I wonder what peoples views are of this it's priced at £13.48 per Litre and the generic is priced at £18.70 per Litre.
I wonder if the price would stay the same if lots of people were switched over to this?

who makes it Simon?

Dee Pharmaceuticals
tel 01978 661993

having searched the internet, they seem to be an Indian company specialising in bulk pharmacseuticals and chemicals with a UK office in Wrexham. They attended (probably exhibited) at the National Drug Treatment Conference so they are obviously out to promote their product. Another possible sponsor out there, if you're into that sort of thing.

quote:

Originally posted by Simon Greasley:
I wonder what peoples views are of this

Specifying a brand (any brand) means that in the event of a supply problem nothing will be supplied to the client.

Most pharmacies I work in don't have the space to stock multiple brands of methadone in the CD cabinets - having both the sugared and the sugar free is enough of a PITA already.
Most CD cabinets don't have shelves tall enough for a 1000ml bottle (not that I've seen a 1000ml bottle of Eptadone) so would most likely be dispensing from and paid for the 100ml bottles.

Some pharmacies might therefore withdraw from the scheme
In addition the lower profit obtainable from an Eptadone script would make it less profitable to be involved.

Also the Eptadone comes in more than one strength (and more than one container size)
That is a possible source of error.

Regards

Jeff

A point to note there is no s/f Eptadone. The 5mg/ml might be of use to some patients however.
I knew posters would have some valuable views on this and it is a big saving.

Simon in spite of the big saving I remeber an email last year specifically advising against branded methadone (was it from the RSPGB?) - similar reasons to those jevf has given as far as i can recall. i can't seem to find the original email, but would advise caution on this one. Will let you know more when I have it

I don't usually get to post later a night than Susi, but couldn't sleep tonight.

I was interested to see this Simon, and am always keen to find ways to make treatment more cost effective for the tax payers (e.g. me), as you know. I will wait to hear from Susi's advisors.

I would not be happy to prescribe the 5mgs/1ml version for fear of accidental OD as mentioned above. ( both 1mg/1ml and 5mg/1ml are described as "clear liquid with a lemon taste" ) but I don't think this is reason to avoid this brand, as we already have to avoid the 10mg/1ml strength offered by other manufactures for the same fear of accidental overdose.

I am forever amazed by the astounding access to info we have in our own homes at 2am. Never a need to be bored. Have a look at this. There are even pictures of the packaging and labeling. Very educational to see the process of licensing of new products so clearly described.
http://www.mhra.gov.uk/home/groups/l-unit1/documents/we...urces/con2023727.pdf

I wonder how the prices of generic medications are set? I would have thought that if a product has become cheaper to manufacture for whatever reason, the price of writing a "generic" form should come down to match the lowest possible properly licensed version? Maybe one of the pharmacist here (Jeff ?) could explain?

Also, could somebody roll on the generic buprenorphine please?

I have no knowledge that this will happen to Eptadone
However in the past, branded products have been introduced, at lower than drug tarif price...and then crept up to a higher value
There is an issue of it being colourless, rather than lurid green, and I know there are 2 sides to that argument!
I also agree with Jeff on everything he says about storage.Having different brands would mean a hugh problem,most of my stores have ordered bigger CD cupboards at extremely high prices!(become a CD cupboard manufacturer and be really rich!) and still stuggle to fit everything in over Easter and Christmas. There is also the problem by using a brand name if there is a supply problem(and it only takes one batch to fail quality control and you are up a creek without a paddle!)
The NTA issued some guidance around this, the advice was not to prescribe branded(I am no good at finding links, sorry) and I know of 3 PCTs in my patch that have asked for non branded methadone to be prescribed
However, you are the prescribers and it's not me that has to take the methadone, but I think I speak for many pharmacists that our preference would be that it was not prescribed as a brand unless there was a clinical need

In general GP land we try to stick to generics only unless there is an overwhelming reason to use one brand. We all have seen brand loyalty being manipulated, buprenorphine being only the latest in a long string of business deals.
The short term gain will without doubt end in a long term loss, a point that needs to be fed back repeatedly to managers

Hi all have now been emailed the NTA letter which deals with this. It's not on the web, and is very long, so I am going to ask SMMGP to put it on their site somehwere with a link, but in the meantime, I will post the most relevant bits here.

Prescribing of branded methadone
December 2007


Summary

A decision to change from generic prescribing of methadone 1mg in 1ml to a branded form of methadone should not be taken without due consideration of all the factors involved. There may be short term cost savings but these should be considered in light of the disadvantages and risks highlighted.

