Prescription drugs not available

I'm also from central europe and had the same issue with an a different prescription drug recently.

Its actually caused by suppliers being able to sell to different markets with higher margins, or national allocation of source ingredients respectively.

https://www.politico.eu/article/europe-still-coming-up-short-on-drug-supplies/

To mitigate this, different pharmacies get supply limits allocated (which is why they send you away to different ones).

What you can do in any case is to ask for a generic (Generikum in german, ask if one exists first), which is the same drug, produced by a different manufacturer - presuming that the patent for that drug doesnt make it exclusive to one manufacturer.

Usually thats when they tell you that there might be a surcharge. (Because the cheapest generic is usually also the one most in demand, it might be harder to get your hands on that.) In my specific case, this was only a few cents. Otherwise I'd be shocked to hear, that they actually wanted you to pay a surcharge on the asking price. Dont pay that - if you don't need to.

With psychoactive drugs, I would double check with your doctor if substituting is ok - but a generic in general is produced using the same ingredients, in the exact same amounts - so you are generally safe to ask for them.

Just as additional information.

Venlafaxine is already the generic for effexor

Over here, if the cheap version is out of stock, they will sell you the more expensive one for the same price. And thank god for that, because shit happens, sometimes there are issues with production or delivery that are out of anyone's control.

@notimp
" but a generic in general is produced using the same ingredients, in the exact same amounts - so you are generally safe to ask for them."

I beg to differ. Yeah, a pizza is just dough, sauce and cheese, but Domino's and Pizza Hut aren't the same. A burger is ground beef on bread, but McDonald's and Wendy's aren't the same.

Yeah, the drug might "be the same", but sometimes, there are subtle differences; usually price, although, sometimes its (generic vs BN) side effects can be of note.

Solvents, filler - those could be different (?). All medically reactive compounds have to be chemically the same as far as I know. I personally didnt have any issues grabbing a generic in my particular case - but I do think as well, that a psychoactive drug is a bit more 'sensitive' and might be worth a call to your doctor to get their opinion in any case.

If anyone who went to med school wants to weigh in, please do.

Usually - all drugs available in european pharmacies went through clinical testing and have to be certified for what they are. In my conversation with the pharmacist he also told me, that in germany pharmacists were allowed to substitute generics for each other on their own, but then again, this is second hand knowledge, and not something that I would go for if I were you.

Check with your doctor, but know that generics are an option.

@notimp
" know that generics are an option."

"“Tell your doctor to prescribe another antidepressant.” (Nice idea. I tried A LOT of them. And Venlafaxine works for me. The others don’t and/or have unbearable side effects.)"
Bullet #2.

@H1B1Esquire

A generic is the same drug manufactured by a different vendor. Same chemical compounds, same dosage, usually also clinically tested to have the same effect.

Not a different drug. Not a different formulation. Not a different dosage.

Just a different name and a different manufacturer. Because f.e. the patent ran out. Carrier medium (think fluid, or pressed powder laced with the chemically active substance) can be different, the medically active ingredients have to be the exact same.

If you think about it, a pharmacist cant give out a drug you need a description for, but you havent been described, right? He can give out the same drug with a different name, manufactured by a different company though.

How a medical drug is designed isn't a secret, it has to be specified during the certification process. So anyone with the capability (with no patent preventing (because f.e. exclusivity ran out) can manufacture the same drug, call it a different name, get certification and put it into the market listing its active compounds.

There are many antidepressants on the market I presume, different chemical structures, mixtures, dosages - those arent what you'd call a generic. A generic is a 1:1 copy only differing maybe in packaging and filler. Produced by a different company.

notimp said:

In my conversation with the pharmacist he also told me, that in germany pharmacists were allowed to substitute generics for each other on their own, but then again, this is second hand knowledge, and not something that I would go for if I were you.

Click to expand...

Unless the doctor forbids it by crossing out [aud idem] on the prescription the pharmacist must use the cheapest available generic.

Dummy example from Wikipedia:



The problem is that Venlafaxine is completely unavailable. Not a single drug containing that substance can be ordered right now – the second pharmacist did the best he could by calling the wholesaler. The answer was: End of January. Maybe. I still have the hope it comes before the next Gateway 3DS update.

H1B1Esquire said:

"Tell your doctor to prescribe another antidepressant."

Click to expand...

She meant a completely different active component.

@notimp
You're missing the mark.
She doesn't want what doesn't work for her.
Sure, generics can be used, but what if I gave you generic everything, regardless of what you actually wanted?

I personally would not have a problem with that and said so in the first posting. But I recognize, that some people might be more attached to the brandname, or manufacturer of a drug than others, so everyone has to decide that for themselves.

Please notice - that KleinesSinchen just filled us in, that in Germany the pharmacist has to give out the cheapest available generic of a product unless specified differently on the recipy itself. So the german system is set up to give out generics by default, unless the doctor specifies otherwise. (If the patient wishes otherwise, he can bring it up with the doctor and have a conversation, I'm sure. )

Pharmacists themselves, might forget to look up generics and availability (for all of them) in their database, if you dont ask them kindly to do so - which is why its worth a mention that you could try to ask them for a generic specifically.

If a certain substance is currently not available but backordered, a pharmacy might tell you to maybe try other pharmacies (usually big ones) in case they have stock left, or still a contingent open to get it from a medical products whole sale, in case it gets rationed (only a select number for every pharmacy), which usually gets set into action before stuff runs out entirely (it was in my case).

Thats the process. Just so we understand, that germany isnt going down the drain, or your pharmacy is sending you to a different one on a whim, or that your pharmacist is charging you more - because he feels like it. (He can charge you more for a generic thats a little more expensive when he buys it though.)

