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Comment by analyte123 | Hacker News Reader

Kind of bizarre that the author won’t entertain the most obvious explanation given the documented problems with many generic drugs [1]. I guess the difference in this case is that the patients can tell right away.

[1] https://www.npr.org/sections/health-shots/2019/05/12/7222165...

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The difference in Concerta and its generic is chocolate and vanilla to me.

The brand one slow releases very evenly while the generic just slams me with the calm, focused joy followed by a significant emotional low for hours.

Completely unsurprised if an Adderall generic had just as significant impacts.

the generic concerta all have a KNOWN issue with manufacturing. The slow release mechanism is mechanic, not chemical, and only ONE generic is manufactured the right way.

https://www.goodrx.com/concerta/certain-generics-are-no-long...

It's literally a plastic capsule with microscopic holes drilled in it. A sponge on one end absorbs moisture and swells at a fixed rate, slowly pushing the methylphenidate out the other side.

That is exactly my experience. The brand-name Concerta is a smooth push all day, the generic is terrible.

same, generic vs concerta fells very different, the generic fills like a bomb while concerta it's slow and steady.

> The brand one slow releases very evenly while the generic just slams me with the calm, focused joy followed by a significant emotional low for hours.

Prolonged-release of an orally drug taken in pill form is a "special feature", it's the difference between regular Adderall and Adderall XR.

There are patented techniques involved to make it work like that, generica manufacturers probably don't have access to those/leave it out to save manufacturing costs.

You can try taking the generica in smaller dosages, to compensate for their lack of prolonged-release, as the symptoms you describe sound like you are overdosing by taking too much in too short of a time.

Concerta doesn't need such manual dosage management, as it also has prolonged-release just like Adderall XR.

How often do you casually dispense medical advice to strangers? Especially without qualifying yourself as a SME expert (or non-expert), or at the very least providing reference sources or other supporting documentation?

Edit: @djmips: Are you familiar with the differences between medical and non-medical advice? The potential repercussions of you following my potentially bad advice on programming are vastly different from the possible fallout from encouraging someone to mess with their medication dosing. The responsible thing to do is refrain, because some people are on a very specific regimen for good reasons. In a medical context, sharing one's own experience (and qualifying it as such) is often appreciated, however this is not how I would characterize the structure of the parent comment.

I hope this helps, I only wish the best for you and others.

Edit 2: @freeflight: Thanks for following up.

I see you are dispensing advice. I'd like to see your advice dispensing certification please.

> How often do you casually dispense medical advice to strangers?

Semi-regularly, as I work in palliative healthcare.

I'm just not sure why that would be relevant to "medical advice" like "If you experience too intense sympthoms, try lowering the dose" and explaining the differences between instant and prolonged-release drugs?

Some might consider that common sense, which shouldn't need to be pointed out.

But life is hectic and complicated, leading to a lot of overthinking, sometimes we just need a reminder of the simpler and straight forward solutions.

It’s the internet: let’s stop with all the fourth-degree second guessing of hypothetical dimwits which are extreme edge cases when they exist at all, but are mostly the figments of imagination. Most often, this comes across as very hollow and disingenuous virtue signaling.

Let’s set our expectations higher. The admonishing rhetorical questions are a waste of time to post and quite boring to read. You seem to be aware of the risks of strangers dispensing advice on the internet, despite stated qualifications (which may be imaginary or real). Assume most of humanity is aware of this as well.

Generic substitutes for extended release medicines are extended release also. The problem is the extended release mechanisms are judged equivalent when they are not.

Two of our kids are on Concerta and can confirm that the first time we got generics it was very fucking obviously working quite differently (in our case, it manifested like them barely working at all). Took us a little bit to put two and two together, but sure enough, the change was just as we switched (well, got switched) to generics.

Be great if the FDA would ensure that a generic is actually the same damn thing.

I’ve found the generic of quetiapine doesn’t work at all.

Certainly not in the same way.

Slightly off topic, I found out generic of my birth control pill is not mono-cycle, meaning not every pill in the pack has the same dosage, it fucked me up for months. It's not documented anywhere

That sounds like your generic is not extended release but an immediate release version, which sound like different medications overall. Maybe split the dose in half and take the second half 4 hours later which is what they usually do when people are taking immediate release? Whoever your doctor is should understand this dynamic...

The FDA allows generics to be sold within much looser tolerances than the brand product (variances allowed of +/- 20% of active ingredient per dose.) If you've ever noticed a "brand medically necessary" checkbox on a prescription a doctor has given you, that's what it is there for.

There's no way that the variance allowed is +/- 20%. That's insane.

Does that also imply that a 30mg Adderall could come out as either a 24mg or a 36mg? In reality that is likely easier for the manufacturer to detect than the individual weights of the active ingredients in a random mixture, but still.

They measure maximum blood concentration and other parameters. Not just how much of the primary ingredient. But the variance allowed for those parameters is 80% to 125%.

I see, that makes much more sense

I've been on 4 different brands of generic Ritalin. I'm sure I can tell them apart by taking one.

1. Normal (the first one - don't remember the manufacturer - was extremely hard to break in half)

2. Actavis - strong, but slow to hit

3. KVK - strong and hits fast

4. Mallinkrodt - weak

For years Mallinkrodt was the only brand my drug store would get. Now they switched back to KVK and it's like night and day. I only have to do half as much.

i've worked in the biotech industry and have been to some generics manufacturing plants and they are "up to code" but also a whole hell of a lot jankier than the big name brands.

The brand name worked significantly better when I took seizure medication with fewer side effects. The differences between the brand name and generic medications were very pronounced.

Not that bizarre when you look at NY Times shareholders.

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