HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

BRIEF COMMUNICATIONS: D. M. Ficker, M. Privitera, G. Krauss, A. Kanner, J. L. Moore, and T. Glauser Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine Neurology 2005; 65: 593-595 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Reply to Protass

David M. Ficker, MD   (29 September 2005)

Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine

Leon M Protass MD FAAN   (29 September 2005)

Reply to Protass 29 September 2005
David M. Ficker, MD, University of Cincinnati Medical Center 231 Albert Sabin Way, ML 525 Cincinnati, OH 45267-0525 Send Correspondence to journal: Re: Reply to Protass david.ficker{at}uc.edu David M. Ficker, MD	In our study, patients could either be receiving brand name or generic immediate release carbamazepine. All patients were then given an equivalent dose of extended release CBZ (Carbatrol®). We agree that there is potential variability in bioequivalence of generic formulations of anticonvulsants. However, since all patients were switched to the same brand of extended release formulation (Carbatrol®), we believe we can conclude that the extended release formulation was responsible for improved side effects and better seizure control. As detailed in the discussion section, this may have been the result of improved compliance or more likely, due the smoother release of CBZ. Disclosure: Supported by Shire. Carbatrol is a registered trademark of Shire. Dr. Ficker received honoraria from the study sponsor. Shire funded the study and was responsible for the design and conduct of the study, and collection, management, and analysis of the data.
Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine 29 September 2005
Leon M Protass MD FAAN, Sound Shore Medical Center 140 Lockwood Avenue, New Rochelle, NY 10801 Send Correspondence to journal: Re: Improved tolerability and efficacy in epilepsy patients with extended-release carbamazepine BLProtass {at}AOL.com Leon M Protass MD FAAN	I read the report by Fricker et al with interest. [1] The authors describe the improved seizure control and quality of life in patients switched from immediate to extended release carbamazepine. With regard to medication compliance, this is logical. However, there are further issues the authors should address. Blood levels were not checked and, in addition, the authors do not indicate whether the immediate release carbamazepine was brand or generic and if each patient had used the same generic formulation. The same issue exists regarding the extended release form. This distinction is particularly important if the extended release form was uniform (from one manufacturer) and the immediate release form was not (from multiple manufacturers). The possible difference is same dose bioavailability or bioequivalence in the products of different manufacturers, particularly in the case of anticonvulsants. This issue has been previously addressed. [2,3] References 1. Ficker DM et al. Improved tolerability and efficacy in epilepsy patients with extended release carbamazepine. Neurology 2005:65: 593- 595. 2. Lesser RP, Krauss G. Editorial. Buy some today. Can generics be safely substitued for brand-named drugs? Neurology 2001: 57 571-573. 3. Gilman JT, ALvarez LA, Duchowsky M. Carbamazepine toxicity resulting from generic substitution. Neurology 1993: 43: 2696-2697. The author reports no conflicts of interest.