You probably don't even need or want to be told at this point that Glumetza™ is simply an extended-release version of the diabetes medicine metformin, which also goes by the brand name Glucophage. It doesn't matter. Look at the graph. Glumetza is way better. That's why the Glumetza® bar is orange and the numbers at the top are way bigger. Because Glumetza® is obviously way better. Santaris Inc. and Depomed, the makers of Glumetza® would like you to stop reading now. They would also like you to not notice or pay attention to the top of the graph, where it clearly says that they used a daily dose 33% higher to get that pretty orange bar.
Or at the very least, they would not like you to think about how maybe it's not all that surprising that when you give a dose of a drug that is higher, it might be more effective.
Here are some other tidbits from the text of the same Glumetza® ad:
Unlike generic immediate-release metformins, Glumetza® uses advanced polymer technology, which provides controlled release of metformin targeting the upper GI system. As a result, more drug enters the bloodstream and less unabsorbed drug remains in the lower GI tract. This may help reduce GI adverse events.
I see. Well I think Glumetza ® may make your penis fall off. And I have provided as much proof for this claim as Santaris Inc. and Depomed have for theirs.
In the clinical trial above, Glumetza® was well tolerated at higher doses. The overall incidence of drug related AEs (adverse effects) was 35% for Glucophage 1500mg/day BID and 33% for Glumetza® dosed up to 2000mg QD.
Sweet. A 2% reduction of the chance of any side effects is totally worth paying $190 extra dollars a month for. Which is what Glumetza® will set you back as opposed to the dirt cheap metformin.
The regular metformin's bar in the graph isn't orange though.
Less than 1% Glumetza® patients discontinued treatment due to GI AEs in the first week of the study, when the assigned dose was 1000mg/day.
Except that pretty orange bar was for a dose of 2000mg/day. Santaris Inc. and Depomed don't seem to want to mention how many people discontinued treatment at this dose. So I'll just assume it's somewhere around 95%.
Sigh. You know, the fact that a drug manufacturer massages some numbers around isn't what bothers me here. Drug manufacturers have massaged numbers around at least since I was a drunken frat boy. They used to be far sneakier about it though. Now it's like they don't even care, and I miss being respected enough that they would at least try to spray some Lysol on their bullshit. These days it's like Big Pharma is giving bulls a special diet to make their shit extra stinky or something.
And evidently extra stinky bullshit works on someone out there. Because I filled a prescription for Glumetza® yesterday. That's what bothers me.
22 comments:
how is QD a decent extended release when most metformins i give out at TD?
also doesnt 2000mg QD = 8000mg
and 1500mg BD = 3000mg
so instead of being 33% higher its 166% higher?
I bet they really don't want you looking at that middle bar, which clearly shows that when actually given at the same dose, fancy new advanced polymer technology is exactly as effective as dirt-cheap metformin. Nice.
We just flat out refuse to stock bullshit drugs like this. They usually arent covered, and we use the argument that they just push the patient into the doughnut hole faster.
Okay, what's the effect on HbA1C and how does the drug compare to Glucophage XR? And, why is there only 10% difference in the orange bar despite 33% increase in metformin drug intake? Alrighty, now.
We were just commenting on that lovely bar graph at work yesterday... Do the manufacturers really think we're that stupid????
FYI: In Canada, HBA1C lab range is 4.5-6.0%. I recently scored 5.9% which returns me to the 'pre-diabetic' stage. However Dr. Richard Bernstein (the Diabetic Doctor) recommends non-diabetic 4.5% range. If I stay off starch and sugar I don't gain weight and glucose levels stay lower. I was lucky when diagnosed a decade ago that diet (and exercise) were prescribed before drugs.
QD is once a day, QID is four times a day.
2000mg QD = 2000mg
1500mg BID = 3000mg
Am I missing something? The total daily dose of plain old metformin was 3000mg.
The total daily dose of the Glumetza-orange-bar was 2000mg.
It's still BS marketing.
Read the graph again. "Glucophage 1500mg/day BID.
1500 mg a day given in 2 doses. Not 1500mg twice a day.
the graph is a real turkey--comparing 1,500 mg non-sustained daily given in two doses (750 mg BID?) to 1,500 mg sustained once a day (with < 2% difference) to 2,000 mg sustained once daily (11% difference in efficacy than non-sustained 1.5 g dose). Gee whiz, if they company is trying to prove a point with the sterilized cow pie penholder souvenir from out west emblazoned with the brass-toned message-'If you can't dazzle 'em with brilliance, baffle 'em with bull...' . Like, why didn't they test 500 mg three and four times a day non-sustained, or run the research against Glucophage XR 2,000 mg once a day? Y'know darn well that the indigent are going to use metformin non-sustained from the $4 Rx plan anyway, unless they can qualify for free brand new drug.
glumetza 500 mg (uhh that would be a quarter tab right?) at bedtime prn for "high"bs along with scheduled metformin 1000mg bid..for real meds patient came in on today..since you don't live in Misery you don't have to worry about getting this doc as your pcp. Actually helped the pharmacist with this one after reading your post yesterday. thanx drug monkey...P.S. got glumetza d/c.the pt was 5"2" 319 and on regular diet so don't think the whole bottle at one time could have helped her HGba1c.
