BG again after you've been on 1500mg for a few weeks.0 -
Not sure they will ever prescribe that. I asked for it last time and she gave me the metformin XR. Next appointment isn't until February. Hopefully I won't even need it by then.0
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Another recommendation (other than Dr. Bernstein) for name-brand Glucophage XR to relieve GI distress from generic metformin.
http://www.diabetesincontrol.com/sometimes-you-gotta-use-the-brand-name-metforminMany of our patients have intolerable GI side effects from metformin. We use ER to try to decrease these, but that doesn’t always work. If they have these symptoms, I recommend they take it slow and take it after they eat. If they still have problems, I recommend they break the tablet to 250mg, even though the label may say one shouldn’t break the tablet. It still works. When it works, I recommend they increase the dose very slowly. Once there are no further GI side effects for a week, then increase to a whole tablet. Then in one week, increase by 1/2 tablet. This continues until they reach max dose for management with little or no untoward side effects.
There are those patients who just can’t tolerate the generic form. In that case I recommend Glucophage XR (Brand). For the most part, we recommend it as above and most patients do well. Some insurance companies will cover it, no prior auth needed. Some will need a prior auth. And, some won’t cover at all, but most of my patients have found the price to be reasonable and are willing to pay more for it.
Express Scripts reported re Valiant’s price gouging: One product in particular, Glumetza® (metformin HCL extended-release tablets), experienced a price jump greater than 800% in 2015. We no longer recommend Glumetza due to the cost…they did us wrong by raising the price.
Lessons Learned:- When patients have untoward GI side effects from metformin, lower the dose, and recommend to take after a full meal.
- It usually works to break the tab, even though it is not recommended to do so.
- Increase slowly.
- When patients still don’t tolerate, change to Glucophage XR Brand and slowly increase, still after a full meal.
- Be aware of the price of the medicine. Ask pharmacist to let patient know out-of-pocket price before filling. Patient can then decide whether they want to pay for it.
- Be aware of price gouging of some pharmaceutical marketing companies, and decide whether or not you want to use their products. These costs affect us all.
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Bumping for newbies.0
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Dr. Bernstein's most recent admonishment that metformin generics "are not nearly as potent" as brand Glucophage (starts around 35'30"):
https://youtu.be/A1QyXWy1_SQ 2 -
Dr. Bernstein's most recent admonishment that metformin generics "are not nearly as potent" as brand Glucophage (starts around 35'30"):https://youtu.be/A1QyXWy1_SQ
Omg! You just reminded me that I missed the teleseminar! I think it was yesterday! I asked a question on it I was hoping he would answer! Do you know if they put those up so you can still listen afterward?0 -
Sunny_Bunny_ wrote: »Dr. Bernstein's most recent admonishment that metformin generics "are not nearly as potent" as brand Glucophage (starts around 35'30"):https://youtu.be/A1QyXWy1_SQ
Omg! You just reminded me that I missed the teleseminar! I think it was yesterday! I asked a question on it I was hoping he would answer! Do you know if they put those up so you can still listen afterward?
I think this video is the January teleseminar, since it was just posted and he announces February's date & time at the end.
There's a lot of T1D discussion (and the obligatory, gratuitous jab at LCHF, which he seems to think entails LP.....)
My Qs have never gotten on; hope yours met a better fate!1 -
@RalfLott - I took the plunge. I picked up my Rx last night. I know the pharmacy called me when my Doc sent it in, and read the description as, "Patient prefers brand name Glucophage if cost is reasonable" and they wanted to tell me what the 90 day price was...I opted to do a 30 day Rx to start. It's far more expensive than Metformin, but if I can avoid the digestive drama I'll be good. I took it last night after dinner, and haven't yet exploded, though it's been too short a time to tell.
I had quite forgotten about how much I will need to supplement the B12. My levels had dropped below 300 WITH supplementation before when I was on Met, and I have a few permanent nerve damage spots that surfaced before I had any idea what was going on... Thanks for that reminder...
I am concerned, though, after reading the insert before taking the med last night, about the warnings about kidney strain. My kidney (basic) tests have been getting progressively worse, though not in the "really get worried" category yet, and I've been struggling to figure out what the HECK is up with my dehydration issues (which also are warned to massively worse with Met)... I don't see how this is going to be a good thing -- UNLESS the kidney and dehydration issues have been related to a slowly elevating blood glucose situation that had not yet reared it's ugly head, which I've started to suspect.
Frankly, the whole situation has me concerned, but I know a lot of that is my own mental F....er...hiccups... Until I get my thyroid better controlled, I'm terrified to drop my carbs all that much... And I know I overthink a lot of things... But, mainly I just wanted to say:
Thank you to @RalfLott @cstehansen @Sunny_Bunny_ @genmon00 @bjwoodzy @Dragonwolf and all you others who've been keeping the topic of blood glucose levels, T2D, IR, all your struggles, and all related discussions kept up front and center on this forum - along with all the amazing links you've shared out. It really was a wakeup call for me to get out in front of this whole situation, because I'd been kind of in that denial/feedback loop of congratulating myself for not being a diabetic yet, and learning to be thankful that so far my obesity was protecting me from the progression of the blood sugar issues, and thinking that I was okay so far, the whole "it won't happen to me" thing... I was deluding myself, and I thank you for not allowing me to continue lying to myself that I was "under control."
