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Two GPs who care for patients who died after switching brands of an epilepsy drug say they were unaware of the Pharmac brand change when they prescribed the drug to their patients.
Judge Marshall at the Auckland District Court
Photo: RNZ / Claire Eastham-Farrelly
GPs were giving evidence in an investigation that opened today into the role that the Pharmac brand change had in the deaths of six people, who died after changing the brand of an antiepileptic drug called lamotrigine.
Gary Loye was the first witness in the Auckland District Court investigation and recalled the day in February this year when his daughter Krystle Loye died at the age of 35.
“I called, ‘Call an ambulance, please, Krystle isn’t breathing,'” he said, after finding her unconscious in her bed. “I knew by then that she was gone.”
Krystle had been on the Lamictal brand of lamotrigine for 10 years and for the past few years had been virtually seizure free.
Gary said in the investigation before Chief Coroner Deborah Marshall that he received very little information about why Pharmac was switching people to a generic form of lamotrigine called Logem.
He remembered asking his daughter’s GP.
“I asked him why the change was being made and he said they stopped using the other one because of the price and that this new brand was cheaper.”
Attorney Todd Simmonds in Auckland District Court during Gary Loye’s trial in court
Photo: RNZ / Claire Eastham-Farrelly
More than 10,000 people with epilepsy were forced to switch brands of lamotrigine when Pharmac decided to fund only the generic form of the drug, Logem made by Mylan.
Pharmac made the decision to save $ 30 million over five years and free up the money to spend on other drugs, but did so knowing that Medsafe strongly opposed the move, saying it went against international best practice and posed a risk of security.
Dr. David Sharples was Krystle’s GP for about 17 years. He said that today the rebrand had been done without him knowing.
“From what I remember, I became aware of the planned change sometime in early 2020.”
At that time, at least six people had died and the chief coroner had already decided to start his investigation.
Sharples also said it did not read the information Pharmac produced about the rebrand.
He said that as a GP, he knew that Pharmac often switched patients to generic drugs, but in retrospect he accepted that epilepsy was one of those that needed special care.
“Retrospect allows us to see that this was significant for a number of reasons, and on reflection, changes in epileptic medication are possibly more relevant than others.”
But was it the drug switch that actually caused Krystle’s death? Not according to neurologist Elizabeth Walker. In a report to the coroner, he said it was unlikely that it would have been a contributing factor, as Krystle was transferred to Logem five months before his death.
Among the other people who died after switching brands of epilepsy drugs was William Oliver, who was 26 when he had a seizure in the back of his car on August 12, 2019.
Once again, your GP, Dr. Joshua Tang, was unaware of the Pharmac rebrand.
“I think I was aware of the rebrand when I saw Mr. Oliver’s death in the newspaper and in the media – that’s when I was first alerted.”
He said that if he had known, he would have asked Oliver to stay with his original brand of lamotrigine.
Walker said in a report to the coroner that the rebrand was unlikely to have any relevance to Oliver’s death because it occurred four months before his death.
However, he said the rebranding couldn’t be ruled out as a factor in one of the other five deaths.
Drug safety regulator Medsafe opposed the rebrand, saying lamotrigine should be prescribed by brand because its seizure-control effects were so sensitive that small differences in dosage could have significant impacts.
Pharmac said the Logem brand of lamotrigine was widely used internationally and was completely safe. The buyer of the drug stressed that if people were using the drug today, they should not stop taking it.
