Lamictal - switch to generic lamotrigine?

After reading through some of the posts on this topic, I feel compelled to contribute, although I'm quite sure my comments will not be well received. Internet forums, after all, are the place where people with complaints tend to come together to comiserate. This is not remotely meant to be an insult to anyone here, the "internet forum bias" phenomenon exists for thousands of products, from medications to cameras. One must realize, however, that the information presented by lay people in these forums is heavily biased towards those who have had bad experiences with the product being discussed. People who love their camera (or medication) don't generally take the time to seek out an internet forum to find if others are similarly happy. However, those unhappy with their camera (or medication) will likely turn to these forums to seek out others with home they can share their problems. Forums are often the internet's "complaint department".  In short, just be careful what you take away from here. You are not hearing from the tens of thousands of people who've had no problems with lamotrigine. You're only hearing from the vocal few that have (or think it's the drug). I cannot think of another aspect of the practice of medicine that turns normally logical thinking physicians into illogical beings. That aspect is the concept of generic drugs and bioequivalence. There is more misinformation being propagated by healthcare professionals (even pharmacists) about this topic than I can sometimes bear. The first is the concept of "generics can vary by 20% and more from brand name drugs." That is completely dead wrong. Generics vary by no more than brand name drugs vary among themselves from lot to lot, and that is about 2.5%. The 80 - 125% variance that's allowed is with regard to the 90% confidence interval. That's statistics, and since nobody understands statistics, they just relate what they think they heard, and that's the 80-125% variance. That does NOT mean the drug can vary by that much, it means the statistical test for bioequivalence at the 90% confidence level can vary by that much. That leaves VERY little room for the generic to achieve a different plasma level than the comparitor (brand) drug. Tablet press technology, normal handling, and the sensitivey of drug assays simple prevents drugs (brand to brand or brand to generic) of being any closer than that. Think of this, however: miss one dose, take the medicine with food one day then empty stomach the next, smoke a cigarette, take interacting drug, or a myriad of other biological events and you'll get up to a 80% difference in blood level from day to day. Biologic variation is MUCH more likely to cause variance in plasma levels than who makes the drug. The FDA ensure that the drugs are very close, patient and enviromental biology will ensure the variance is more like 10-15% from day to day. This happens whether your're on brand or generic. To make matters worse on the "generic vs. brand" front is the psychological effect (placebo effect) drugs have on patients. Every clinical trial reports headaches, sinus infections, muscle aches, etc. on placebo pills. The power of the mind. The perception the patient has on how (or if) a drug is going to work is a very powerful thing. If your physician has done you the huge injustice of suggesting that generics are inferior, then that's exactly what they'll be for you. Some disorders (depression, irritable bowel syndrome, fibromyalgia) have gigantic placbo effects, up to 50%. The active drug may only work 10% better than the placebo. If you think you're epilepsy drug isn't going to work or it's going to have side effects because it's generic, you may well fulfill that prophecy. Visiting this forum and hearing others confirm your belief just compounds the problem. It isn't the generic drug that's the problem, it's the misinformation and perception - a powerful weapon not unrecognized by pharmaceutical companies that pour money into agencies like the American Academy of Neurology and the Epilepsy Foundation to promote brand name drugs. Suggestions by these organizations that generic drugs may be unsafe are completely groundless and based on anecdotal information, not good science. Politics and money, however, have trumped common sense even for many physicians on this topic. My intent was not to offend anyone, only to educate. Take this information like you should take anything you read on the internet, with a good dose of skepticim.  I'm happy to personally communicate with anyone and provide you with information from the medical literature and the FDA that makes my point here. Thanks