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there are differences

Dealing with Side Effects | Common Crazy Med Crap Index | Meds & Supplements

1.  Introduction

One of the most debated issues in health care today concerns the difference between brand name (also called branded, innovator, and pioneered) drugs and their generic versions (usually called “equivalents”). While most everyone can agree generic drugs are less expensive than the branded versions,1 whether or not generics are always the same as brand is another question. “Different” doesn’t always mean “not as good.” In some cases a generic drug can be better than the branded version in more ways than just being significantly less expensive.

This page is about prescription, dosage-critical medications, mostly antiepileptic drugs (AEDs). When it comes to something you can buy at a bodega/corner store/convenience store like Aleve (naproxen sodium) or Advil (ibuprofen), you’d be an idiot not to get the generic2. Unless you’ve had a bad experience with the store brand of whatever store you find yourself in.

2.  What’s the difference?

The party line answer from the FDA, the AMA,3 big pharma, and most pamphlets, books, TV commercials, and any other source of information is: generic drugs are exactly the same as brand name medications.

Reality is more complicated than that, especially in the world of crazy meds. Like so many things it depends on the drug, the condition being treated, and the person taking the medication. The odds are it won’t make much of a difference as far as you’re concerned. But if you do notice a change in how well your meds worked, side effects, or anything else after you were switched from a branded/brand-name medication to a generic, or from one generic to another (the pills look different, and/or the numbers changed), it’s not all in your head. Literally. In spite of these drugs usually targeting your brain, your brain has little, if anything, to do with any difference in effect when taking meds made by different manufacturers.

3.  A Dose by Any Other Name

We’ve got a lot of terminology to cover.

3.1  Brand Whatsits

We pretty much all know that “Generic” is the generic term for any drug made with an active ingredient that is no longer on patent and is no longer protected by FDA exclusivity4. Only a few crazy meds are almost always referred to by their generic names, like lithium and phenobarbital. “Generic” is both a noun and an adjective.
“Brand name” is complicated. “Brand name,” or “trade name,” are fairly straightforward. Unfortunately they are not universal. The term “branded” is also used, as is “brand.” You may even see terms like “pioneered drug,” “innovator’s product,” or “originator tablet,” but those aren’t used very often these days. Except for “innovator” drug/medicine/some other term, which is still used in research papers. “Brand” alone is confusing because many people use “brand” to refer to generics made by different manufacturers (e.g. “I never had any problems with Teva’s brand of lamotrigine…”), while “branded” is problematic because of the term “branded generic.”
“Branded generic” has three meanings:

  1. A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, who bought Warner-Lambert, who pioneered Neurontin.
  2. A branded generic is also a generic drug given a ‘brand’ name by the manufacturer (e.g. Teva’s Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
  3. A branded generic is also a generic drug given a ‘brand’ name by the manufacturer and uses a salt of the active ingredient that is different from the original branded version and other generics. E.g. Sanofi-Aventis’ Aplenzin, which is bupropion hydrobromide, while Wellbutrin, Budeprion and most of the others are bupropion hydrochloride. The FDA says they’re the same thing, and, as usual, the data are contradictory but leaning heavily toward the FDA being as wrong as they usually are about pharmacokinetics.

3.2  Therapeutic Equivalence

In English: A generic drug is as safe, effective, and acts the same way as the brand name drug at the same dosage. I.e. it lives up to the promises that everyone makes about generic drugs.

Drug products are considered to be therapeutic equivalents only if they are pharmaceutical equivalents and if they can be expected to have the same clinical effect and safety profile when administered to patients under the conditions specified in the labeling.

FDA classifies as therapeutically equivalent those products that meet the following general criteria:
(1) they are approved as safe and effective;
(2) they are pharmaceutical equivalents in that they

   (a) contain identical amounts of the same active drug ingredient in the same dosage form and route of administration, and 
   (b) meet compendial or other applicable standards of strength, quality, purity, and identity; 

(3) they are bioequivalent in that

   (a) they do not present a known or potential bioequivalence problem, and they meet an acceptable in vitro standard, or 
   (b) if they do present such a known or potential problem, they are shown to meet an appropriate bioequivalence standard; 

(4) they are adequately labeled;
(5) they are manufactured in compliance with Current Good Manufacturing Practice regulations. --the Orange Book 5

Emphasis on identical mine, as are some formatting changes for legibility.

