Monday, January 11, 2010

Metanx vs. Folast

In my quest to find the truth about Folast, I e-mailed Brookstone Pharmaceuticals and PamLab.  I received a response from PamLab the maker of Metanx.  Here is the response I got:

Thank you for contacting Pamlab. Here is Pamlab’s response to what we have discovered is not the same formulation as Metanx:

“Recently, Pamlab learned that Brookstone Pharmaceuticals (which recently changed its name to Acella Pharmaceuticals) launched a competitor to Metanx with the NDC number 42192-0311-90. Brookstone labeled this product as containing the identical active ingredients in identical strengths as Metanx. Pamlab believes Brookstone’s representations are intended to convince the pharmaceutical trade in general, and Pamlab’s customers specifically, that the Brookstone product is a generically equivalent substitute for Metanx.

Laboratory testing clearly demonstrates the Brookstone product does not contain the same active ingredients in same strengths as Metanx. Instead of L-methylfolate[6(S)-5 MTHF], the Brookstone product contains a racemic methylfolate mixture of both the L (active) and D (inactive) forms of methylfolate in an amount that is more than twice the amount of L-methylfolate contained in Metanx. The same testing also shows that the Brookstone product contains less than two-thirds of the amount of pyridoxal 5’-phosphate that is contained in Metanx. Pamlab believes that Brookstone’s representation are false and misleading.” We have filed a suit against Brookstone for false advertising.

So what the response says is that it does contain the same ingredients just not the same amounts, therefore saying it is the same as Metanx is false advertising, but is it harmful or not beneficial?  Is this just a case of the pharmaceutical company protecting their brand name product?


  1. Pamlabs response is very correct....Brookstone mis-labeled their product and I must say my physician was on top of this and made sure I did not get Folast (counterfeit generic). My doctor is Charles Ross in Greensboro, NC and he told me Folast was just simply the racemic mixture and not L-Methyfolate which means Brookstone cannot break down theirs to L-Methyfolate and also because of Patent Laws cannot legally make L-Methyfolate because Merck and Pamlab have the only patent for it. He gave me a comparison...he said it was like getting cough medicine without the cough suppressant which made perfect sense to me. I will continue with the real Metanx and let my pharmacist know that he does not need to try and substitute my prescription. Great info on your page!

  2. It may be my ivestigative background but I do not trust anonymous commenters. Still sounds like a PR person for Pam lab.

  3. Anonymous,
    Or is it like taking cough medicine with a little cough suppressant?

    I'm confused b/c the generic does contain L-Methylfolate, but in a racemic mixture with the D-Methylfolate? I'm not really sure what racemic mixture means.

    I'm glad I'm getting this info out. There's not much available when you "Google" generic metanx except for my blog.

  4. I am the rep who posted the first response to your "generic metanx" blog. me, we don't need a PR campaign to sustain Metanx from this counterfeit product. Go ahead and take the Folast and see when your symptoms resurface. Brookstone admittedly labeled their product incorrectly as stated by them in the lawsuit. It does not contain the exact ingredients in Metanx and honestly its not even close. The racemic mixture is the non-natural form of Folate instead of the naturally occurring L-Methyl thats in Metanx. Basically it never breaks down within your body and never gets used whereas Metanx does break down and become fully bioavailable to the system. Like I posted earlier, call Brookstone and ask for Philip Vogt who is the Product Manager/Executive VP of Brookstone and there whopping 6 employees. Ask him point blank if Folast is the exact equivalent of Metanx and if there product is labeled correctly. You should get back on here and post his answer. I already know the answer to one of those questions because its filed in the lawsuit. I believe in educated my doctors who in turn educate the patient on our drugs. Thats my job as a representative. I don't want you thinking you bought a diamond when you really have a CZ if you know what I mean. It might look the same but its not the real deal!

  5. I started taking folast a couple of weeks ago for peripheral neuropathy after my doctor ordered metanx and cvs substituted it as the generic form. My podiatrist wanted me to take the medication for 6 months and then have a repeat nerve fiber density test done. After taking it for just this short time i am having tingling in my feet and more pain which before starting it was controlled with the lyrica and this is why i found your blog after googling it. not sure if the medication is working and reversing the damage or if it is a side effect. i will go in and discuss this with my pharmacist tomorrow and see if they can switch me back to the metanx given the lawsuit and all. i just hope my insurance company will cover it! did you talk to your pharmacist? i just wanna make sure i get the right drug. i am 40 and a nurse so i have to get my feet healed as quickly as possible! thanks for the info. I'll let you know what the pharmacist says btw. (Tracy in winston-salem, nc)

  6. Thanks for the comments. I haven't had a chance to talk to my pharamacist yet, but I will post as soon as I do. Unfortunately for me, I am using Metanx for a non-conventional reason. I need the L-Mehthylfolate due to a genetic condition where I may not be metabolizing folic acid which may be causing my homocysteine level to go up which may make my blood clot more easily which may or may not be causing me to have recurrent miscarriage. It's not really proven and most doctors don't buy it, but there is no harm in trying it. However, I don't have any symptoms that I can monitor to see if they change. My homocysteine level has not been checked before or after, but that would have been helpful it it had, but the doctor's just don't want to help me if it's something that's not proven by research. I had to find the doctor that gave me the prescription originally, and then I convinced another doctor to give me another one. But yes, I really need the L-Mehthlfolate and I will be talking to my CVS pharamcist soon.

