Generic Provigil, Ritalin, Adderall, & Nuvigil vs Brand

USER EXPERIENCE:

Stims questions & warning! Background: Since dx in 2000, I’ve taken Provigil, Ritalin, Adderall, & Nuvigil in that order. I’m historically tolerant of almost all meds w/ minor exceptions & when I’m not it’s usually (not stims that cause just nausea, vomiting, or migraines). Provigil & Ritalin was so long ago, I don’t know why we changed, but assume it was either that they just didn’t work or I built up a tolerance. I built up a tolerance to Adderall. It’d stop working, then I’d lay off it a while & it’d work too well, so I was up (as high as 30mg) & down (to 15mg) on dosing. Dec. 2012 my (then) doc put me on 150 Nuvigil & it didn’t keep me awake, so we upped to 250mg which made me hypomanic. I was fine otherwise. I complained that it made me hypomanic, so my doc switched me to 150mg Nuvigil (half to 1 full pill) + 20mg ER Adderall both at the same time in the am. The 1st day I took the full Nuvigil pill (150mg) & the 20mg Adderall. That was about 10am or so on New Year’s Day. We went to the movies, it kept me awake. In fact, I managed to watch a record-breaking 3 movies that day (2 at home) without any sleepiness nor N-induced ADD. But about 10pm or so (so about 12 hrs after the meds), I got a migraine. Didn’t think much about it as I get chronic migraines anyway. Didn’t want to take anything with the stims even though it’d been hours & the migraine wasn’t too bad, so went to bed with it. The next morning, I woke up with it, but that also is not unusual.

This time I remembered to only take the 1/2 Nuvigil pill (75mg) & the 20mg Adderall. That was about 7:30am. Within 45 mins I was crazy nauseated. I normally do not get nauseated with my migraines, but if I do, it is brief or I’m fine once I can puke. I was literally nauseated off and on all day long (& unable to puke). The migraine pain itself was tolerable & no worse than usual, but the nausea was bad. I associated it with the combination of meds (never did a combo of stims before) & was gun shy so refused to take them again. I’d tolerated Nuvigil (up to 250mg) & Adderall 30mg ER separately fine in the past, though I had been off both for a while. The NP just switched me to Adderall (not ER) 10mg, 3x a day as needed (& no Nuvigil). Took it today for the 1st time; 1 pill about 10am (after my unrelated fasting labs). I had my typical breakfast right after. But I just walked upstairs for something (about 1 1/2 hrs later) & got another one of my chronic dizzy spells immediately followed by a wave of nausea which is not typical. It’s passed for now, though I don’t know if it will come back. Of course, the possible side effects of Adderall are nausea, vomiting, & dizziness as well as headache. Again, I did not have these effects in the past on Adderall, though it’s been a while. But I noticed that BOTH these last times I got my Adderall filled, apparently the Rx must have approved generics as the 1 I had on New Year’s is labeled as “Amphetamine ER 24hr 20mg Mfr Actavis: Generic for Adderall 20mg ER” & this last one is “Mfr Corepharma Generic for Adderall 10mg” (not ER). But I am fairly certain I have had generics for Adderall in the past, though I don’t know if I’ve had these 2 generics before. (The Actavis was a bright blue capsule that I don’t recall, but I was usually either 15 or 30mg, not 20mg).

Questions:

1) Has anyone ever tolerated a med fine then had to change or stop it for another reason (say building a tolerance), and gotten back on it (same pill; not a substitution) and then had side effects from the same med?

2) Has anyone ever found they could tolerate say the name brand, but not the generic?

3) Does it sound like such might be the case for me – at least these 2 specific generics (is that an oxymoron?)?

