People’s Pharmacy: Generic Prozac failure led to dog bites
Q. You’ve written about problems with generic drugs, and I wanted to share that pets can also be adversely affected by changes in generic medications. Our dog was prescribed generic Prozac nine years ago for severe dog aggression. She was given the same generic (same manufacturer), which worked beautifully for eight years. No dog aggression.
About a year ago, the pharmacy changed its fluoxetine supplier to a different generic. I did not think much about it: same drug, same dose, right? Wrong! We had two significant episodes of unprovoked dog aggression, both requiring vet care, within four weeks.
At that point, it dawned on me that the only change we had made was the generic fluoxetine. We asked the pharmacy to switch her back to her old generic. That was 18 months ago. She has not had a single incidence of aggression since.
A. Many readers have reported problems with their own generic drugs over the past two decades. Yours is the first to describe a problem with generic medicine in an animal.
Not all generic drugs are perfectly interchangeable, even if they have the same active ingredient. Different formulations and excipients (inactive ingredients), as well as quality control at the manufacturer, may result in differences in effectiveness. Thanks for alerting us that generic drug problems may also impact our pets.
People who would like to know more about using generic drugs wisely may be interested in our eGuide to Saving Money on Medicines. This online resource is found under the Health eGuides tab at peoplespharmacy.com.
Q. I complained to my ENT about itchy ears and also confessed to using cotton swabs to dry my ears after showering. In addition, that’s how I apply a dab of baby oil for the itching. He said the swabs irritate my ears, which makes them itch.
I doubted this, since I am very gentle. I must say, however, that since I reluctantly stopped using the swabs, the itching has not only drastically subsided, it’s almost nonexistent.
A. Thanks for sharing your story. Ear, nose and throat doctors discourage the use of cotton swabs because they can cause ear injuries (JAMA Otolaryngology Head & Neck Surgery, Feb. 1, 2018). They recommend a damp washcloth instead.
Q. My doctor is recommending Reclast to treat osteoporosis. I just heard from a friend, however, that when she received injections of this drug, she developed terrible problems with her teeth.
I have not been able to find out whether this medication causes dental problems. Could you please provide some insight into its benefits and risks?
A. Zoledronic acid (Reclast) is considered effective for preventing fractures due to osteoporosis. A study in the New England Journal of Medicine (Dec. 20, 2018) found that: “The number of women that would need to be treated to prevent the occurrence of a fracture in 1 woman was 15.”
There is a name for the complication your friend may have experienced: Medication-related osteonecrosis of the jaw, or MRONJ. In this condition, the jawbone fails to heal after dental surgery, such as an extraction. This may leave the bone exposed, and is difficult to treat.
This complication is rare with oral osteoporosis drugs such as alendronate (Fosamax), ibandronate (Boniva) or risedronate (Actonel). You might ask your doctor if one of these might be appropriate for treating your bone loss.
Side effects of Reclast may include muscle and bone pain, arthritis, headaches, digestive upset, dizziness, high blood pressure and kidney problems. For a few days after the infusion, patients may complain of fever, flulike symptoms and inflammation of the iris of the eye.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website peoplespharmacy.com. They are the authors of “Top Screwups Doctors Make and How to Avoid Them.”