  7. I talked to my pharmacist and he said he was gonna look into it. in the mean time he changed me back to metanx and unfortuately i have a $35 copay instead of the $10 generic but peace of mind is worth it. thanks for bringing attention to this. it is really odd that their is no other information regarding folast online! have a great trip to disney! Tracy Scotto Rinaldi, Winston-Salem, NC

  8. I am Dr. Robin A.Eckert MD at, I also have degrees in Biochemstry, and I just scolded a pharmacist for substituting Folast for Metanx.

    Pharmacist and Doctors and consumers need to know:

    What a "racemic" mixture is; in Folast L-5-methyl Folic Acid which is bio-active and bio-friendly is mixed with the Mirror image "D" - folic acid that is backwards folic acid ( and it might as well have come from Mars!) in a 50:50 mixture - the backward D-folic acid you are getting in the Folast is at a very high dose. And theoretically, the effects of this backwards folic acid could be potentially very toxic, especially if you have an MTHFR gene defect ( which 1 in 10 of us do). The "Racemic" Mixture had not been tested. And we have a lot of examples in our drug formularies that show when Drugs are "Racemic" ( which is a cheaper quicker easier way to make a drug) that these drugs almost always have more toxic side effects. Many new drugs that we see come out in the market now are just simply non racemic versions of an older racemic drugs ( they keep the beneficial bio-active part and toss out the potentially toxic mirror image analog ) The MetanX Representative is absolutely correct and I hear that Brookstone's Folast will be pulled from the market.

    I am very upset that the pharmacist tonight filled my clients Rx with the Folast.

    I have no financial interest in Metanx, but I use it to make a lot of people feel better, Robin A. Eckert MD

  9. My Metanx Rx was filled by CVS on 12/24 with Folast. I presumed it to be a suitable generic and began taking it regularly. I had an appt. with my podiatrist on 1/12 and mentioned to him the Folast. he showed me a letter from Pamlab he had received discussing the difference and the pending lawsuit against Brookstone.

    I am headed to the same CVS in an hour or two to complain and bring copies of this and other discussions for them to read. I fully expect a replacement with Metanx! Also...Medicare apparently will not corebarcver Metanx. Has anyone found differently? Jim in AZ.

  10. Oops..that last 2nd to last line should have said "cover" Metanx

  11. Thanks Dr. E! I will be getting my refill of Metanx instead of Folast. My old HMO did not cover Metanx b/c it was a medical food, but my new insurance does so I will be paying the copay of $25 or $30 I think. The folast was $9. does have a coupon for anyone who needs it. You can get 30 tablets for $31.03 by using the coupon.

  12. I went to see my cardiologist today and told him I had recently been given a generic version of Metanx by CVS. He was very concerned as he explained how the two are different and act differently in the body. He said several of his patients had normal homocysteine levels while on Metanx and then suddenly new bloodwork saw the numbers change for the worse. In all of these cases, folast had been substituted by the pharmacy. Needless to say, he promptly wrote me a new Rx for metax and included the "dispense as written" instructions!

  13. Don't know about the contents of Folast but I can tell you from my experience with representatives of the company, from customer service to the CEO, that they are NOT very responsive to customer questions or concerns. I will not be spending money with this company

  14. Mrs. Chief - I found your posts on Metanx vs. Folast as 'proof' from my doctor why I should use Metanx and not Folast (and your posts show up in a Google search) . . . however, to be frank, your blog and many of it's replies only got me more confused . . . so I decided to do some more investigation on my own, and I found this site/posted this entry . . . I have yet to respond to it, however, I think it sounds very promising to me . . . and I thought since you’ve been doing so much research on the subject yourself, and I used your site in my research, I should at least share my findings with you :

    many thanks for your help and good luck to you . . . I wish you nothing but luck and success in your future

    (FYI - in my original thread, you’ll see *edit* . . . they were quotes and/or links to back to you blog)

  15. LarP, thanks so much for posting the link to your thread. There is so much information available it just gets more and more confusing...I will be posting again soon with a summary of what all I've found.

  16. In January, my pharmacist insisted that Folast was a generic substitute for Metanx. Since taking Folast, I have had increased heart rate, center chest discomfort, and difficulty sleeping. I stopped taking Folast last week and am much improved. I was wondering if anyone had similar issues. I have convinced my pharmacist to replace the Folast with Metanx, but am concerned about starting up again. Thank you for the valuable information on this page.

