Pharmac pill switch 'risks lives'

A woman who became suicidal when her anti-depressant medication was changed to a new brand says Pharmac, Medsafe and medical professionals have failed to properly warn patients of possible problems, putting lives at risk.

Pharmac has confirmed that from July 1, it ceased funding Fluox, a generic equivalent of Prozac, and moved to a new brand, Arrow Fluoxetine, whose producers offered a more competitive price. Patients who want to stick with Fluox have to pay for it themselves but patients have been told there is none left in the country.

Millions of people around the world take the drug, including 52,000 in New Zealand.

The Pharmac website says the new medicine will work the same, as it contains the same amount of the active ingredient, fluoxetine hydrochloride.

"You shouldn't notice any difference in how you feel after taking Arrow-Fluoxetine," the website says.

But the Centre for Adverse Reactions Monitoring (Carm) in Dunedin said it had received nine reports involving the change to the Arrow brand, including reports of reduced therapeutic effect and adverse reactions.

Dr Ruth Savage, Carm's senior medical assessor, said the numbers of adverse reports following brand changes varied greatly "but this is not a high number".

Sarah Fitt, Pharmac's director of operations, said the agency took "considerable steps" to inform health professionals about the change and pharmacists were also paid a "brand switch fee" to recognise the time taken to counsel patients about it.

But Wellington woman Louise Cubitt, 37, is furious that neither her GP nor her pharmacist warned her of possible adverse reactions. It had taken her a long time to find the right medication, and she was extremely sensitive to any changes.

The first she knew of the brand change was in April when she rang her doctor for a repeat prescription.

When she picked up her prescription at the pharmacist, she noticed the packaging was different.

"[The pharmacist] said it was the same ingredients, just a different company making them. I thought nothing further of this." But over three months, she noticed changes in her mental state.

"I started to get my anxiety and depression back, I became reclusive, I couldn't sleep and I also felt like what were small electric shocks going off in my head. I began to withdraw and become angry and agitated and, earlier this week, suicidal."

Medsafe confirmed that different medicines could contain different non-active ingredients to which some patients might be allergic or intolerant. Those ingredients could be checked on the Medsafe website.

Cubitt said: "I wasn't given a fact sheet from the chemist or doctor's when I got the Arrow tablets . . . and it's not as if I go on the Pharmac or Medsafe website every day."

She said many patients would not have connected their worsening symptoms to their medication.

"Some people are not that self-aware and would be confused as to what's happening to them and not realise it could be a reaction to the different tablets."

Kate Baddock, chairwoman of the New Zealand Medical Association's general practitioners council, said GPs would typically receive a bulletin from Pharmac alerting them to an upcoming brand change.

"But how many of us are going to remember that one of a multitude of medications is going to change on a particular day? It behoves the pharmacist to warn people to contact their doctor if they notice any change."

Bob Buckham, the Pharmaceutical Society's chief adviser, said pharmacists were expected to clearly explain changes to any medicine.

"For some individuals, even small changes in how the medicine is released into the body may result in a side-effect that was not previously experienced."

Medsafe's clinical risk management manager, Chris James, said there were individual differences to medicines whether they were generic versions or not.

The Arrow brand was a bio-equivalent to Prozac "and is expected to have a similar safety and efficacy profile".

Sunday Star Times