Generic drugs are estimated to save health plans and patients billions of dollars yearly because the expense is less than that of the brand name version. By law generic formulations must have a peak blood concentration and total amount of drug absorbed that falls between 80% and 125% of the name-brand version. Medication switching is a major concern in epilepsy because breakthrough seizures may severely compromise health, well-being, and financial situation. Some AED have Pks with a high potential for over- and under-dosing with a narrow window of efficacy-toxicity. Lower serum levels of PHT as in our patient have been reported in patients switched from brand to generic PHT. Individualizing standards for generics should therefore be AED-dependent. Bioequivalency for most generics do not significantly deviate from brand, however multiple generic switches of individual drugs may vary as much as 30%1. Therefore multiple switches (figure) may have significant costly ramification of seizures or toxicity. Another study found patients who had an epileptic event requiring acute care were about 80% more likely than matched controls without an acute event to have recently had an AED substitution. Our Haitian epilepsy patient had a limited understanding of AEDs and generic issues. A combined physician-pharmacist approach was helpful in obtaining brand medication resulting in resolution of her side-effects.
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