  17. I have been directed by my Dr to try Metanx due to a MTHFR gene mutation that could have possible future health ramifications (ie: elevated homocysteine, heart issues, cancer, etc.) Unfortunately, there are no real definitive tests to check to see if the Metanx is having any positive effects.
    Ms Chief, it sounds like you are dealing with the same issues. How are you monitoring your progress?

  18. This whole blog is company driven, more than likely Reps. Come on guys.... this is the oldest tactic in the book... like reviewing you own drugs on websites. Disappointed and you know that I am on point.

  19. My podiatrist gave me a script for Metnax to see if it would help with the burning in my feet and legs(neoropathy--not associated with diabetes). In the office she specifically said she wanted me to take Metnax for one month and follow up with her. I went to my local Walmart to get my script filled and it was not in stock. They ordered it on Friday and it came in on Tuesday. After I got home I found that the pharmacy had filled the script with Folast a generic which cost 48.00 because it is not on Medicare part D's Formulary.

    After reading this article I called the pharmcist who said it was policy to fill with generic unless specified by the physician or asked for by the patient. I am not a physician and had no idea about the difference between the two meds or the lawsuit.

    The pharmacist also stated that he called the podiatrist's office to see if he coul fill the script with Folast and was given approval by someone in the office but not my Dr. to make the substitution. I had to pay out of pocket anyway since it was not on the formulary. The pharmacist said that Metanx was about 95.00 when I asked the price difference between the two medication. Can you please advise me what to do? I have opened the bottle of worthless pill and I have taken one already. Everyday I am getting a script filled, none seem to work. It is as if I'm in some sort of endless experiment. This is very expensive.

    Please advise as to what I should do? I do not wish to take something that if not the same as my physician perscribed, expecially if it is I have read about on this page. I have enough health problems. Please advise, I would have rather paid for the real thing than spend almost 50 dollars on something of no use to me.

  20. It's a natural tendency to think that an anonymous reply or responses from the manufacturer of the brand product might be misleading in favor of Pamlab. I believe the response above from the Pamlab rep and anonymous are totally correct when they say that Metanx is not equivalent to Folast. I have a degree in chemistry and in pharmacy which means I spent some time on the subject making it possible for me to understand what it means to say that L-methylfolate is a biologically active stereoisomer. I don't expect to be able to explain that to someone in this space. Maybe Googling or reading chemistry text books would help anyone who wants to understand the subject. An L- stereo isomer is the mirror image of the D- stereo isomer which means it is like having a right and left handed glove. The molecules are made of exactly the same atoms in the same sequence but are mirror images of each other. A right handed glove won't fit properly on a left hand. Drugs often work by finding an area on a large molecule in our bodies where they "fit" and can do the work that they do or where they will be transported to the inside of a cell. Sometimes a chemical is so similar to the drug needed that this chemical blocks the site of action where the drug would do it's work or needs to attach to be transported. That is the case with D-methylfolate. 50% of methylfolate in Folast is D-methylfolate while there is 0% in Metanx. D-methylfolate blocks the site where L-methylfolate needs to attach to transport proteins in order to be taken into the cells. This is called competitive inhibition. So even if Folast had the same amount of L-methylfolate in it, the D-methylfolate it has counteracts part of it. Also, making the deleterious effect worse, D-methylfolate clears two times slower from the body than L-methylfolate. So there is even more than a 50-50 chance of a blocking effect. I think that maybe the manufacturers of Folast were leaving an ingredient, D-methylfolate, off their label which is just plain wrong. It's like taking a mixture of sugar and dirt and labeling it sugar.

    I take Metanx for diabetic peripheral neuropathy. Recently I showed my prescription to the pharmacist at Walgreens which is closer to my home than Costco where I had been getting it filled. My wife picked it up for me, and I put it in my weekly pill minder. Since my vision isn't all that good, I don't read everything that comes before me like I did when I was younger. Five days later, after noticing that my feet felt like they had booties on them, I got a Metanx tablet left over from Costco out and held it up next to what I got from Walgreens. They are a little different in appearance and then I noticed my bottle said Folast on it. I wasn't expecting that since I knew there was no generic substitution for Metanx and the doctor wrote the Rx as Metanx. Apparently Walgreens and some other pharmacies are engaging in illegal practices in substitution. I'm retired and never worked for Costco or Walgreens so it's not that I have an ax to grind. I think people higher up in Walgreens just are ignorant of the fact that Metanx has no equivalent substitute. The point is that when I took Folast, I got the symptom back in my feet that I had before I took Metanx, so I know they aren't the same.