3.3  Bioequivalence (BE) & Bioavailability (BA)

Most of the therapeutic equivalence standards are essentially paperwork. The only things that requires any testing are bioequivalence (BE) and bioavailability (BA). These are the numbers with the allowed 80–125% variance everyone talks about. Like most people without any training6, I wrote that had to do with how well the active ingredient got absorbed and distributed, which would be its BA. At least I wasn’t as wrong as everyone who that that was how much of difference in the actual active ingredient a generic med could have in it. The 80–125% range actually refers to the confidence interval (CI) of different pharmacokinetic parameters (see below for those). In English: if you remember what you learned in statistics class I probably don’t need to explain it to you, which is a good thing, because years of poorly treated epilepsy and bipolar have fried the part of my brain that remembered and understood math more complicated than adding and subtracting anything larger than 3-digit numbers. As for the rest of us it means their math looks good when they show there’s not too much of a variance.

So BE essentially means the pharmacokinetics (PK) are fairly close, and with a CI of 80–125% the actual difference in BA shouldn’t be more than 5%. Sometimes that’s enough, and sometimes it’s way more than that in spite of passing the BE tests. Why?

First of all, whenever generics manufacturers run BE/PK testing on humans, they do one test on 24–36 professional guinea pigs “healthy volunteers” who are mostly white males between the ages of 18 and 55. The tests are always the same, one dose, often the lowest anyone would ever take, first thing in the morning on an empty stomach. It doesn’t matter if it’s a sleeping pill that works better (even to deal with side effects) when taken with a meal, it’s the same routine every time.

If they want to be really thorough - but not go so far as to have on group of patients taking the brand name med and another group taking their placebo generic version - a generics manufacturer will do a crossover test. That’s where they’ll get two groups of the usual suspects healthy volunteers. One group will take a single dose of the generic and one group will take a dose of the brand, and the only PK values that seem to matter are measured. Then two or three weeks later each group gets the other med. In that way anyone who is a poor or rapid metabolizer of a drug won’t skew the numbers. The crossover test makes a lot of sense, with a single-dose test it’s meaningful only for medications with active metabolites like Trileptal and Risperdal, where the pill you take isn’t what works on your brain, your liver needs to transform it first. And even then its relevance is only to see how well the transformation works, and not the BA/BE of the active metabolite itself.

The rest has to do with the complexities of PK…

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3.4  Pharmacokinetics (PK)

Pharmacokinetics (PK) is what your body does to a drug. It’s a geek’s paradise of hardcore technical data, full of data regarding how well a drug is absorbed and distributed, how long it takes to clear from your system, what potential drug-drug interactions there can be, and so forth. As far as BE goes, the FDA cares about two things: the maximum blood plasma concentration (C-max), and the plasma concentration time curve (AUC). If you look at Paxil’s PK, including most of the popular BA / BE parameters,7 there are a hell of a lot more data that can be used to nail down the theoretical difference in BA / BE, or to explain why an actual difference exists. Somehow the FDA thought those two were enough.

So with only those two parameters used, and only after a single, often sub-therapeutic, dose, it’s way too easy for a drug to appear equivalent when it’s not.

The FDA also allows for a dissolution test, the pharmaceutical equivalent of trial by combat. The manufacturer can submit data on how their drug melts in test tubes. It’s not acceptable for a meds like Wellbutrin or Effexor, where an active metabolite is responsible for part or all of a drug’s effect, but for other meds it’s OK. I think it’s bogus, but the FDA is on board with it. You’d think generics manufacturers would be all over this one, as it’s fast, cheap, easy, and the numbers aren’t open to interpretation. It’s the last part that keeps it from being used too often. You can see why in this test Crazy Talk user noreply made using brand Wellbutrin and three generics. His post explains it, even if he did get the 80–125% thing wrong. As I’ve been writing since forever, it’s all in the inactive ingredients.

3.5  Dose/Dosage Critical & Narrow Therapeutic Index/Margin/Ratio (NTI)

These all mean the same thing, which is two different things.

