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Generic drug didn't work

>Q. I am a cardiologist with a patient who had elevated cholesterol in 2010. Her total cholesterol was 245, and her LDL was 156. This was too high, so I put her on Pravachol. It brought her cholesterol down to under 200, and her LDL to around 100.

Last year, her insurance company switched her from Pravachol to generic pravastatin. It came from India. After two months on this generic medication, her total cholesterol had risen to 249, and her LDL was 151, basically back where she started.

Needless to say, I was not pleased, so I prescribed a generic from an Israeli company. Within six weeks, her cholesterol was back to 196, and her LDL was 113. While she was on the generic from India, it was as if she were taking nothing at all.

A. In the past decade, we have heard from thousands of people who have experienced generic-drug failures. Sometimes it happens when they are switched from a brand to a generic. Other times it occurs when one generic product is substituted for another.

We discuss the pros and cons of generic drugs and ways to use generic drugs wisely in our Guide to Saving Money on Medicines. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (65 cents), self-addressed envelope to: Graedons' People's Pharmacy, No. CA-99, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

One way to tell if generic drugs are doing the job is to test the results and keep careful records, as you did with your patient.

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>Q. I need cataract surgery and have been told I must stop taking Flomax pills two weeks beforehand. I need an alternative drug to help me urinate. Otherwise, I might explode or end up in the emergency department.

A. Tamsulosin (Flomax) is prescribed to alleviate difficult urination caused by an enlarged prostate gland. One difficulty with this medication may occur during cataract surgery. Men taking tamsulosin are at risk for something called "intraoperative floppy iris syndrome." This can complicate surgery and explains why you have been told to stop the medicine.

Ask your doctor about using the erectile-dysfunction drug tadalafil (Cialis) while you are waiting for surgery. The Food and Drug Administration recently approved this medication for urinary symptoms of prostate enlargement.

Be prepared for your insurance company to reject payment for this treatment unless your doctor intervenes on your behalf. Because Cialis is primarily prescribed for erectile dysfunction rather than prostate problems, insurance companies may try to deny it as medically unnecessary.

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In their column, Joe and Teresa Graedon answer letters from readers. Email them via their website: www.PeoplesPharmacy.com.