Also yes, there have been supply shortages on certain compounds and therefore drugs, even in central europe for the past months. Politics tries to tackle it ("by paying more").

@notimp
Yeah, that's why I gave her information of examples on getting "your" medication discounted from the manufacturer. I'm unsure of how Germany works in that (discounts) regard (didn't want google translate to give me a broken translation, translation doesn't work on .pdf, und mein Deutsch ist sehr rostig).

I think, as Martin Shkreli said, companies raise prices to screw over big corporations, not the general public--the big corporations screw over the general public when they want to turn a profit, stop losses, ect,.

Live and learn.

@notimp That is not entirely true - drugs often have helper additives added, some people react negatively to cetain additives, making the drug less effective or even causing unwanted side effects.

While true, thats exactly what you'd tell to upsell a product as well. ("But the quality isn't the same.")

Side effects have to be evaluated as well. The societal default in germany is, that pharmacist are encouraged to subsidize one with the other - if the doctor doesnt state otherwise. European cert processes usually (read WIkipedia for this, might not be needed for every generic), have clinical studies attached to them, where products are refused market entry, if they dont perform as expected. So usually - its fine to substitute with a generic.

If you go by chain of trust. Its far more unlikely that your doctor will have read every study regarding every generic on the market he might prescribe - and its far more likely, that he/she will put trust in the cert process as well, and prescribe the cheapest, or the one, where the pharma sales wrep financed his last congress visit. (This is a prejudice, but also industry practice).

So 'id have no problem with substituting for a generic' already is an informed decision, with delegated risk (to the certification process, and the medical system as a whole), I personally would take - in central europe.

That said, it must remain an individual choice, dont just do it because somone on the internet says so - and certainly, ask your doctor first. Perhaps he/she has read studies indicating something like a higher propensity of sideeffects. And certainly, because the patient trust relationship usually depends to delegating such 'risks' to your doctor, not random guy on the internet.

Generally speaking though, it should be fine to go with a generic. (Unless its not. In a minority of cases. (Statistics...))

Also, if you know that you have certain allergies, or higher risk profiles - certainly double check with your doctor. Actually in case you are substituting something like a psychoactive drug, always check back with your doctor.

Just know that there is the option.

(We also found out, that in germany your pharmacist already would be encouraged to substitute your drug for the cheapest generic available (licensed to be sold), unless - specified differently, so in this specific case the advice to ask for them, probably didnt help.).)


That said. Likelihood for people being very attached to their brand, and very worried when they get given something different by their pharmacists, might prevent them to look up 'generics' in general (customer relationship issue). So asking is an option.

That said, please - under no circumstance do I want to be responsible for even a lower chance side effect occurring, because I 'recommended' a certain drug on the internets. So I don't do that.

If they want to go that route, people have to decide on their own (where the state doesnt say 'its fine' by default like in germany), I'd just insist, that its beneficial to know, that there is the option.
-

I'm not here to discuss with people random chance events and "but what if" scenarios on side effects (for how likely see: http://i-base.info/qa/812 )

@The Real Jdbye There's usually a manufacturers recommended generic (sometimes made by the manufacturer), also if you complain your doctor might be willing to talk to your insurance and tell them you must have the name brand. Usually you must have used the generic for at least a month though.

I don't know the German system at all but it seems the drug is not covered by any patents*, and looking at the formula/manufacture method it is not that bad. To that is there such a thing as a compounding pharmacy in Germany? (Eigenherstellung von arzneimitteln maybe being a reasonable starting term).
These are places that will make up the chemicals you want, and do it especially in cases where it is not available but not covered by other things.

That said it might be more expensive than just paying the asking price from the pharmacy.

*in the US they also seem to have stopped making it but seem to have a new formula that is much the same but has an added perk or two and thus probably qualifies for a new patent.

For this topic…
…A little update:
==============

Today I went to the pharmacy again. The pharmacist was happy and showed me three boxes of Venlafaxine. Nice. But my prescription had expired. Back to the doctor… with confirmation from the pharmacy that they had not been able to give me anything in January.

Got a new prescription and finally 100 brand new pills.

Happy ending? Not quite. The pharmacist said: "Does not look too good at the moment. I would not get any additional Venlafaxine right now. Please come a few weeks before you run out so we have time to try ordering from various sources." I very rarely use any emojis in the forum/blog because they do not real add something valuable.

But look at her. This is how I feel when thinking about the big drug shortage in Europe.
↓↓↓↓↓↓↓


Back to the middle ages we go. Just… FACEPALM!!!

2 thing wil help you good multivitamine with extra magnesium < is for emotions depression etc etc !
second cold shower 10 min <try it
if you stick with it you wil see omprovements with in 1 week
and i speak from experience

synthetic medicine < drugs wont help you in the long run it wil make it wors and you wil have allot of side effects

@scroeffie1984 I'm not a big fan of taking vitamin supplements without proven vitamin deficiency (and according to blood examinations I clearly don't have any deficiency). Using excessive amounts of cold water has been tried in psychiatry very early on and I'm not convinced in it's effectiveness (though cold showers can be enjoyable sometimes).

If you read a bit in my blog you will find out that I'm not new to chemical drugs and not an advocate of their usage in most cases – especially on not fully grown up people.

That said, I sadly must confess that after trying about everything, I came to the conclusion: Living with chemical drugs is the lesser of two evils – for me. I accept the side effects and the potentially devastating consequences (these legal psycho drugs are really dangerous). I'm an adult and I decide for myself. Never will I allow others to decide for me again. If I decide wrong, I will have to accept the consequences.

hey, question. Have it resolved for you?

Else here are 48 makers of it that Swedish pharmacies.

@linuxares It's fine for the next three months.
Hopefully the shortage ends before I (almost) run out again…