  • First is what we’re discussing here - how the slightest change in a med’s dosage (how much you take), or dosing (when and how often you take it), is the difference between a med that works and a med that doesn’t work or has side effects that suddenly suck worse than the condition being treated. Lots of people who take Topamax or Lamictal know what a huge difference there can be between 375mg a day and 400mg a day of either. Lots of people who take Effexor or Keppra know that taking your pill a few hours late can sometimes lead to a world of hurt.
  • Then there’s the original meaning - that there’s not much of a difference between an effective dosage and a toxic dosage.

I use dosage critical for the former and narrow therapeutic index (NTI) or margin for the latter. There aren’t very many crazy meds with an NTI. Lithium is one. For bipolar disorder a blood plasma test usually determines, or at least strongly influences your dosage. The therapeutic range is 0.6–1.2, but lithium toxicity can start at a level of 0.9.

  • In any event, the FDA now considers all crazy meds to be NTI, and has tightened the standards for bioequivalence (more below).

This page, and the concept itself, has nothing to do with drugs that are not dosage-critical. I have no idea if the therapeutic margin is so narrow there can be a difference in efficacy between brand Viagra and generic sildenafil, but I find it highly unlikely there will be much of a difference in efficacy between brand Propecia and generic finasteride. Differences in side effects due to inactive ingredients are always a possibility regardless of the drug.

4.  Four Out of Five Doctors and Pharmacists Agree

Actually it’s more like half of doctors and pharmacists surveyed say when dosage-critical drugs are involved, there can be a significant difference between brand-name and generic drugs, as well as between meds from different generics manufacturers. With doctors it tends to depend on their specialty. But more and more doctors from more and more specialties are getting behind the new party line:

  • If their patient began treatment with a brand-name, dosage-critical drug, or drug with a narrow therapeutic index, then they should stay on the branded med.
  • If their patient began treatment with a generic dosage-critical drug, or drug with a narrow therapeutic index, then generics are fine. And, if at all possible, they shouldn’t be switched from one manufacturer’s med to another’s without a good reason. E.g. an allergy to an inactive ingredient.
    • Many individual prescribers and pharmacists are with us in that they know some manufacturers are churning out sub-standard products that no one should take, unless they should be taking a placebo. As far as I know no organized group has come out to call specific drug manufacturers on that, or to recommend the FDA do something about it, etc.

4.1  Survey Says…

How do I know doctors & pharmacists are starting to come around?

4.2  On the Other Hand…

Nothing is ever cut & dry in pharmaceuticals.

  • The price we pay for physician gullibility on generics. With a title like that…oh, it’s an HMO-sponsored publication. Still, the author raises the obvious point: there’s a hell of a lot more money to be made by Bigger Pharma (i.e. drug pioneers/innovators) pushing brand name drugs than Not-Quite-So-Big Pharma (companies that make nothing but generics) with big box stores selling $4 generics.
  • A lot of people making noise about the problems with generic meds, like the Epilepsy Foundation, get a shitload of money from Bigger Pharma.

5.  How Much More Proof do You Need?

Once again, don’t just take my word for it.

5.1  As ever, the data are never clear.

  • This Danish study found no significant difference in the blood plasma levels of people taking brand Lamictal and those taking generic lamotrigine.
  • Comparing Depakote with valproic acid usually pisses me the hell off, but in this blatantly pro-generics study, they admit the two are different drugs. The results: although they ended up taking more valproic acid, and the GI side effects sucked more, there was no difference in how many people stopped taking either med. Although the people taking Depakote were on it a hell of a lot longer than those taking valproic acid.8
  • There are probably more, but searching for this sort of thing is like looking up side effects on teh InterGoogles, complaints will always outnumber reports of everything being just fine, because hardly anyone reports “I didn’t have any side effects.” A bit further down I’ve got a bunch of clinical trials where the generics tested as well as the branded versions…

In case you were wondering how all the accidental and “inadvertent” switches happened, this study, 30% of doctors and pharmacists randomly selected from a teaching hospital were unable to identify any of the three meds placed in front of them.

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6.  What Does the FDA Have to Say About it?