  21. Where are the government regulators, asleep at the switch again? I just went down to Walgreens and looked at the stock bottle for Folast. It still lists only L-methylfolate with no mention of D-methylfolate. I asked the pharmacist and he said that both the Folast and the Metanx come in bottles labeled as prescription only drugs. Unless I'm mistaken, that means the government's responsibility is to regulate them for safety and efficacy. I don't blame the pharmacist. He relies on the label on the bottle. If testing has shown that Brookstone's product contains a racemeric mixture of D- and L-methylfolate, why haven't they been forced to recall all of it to re-label ? I would certainly be embarrassed if I discovered that the information I'm relying on from Pamlab is incorrect, but I am shocked to think that people are being given an ineffective substitute month after month because Brookstone (Acella) is allowed to mislabel their product. Does anyone have an update on the legal situation?

  22. Mike, Please read my follow up post here. Matanx is a medical food therefore it can say RX only, but it is not FDA approved.

  23. mrs chief:

    as per your quote above: "I need the L-Mehthylfolate due to a genetic condition where I may not be metabolizing folic acid . . . "

    well then, you really don't need that way overpriced mentax . . . or the potentially rip-off folast . . . as you can buy this nutrient all by itself, over the counter . . . i did, at iherb: (i've since completed my research as per my last post, and decided to create the mentax formula myself)

    again, i wish you nothing but success on your family plans


  24. I just learned about Melanx and wanted to try it to see if it would help me with my diabetic peripheral neuropathy. My foot doctor wrote me a prescription but when I went to CVS, I was told it is $84 a month ($250 for the 3 month supply)and not covered by insurance. I usually get my prescriptions 3 month supply thru Caremark. Can anyone find it cheaper or know if Pamlab has some program to help people aford this.
    It is sickening that this drug might alleviate the symptoms of neuropathy and they are unaffordable. Any info would be appreciated.

  25. FYI, I am a nurse practitioner in southwest louisiana. we have many patients on metanx. I have one patient began complaining of symptoms returning. After reviewing his medications, his wife, who handles his meds stated he was switched appx 2 months ago to folast which essestially costed the same. she was told walgreens no longer handles or carries metanx. She is now shopping for a pharmacy who carries branded metanx. I found it interesting that the patient began complaining of symptoms not knowing he had even be switched. just thought this was relevant.

  26. First....I love your heading that reflects your faith :)

    I also have a double mutation and have had a doctor ask me if I have had there are others out there that do believe there might be a connection.

    If you get your folate tested, I found that the RCB folate better reflects the tissue storage than just serum folate. My homocysteine was mid-range despite the double mutation (although I had taken about 20 pills of the prescription folate about 6 weeks prior - I stopped in order to get the bloodwork done before resuming).

    Someone else mentioned ordering from iherb. This is what I have just now done for neuropathy issues. My B12 levels were also low (as well as Vit D, so please check that as wel). I started the wrong B12 supplement and was getting only one of the two co-factors and the one I was taking was not helpful for peripheral nerves -- so the form of B12 does matter as well.

    I am hoping the folate I have ordered from iherb is the right kind. I think they have a couple of different brands - the one I am using now is Solgar. It says on the bottle that it is Metafolin and on the back it says that Metafolin is a registered trademark of Merck KGaA, Darmstadt, Germany.

  27. A very interesting discussion on Folast!
    I found this page on Sunday morning after searching the net for info on Folast. These tablets were given to me as generic substitute for MentanX by CVS in Aiken SC. (I have been using MetanX for more than 12 months without problems.) CVS told me it is the generic for MetanX, and I took one. About 30 minutes later I did not feel too well, this lasted for about 3 to 4 hours. Monday morning I took one again and felt even worse. I called my Doctor's office yesterday (Monday) to question the use of this generic, more so after I had read a lot of negative info about Folast, and the response from him (through the receptionist)was "take the bottle back to CVS and tell them to give you what I prescribed. Your prescrition did not state "Folast". If you have any problems, call me and I will explain it to them."

  28. Carmen from GenevaJune 26, 2010 at 1:20 AM

    Good grief -- I had no idea that there was such a controversy over these two drugs. I live in Switzerland and am trying to take Metanx for the same reason as you. It's not easy to get this product here in Geneva and so my mom shipped me a 90 day supply from Texas. When I received it I realized that the RX had substituted an Acella product named 'Neurpath-B'. It wasn't even cheaper. And, of course, I looked it up on Google and saw your blog with all of the comments. Also found a letter from Pamlabs attacking this one too:

    First of all, thank you for posting your original message. Women in our situation, dealing with so many conflicting bits of information, need content. It can be confusing at times, but I personally like to read a lot of stuff and decide what to do myself.

    Secondly, I don't really care whether big pharma will benefit from my picking a label rather than a generic. To be honest, when you are dealing with miscarriage, you don't have time for controversy and you don't have room to experiment!

    So, thanks for the post and thanks for providing a forum for this discussion.

