Medical Forum / Diseases and Disorders / Epilepsy / November 2004
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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