6.1  Certainly not “I’m Sorry”

Let’s start with the good news. Of sorts. The FDA admitted that Impax & Teva were wrong, the 300mg size of their Budeprion XL is not bioequivalent to a 300mg tablet of Wellbutrin XL. And only the 300mg tablet. Why? Because Impax didn’t use a 300mg tablet when they did the tests, that’s why. It doesn’t matter that the results were the same. By not using a 300mg tablet in any of the tests, the FDA was able to make Impax do it again, get the same results, and then declare that size to be unclean and not kosher.

Since the FDA has finally admitted that what I’ve been writing for the last 10 years is possible, and they are in the process of testing generics on the market for bioequivalence, there’s no need to flog that dead horse. If you’re interested, here’s a page on some of the history of the Budeprion XL vs. Wellbutrin XL debacle, and all the reasons why the FDA was full of shit and denial on the subject of generic drugs. Still no word on when they’re going to apologize to everyone they said was just imagining the symptoms; or it was just a coincidence and brand Wellbutrin would have failed, so they should try another antidepressant.

6.2  At Least They Did Something Sorta Real About It

There’s even better news. As noted above the FDA now considers crazy meds to be NTI meds and holds generics to a higher standard: they now have to meet a 90–110% ratio for Cmax and AUC in addition to the 90% CI and 80–125% BA/BE. The page on the Budeprion XL vs. Wellbutrin XL debacle now has data from the quietly-released tests on the never-should-have-been-approved Budeprion XL showing how that works. The 90–110% ratio, while tougher to meet, is actually easier to comprehend. Sort of. It also includes a dissolution test that Budeprion XL utterly failed. XL my ass.

7.  And it all Comes Down to…What?

So what’s the takeaway from all this?

  • Significant problems caused by the differences between brand-name drugs and their generic ‘equivalents’ are infrequent but real.
  • What do I mean by “infrequent?”
    • Based upon all of the examples I’ve used, and all the ones I didn’t include, and all of the anecdotal accounts I’ve come across, problems caused by switching from brand medications to generic drugs or one generic drug to another generic drug comprise, at the very most, 1–2% make that getting close to 7–10% of the adverse reactions / negative experiences / “side effects”-that-aren’t-really-side-effects everyone has had with crazy meds from the 1990s until now.
    • Extrapolating adverse reactions caused by allergies and/or sensitivities to excipients in both branded and generic meds, including those mistaken for side effects of the actual active ingredient, increase that to 15–20%.
      • That’s my best guess9. I honestly don’t think it’s much more than that.
    • Given that 2% is the approximate rate of schizophrenia and 5% is approximately how many people have affective mood disorders serious enough to require medication, 7–10% is a wholly unacceptable number of people.
  • I have no clue at all what the numbers are like for other dosage-critical and narrow therapeutic margin meds, like those used to treat cancer and immunosuppressants for organ transplants.
  • With some people a slight change in a med’s PK can cause a change in side effects and/or relapse of symptoms.
  • With other people, a different inactive/inert ingredient/excipient is all that’s needed to cause new side effects.
    • The two are not mutually exclusive groups.
  • The FDA didn’t give a rat’s ass about it for YEARS as patients and doctors rubbed their faces in the lies they and their toadies were spreading.
    • Even with the tougher 90–110% AUC & Cmax ratio, they’re still using the same bullshit PK testing as the standard and not real tests involving people with the conditions the meds are designed to treat.
  • Which creates a wonderfully paradoxical situation:
    • Bigger Pharma can keep forcing the generics manufacturers to spend more money on lawyers arguing about FDA-approval for the generic drugs instead spending it on real testing.
    • While the generics manufacturers who wish to be first, second, and third on the market still do bullshit testing on healthy volunteers, the ones willing to wait merely submit paperwork. What BA/BE testing?
  • And PK has absolutely nothing to do with allergies & sensitivities to inactive/inert ingredients/excipients. You’re on your own with that.
    • Good luck getting the FDA, or Congress, to mandate highlighting any ingredients that cause people those sorts of problems.
      • The most I’ve seen, as far as neurological and psychiatric medications are concerned, is mentioning if there’s lactose in a pill, and that’s buried in the PI sheet.
  • So in the end, we’re fucked.
    • The pioneering companies will get to keep FDA exclusivity for their meds longer, keeping the prices up.
    • And we won’t really know which generic versions, if any, are truly equivalent until most of us are paying to take them for a year or more instead of the generic manufacturers paying a couple hundred or so of us to take them for 30–90 days to see what the BA/BE numbers are really like in the real world.
  • Which means we have to always be on guard about which versions we get from our pharmacists.
    • As if our lives weren’t difficult enough.
  • At least we have some tools.
  • In any event, there’s not a damned thing we can do about it.
    • Congress won’t act, let alone overreact, unless you’ve got a bunch of weeping mothers telling them, and the two dozen people watching C-SPAN, the stories of the children who died of socially-acceptable conditions like cancer, or something requiring an organ transplant, because of substandard or allergen-packed generic medications.
    • So we’ve probably got the best we can hope for. For the next decade or so.

