Dan DiMatteo - 04/28/99 02:46:33 My Email:ddia8145@postoffice.uri.edu Employer: Baker's Pharmacy of Jamestown, RI

Comments: A very informative web site for the both the pharmacist and pharmacy student. Good work, Webmaster!

Yvette Cruver - 04/23/99 02:11:44 My Email:keeno@frontiernet.net Employer: Eckerd Drugs

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Jeff Papo - 04/22/99 16:40:15 My Email:PAPOJ@FRONTIERNET.NET Employer: Baxter's Pharmacy

Comments: A very impressive web site.

Alfonso J. Squitieri - 04/22/99 15:19:34 My Email:squitieri@citlink.net Employer: Eckerd Drug

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Angelo Angerame - 04/21/99 21:33:13 My Email:angerame@orn.net Topic: This Site

Comments: Great job on the site webmaster. I've already used a number of links! Keep up the good work!

John Noviasky - 04/21/99 18:25:21 My Email:NoviaskyJ@juno.com Employer: Student Topic: NTI- prepared for Blue Cross Rotation- To be sent to Docs

Comments: When Your Patients Ask About A Generic for Coumadin… Rethinking Generic Substitution of Warfarin History: Coumadin in clinical use since 1956, first Generic in 1988, then withdrawn, Barr AB rated generic available 1997. Issues: In the past, the following concerns have been raised regarding substitution with generic drugs: · Tablet Potency, Bioavailability, Problems when Switching between Brand and Generic Medication Perceptions: Some of these perceptions have been fueled by the pharmaceutical industry which has a vested economic interest in limiting the acceptance and use of generic drugs. These cases have come under close scrutiny by the FDA and applies to those dru s considered to have a "Narrow Therapeutic Index" (Warfarin, Levothyroxine and others). Current Status: Both P and T and DUR committees have reviewed this issue and have prepared this information as a guide for physicians. The following information is a summary of the literature which evaluates the generic warfarin manufactured by Barr and t e branded reference drug by Dupont. Future: With increasing number of patients needing warfarin therapy and increasing "out of pocket" costs for medications by these patients this issue will be increasing in importance for the future. Drug Content Uniformity Bioavailability Study of Warfarin 5mg of Warfarin 5mg Drug Source 5mg Tablet (range) Coumadin ® (Dupont Pharma standard) 4.63-5.38 Barr Laboratories (actual range) 4.74-5.17 Clinical Comparisons of Brand (Coumadin ®) to Warfarin (Barr) Switch Neutel JM, Smith DHG. A randomized crossover study to compare the efficacy and tolerability of Barr warfarin sodium to the currently available Coumadin. CVR&R 1998;2:49-59 · Randomized crossover study to evaluate dose and INR changes when switching warfarin brands · 55 chronic anticoagulation patients with atrial fibrillation · Results INR in range Coumadin- 84% Warfarin (Barr) -85% Dosage Changes Due to Out of Range (<1.8 or >3.2) : Coumadin had 10, Warfarin (Barr) had 5 SE- No hospitalizations, Any bleed- 7 Coumadin, 15 Warfarin (Barr), (ecchymosis, gum bleed) Handler J, Nguyen TT, Rush S, Pham NT. A Blinded, randomized, crossover study comparing the efficacy and safety of generic warfarin sodium to coumadin ®. Preventive Cardiology 1998;4:13-20 · Randomized crossover study to evaluate dose and INR changes when switching warfarin brands · 57 chronic anticoagulation patients with atrial fibrillation · Results INR in range Coumadin- 90% Warfarin (Barr) -89% Dosage Changes Due to Out of Range (<1.9 or >3.2) : Coumadin had 6, Warfarin (Barr) had 3 SE- 4 hospitalizations (2 on Coumadin, 2 on Warfarin (Barr), Any bleed- 12 Coumadin, 9 Warfarin (Barr), (ecchymosis, epistaxis) Summary · The FDA states that medications with AB rating (such as Warfarin by Barr) should not require any additional testing or monitoring other than what is usually required by the reference drug · Warfarin by Barr has Good Drug Content Uniformity and Good Bioavailability · Dupont to Barr switch has been studied in randomized controlled trials with positive results · Warfarin by Barr provides similar patient education materials (1-888-927-3274) · Patient "Out of Pocket" expenses are usually $5 - $20 less per generic Rx than brand rx · For the vast majority of patients warfarin generic represents an economical and safe substitution · ·

Stephen Andrews - 03/25/99 19:50:49 My Email:andrews@warwick.net Employer: Eckerd Drug #5978 Topic: Guest Book

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