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Medical Forum / Diseases and Disorders / Epilepsy / November 2004

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What Is the Difference?

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Mary MacElveen - 14 Nov 2004 04:08 GMT
To anyone out there reading this.  I just received a letter stating
where my insurance will cover my daily intake of Tegretol but at a
higher co-payment, but has stated that they will cover me at a lower
co-payment should I switch to Tegretol XR.  So, what is the difference
between Tegretol and Tegretol XR?  If anyone can help me, I will greatly
appreciate it.

Thanks,
Mary!
gaross - 14 Nov 2004 04:54 GMT
> To anyone out there reading this.  I just received a letter stating
> where my insurance will cover my daily intake of Tegretol but at a
[quoted text clipped - 5 lines]
> Thanks,
> Mary!

  How very strange !!  Tegretol was developed in the 1930s?  and is the
Older pill, so it should be cheaper.   Tegretol XR or CR (Extended Release
or Controlled Release), is a Time Release version of the original pill.
It's intended to give more stable blood levels over longer periods than the
original format, so (in my opinion) it should work better.   You can miss
taking a dose up or down several hours from when it was due without ill
effects, while I thought the Olde Tegretol was fussier about taking the dose
Close to the specific rate the Doctor had suggested or might cause side
effects.

  Your Doctor would likely write it for you, and should tell you How to
**phase over from the Plain to the XR version.  There might be a period of
up to 4? weeks to do that, OR since it's the same family you might be able
to do it in a short time.   (I'd be interested in knowing just for
information, which method they use.)

   I never had the original version-- just the Tegretol CR we have in
Canada.    Mine are solid and can be broken in half to make half doses.   I
*think the XR is a powder in a hollow plastic tube? that's swallowed whole.
There are people 'around here'  who use that so they might post in next day
or 2 to clarify that.   ONE of those 2 is called Tegretol Retard in the UK,
but I don't remember if it's the Solid one or the 'tube'.

   The Ep. Foundation of America has a Pill Glossary at their site
http://efa.org   .   I think I also have a direct route bookmarked somewhere
but couldn't find it in a short time.   Your Pharmacy might be able to give
you a link for the manufacturer if you give them a call.   If for some
reason a Glossary (like above) can't find Tegretol,  type in Carbamazepine--
but that's the Doctor / Pharmacy name of the Generic, so Tegretol XR or just
Tegretol shoud get you what you want.

   If above site is one I was thinking of, it shows actual pictures of the
various pill types and doses for Tegretol so you could see if it was the
hollow type or not.   As with regular Tegretol my instructions said to take
it with Milk Food or Juice -- but *not Grapefruit Juice if you hadn't heard
that before too -- one of the acids in Grapefruit interferes with
functioning of All the Tegretol versions.

  If above site doesn't have much on the versions of Tegretol, post back
here and I'll look for the Specific manufacturer link or the Canada one I
had some time ago, in case I still have it bookmarked.    G./.
gaross - 14 Nov 2004 05:19 GMT
> To anyone out there reading this.  I just received a letter stating
> where my insurance will cover my daily intake of Tegretol but at a
[quoted text clipped - 5 lines]
> Thanks,
> Mary!

 I found 1 of 2 sites Bob posted a short time ago too.  The General site
you might want to bookmark in case you want to use it again.
http://www.rxlist.com     Once there, there's a search box where I typed in
Tegretol ? (I think without the XR) and click on GoList ?? or whatever is
the activator you'll see.   That pulls down a description that includes
Tegretol XR but without any pictures.  There doesn't appear to be a
*Printable version option like I think the efa site has.   Also ignore
(mostly) the Warnings section.    While some of the side effects listed
might affect Some people, *no one I've met here over last ~5 years  has had
any of them.   I think there was One person  who had some kind of reaction
to it and had to change to another version, but since you're already using
the Plain Tegretol,  that shouldn't happen with you.
   The Link I copied that above took me to for tegretol is at -->
http://www.rxlist.com/cgi/pharmclips.cgi?keyword=TEGRETOL :-<That's why
address above is easier to bookmark. G.
Bob - 14 Nov 2004 16:42 GMT
>>To anyone out there reading this.  I just received a letter stating
>>where my insurance will cover my daily intake of Tegretol but at a
>>higher co-payment, but has stated that they will cover me at a lower
>>co-payment should I switch to Tegretol XR.  So, what is the difference
>>between Tegretol and Tegretol XR?  If anyone can help me, I will greatly
>>appreciate it.

