Topamax or Topiramate for Migraine — A Difference?

by Teri Robert, Lead Expert

With Topamax being used for Migraine and headache prevention, many of us eagerly awaited the release of the generic topiramate. However, since the release of generic topiramate, we've seen numerous questions and posts from people who hare frightened, frustrated, and even angry about the generics. Some have seen their Migraines increase with the generics; some have started experiencing increased negative side effects.

As is common with widely used medications, there are generics of topiramate being produced by multiple pharmaceutical companies. Also common is the situation of the possibility of getting a generic made by one company when you fill your prescription one time, and getting a generic made by another company the next time you fill it.

A study published in this month's Neurology investigated "clinical and economic consequences following generic substitution of one vs. multiple generics of topiramate." Although this study evaluated patients taking topiramate for epilepsy, the findings should be quite interesting to many using generic topiramate.

Study methods:

  • Medical and pharmacy claims data of Re´gie de l’Assurance-Maladie du Que´bec from January 2006 to October 2007 were analyzed.

  • Patients who had epilepsy and were being treated with topiramate were selected.

  • An open-cohort design was used to classify the observation period into periods of brand, single-generic, and multiple-generic use.

  • One-year generic-switch and switchback-to-brand rates were estimated.

  • Medical resource utilization and costs were compared among the three periods.

Study results:

  • 948 patients were observed during

    • 1,105 person-years of brand name Topamax use

    • 233 person-years of single-generic use

    • 92 person-years of multiple-generic use

    • 23% of generic users received at least two different generic versions.

  • Compared to using brand name Topamax, the use of multiple generics was associated with:

    • higher usage of other prescription medications

    • higher hospitalization rates

    • longer hospital stays

  • This effect was less pronounced in single-generic use but still higher than with brand name Topamax usage..

  • Risk of head injury or fracture was nearly three times higher following switching from one generic to another generic compared to brand name Topamax use.

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