Saturday, December 21, 2013

Cymbalta Goes Generic

On December 11th, the FDA approved the use of generic Cymbalta.  The generic version, Duloxetine, delayed release,  became available in the USA four days ago.

Generics generally work just fine and they cost less.  Now and again, some people have side effects or feel the generic is not as effective effective, and for those individuals, it makes sense to remain on the name brand medication.  Generics cost less and the active ingredients are the same.  Oh, but there was a little issue with the efficacy of one pharmaceutical company's preparation of Wellbutrin, XL, 300mg.  See the In The Pipeline discussion of the problem in this blog post, "The Generic Wellbutrin: Whose Fault is It?"

So, generic Cymbalta -- is it okay to take this today?  I have some thoughts.

 I imagine it's probably fine and it's probably cheaper.  In fact, I called one pharmacy, and their out-of-pocket price  for a single 30mg tablet ss $11.73 for Cymbalta, and $8.44 for generic Duloxetine.  So the cost is less, but we're still talking about a very expensive medication, even in generic form.   It's also the holiday season: stress runs high and moods run low.  I imagine it's fine, but for any given person, there is the question with any medication switch as to whether that person might be the person to have side effects or experience less efficacy.

So just to consider :
  --What happens to this person during an episode of depression?  If prior episodes of depression required hospitalization, it might be worth waiting a little and seeing how others who have had milder episodes of depression respond to the generic.
 -- Physicians won't be consulted first, the pharmacy simply makes the substitution.
 -- If there is a problem, the psychiatrist may be away for the holidays and a covering doctor may have to be consulted.
-- It's a preparation of the medication that US physicians have no experience with.  The generic form has been available in other countries.

Medications change to generic all the time, including many antidepressants.  The cost drops and the medication becomes more accessible.  Generics work fine, and I personally have no qualms about taking them.  So I'll leave this as my take away message: just beware that this change has occurred and prescribers may not know about it.  If patients call with problems, it may be worth asking if their medication was changed to a generic, and patients who have problems may want to mention to their doctors that the medication was changed.