8.  I Can Make it Really Simple for You Paper-Pushing Morons at the FDA

There is an incredibly easy solution to all of this that would have one standard of testing for all medications, regardless of their PK.

A double-blind trial with people who are already taking the brand-name drug to treat an approved condition. You give half of them the generic and half of them the brand for a month. If no one can tell the difference, it passes; if too many people have a relapse in symptoms, it fails. You collect all the PK data, but that would mainly be for any failed drugs. How fucking difficult is that? It must be extraordinarily hard to do, since no one has done it before. Oh, wait, it has been done before.

  • Epitol vs. Tegretol. A double-blind, cross-over study that lasted for 90 days. 40 epileptics, half seizure-free, half no such luck on meds. The results: a tie.
  • They can even do it in Thailand. Tegretol vs. 2 branded generics and one other generic carbamazepine. They gave 18 people who had been taking Tegretol one of the four meds, waiting until they were at steady state, and started taking blood samples. Two of the three passed the important test of “did it work?”. The abstract reports breakthrough seizures, but it doesn’t state if that was for the failed product or what. Good to know who has better standards, Thailand or the good ole U!S!A! U!S!A! U!S!A!
  • Generic clozapine vs. Clozaril. 17 schizophrenics switched from brand to generic. This study is a bit fuzzy on details - the abstract is all about the white blood cell count and other side effects - and has been challenged by Novartis. But at least Zenith (now part of IVAX) had the balls to run trials using actual patients.10

So why don’t we do it that way here? No, really, I’d like to know the answer to that question. Why don’t we use that method to test generics? Are the generics companies too chickenshit to put their meds in head-to-head competition with the real thing?

9.  Sometimes It’s So Fucking Obvious. Except When It’s Not.

So far article, along with most of the debate regarding the differences between brand/pioneered/innovator and generic drugs, has concentrated on the obscure and eye-glazing-over subject of PK, when a far more common cause of problems is a difference in one or more inactive/inert ingredients (known as excipients in pharmacologese). If you’re highly allergic to some inert ingredient that is in one version of the drug but isn’t in another, you obviously need to take the allergen-free version. Simple, right?

  • Assuming you know what you’re allergic/sensitive to.
  • And you can get the list of inert ingredients, as not all generics have complete PI sheets available.
    • Fortunately, more and more are available at DailyMed.
    • You’ll need to work with your pharmacist regarding which Packagers (what the FDA calls the drug distributors) from whom they get the particular med in which you’re interested.
    • Because you’ll need to check the Labels (AKA PI sheets) for each Packager in order to see what the different inactive ingredients are.
  • So if you have, or you suspect you have an allergy/sensitivity to something used as a binder/filler/dye, etc., that could be causing an adverse reaction (and not, technically, a side effect) unrelated to the med’s active ingredient.
    • It doesn’t matter if you’re taking the brand version or a generic, if corn starch or D&C Red #2 causes you to break out in hives, and there’s a version of a med that doesn’t have either of those, ask your pharmacist to order that one. It’s possible that a drug may work for you after all, and it was an inactive ingredient that was screwing with you.
    • Cornstarch is especially popular as an excipient and, despite what the FDA thinks, lots of people are allergic to corn11.
  • What this also means is, as mentioned at the beginning of this article, some generic drugs are better than the brand name med in addition to being better than other generics.
    • This is the most jaw-dropping example. Although tested on rats, it seems a generic form of vancomycin - a drug to treat colitis that is potentially effective against one of the deadliest and most frustrating problems in hospitals today: multiple drug-resistant Methicillin-resistant Staphylococcus aureus (MDR MRSA) - is far less likely to destroy your kidneys than the brand-name version when taken at dosages high enough to be effective against MDR MRSA.
    • Most generic crazy med tablets are white. I couldn’t find an example in the literature of white pills causing fewer problems than their more colorful cousins12, but this study of topical corticosteroids found the generic versions had far fewer allergens than the branded products, thus far fewer adverse reactions.
    • As I’ve written elsewhere, Teva’s lamotrigine is much easier to split than GSK’s brand Lamictal, and all other generics with which I’ve had any experience13.