Here's the best part: in people with really bad insulin sensitivity (giant fat asses), the once daily dose will "wear off." Awesome. Now you're fat, got ripped off and fatter because of it. Hey, what's that, you're fat? From the makers of Glumetza, there's Zegerid! Prilosec, Priloschmec. You need the stability and profit that Sodium Bicarb provide. BTB, Anonymous: Max daily dose of metformin = 2550 mg / ER = 2500 mg. It's essentially the same, but marketing prevents them from being equal - that's just life.
I am really going to hate myself when I get a script for this. It is going to happen. If there is a BS medication on the market I always get a script for it. I recently got a DAW for "new" auralgan.
This smells like Invega all over again. Except worse. They're not even sneaky enough to use an isomer to trick unsuspecting doctors anymore...
Well, at least with Invega, the destitute absolutely cannot pay for it, so they HAVE to get the brand name from the company's free drug program. And, the company is incentized to provide it 'cause they don't really have that much usage data to show, how it's so different from the generic. And there may be an upside to Invega (that we don't know about) vs. what's available. Whereas, no one is going to be ablet to tell patient definitively that new longer acting metformin is so much better if BG doesn't improve in 6 months (HbA1C t1/2 =6 months). And, then, again, maybe not.
I wonder if just dipping the metformin in chocolate would make it extended release? I think the diabetics would go for that rather than all that fancy new age polymer whatever....
I work at a large grocery store pharmacy and our tech hours are based off of sales now, not # of scripts filled or inventory size. Therefore, filling one prescription of this will bring me more tech hours than filling 20 metformin scripts (one of our $4 drugs). The stupid district manager does not realize that sure high sales look great, but they come from brand name drugs, which have almost no profit margin and end up costing the company in the long run because of all the inventory problems.
I don't even have time to start talking about how my stupid DM thinks transfer coupons are good for our pharmacy business and we should not limit them to 1 per day and we should even accept them on refills to prevent them from transferring out elsewhere.
As a pharmacist, I really hate to admit this, but I take Fortamet and it has been so much more tolerable than generic metformin OR metformin ER. I could not get past an initial dose of 500mg/day on generic metformin without a constant urge to vomit all day or stomach cramps that had me doubled over. The nausea was so severe each time I tried it that I missed some work. I stuck it out for over two weeks on 3 occasions with no improvement at all in ADRs. We finally tried Fortamet (which thankfully my current insurance covers) and I can pretty easily take 1000mg/day. I am dreading the switch to Big Chain's insurance because I know it won't be covered/my copay will be ridiculous. Btw, I am taking this for PCOS, and NO I am not even remotely obese (5'4'', 125lbs).
Why don't they ever get charged with false advertizing when they put up a graph that equivocates dissimilar dosages?
Also: "And, why is there only 10% difference in the orange bar despite 33% increase in metformin drug intake?"
That's common with higher dosages of a monotherapy, which is why a lot of diabetic patients are on mid-range doses of two or more drugs instead of the highest dose of one drug. Hopefully the doctor in those cases isn't such an incompetent taintbadger that he/she writes for some combo drug that costs $200 more per month, because "the drug rep says it saves them money because they only have one copay." Yeah, one Tier 3 copay of 50% instead of two $8 copays. Do the math, dipshit. And stop listening to ANYTHING drug reps say about ANYTHING. If they say the sky is blue, look up first. Jesus. Are you stupid, or just lazy?
Um, I got off on a tangent there, didn't I?
they should have labeled the metformin 750 mg BID; 1500 mg/day BID is misleading.
"Because I filled a prescription for Glumetza® yesterday. That's what bothers me."
LOL!
Glucophage XR is not equivalent to Glumetza even in the generic sense, even Fortamet. Metformin is a medication that seems like its designed to cause diarrea on purpose, its like half of folks get it as opposed to a small percentage. However, since metformin is the most effective drug and the safest one for most folks, I think it speaks to glumetza's coverage base. But yes, it does make sense to try Glucophage XR which has generics, fortamet is also now generic.
I have no idea on whether brand or generic glucophage xr compares to glumetza for diarrea or fortamet. However, if you can't tolerate metformin, it may be worth the price, perhaps compared to untreated diabetes(not justifying high drug prices but you get that sense). Of course, if you are taking multiple drugs and since glumetza is brand name, it seems partially sympathetic to insurers that they scrutinize the cost, since its an extra couple thousands a year in costs when the generic glucophage xr is probably only $50 a year,especially if your taking other brand name drugs.
Interestingly, the manufacturer of glumetza is a small drug company, not big pharma, but they do try to market it.
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