However, the formulation of methadone oral solution 1mg in 1ml as a green, viscous liquid has not been reviewed since the 1970s and new formulations should be risk assessed in light of current knowledge and experience.

If prescribers are considering changing from prescribing “methadone oral solution 1mg in 1ml” to prescribing a branded form, then it is recommended that they carry out a risk assessment of the proposed product and discuss this with their chief pharmacist and the Local Pharmaceutical Committee before any action is taken.

Disadvantages and risks with prescribing by brand name

Prescribing one particular brand of a medicine can cause problems for budget holders, patients and pharmacists:
• Delayed treatment for the patient as the pharmacist may not stock the particular brand and so it may have to be ordered in specially.
• The pharmacist may have to keep several brands of the medicine in stock due to different brands being prescribed including their own preferred generic brand (which may be dictated by their “head office”).
• In the case of controlled drugs, such as methadone, the pharmacist may not be able to store adequate stocks of several brands due to the limited size of the Controlled drug cupboard. This in turn may lead to a pharmacy having to reduce the number of (methadone) patients they can manage at any one time.
• The patient may not find the new brand acceptable because of taste or formulation. Different brands have different additives including chloroform, tartrazine, and sorbitol, which may cause unwanted side effects for some clients.
• The manufacturer may decide to increase the price, without warning, once sufficient market share is achieved – having presented the product as a “loss leader” initially. It then can become very difficult to persuade prescribers to change their prescribing habits again. Patients and pharmacists may lose confidence in the prescriber if frequent changes occur.
• Prescribing by brand decreases competition in the market and is likely to lead to prices rising in the market overall in the long term
• Another manufacturer may offer a cheaper price – again, requiring prescribers and pharmacists to change their prescription and dispensing arrangements
• The manufacturer may not be able to respond to increased demand resulting in supply problems and delays in treatment for patients.
• Relationships with community pharmacists may be damaged as patients may perceive any problems created by the change in prescribing practice (such as delayed supply) to be the pharmacist’s fault. An increase in prescribing by brand name may result in a reduction in their profit margin as well as losses due to current stock held going out of date if no longer being prescribed. It is important to understand that the profit margin is built into calculation s made by DH when setting the DT price as this is what pays for running of the business and staff wages. Automatic adjustments are made by DH through the prescription pricing division system to “claw back” money from community pharmacists – pharmacists can be penalized financially as a result of increased prescribing of generic items by brand name.
• Also where a product is prescribed by brand, pharmacies can claim for any ‘out of pocket expenses’ incurred in obtaining a product, for example a handling change or special order charge. This is likely to occur where a pharmacy orders through a wholesaler that does not stock a particular brand and has to procure the product specially. This ‘hidden’ cost, when incurred is passed back to the prescribing budget. If a product is in Category A of the Drug Tariff, (as is the case with methadone oral solution 1mg in 1ml) it is recognised as being available from a wide range of suppliers so if the prescription is written generically, pharmacies cannot claim out of pocket expenses.
• Prescribers should consult with pharmacists when considering prescribing by brand for advice as to whether the product is of a satisfactory quality. There have occasionally been problems with poor labeling of products and poor distribution by manufacturers that can result in wholesalers refusing to stock a particular brand. Again, in such circumstances, the community pharmacist will only be able to obtain the product by special order – and will claim “out of pocket expenses” which are recharged to the prescriber’s budget.

Hope this helps

susi

Susi,
Thanks kindly - some food for thought.

Following this up after talking to the staff on the Eptadone stand at RCGP it is not the same company as the Indian company. They will also send anyone a letter that they will guarantee for two years it will not go up in price. They do not have any plans however to increase the price in two years. I asked the chaps if they might post on here so people might be able to ask directly any questions, but asked that posts are not for marketting.
My colleague has even given it a name ladies and gentlemen I present you with 'Lemony Meth'

I think the NTA statement is very well balanced, and answers more questions than any pharmaceutical company could, or would.
Without being anti new products - after all that is how many useful and reasonably priced treatments have emerged - I would always be wary of taking answers from a company with an obvious vested interest in selling their product.
I was told a while ago that some areas had moved over to prescribing Eptadone as their sole methadone product - you only have to look at the comments above for reasons not to do this. Similarly, suboxone is now being marketed as the safest form of opiate substitute - but when I asked about risks in pregnancy the rep fell silent ... and then started trying to interpret the data sheet. The reply to any question like this should be understood by the company ( and the rep ) and it undermines my faith in the marketing when they can't give an answer. All they want is a large part of the market. I forget which company manufactured the drug for AMD at something like 5 times the price of an equally effective treatment, which they also produced but kept very quiet and would only license for the treatment of bowel cancer. Now NICE are unable to support treatment with the more expensive product ....... and people are going without treatment. If that is ethical I will eat my stethoscope Maybe I am a grumpy "older" woman ..... or maybe I am getting to an age where I have just been around too long ....