    My best wishes go out to you in your journey for a family.

  29. There is now a drug called "Neuropath-B" which claims to be a generic for Metanx. Is it really the same?'

    Pam from Statesville, NC

  30. "Neurpath-B" is purported to be the generic equivalent now commonly substituted for "Metanx." Prior to the marketing of Neurpath-B, the generic equivalent being substituted for Metanx was known as "Folast." BOTH of these purported substitutes are/were manufactured by Brookstone Pharmaceuticals, now under ownership of Acella Pharmaceuticals.

    Refer to - and click on "Attention Metanx Patients: Important information about your Metanx prescription" located at the top of the page. There you will find letters from the CEO of Pamlab (who manufactures Metanx) regarding serious concerns with the integrity, stability, and safety of the actice ingredient XOLAFIN-B (L-methylfolate calcium) found in Acella Pharmaceuticals products (Folast AND Neurpath-B). Yes, Pamlab is the competing company in this case (who brought the lawsuit against Folast getting it off the market), but the facts and figures do appear to speak clearly to the problem with these purported "generics."

    As a Type II diabetic, with neuropathy problems, my husband has been prescribed Metanx for his condition. Starting a couple of years ago, his prescription initiated with Metanx in brand name form because that was the ONLY form available at that time. He experienced improvements during the time he used Metanx and had no problems with the brand name form. Several months ago, when it came time to reorder his prescription, our pharmacy automatically substituted "Folast" which we were certainly willing to try as a cost-cutting measure. However, my husband has NOT found Folast to be as effective for his condition as the Metanx was, and he developed a severe skin rash (allergic reaction) that surfaced concurrently with his last refill of Folast. We cannot know for sure if there was any direct correlation between Folast and the allergic reaction, but there have been enough valid questions raised about the integrity of BOTH Folast and Neurpath-B, that my husband and his doctor have concluded it is NOT in his best interest to take either of those products as substitutes for Metanx. The doctor is now noting my husband's Metanx prescriptions as "Name Brand ONLY; dispense AS WRITTEN."

    Although Metanx is not particularly cost prohibitive, it seems that many insurance plans are placing it in a tier level category that incurs the highest out-of-pocket cost to the patient. They are then trying to tout Folast / Neurpath-B as cheaper substitutes. Pharmacy personnel, and particularly prescription drug insurance plans, need to be educated about the safety concerns with Folast and Neurpath-B and informed that they are NOT generically equivalent to Metanx. Based on all of these recent findings, I have asked our insurance plan to review and re-evaluate the level classification to which Metanx is assigned.

  31. I write for USA TODAY. I'm working on a story about Metanx vs Folast or Neuropath-b. I'd like to hear from people whose doctors have expressed a preference about one compound or the other. Many thanks. I can be reached at

  32. After reading through this blog I am amazed at how many of you are so quick to blame someone else! Several of you admit to putting a medication into your body without even knowing it has been changed! Do you not READ your prescription labels? If not, you probably shouldn't be on this blog trying to give other people advice or blame someone else for your own shortcomings.
    Also, how can you blame your pharmacist or pharmacy for dispensing an "inferior" product when the information they have from the manufacturer is apparently not correct (no listing of a racemic mixture)? If you buy a gallon of milk from a grocery store that is labeled 1% but is in fact whole milk, is it the grocery store's fault?
    Today's society is so caught up playing the "blame game" because it's easy. Before you run out to blame someone next time, ask questions, educate yourself, and READ. And, if you want brand Metanx, just simply ask for it, I do.

    1. I'm Rev. Paige and how dare you say this. My wife has diabetic nerve pain and is very careful of what she takes and I believe that all diabetics have to and must read and be careful of what they put in their bodies.When she read her prescription label after being switched the first time she was told by doctors and pharmacist that not to worry it was safe and the same as Metanx. After a few weeks all of the real Metanx had went out of her system while taking Folast and now Foltanx her symptoms have come back worse. No one should be made to suffer only for profit. Just because you said those horrible words about diabetics I encourage all affected to sue. And yes I'm from Mississippi and all of the pharmacies and most of all the doctors are all lying about this matter.

  33. The preceding comment from "Anonymous" is noted. I think the only point that people are trying to make in MOST of these postings is “patient beware” and “here is what is going on.” They are quite rightfully annoyed by this situation and it sounds as though the preceding commenter is trying to silence the messenger.

    If anyone is to “blame” in such matters, it is the manufacturer of the generically UNequal product who has misinformed (and hoodwinked if you will) medical personnel, pharmacists, and the general public as to its merits. Pharmacists are medical professionals who SHOULD make it their business to know more about what they are dispensing and it is ludicrous to even compare that profession to a grocery store selling milk. But let’s get real here – even when these issues are brought to their attention, I dare say most pharmacists are not going to give the matter any credence until forced to. It took a LAWSUIT to get Folast removed from the market and now the same manufacturer is trying to do the same “stuff” all over again with Neurpath-B.

