Generic Methylphenidate for ADHD

September 13, 2020 4:04 AM

I asked my doctor for Concerta because it's helped my ADHD in the past. I've run into some issues with it.

The pharmacy gave me the generic (extended release) instead of the brand name. I'm having a hard time with the generic - I get some focus in the morning and then in the afternoon I feel exhausted and just want to lie down. But oddly, I sometimes get a fresh burst of energy in the evening. I read that the generic I'm on has osmotic (water pressure) release, so today I've tried to drink water more regularly - I still got tired in the afternoon but I also did intense physical labor in the morning, so I'll have to try again tomorrow and see.

I'm concerned about being able to adequately perform at work if I'm exhausted for half the work day. I can call my doc on Monday but I'm concerned that she might not be willing or able to write me another script for a controlled substance. I found someone had described a similar experience on that other website that starts with an R, but they resolved it by switching to the brand name.

I'm interested in hearing any other ideas on what I could do to help this medication work for me - I've been taking fish oil in the morning with the medication, and I eat soon after taking it. I will also ask my doc but she's a GP and doesn't specialize in this area, and doesn't seem particularly knowledgeable.

posted by anonymous to Health & Fitness (9 answers total)

You don't state your location, but in the US, generic manufacturers are required to certify that their drug's active ingredient is within 20% of brand (so, 80-120%). For many people, that wiggle room doesn't matter, but for some, it's absolutely critical.

Honestly, the best way to solve this is to talk with your doctor about re-writing as brand only (there is a special box to check on the e-script; she might also have to write a short comment explaining why an early refill is ok), or maybe talking to the pharmacy about whether you can exchange your remaining generic pills for brand. This is something doctors see a lot (and pharmacists probably even more) so in itself, shouldn't raise any eyebrows.
posted by basalganglia at 4:23 AM on September 13, 2020 [2 favorites]

US perspective :

You'll likely have to wait until your script runs out (or thirty days from your last fill if you don't use it every day and your perception lasts longer than 30 days unless you somehow got a 90 day supply then you'd have to wait 90) to change back to the brand name, but physicians can designate on the script for brand name only no generics in the future. You can also tell the pharmacy and simply refuse to pick up medicine that is not the brand name, then you'd be able to try and fill elsewhere that will fufill your request. Once you have the medicine in your posession though you can't return it or fill the same script. If you have money and are willing to pay, AND your doctor was willing to write it out again (they are probobly NOT going to) you could pay for it, I think. But controlled substance laws may prevent that as well.
But you could possibly change dosages with a new script and that would covered by insurance again your physician may not do that.

This doesn't sound like the case for you but in the US some insurance require generics when available and will not pay for the more expensive brand name version. So make sure this isn't the case for you.

I don't have any tips or tricks for the generic to optimize how it works with your body, sorry.
posted by AlexiaSky at 4:26 AM on September 13, 2020

Response by poster: I take a different Schedule 2 drug (Adderall) and have not had issues when my doctor needed to write me a slight variation of my prescription. It is worth at least checking. Also if you can get a psychiatrist to oversee your medication rather than a GP that would be ideal, they have more experience and are better equipped to handle these situations.
posted by Anonymous at 5:27 AM on September 13, 2020

As far as your energy levels go, i know that on my meds (not Concerta, but another generic for Adderall) that they completely wipe out my appetite and I have to force myself to eat sometimes. This may be what's going on maybe for you? If you're lagging in the afternoon, remember to eat something solid along with your water intake to give your body a natural energy boost.
posted by Lipstick Thespian at 7:05 AM on September 13, 2020

I'm on methylphenidate also, and even though it's a controlled substance, I had no issues getting an immediate new prescription filled when one of the new brands I tried gave me horrible side effects (diarrhea and gas, so weird!). My doctor gave me to understand that when trying a new brand or new drug, the regular controlled substance rules don't actually apply, especially if you just return the unused portion of the prescription to the pharmacy or doctor. This is NY state, your rules may vary.
posted by MiraK at 8:05 AM on September 13, 2020

Not a big deal to request brand-name but your insurance may not cover it, meaning you would be paying several hundred/month for the brand-name.
posted by namemeansgazelle at 8:22 AM on September 13, 2020

Generics of extended release ADHD meds not being true equivalents of the name brand is a known problem. So much so that my daughter's psychiatrist warned me about it. I would ask both your pharmacist and your doctor about it.
https://www.google.com/amp/s/www.additudemag.com/generic-concerta-is-not-created-equal/amp/
posted by stowaway at 9:08 AM on September 13, 2020 [3 favorites]

There used to be a famously terrible generic of Wellbutrin/bupropion out there; wonder if that’s what you were thinking of. If it turns out your insurance won’t cover the brand for some reason, you can also get a prescription written for a specific generic (or one that excludes the one you’re taking now). The problem with generics is that they don’t actually have to use the same fillers or manufacture the drug in the same extended release matrix, so while on average what they’re doing might be okay, there’s always the possibility that you specifically will end up digesting it differently.

In fact I just checked and it looks like there is also an ”authorized” generic that’s actually made by the same people as the brand name, just with a different distributor. That should actually be basically identical to brand name Concerta. The site I linked gives guidelines for how to get prescribed that one specifically but notes that not every pharmacy may be equally cooperative.
posted by en forme de poire at 9:41 AM on September 13, 2020 [2 favorites]

(MiraK, my theory on what happened with you is that they used some “inactive” starch as a binder like inulin. People don’t break down inulin much themselves, it’s mainly gut microbial metabolism, and that can both result in a ton of gases being generated and also be very variable from person to person.)
posted by en forme de poire at 9:58 AM on September 13, 2020 [1 favorite]