My recommendation is two-fold. 1) I THINK I have an issue with generics vs. name-brand, at least with this 1 med or these specific generics, so others might want to make sure they always try to get the same brand (no substitutions) on refills that they’ve had success with. 2) I saw a news story a few months ago on the Today Show (I may have posted the link then) that there is a huge problem with generics over name brands in that by FDA law, the generic manufacturers simply copy the SAME warnings from the name brand vs. providing their own versions AND that some people can have side effects, even severe, from the generics. One woman had taken the same med for & then developed severe & permanent side effects from the generic. But what is even more scary is that per FDA law / rules, you cannot SUE the manufacturer of generic drugs AT ALL, so while you may be saving say $10 a refill by opting for generic, you are essentially a sitting duck. Since my husband works & I don’t, so he’s always out & since I have all these health problems, he always drops off & picks up my Rx, so I am not there (or remember to tell him) to say “No substitutions or generics.” With Narco mush brain, I’d likely forget myself anyway, especially if the Rx says subs or generics are ok & the pharmacist doesn’t ask ME point blank if *I* am ok with it. So I’m thinking that I should probably call them & have a standard “no generics or substitutions” preference put in for all Rx (unless they ask & I approve on a case by case basis) so that it’s the default, especially for my stims (or Adderall anyway). Other than the milder side effects (nausea, vomiting, migraines, dizzy spells, which will pass), I would hate for something to happen to one of us because we were trying to save $10 on an Rx & we had a very bad reaction to the generic / sub. You could have a very bad, irreversible reaction to a name-brand Rx as well, but at least you would be able to sue the name brand manufacturers! I just re-Googled it & found this related story. I saw the clip on the show and I don’t recall them saying Tardive Diskenesia, but maybe I missed it. And I don’t recall them saying on the show that the FDA is trying to change the lawsuit thing, so this may be updated since the segment aired.

comment 1.

1. Yes, but only bc it was a different distributor. When I went back to original distributor I was fine. The active part of the drug is regulated, the fillers are not. You could be reacting to fillers. Even years later. I wasn’t allergic to shellfish until I was in my 30s.sensitivities happen the older we are sometimes.

2. Yes. I am taking two drugs where the generic was unacceptable for me. Wellbutrin and Plaquenil (Both unrelated to N). In both cases it was very common for sensitive folks to have a bad reaction to generics.

Anytime I drop off scripts I make sure to tell them what distributor I want bc I also need gluten free drugs. The insurance company has a fit over providing the name brand for me so I have to go through a drawn out dance w them and my docs w prior authorizations. It’s my ins co that insists on generic, not me or my pharmacy.
I don’t trust the FDA for anything. Managing my drugs from refilling to compliance is a job in and of itself, but if you want the best care you have I be vigilant and put in the energy and research to manage it. It’s not easy. In fact it’s a pain in the ass, but the alternatives for me made me very ill.

comment 2

When I was on Ritalin I could not take the generic. There is a difference, usually in the manner/timing of release and/or the inactive ingredients between generic and name brands.

I have not had issues with other stim generics, taking 40-65mg generic adderral currently with no problems.

Have your doctor check or write “no substitution” on your prescriptions.

comment 3

For those in the generic extended release Ritalin (technically it’s concerta) there are different companies that make it. All but one if them makes it completely different than the name brand in how it slowly releases in your body. (The correct ones look weird)
Anyways, the generics that are not like the original do not work near as well

comment 4

I have been on Adderall and generics for years with NO side effects, but the occasional built tolerance. Last time, I got mine filled, I had severe nausea all day with a migraine. (I normally get unrelated migraines, but without nausea). Be wary about generics in general and I don’t believe they are all equal. Per FDA rules, they have to copy the warning lit exactly from the name-brand mfg AND furthermore, if you even accept generics and have major life altering side effects (like tardive dyskenesia, which can cause stroke like permanent effects – saw it on the Today show), you are also giving up your right to SUE! Since I’m not working (and have N), I keep meaning to tell my husband & the pharmacist NOT to sub without checking with me first (or at the very least, give me the proven generic, not a new one & certainly not the last batch), but I keep forgetting. My son also just started Adderall this month (for IH) and he has a regular 10mg pill and then a booster 5mg pill up to 3x a day as needed and they gave him different mfgs for those filled at the same time. But so far, so good with him. I would try to keep your bottles or lit or at least check in with the pharm and tell them to only give you what you have successfully taken in the past from now on regardless of substitutions or generics being OK per the doc. And have them make a note of it in their system which ones are ok and to put this one on the do no sub list. I would assume they could at least do that much for the future, but not sure what they can do to help you out this time. It wouldn’t hurt to call them and tell them your concerns. They can’t take it back as if to reuse it, but since you have a valid concern and since it is a control (so they can’t give you more), perhaps you can swap it out (therefore you don’t have more than legally allowed) and they can dispose of the original Rx entirely and give you a new one. One day my husband picked up my Rx headache pills and the pharm gave me the same thing but in tablets vs. dissolvables. They said they couldn’t take the others back (since it had already left the store), but they gave me the replacement at no charge. But with this being a highly controlled substance, they couldn’t presumably do that for you, but I would think they could take back the old and destroy them, then replace it at no charge