Hmmm
This is reminiscent of the 'Alcopopish' filth and concerns me as the gloop that i am so happy to rec, due to the benefits it has brought me over the last five years has already killed ppl and children esp it should not have. I do not mind that 'HHHaaaaahhhhhGhrhhhh' after the dose particuarly, taking the big picture into account.
If this gloop is attractive to kids then how much so would/could this be???
Scares the heck out of me.
TonyB

quote:

Originally posted by gill redshaw:
I think the NTA statement is very well balanced, and answers more questions than any pharmaceutical company could, or would.
Without being anti new products - after all that is how many useful and reasonably priced treatments have emerged - I would always be wary of taking answers from a company with an obvious vested interest in selling their product.
I was told a while ago that some areas had moved over to prescribing Eptadone as their sole methadone product - you only have to look at the comments above for reasons not to do this. Similarly, suboxone is now being marketed as the safest form of opiate substitute - but when I asked about risks in pregnancy the rep fell silent ... and then started trying to interpret the data sheet. The reply to any question like this should be understood by the company ( and the rep ) and it undermines my faith in the marketing when they can't give an answer. All they want is a large part of the market. I forget which company manufactured the drug for AMD at something like 5 times the price of an equally effective treatment, which they also produced but kept very quiet and would only license for the treatment of bowel cancer. Now NICE are unable to support treatment with the more expensive product ....... and people are going without treatment. If that is ethical I will eat my stethoscope Maybe I am a grumpy "older" woman ..... or maybe I am getting to an age where I have just been around too long ....

Hi Gill,
I am aware of marketing and not just taking as gospel one source from a drug company. I am however keen to keep things as cost-effective as possible and we are using public money. I will be discussing this with my PCT pharmacuetical advisor.
I'm not aware who is your Schering-Plough advisor is but mine got me a comprehensive list of research on suboxone in pregnancy - by the next day I think.
I guess being a drug rep is hard and I have a great deal of respect for my Schering-Plough advisor but we have to remember we are also selling products to patients. We are constantly advising why one product is better than another or is more suitable.
It does need careful consideration and further advise.

quote:

Originally posted by Tony.Birt.:
Hmmm
This is reminiscent of the 'Alcopopish' filth and concerns me as the gloop that i am so happy to rec, due to the benefits it has brought me over the last five years has already killed ppl and children esp it should not have. I do not mind that 'HHHaaaaahhhhhGhrhhhh' after the dose particuarly, taking the big picture into account.
If this gloop is attractive to kids then how much so would/could this be???
Scares the heck out of me.
TonyB

Hi Tony,
I'm not sure why this would be more attractive to children? I did dip my finger in some generic Methadone some years ago and that tasted very sweet if my memory serves me correctly. It would be nice if every patient on any medication that could harm children had a locked box and maybe the drug companies would kindly pay for them.
I did have one thought that when people have to take Methadone supervised at a counter i.e. no consultation room available then a clear liquid would not look like the Green stuff that many of the public would know what it was.

Simon great to hear from you.
Shame i couldn't get to Brighton.
'Lemony Meth', made me think of mad dog 20/20 or 'Peachy alco', a brutal, unethical and shameful marketing of a harmful substance to our young.
I agree with your words and actions on locked boxes, fair play. I was asked two years ago to look into them by our clinical board, so expensive yet a life saved.
As for clear liquids in Pharmacies, i say get treatment into primary care and we should see the changes we want. To feel it is normal to have problems would benefit so many so quikly for so long.
My Best Simon
TonyB

I wonder is anyone using Eptadone yet? I prescribed some today for a lady who is pregnant and the smell of her usual Methadone has been making her throw up - split dosing has not helped. I thought it might be worth a go and see if the different smell/ flavour might work.
I also received a letter from the company as mentioned before about not increasing the price.

Just a bit of an update, the Eptadone went down well with the pregnant lady and she has managed to tolerate it much better than the generic.
We do have quite a few patients on this and no complaints.