    My understanding is that because Folast and Neurpath-B are NOT drugs, but rather prescription food products, they do not fall under the same stringent FDA drug requirements (for certifying generic equivalency) which the average person often has to rely on for proper oversight. The prescription label does NOT provide information on the product differences that have been the cause of such concern, much less is it going to point out the safety issues of the Xolafin-B ingredient which has not been certified in either USA or China (the country where it is manufactured). There are many physicians who do not have the full picture on this, and until the word really gets out there, that will remain the case. In the meantime, this leaves many patients at the mercy of the system and justifiably concerned.

    Posts, such as this one, are at least a start in prompting people to do their homework. It is apparent that many of the bloggers in this post are most definitely reading, asking questions, and TRYING to educate themselves, and despite the fact that most are probably not chemists, they are doing what they can to decipher and wade through all the scientific jargon. For that, they should be commended and given credit where it’s due.

  34. For any fellow-sufferers who might be lurking, Walgreens DOES handle and carry Metanx (although it may be a special order). I got a prescription for Metanx filled yesterday at my local Walgreens for the exact drug with no hint of substituting a generic (of which there isn't any). Price was $75.99 for 60 pills because it was not covered by my insurance.

  35. I am a Pharmacist with CVS Pharmacy and WE DO carry Metanx, in fact my wife takes it at the recommendation of her Neurosurgeon.
    I have read these posts and they are quite interesting, from both the patient and Physician perspectives. In fact, "Donzie" even states: 'Pharmacists are medical professionals who SHOULD make it their business to know more about what they are dispensing.' Well Donzie, I'm not sure what you do for a living, but I'm sure you do the absolute best you can at your job, as most of us Pharmacists do. The anonymous posting from 9/9/10 regarding the milk DOES sum it up! We are running pharmacies, not chemical laboratories. If the information provided from the drug manufacturer is not accurate, how can we be held accountable? Is it our responsibility to send EVERY MEDICATION to a chemical lab "just to make sure the manufacturer has listed everything accurately?" WE CAN ONLY KNOW ABOUT THE INFORMATION PROVIDED TO US.
    As I stated earlier in this blog, my wife does take metanx, and for those interested, their website has a down-loadable coupon that makes the cost much more affordable.
    Sorry if I sounded a bit harsh to Donzie, but I take exception to people outside of the business "trying to tell me how to do my job."

  36. The concerns expressed in these posts are not ALL about the pharmacist, as the preceding commentor seems to be focused on. My own medical doctor was unaware of these Metanx substitution issues until he was actually apprised of the product differences from the same sources cited by others in this post. Our physician took interest in the situation, did not defensively accuse anyone of trying to “tell him how to do his job,” and his ONLY concern was with getting to the bottom of the truth about these pharmaceutical products.

    No one has suggested that pharmacists have any obligation to send anything out to a chemical laboratory. Pharmacists are not to blame or accountable for what information drug manufacturers do, or do not, provide. Nor are they clairvoyant. However, once product concerns become known, we ALL have a responsibility to share such information. The product differences between Metanx, Folast, and Neurpath-B are now published in black and white. Pharmacists HAVE been provided with the information but are not heeding it.

    As excerpted from multiple encyclopedia and academic sources, a pharmacist is commonly defined as:

    “A health professional who links the health sciences with the chemical sciences and is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek: (pharmakon), meaning ‘drug’ or ‘medicine’ (the earliest form of the word is the Mycenaean Greek pa-ma-ko, attested in Linear B syllabic script.) The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to health care, including clinical services, reviewing medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are the experts on drug therapy and are the primary health professionals who optimize medication use to provide patients with positive health outcomes.”

    The role of a pharmacist is already commonly defined, and I heard no consumer in this post “tell” a pharmacist how to do his job. However, there is a rightful expectation that once physicians, pharmacists, and other medical professionals become aware of inadequate and/or potentially harmful pharmaceutical products, those service providers will care enough to do their part in the review process and do what they can to protect the public. If the aforementioned definition does not define the job description of a CVS pharmacist, we consumers should probably thank “Anonymous” for bringing this to our attention as we continue to assess the shopping venues we choose to patronize. THAT is OUR job.

  37. My doctor electronically sent a prescription for Metanx for me to CVS pharmacy. They filled it with Neuropath-B. My doctor annotated on the prescription that it should be brand name. According to the person that answered the phone at CVS pharmacy, they wouldn't fill the prescription as brand name unless the doctor gave me a hand written and signed prescription. They would not fill it as Brand name because it was submitted electronically. I've never heard of such a thing. I noticed that CVS pharmcy is mentioned in several of the posts.

