News appeared in Russian agencies about a shortage in some pharmacies of the popular antidepressant Zoloft, and RIA Novosti immediately released material with psychiatrist's recommendations on how to replace the drug. Psychiatrists told The Insider that it is possible to use generic or analogue antidepressants, but patients in such cases are more likely to experience side effects, and the tolerability of such drugs is worse. At the same time, doctors note that global changes in the Russian pharmaceutical market took place five years ago, when a large number of Russian generics flooded into it, and they began to displace original drugs.
Psychiatrist Viktor Lebedev
Zoloft is the original sertraline (an antidepressant from the group of selective serotonin reuptake inhibitors, in therapeutic doses blocks the uptake of serotonin in human platelets). It is considered the best sertraline in existence. There is an original drug (Pfizer), but the patent for sertraline has long expired, other companies can synthesize the same drug. He has a lot of generics all over the world – for example, drugs made in India or Russian.
This is not some exclusive drug that you will not find in the afternoon with fire. In addition, you can always switch to a drug within the group – sertraline belongs to the selective serotonin reuptake inhibitors, and this is one of the most popular pharmacological groups in psychiatry. It is quite widely used in psychopharmacotherapy, and there are a number of other drugs in this group – it can be found either among generics or among drugs within the group. Zoloft is still available in online pharmacies, but not in physical ones anymore.
But the fact is that the original drug and generics are different, because the generic copies the molecule itself, but the tablet consists not only of the active substance, but also of auxiliary ones. There are questions about the purity of the substance itself and the purification of the active substance, because, willy-nilly, the effectiveness [because of this] can be different. Maybe just a bad substance – and a bad pill comes out. By-products of synthesis can also influence.
When switching to a generic, patients may complain that the drugs may work worse. But in my practice there were other cases when a person drank the original drug, and it did not help or had side effects, and the generic was better tolerated. These are individual stories. It is better to drink original drugs, but there are financial difficulties with them, because they are usually more expensive due to the fact that companies need to recoup the cost of expensive research. In order to put a molecule into production and onto the market, one must first discard a dozen or a hundred other molecules.
You can switch to generics or move within the group itself and look for another drug. This is not a catastrophic story, because the pharmaceutical market has been stormy for the past two years and drugs periodically disappeared even before the “special operation”. For example, Zoloft sometimes disappears due to labeling problems. I don't think it's a global story about Pfizer leaving the country or that it has to do with military and economic matters. Because global changes in the Russian pharmaceutical market took place five years ago, when a large number of Russian generics poured into it, and they began to force out and dump in relation to original drugs. Generics were of disgusting quality.
Now Russian drugs have become better – perhaps the substance is better, or the manufacturers have more experience. I still recommend buying a foreign drug, since I do n’t trust Russian generics much: there have always been many questions about them due to the fact that the industry itself is not so developed . I have seen more side effects with Russian generics and their tolerance is worse. It was normal for some, of course, but in general, patients complained more about Russian generics.
For those who are accustomed to this drug, it will be inconvenient, but in the absence of Zoloft, we will look for other options. Here you just need to adjust and see how temporary this difficulty is.
Psychiatrist, psychotherapist Pavel Beschastnov
Zoloft is the original version of the drug sertraline, a popular and frequently prescribed antidepressant. Now it is he who has disappeared from sale, and our psychpharmacy is periodically characterized by the disappearance of some imported drugs, but this has been happening for the last one and a half or two years, so the situation is not related to current events. "Zoloft" disappeared in the winter, other drugs also disappeared. Apparently, this is due to regulation and certification in the pharmaceutical market, since the shortage concerns only original imported drugs, while generics are still present on the market. Some drugs disappear for a month, and then appear again.
In the case of Zoloft, there are domestic, and there are Eastern European generics. In general, they are inferior to Zoloft, but they are not catastrophically worse. Only new original drugs usually do not have generics, because the license has not yet been withdrawn, and they are produced under only one name, then there is nothing to replace them. There are indispensable drugs, for example, in children's epilepsy – there they use strictly controlled drugs, and there are no options. There were human dramas when he was unavailable.
In different branches of medicine, there are very specific drugs, for example, some kind of antibiotic tailored to a specific strain, or drugs for metabolic diseases. Such drugs do not have generics, but even original analogues do not. Fortunately, in psychiatry, we almost never see this. Drugs that have not been licensed can be counted on the fingers, and they can be replaced. Perhaps the analogue will not be so suitable, but it does not happen that there is nothing to treat at all.
Some narcotic analgesics (opium painkillers), which are used in surgical and oncological departments, cannot be replaced at all, because no other painkillers give such an effect. This leads to human dramas when it is impossible to find drugs for cancer patients. Fortunately, this is not the case with antidepressants.”
The supply of the Zoloft antidepressant to Russian pharmacies was temporarily suspended due to technical problems in production, RIA Novosti reported , citing the press service of the domestic division of the American manufacturer Viatris. At the same time, Roszdravnadzor explained the lack of an antidepressant in pharmacies as a rush demand. In general, the spending of Russians on antidepressants in January-September 2022 increased by 70% compared to the same period last year and amounted to 5 billion rubles, TASS was told at the Center for the Development of Advanced Technologies.
Back in early March, problems with foreign-made medicines began in Russia. Some drugs have disappeared from the market, prices for some drugs have risen sharply. Cancer patients, diabetics, people with thyroid diseases are in a vulnerable position – they have to switch to analogues of dubious quality and gather in groups to look for medicines together and help each other. Experts with whom The Insider spoke believe that the problems are related to logistics. Transport companies turned out to be unprepared for such an increase in demand, and stocks from warehouses do not have time to arrive at pharmacies.