> That pulls down a description that includes
> Tegretol XR but without any pictures.  

Here's one for Tegretol with pictures.
<http://www.epilepsy.com/medications/b_tegretol_intro.html>
and it has a hotlink to Tegretol XR, but here that is also
http://www.epilepsy.com/medications/b_tegretolxr_intro.html

This is all very strange. An insurance company should not be directing a
patient's medical treatment. Are you sure that the above is exactly what
the letter said, Mary?

Bob
gaross - 14 Nov 2004 18:10 GMT
 Another good website !!  The XR looks like (description) the one that's a
powder inside a plastic shell that's swallowed whole.    They have several
places where they mention not to open or break the tablets, and they also
include the Grapefruit advisory.

    The CR type I use is different colour (similar to part of text in above
group ) for each mg. size tablet,  but mine had a slot across the centre so
I could snap a 200mg Solid Tablet in half and swallow it whole from there,
as a 100mg dose as we phased up the dose originally (~1995).

   And your comment about the Insurer Directing a Patient's Treatment was a
good one too that I hadn't thought about.  I've had a couple of cases where
a 'suit' paid less on a claim because the 'lab fees' exceeded XX percent of
the total costs (after the Dr. charged me Below his Allowed Fee amount), but
that was on a *Dental Insurance Claim,  and not on a Medical Insurance payer
interfering with a Doctor's  judgment and assessment.   G./

> >>To anyone out there reading this.  I just received a letter stating
> >>where my insurance will cover my daily intake of Tegretol but at a
[quoted text clipped - 16 lines]
>
> Bob
CyberCafe - 14 Nov 2004 20:28 GMT
> >>To anyone out there reading this.  I just received a letter stating
> >>where my insurance will cover my daily intake of Tegretol but at a
[quoted text clipped - 14 lines]
> patient's medical treatment. Are you sure that the above is exactly what
> the letter said, Mary?

My husband and myself have had experience with our health insurance provider
not approving certain medications or questioning the dosage.  That includes my
Dilantin dose, so I'm still on 700 mg daily, which keeps me at the low end of
therapeutic.  My health care provider wanted to increase that dose one more
capsule, but we can't do it because of the insurance issue.  In the last two
or three months, however, the health insurance company has started to allow us
to get more than a month's supply of medication at a time.  My late
sister-in-law was covered by the same insurance (her husband and my husband
worked for the same company) and she could only get a 17 day supply for one of
her meds.  One thing that really irks me, and I really don't know if this is
related to insurance or not, is that if I try to get a refill, sometimes
they'll tell me I'm too early, and they won't be able to refill it for a day
or two.  I don't keep track of what day I got a refill, and if I'm in the town
where the pharmacy is, which is 32 miles from my home, I'm going to take care
of all my shopping in one trip.  ARGHHH.

Barb

> Bob
gaross - 15 Nov 2004 00:30 GMT
> My husband and myself have had experience with our health insurance provider
> not approving certain medications or questioning the dosage.  That includes my
[quoted text clipped - 12 lines]
> of all my shopping in one trip.  ARGHHH.
> Barb

I might already know the answer to this from what you said above about the
Druggist not refilling prescriptions when it might be convenient for the
Customers  (remember when C.Service mattered? ),  but *some of the
Drugstores in Canada will take an order with Cash or a Chargecard, then
Deliver this pills to a person's home 'for free'.
  *If they'd rather do that, maybe you could place the order 'post dated'
with them, then They can drive the 32 miles (in winter) to deliver the stuff
!? :-<
   With my Insurance and Druggist in Canada I get 200 tablets of each per
refill -- that's 100 day's supply per time.  And one time when they ran out
of Frisium (Clobazam)  they offered to deliver it to me 'for free'.  (I live
about 15 blocks away and she knows I walk that far to that Shopping Centre.
   But I wondered if they might deliver the stuff 'for free' when they do
that.