  38. I am a physician who regularly prescribes Metanx, Deplin, Cerefolin NAC and Neevo prenatal. Only these products contain the patented L-Methylfolate. The parent company, PamLab, licenses the L-Methylfolate to other companies like Shionogi Pharma, for products like Prenate prenatal vitamins.

    In the last year I have seen a flurry of substitutions on these products I have prescribed to my patients and honestly I am getting tired of it. When my nurses and office staff receive many phone calls regarding headaches, muscle tingling, memory loss, nausea, etc, they always ask the patients what are they taking and nine out of ten times it is a substituted product. I am very concerned that pharmacists are taking on their own a direct order from the physician and changing it without complete understanding of the product and the clinical implications it brings to the patient. But worse, insisting that the generic is all the same and not having adequate scientific proof to back their claim ( case in point Metanx vs Neuropath and Folast). The FTC comes very strongly in cases like these as well as the money hungry plaintiffs attorneys.

    So what can we do? I educate my patients on the product when handing the prescription to them. Now it is up to the patient to alert the pharmacist not to replace the product and then confirm that they have received the real thing. Sorry pharmacists but you guys are way to busy to pick up on stuff like this and it is the people we are trying to serve who end up suffering and paying for your mistakes.

  39. On December 25 i carried a prescripition to my
    pharmacist for Metanx. I told him that I was aware that the cost I would have to pay because of my copayment would be more than the prescripition was. At this time he informed me that there was a generic for it I said great.
    Now one thing I do is I check information on
    all my drugs side effects and its contribution
    to my overall health. When I did I discovered
    this blog, pulled up the site of Metanx and read also the contents. I called my Pharmacist back
    and told him that I was concerned about the difference of the two. He said that the FDA would not allow anythiing on the market that did not comply with the orginial. The mistake he made is this is not considered to be a drug but a supplement therefore the FDA does not regulate supplements. I have called my Doctor back to get his directions on what to do.
    I do have neuropathy I am non diabetic and have to this point managed it well. I am convinced myself also my doctors are that Neuropathy is caused by levels of gluclose and
    others factors. I know what the parts of Metanx
    are and according to others writers Folast is not the same. I have also read that you could obtain from I Herb.Com the same ingrements contained in Metanx in another form. Would someone answer me in doing this what do I ask
    for? What is the name of this patricular supplement I should order or look for. As you can see if I can obtain this in the same form I would get the same benfits at a lower cost. I would appreciate any help from anyone. Thanks

  40. I don't know about the other ingredients of Metanx, but the main ingredient I need is the Folate which can be purchased at any vitamin store. You want Metafolin (L-methylfolate). The brand I buy is Solgar which can be found at the Vitamin Shoppe if you have one in your area.

  41. Thanks Ash. You are right about Folate. Here iswhat I understand. Metanx consist of L methylfrolate 2.8 mg is B12. Also pyridoxal 5
    phosphate 2.5 mg B6 aand Methylcobalamin 2 Mg
    being folate of B12 and B6. If you read the reply of Mike Ridlen who appears to know what he is saying that Folast contains 50% of D Methyfolate which actually blocks L methyfolate
    which needs to enter the cell for attachments. Sorry to have gone in this direction and this is not to imply to you in any form that what you are takeing is a mistake. I do thank you for your reply I am trying to find the above ingrements in the same form as Metanx yet at a
    lower price. I again invite you as many appear
    to be experts and have a greater knowledge of this than I do to assist me. Thanks so much

  42. everyone needs to calm down. these are vitamins. basically, metanx is vitamin b6 (pyridox), b9 (folate) and b12 (cobalamin).
    l-methylfolate has been around since 1970 as the ammonium salt, and then since 1999 as the d/l (racemix) l-methylfolate calcium salt.
    the brookstone product used a chinese source (i know them well), Jinkang, and used the racemix. later they added the non-racemix.
    NON of the pam labs products are FDA approved. they are medical food vitamins.
    the FDA (AND Merck KGA who created metafolin/l-methylfolate) ALL say that l-methylfolate, levofolinate (folinic acid) and folic acid are BIOEQUIVALENT. which is stronger than saying pharmaceutically equivalent.
    I personally have developed over 400 medical food prescription products. I know what I'm talking about.
    Don't get ripted off by brands pretending to be "approved." try the generics or "comparables," if they don't work then go back to the brand.
    contact me for questions, I love helping people!

  43. I can personally testify that after taking Folast, I had horrible side effects. I couldn't sleep, had incredible throbbing in my head, and all my sympotms became worse. I couldn't figure it out until I contacted the Dr. who prescribed the Metanx. Her comments were "I never gave the pharmacy permission to substiture. Folast is Toxic - stop taking it NOW." I don't remember what I used to sign in on this website, but if you want to contact me, my email is Hope that clears up anyone thinking this is anonymous and that I work for any Chemical company. I have been through an unbelievable experience that last two years with nerve pain - I would suggest anyone who is prescribed any of these types of medicines to consult with as many doctors as possible before going down the path.