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Dealing with Side Effects | Common Crazy Med Crap Index | Meds & Supplements

1 Except for some utterly insane insurance plans with generic equivalents cost the same and, yes, even more than the brand name version. Then again, if whoever put those formularies together read some of the medical economics papers I've referenced, they may actually be brilliant and only appear to be crazy to anyone who doesn't understand medical economics. Which is probably 99.95% of the population.

2 Want to know the difference between the non-narcotic (i.e. without the hydrocodone component) prescription versions of Aleve and Advil and the regular stuff you can just walk into any store and buy? The dosage is twice as much. That's it. As long as you don't have any other health conditions involved and aren't taking any meds that can interact with them, you can safely take twice as much naltroxen sodium and ibuprofen as listed on the bottle. But if you weren't taking a shitload of meds and/or had an otherwise clean bill of health you probably wouldn't be reading this site in the first place, would you?

3 You just assumed I meant American Medical Association, didn't you?

4 This gets super complicated. The short explanation is: The FDA will let drug companies keep exclusive rights to sell their brand name drugs for months, even years, after the patents expire for many different reasons. The main reason being they have really good lawyers.

5 What the FDA calls its big book about generic meds. It must have been orange at one point. I don't even know if they still print it out on paper.

6 And plenty who did.

7 I usually can't find other useful ones like volume of distribution (VOD).

8 I also wonder if anyone who was severely crazy enough to be hospitalized for a long time then allowed back outside is going to bitch about side effects that much in the first place. Wanting to spench every day sucks, but it sucks a lot less than hearing the people in your bathroom whispering their latest plans about how they're going to kill you.

9 I.e. Numbers I pretty much pulled out of my hemorrhoid-laden and frequently-constipated ass. There may be more truthiness to them than good science, but with more and more 'legitimate' sources writing about this, I'm no longer the lone voice in the wilderness that I was ELEVEN YEARS AGO when the first version of this article went up on crazymeds.org.

10 While the schizophrenic are among the most vulnerable people in our society, with so many being seen at community clinics who will end up being switched to generic versions of what they take no matter what, the schizophrenia community will be best served by people with conditions in the psychosis spectrum volunteering to participate in brand vs. generic testing than letting the FDA rubberstamp an approval for nothing more than a PK test carried out on the usual suspects.

11 Next time you're looking at the ingredients list of packaged food, note how foods with common allergies & sensitivities are highlighted. Soy, milk, wheat, nuts and their derivatives. Take a look at anything with corn. Fortunately for me the amount of cornstarch in meds is too small to cause me any problems. Other people aren't so lucky.

12 Way, way back when my daughter was first dealing with crazy meds and practically everything she was trying was still on brand, one of the requirements for evaluating a med was what we jokingly referred to their being 'Aryan', as she has severe sensitivities to a shitload of D&C and FD&C colors. This is where expensive compounding pharmacies come to the rescue, and why I get so pissed off when some asshole gives them all a bad name by getting sloppy and infecting a bunch of people with meningitis.

13 As well as being better overall than any other generic lamotrigine I've taken.

Brand Name Vs Generic Medications by Jerod Poore is copyright © 2011 Jerod Poore

Last modified on Tuesday, 17 November, 2015 at 11:15:25 by JerodPoorePage Author: Jerod PooreDate created: 26 February 2011

All drug names are the trademarks of someone else. Look on the appropriate PI sheets or ask Google who the owners are. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of any trademarks may have changed without my noticing.

Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore

1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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