2)  You know this stuff better than I, but I wonder what they'd do (them and
the Insurer) if the Doctor wrote you a Fresh Prescription for the Higher
Dose and wrote 'no substitutions' on it -- usually they do that to prevent
use of Generics, but if he effectively Certified you needed the higher dose
amount, if that would get the *Insurer to back off ?   G./
Bob - 15 Nov 2004 01:46 GMT
>>>>To anyone out there reading this.  I just received a letter stating
>>>>where my insurance will cover my daily intake of Tegretol but at a
[quoted text clipped - 19 lines]
> Dilantin dose, so I'm still on 700 mg daily, which keeps me at the low end of
> therapeutic.  

Interesting! You must metabolize it like crazy. I'm at the low end on
300 mg/day

> My health care provider wanted to increase that dose one more
> capsule, but we can't do it because of the insurance issue.

The Dilantin is relatively inexpensive at 120 count 100mg capseals for
US$39.26 total price. I paid US$35.20 after insurance instead of nothing
or very little because of end of year and I've almost used up the
insurance. In any case, you would only pay for that one more capsule out
of pocket unless you're situation insurance-wise is different than mine.

> In the last two
> or three months, however, the health insurance company has started to allow us
[quoted text clipped - 5 lines]
> they'll tell me I'm too early, and they won't be able to refill it for a day
> or two.  

That really bugs me too! I don't like to get caught short-handed and
always stock up on whatever it might be. That happened to me early on
and now I have to wait until the last minute to order. However, I don't
know if the culprit is the insurance company or FDA rules.

> I don't keep track of what day I got a refill, and if I'm in the town
> where the pharmacy is, which is 32 miles from my home, I'm going to take care
> of all my shopping in one trip.  ARGHHH.

I agree. I've 5 separate medicines sitting here and their reorder dates
are unfortunately not synchronized. So with my memory . . . well you
know the rest. :-)

Bob
CyberCafe - 15 Nov 2004 16:58 GMT
> >>>>To anyone out there reading this.  I just received a letter stating
> >>>>where my insurance will cover my daily intake of Tegretol but at a
[quoted text clipped - 22 lines]
> Interesting! You must metabolize it like crazy. I'm at the low end on
> 300 mg/day

I don't know.  I've seen a few other folks on doses even higher than mine.  I have
excellent control unless I get sick.  Talking about getting sick, I asked if I was
eligible to get a flu shot, and they started questioning me about what health
conditions I have (they actually were trying to help me and not deny me the flu
shot).  Even though there's a good chance I could have seizures if I get the flu,
that is not a criteria for getting the flu shot.  I mean, I got the flu shot anyway
because I have asthma and another health problem that made me eligible, but my first
concern really was the seizures.

> > My health care provider wanted to increase that dose one more
> > capsule, but we can't do it because of the insurance issue.
[quoted text clipped - 4 lines]
> insurance. In any case, you would only pay for that one more capsule out
> of pocket unless you're situation insurance-wise is different than mine.

So far I haven't run short, thank goodness.  But I use any capsules I drop (except
for the one that ended up in the cat's water dish).  I've also taken less medication
a few days a year so I have the reserve when I really, really need it.  So far, so
good.

> > In the last two
> > or three months, however, the health insurance company has started to allow us
[quoted text clipped - 10 lines]
> and now I have to wait until the last minute to order. However, I don't
> know if the culprit is the insurance company or FDA rules.

