Wednesday , November 22 2017
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Sometimes You Gotta Use the Brand Name

Many of our patients have intolerable GI side effects from metformin. We use ER to try to decrease these, but that doesn’t always work. If they have these symptoms, I recommend they take it slow and take it after they eat. If they still have problems, I recommend they break the tablet to 250mg, even though the label may say one shouldn’t break the tablet. It still works. When it works, I recommend they increase the dose very slowly. Once there are no further GI side effects for a week, then increase to a whole tablet. Then in one week, increase by 1/2 tablet. This continues until they reach max dose for management with little or no untoward side effects.

There are those patients who just can’t tolerate the generic form. In that case I recommend Glucophage XR (Brand). For the most part, we recommend it as above and most patients do well. Some insurance companies will cover it, no prior auth needed. Some will need a prior auth. And, some won’t cover at all, but most of my patients have found the price to be reasonable and are willing to pay more for it.

Express Scripts reported re Valiant’s price gouging: One product in particular, Glumetza® (metformin HCL extended-release tablets), experienced a price jump greater than 800% in 2015. We no longer recommend Glumetza due to the cost…they did us wrong by raising the price.

Lessons Learned:

  • When patients have untoward GI side effects from metformin, lower the dose, and recommend to take after a full meal.
  • It usually works to break the tab, even though it is not recommended to do so.
  • Increase slowly.
  • When patients still don’t tolerate, change to Glucophage XR Brand and slowly increase, still after a full meal.
  • Be aware of the price of the medicine. Ask pharmacist to let patient know out-of-pocket price before filling. Patient can then decide whether they want to pay for it.
  • Be aware of price gouging of some pharmaceutical marketing companies, and decide whether or not you want to use their products. These costs affect us all.

Anonymous

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