The battle between generics and brand name

DEAR DR. ROACH: My pharmacy recommends that I switch to the generic to save a lot of money on each refill, as it’s exactly the same as the brand name. My neurologist is adamantly against this and says that generics vary too much and may not be effective. Who is right? I am paying the much higher amount for the brand name Keppra out of pocket.

Also, I only had a couple of seizures years ago — at some point, can’t I wean off the meds? I think my seizures were a one-time event. — N.R.B.

Generics are required to have the same amount of the exact medication as the brand name. Some clinicians feel that some generic medications are absorbed differently from the brand name, and that very small variations in dosage are important. I won’t tell you to ignore your neurologist’s advice, but most people stay just as well-controlled on generic levetiracetam as on brand name Keppra.

As far as discontinuing seizure medicine, really, only your neurologist can answer that. It depends on your seizure history, and the results of your EEG and possibly your brain MRI. Most neurologists will consider stopping the medication after one or more years with no seizures, in most cases.

DEAR DR. ROACH: You have written about screening for breast cancer, but are there any ways to prevent breast cancer in the first place? — T.C.

There are three behaviors that are well-accepted to reduce the risk of breast cancer. Breastfeeding is one, and it’s so good for the baby that we might forget that it has long-term advantages for moms, but add reducing the mother’s breast cancer risk to the list. The second is dietary phytoestrogens, compounds such as soy isoflavones and lignans, which are found in soybeans and other legumes. This data is most clear among Asian women. Finally, regular physical exercise reduces breast cancer risk, especially for women after menopause.

Other dietary factors, such as a diet high in fruits and vegetables and low in meat and saturated fat, may reduce risk of breast cancer, but this isn’t proven. Studies are ongoing to examine whether vitamin D or omega 3 fatty acids may reduce risk, as suggested in previous studies.

For high-risk women, consider chemoprophylaxis with a SERM or aromatase inhibitor, and also a more-intensive screening program.

DEAR DR. ROACH: In discussing treatment of nail fungus, you did not mention newer laser treatments that I see advertised by podiatrists in my area. Are they effective? — J.F.

We don’t really know if they are effective, since well-done studies haven’t yet proven it; however, preliminary evidence is suggestive. This would be a great addition to treatment, since the only currently accepted highly effective treatments are oral medications, which have risk of liver damage. Even more exciting is the idea of combining a topical antifungal agent, amorolfine, with laser. This medication is not available in the U.S., but a study in Korea showed a 50 percent effectiveness rate (which is pretty good for this difficultto-treat condition).

Since I last wrote about this condition, I heard from a lot of readers. Some mentioned cures from Vicks Vapo-Rub, but the only study I found on that showed a 22 percent cure rate. One person asked about surgery, but since the fungus gets into the nail bed, the infection often recurs after removing the nail. Listerine and white vinegar mixed half and half cured one couple, and several people had success with Dr. Paul’s Piggy Paste, which also is vinegarbased. None of these has good data to support its use, but all likely are safe.

Keith Roach, M.D.