People’s Pharmacy: Problems with generic hydrocortisone could be dangerous
By Joe Graedon, M.S., and Teresa Graedon, Ph.D.
As an endocrinologist treating patients with adrenal insufficiency, I have recently come across concerning reports regarding the effectiveness of generic forms of hydrocortisone. Patients have reported significant variations between different generic forms, with some experiencing improvements in their condition after switching from one generic to another.
Hydrocortisone is a medication used to replace cortisol in individuals who cannot produce it themselves due to adrenal insufficiency. However, the content and absorption of hydrocortisone can vary among generics, posing risks to patients. Hydrocortisone has a narrow therapeutic window, meaning that too little can lead to adrenal crisis and death, while too much can result in long-term side effects such as weight gain, diabetes, heart disease, and osteoporosis.
Unfortunately, limited information is available regarding this issue with hydrocortisone, which is why it is crucial to address it for the safety and well-being of patients relying on this medication.
The brand-name hydrocortisone, Cortef, manufactured by Pfizer, is quite expensive, costing over $300 for 90 tablets. However, patients can consider purchasing brand-name Cortef from legitimate Canadian drugstores at a lower cost of about $80. Another more affordable option is the authorized generic form of hydrocortisone from Greenstone, available in the U.S.
To provide patients with more information about authorized generic drugs and how to access affordable brand-name drugs from Canada, I recommend reading our eGuide to Saving Money on Medicines. This comprehensive resource can be found under the Health eGuides tab at www.PeoplesPharmacy.com.
In another reader inquiry, someone who had recently recovered from COVID-19 shared their experience with the antiviral medication Paxlovid. They mentioned that the drug interacted with their blood pressure medications, causing their blood pressure to drop to dangerously low levels. It is crucial to highlight that Paxlovid can potentially interact with various medications, making it essential for prescribers and pharmacists to thoroughly check for potential drug interactions before administering this medication.
Lastly, a reader raised a question about the strength of Voltaren gel purchased overseas compared to the one available over the counter in the U.S. The reader noted that the gel they bought abroad required application every 12 hours, while the U.S. version recommends application every six hours. The FDA approved a prescription form of Voltaren Gel in 2007, with the same strength (1%) being approved for over-the-counter use in 2020. The gel contains 10 mg of diclofenac per gram, and individuals may experience varying levels of relief and potential side effects, including digestive issues, skin reactions, and cardiovascular complications.
In conclusion, the issues surrounding the effectiveness of generic hydrocortisone raise concerns about the potential risks faced by patients with adrenal insufficiency. Understanding the importance of authorized generic drugs and exploring alternative options, such as purchasing medications from legitimate Canadian drugstores, can help patients find affordable and reliable alternatives. Furthermore, the need for healthcare professionals to be vigilant about potential drug interactions with antiviral medications like Paxlovid and the differences in strength and application guidelines for medications like Voltaren gel highlights the importance of individualized care and patient safety.