Because even though I need to get my thyroid leveled out before dropping my carbs much more, I can stop at the ongoing (silent) background damage to everything by getting back onto this medication... I'm still missing one of the anchor pieces to my "life/health" puzzle, but this is one step further in refusing to let it get even worse before leveling out or improving...
My sincerest thanks.2 -
Sunny_Bunny_ wrote: »Dr. Bernstein's most recent admonishment that metformin generics "are not nearly as potent" as brand Glucophage (starts around 35'30"):https://youtu.be/A1QyXWy1_SQ
Omg! You just reminded me that I missed the teleseminar! I think it was yesterday! I asked a question on it I was hoping he would answer! Do you know if they put those up so you can still listen afterward?
I think this video is the January teleseminar, since it was just posted and he announces February's date & time at the end.
There's a lot of T1D discussion (and the obligatory, gratuitous jab at LCHF, which he seems to think entails LP.....)
My Qs have never gotten on; hope yours met a better fate!
Good. I will watch it today. It would be awesome if he got my question.
@KnitOrMiss it sounds like you've had a serious mental breakthrough. I hope this brings you progress. You truly deserve it. I'm thinking positive thoughts for you.
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@KnitOrMiss, it's never simple, it seems. N=1 experiments, mine at least, are tough to control. Many of the things I thought I knew in 2016 I not only don't know in 2017, but have come to doubt.
I suppose the fact that things appear differently now than they appear to have appeared then is an artifact of feeling a different part of the elephant (even though the elephant is us....).
Anyhow, here's a 2014 review of studies involving Metformin and kidney disease:
http://jamanetwork.com/journals/jama/article-abstract/2084896
FYI, Dr. Bernstein was able to "reverse" (his word) his kidney disease by maintaining tight BG control.
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This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...2 -
KnitOrMiss wrote: »This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...
Yep. Lots of ????s.
@midwesterner85 knows a lot about Metformin (check upstream in this thread for some of his observations).0 -
KnitOrMiss wrote: »This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...
I'm thinking of it this way...
Currently you have high insulin and insulin resistant cells that must force any dietary source of glucose into cells in addition to any internal source of glucose. So there are only certain things you can do to reduce the glucose your cells have to respond to.
1.) reduce carbs or at least reduce fast carbs.
2.) reduce internal glucose production. Which is what I believe metformin does right?
And a 3rd option is to do both.
It's fairly straightforward how to control intake of glucose but it's not as simple to control your body producing it. Metformin should provide you more control of your body's total glucose load if I understand how it's supposed to work.0 -
KnitOrMiss wrote: »This is kind of wacky and interesting. It implies that Metformin doesn't actually reduce insulin resistance - that it works directly on the liver...
https://diabetesselfmanagement.com/blog/diabetes-metformin-and-your-liver/
I find it frustrating to find information that explains how Metformin works without the presence of elevated blood glucose levels...
Yep. Lots of ????s.
@midwesterner85 knows a lot about Metformin (check upstream in this thread for some of his observations).
@RalfLott - I've been following this thread since the beginning, and caught up on the last 20 responses or so today, but the main reason I posted this was that I've always been told that Metformin REDUCES INSULIN RESISTANCE. If it doesn't, yes, this should still help my overall levels of insulin, theoretically, but it may not do specifically what I need it to do. I'm still going to the Metformin/Glucophage trial for as long as I can...but...the mechanism seems to NOT be what everyone assumes... What everyone says Met does is an odd byproduct resulting from what it does do, but it isn't the mechanism of the medication itself...1 -
Yep, I believe Metformin makes the body more sensitive to the insulin you produce, but this is not just from reducing muscular, hepatic, and adipose resistance, but also from an effect on the pancreatic beta-cells (and probably other organs).
If you buy the idea that the reason for diabetes is to ensure that the brain has enough glucose to function, then perhaps it also makes the brain's use of glucose more efficient. Pure speculation....
I haven't read any articles whose authors don't caution that the workings of metformin remain unclear and that more research is needed.2 -
<refresh> for new groupies0
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jetsamflotsam wrote: »I was taking metformin for PCOS related insulin resistance (have since been able to get off it successfully)... but when I was taking it... here where I live my pharmacist stopped carrying the name brand metformin because the gov't subsidized medical plan would only cover the generic. Even though I don't qualify for subsidy, he went ahead and changed me over to generic without telling me. I went from having no stomach issues to non stop diarrhea. He INSISTED there was no difference, but after a couple weeks I convinced him to bring back the name brand one for me and my stomach issues totally stopped.
Ugh this makes me so mad for you! If the Glucophage works starting tomorrow after six months of the dumping/stool samples/glipizide issues I'm gonna be so mad at metformin!!!!0 -
Be mad at the pharmaceutical industry. They're the ones who allow generics to use whatever crap they want... Like gluten in thyroid medications. Soy, dairy, sugar, too... In almost everything.0
