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.
ANSWER: 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.
ANSWER: 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.
Readers may emai l questions to ToYourGood- Health@med.cornell.edu.