I just have them mail it to me when the wait period is over, but I definitely don't
like having medications mailed to me.  I also have another medication that can't be
mailed because it is so temperature sensitive.  What I don't like is being tied down
to home because your meds might run out when you're gone.  I know a person can get a
spare prescription for travel purposes, but if I travel with my husband (semi-truck
driver when he's not growing corn and soybeans), we don't know where we'll be and
when.

> > I don't keep track of what day I got a refill, and if I'm in the town
> > where the pharmacy is, which is 32 miles from my home, I'm going to take care
[quoted text clipped - 3 lines]
> are unfortunately not synchronized. So with my memory . . . well you
> know the rest. :-)

Oh, yes.  That's another good one.  That drives me nuts too.

Barb

> Bob
Mary MacElveen - 15 Nov 2004 12:02 GMT
Here's one for Tegretol with pictures.
<http://www.epilepsy.com/medications/b_tegretol_intro.html>
and it has a hotlink to Tegretol XR, but here that is also
http://www.epilepsy.com/medications/b_tegretolxr_intro.html

This is all very strange. An insurance company should not be directing a

patient's medical treatment. Are you sure that the above is exactly what

the letter said, Mary?

Bob

Dear Bob,

Yes, the insurance company did tell me which medication they percieve to
be the ones they will cover fully, those that they will cover somewhat
at where a the copayment will be higher.  No, they should be relying on
what the doctor has perscibed.  After all, those in the decision making
process did not go through many years of training.  Thanks for the links
and I will use them.

Hugs,
Mary!
gaross - 15 Nov 2004 15:57 GMT
> Here's one for Tegretol with pictures.
> <http://www.epilepsy.com/medications/b_tegretol_intro.html>
[quoted text clipped - 15 lines]
> Hugs,
> Mary!

  Very strange.   I can't tell where you are, except same timezone as
Ontario (mine) and an ISP that's not in Canada?  Have you considered calling
either a Local Epilepsy Association  (if one is close -- you don't have to
be a Member), to Tell them about this and ask if that's "Normal"  for your
area **Plus they might know who Else to contact at the State? level about a
Company interfering with Patient Care.
  You don't have to be belligerent, unless you Want to, but suggest that
you thought (and were told online) that *they shouldn't be telling you how
to *Modify what a Doctor has Prescribed in caring for your Health... but you
just thought they (the State representative or ??) should know that some
corporations were presuming to practice medicine by Budget Constraints
instead of by Doctor's opinion.

   I hope you can get this sorted out.    Control of this is SO NEAT !!
G./
Satch - 14 Nov 2004 09:39 GMT
> To anyone out there reading this.  I just received a letter stating
> where my insurance will cover my daily intake of Tegretol but at a
> higher co-payment, but has stated that they will cover me at a lower
> co-payment should I switch to Tegretol XR.  So, what is the difference
> between Tegretol and Tegretol XR?  If anyone can help me, I will greatly
> appreciate it.

Each drug has a half-life (the time required for the concentration of the
drug in the blood to decline to half of its original value). Medications
with a short half-life, such as carbamazepine (the regular form, not
extended release) and valproate, pose a slightly greater problem than those
with a longer half-life, such as phenytoin or phenobarbital (brand names
differ per country). For drugs with a short half-life, it is important to
keep the interval between doses as close to the usual routine as possible.
Otherwise, the person risks adverse effects from high drug levels in the
blood or seizures from low drug levels. For drugs with a short half-time, it
is better to take a couple of pills during the day to keep the levels steady
then taking them all at once in the morning or one in the morning / one in
the afternoon, etc. Note that an extended release exists for Depakine which
is called Depakine Chrono (don't know in what countries this drug is
available, but I am able to take it in the Netherlands). It increases the
half-live time a bit.
I guess the same applies to Tegretol / Tegretol XR?

Signature

Thanks.

Marco
The Netherlands


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