1524788977179 - Fight over Pharmac’s switch to generic anti-depressant brand continues

Fight over Pharmac’s switch to generic anti-depressant brand continues

Depression sufferers wanting to remain on old anti-depressant brand can – but at a cost. MONIQUE STEELE reports.

Pharmac’s switch to a generic anti-depressant brand is causing concern as more Kiwi depression sufferers warn the change may be doing more harm than good.

Following the death of her husband in 2008, Christchurch woman Marise Jose, 54, began taking venlafaxine medication Efexor XR to treat her depression, anxiety and panic attacks.

She was told by her pharmacist in September that she would now have to pay for the medication as Pharmac had switched its funding to a generic brand.

Jose tried the new funded medication, Enlafax, three times, but experienced rashes all over her body, suicidal thoughts, paranoia, mood swings and severe stomach pains.

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“This [generic] stuff is poison. It’s not the same. We’re being used as guinea pigs,” she said.

The formerly funded venlafaxine brands – Arrow-Venlafaxine XR and Efexor XR – were changed to Enlafax by Pharmac in April last year. Enlafax became the country’s only funded brand of venlafaxine in September. The original venlafaxine brands are still available in pharmacies at retail price.

Jose, who is on the invalid’s benefit, returned to the original medication. She receives Work and Income support to purchase it, but still struggles to pull together the $30 a month needed and is cutting her dosage to what she can afford.

“[Efexor XR] wasn’t a cure, but it did help a lot,” she said.

Since April 1, 2017, Medsafe has received 142 reports of adverse side effects to venlafaxine including reduced effectiveness, headaches, anxiety, suicidal ideation and one suicide attempt.

An online petition fighting to bring back Efexor has gained nearly 5000 signatures.

Pharmac and Medsafe agreed the brand switch was safe for the 45,000 people prescribed venlafaxine each year, Pharmac chief executive Sarah Fitt said.

The government drug-funding agency saved $5 million a year by making the switch to the generic brand, she said.

“We understand change issues are real for people. Pharmac will be guided and take any action determined appropriate by Medsafe.”

More than 150,000 publicly-funded prescriptions for venlafaxine were dispensed at community pharmacies nationwide in 2016, Medsafe manager Chris James said.

​”It is expected that approximately 1 per cent of patients will experience problems with a brand switch,” he said.

James said it was expected some people would have side effects, but Medsafe had not identified issues with the quality of Enlafax and neither had medicine regulators in other countries, like Australia, the United States or the United Kingdom.

For a generic medicine to be distributed in New Zealand, it must contain the same active ingredient that was released in the same way as the originator brand – Efexor, in this case.

Medsafe acting group manager Alison Cossar said both Enlafax XR and Arrow-Venlafaxine contained the same active substance (venlafaxine), in the same salt form (as hydrochloride) and amount as the original brand.

Sara Smith, who did want her real name published, spent six months taking Enlafax after the original brand – which she had used for 15 years – stopped being funded. She said she experienced severe mood swings, stomach pains and suicidal thoughts, and swore she would never try it again.

However, during her recovery from quadruple bypass surgery after a heart attack, she was put back on Enlafax while in hospital. 

“Within two days I started to feel really, really horrible, I was really struggling. I felt like I was going mad actually.”

She pleaded with her doctors and was prescribed Arrow-venlafaxine again.

“After 20 years working in the mental health sector, I’m very good at advocating for myself, but I kept thinking, ‘what happens for other people?’” 

She said the issue went beyond the doctors, who were prescribing what they knew, and the patients, who often copped the blame. The problem was Pharmac’s decision to switch its funding to a generic brand, she said.

“People are being ripped off and it’s a lot of people who are forced to live these half-lives because they feel so terrible,” she said.

Pharmacy Guild chief executive Andrew Gaudin said it would be “unusual” for a patient to experience adverse side effects from this brand change.

A guild spokesperson said the organisation did not officially record complaints, but if members had received many complaints about a drug change the guild likely “would have heard about it”.

Christchurch-based Sigjaw Trust consumer advocate Gary Watts said about 25 of his 150 clients around New Zealand had reached out to him for support after experiencing adverse side effects following the brand change.

“Venlafaxine generic drug change is causing massive problems throughout the whole country, it’s quite widespread,” he said.

“The people that come to me often have the rashes, head aches, increasing their anxiety levels . . .  a whole series of problems. The medication is not proving to be successful for a lot of people.”