edg asked
I was taking Mylan brand lorazepam, 2mg tablets daily for sleep. Now, they have switched to the Watson brand, which is not as effective... I only get about 3-4 hours of sleep nightly. Can the Watson brand be increased by my doctor to taking more 2mg pills at night?
Answer
The vast majority of generic drugs are produced by more than one manufacturer. For lorazepam 2 mg, there are no less than eight manufacturers that make the product, including:
- Watson/Actavis
- Mylan
- Teva
- Sun Pharma
- Major
- Ranbaxy
- Sandoz
- Amneal
All generic drugs are required by the FDA to meet a certain statistical standard with respect to their bioavailability (i.e. their rate and extent of absorption) when compared to their brand name counterpart (Ativan in this case).
There is a significant amount of controversy regarding the efficacy of generic drugs when compared to the brand name, and while that topic would be the subject for another article, you can read more on the matter on the FDA website which provides a nice 'primer' into how generic drugs are approved.
What is often not taken into account when brand and generic drugs are compared are the different inactive ingredients they contain. While inactive ingredients shouldn't, by definition, elicit any medicinal effect in the body or interact with the active ingredient, they can be a source of significant issue for an individual that may be allergic or sensitive to any of them.
Mylan Vs. Watson (Actavis) Lorazepam 2 mg
Below is the complete ingredient list for both the Mylan and Watson lorazepam 2 mg products.
Mylan Lorazepam 2 mg
Note*: Mylan lorazepam 2 mg is available in 2 different forms. The NDC (National Drug Code) for each is listed. The NDC may be displayed on your prescription bottle, but if it is not, ask your pharmacist which product you have.
Mylan Lorazepam 2 mg Ingredient List NDC (00378-0777-01):
- Lorazepam
- Calcium Phosphate
- Croscarmellose Sodium
- Magnesium Stearate
- Microcrystalline Cellulose
- Sodium Lauryl Sulfate
Mylan Lorazepam 2 mg Ingredient List NDC (00378-2777-01):
- Lorazepam
- Lactose
- Microcrystalline Cellulose
- Polacrilin potassium
- Pruv (Sodium Stearyl Fumarate)
Watson (Actavis) Ingredient List
*Note: Watson Pharmaceuticals is now Actavis following a 2012 acquisition.
Watson Lorazepam 2 mg Ingredient List:
- Lactose
- Magnesium Stearate
- Microcrystalline Cellulose
- Polacrilin potassium
Comparison And Final Words
As you can see from the ingredient list, the Watson/Actavis lorazepam product does contain different ingredients than the Mylan product. While both are FDA approved generics for Ativan, and are legally substitutable for one another, it isn't uncommon to hear a patient concerned that one isn't working as well as the other.
If you prefer one manufacturer over another, ask your pharmacist if they are able to order in your preferred product. They may be able to accommodate the request if their wholesaler carries it.
In order to prevent automatic substitution with your generic drugs on every fill, ask your doctor to specifically write in the manufacturer they want you to have, along with the letters 'DAW'. This stands for 'Dispense As Written' and in most states, a pharmacy cannot auto-substitute if a prescription is marked as such.
It's very unlikely that your doctor would increase the dose of your lorazepam because one manufacturer isn't working as well for you. They would more likely request the pharmacy order the manufacturer you prefer, or, if it isn't available, consider a drug switch. Be sure to have a conversation with your doctor.