  44. In response to “CigaRHETT:”

    Just because people are reporting poor experience with a “medical food,” as opposed to a pharmaceutical drug, does not mean their concerns should be minimized or justify telling them to “calm down.” The public can be harmed just as much (or more) by a poorly-regulated medical food product as they can from an actual drug. It is exactly because there is lack of proper oversight (FDA approval) of ALL of these “medical foods,” that posting on-line is the best way to warn others of the potential problems with products that are being automatically substituted (in most cases without patient or physician consent).

    My family member’s direct experience with “Folast,” was horrible, resulting in breaking out in hives. The same company that caused the problem with “Folast,” (Brookstone / Acella) then went on to market “Neurpath-B.” After already striking out with “Folast,” we lost all trust with its manufacturer, and I’m not sure they really deserve a second chance with my family’s health. If we had not found this posting (as well as others), we never would have known what was going on. As soon as we discontinued the “Folast” and assertively made it clear that there was to be NO substitute dispensed for the “Metanx” product, the problem was eliminated and the Pamlab product was allowed to do what the doctor intended for it to do in the first place. Direct experience speaks volumes, and quite frankly means more than spinning the lab numbers to make them appear like you want them to.

  45. I would like to ask this Blog what are the consummers rights when a pharmacy substitutes a product without telling the patient?

    I am a diabetic and 2 years ago suffered a back injury which hit the nerve to my right food causing droop foot. After going to several doctors and working with Physical therapy I showed some improvement. My doctors told me that it would take quite awhile for the nerve to heal from the back down to the foot. To help the process my podiatrist wrote a script for Metanx. The bottle said Nueropath-B on the lable and I asked the CVS Pharmacist if it was the correct mediation and he said yes it is for the nerves. I took the medication for 3 weeks and my feet started to burn and tingle. I stopped taking the Neuropath for a few days and my feet felt batter.
    My next visit to the podiatrist 5 weeks later and she asked how the Metanx was working and I told her it had burned my feet and I stopped taking it. She told me that was unusual and asked me if I was still taking it. I told her no, that the pain was worse than having drop foot and wearing a brace. I failed to mention to her that the the bottle said Neuropath-B. I went for my follow up 2 weeks ago and my podiatrist asked if I wanted to try the Metanx again, after talking about it I agreed and filed the prescription. Last night the pain started again so I went online and found this blog.
    After reading the blog I called CVS and asked the pharmacist if the medicine I was receiving was Metanx or something else and he said that they replaced the Metanix with Neuropath-B because it was cheaper and that the government allows them to replace with a generic whenever one is available. I asked the pharamasist why was I not given a choice on whether I wanted the generic or the brand written on the form and he said they don't usually do that, the patient gets an information sheet and should read it.
    Bye-Bye CVS is all I can say. I am removing my scripts from their store and although it is much less convenient I am going to a local pharmacy that will give me the service I require. I have contacted my doctors office for a new script that states NO SUBSTITUTIONS so this cannot happen in the future and will give Metanx a real try. Thank you for starting this Blog without it I would not have known. I know I cannot pin my hopes that the drop foot will heal but at least I have a little optimisim that maybe it can.

    1. Generic substitution laws are state specific. Unfortunately, yes, in most cases the pharmacies can automatically substitute what they consider “equivalent” without telling the patient, unless the physician clearly notes the prescription otherwise. Each state qualifies how the physician must note the brand name designation on the prescription. Some mandate that the physician must sign the prescription signature line labeled “May not Substitute” or “Dispense as Written.” Some mandate that in the physician’s handwriting, the words “Brand Medically Necessary,” or “Dispense as Written,” or “May not Substitute” must be written out. Your physician and/or pharmacist should be able to inform you which mode of communication is required (and accepted) for your particular state. But it is most often necessary for the patient to initiate the request and then make SURE the pharmacist has dispensed the correct product before you pay and walk out the door with it. As always – buyer (and patient) beware. (CVS is not the only pharmaceutical culprit who has caused problems with this process.) I hope you have obtained relief with your situation.

  46. pricewise go to the website
    $144 for 3month supply or $48 monthly.

  47. Metanx so effectively alleviated my nerve pain, that I was able to cut my Tegretol dose in half for the first time in 20 years! Side effects of fatigue/drowsiness were reduced 50%, also.

    When offered Folast, I tried it. It only took a few days befor the nerve pain began to return. I didn't consider Folast a problem because generics had always worked great for me.

    I eventually learned from my doctor's staff that Folast doesn't work as well as Metanx. I returned to Metanx and feel like myself again!

    In Aug 2011, the price for 60 Metanx increased from $64 to $100. A 3 month supply will be approx $300, but on I would pay $144. I have been using Sam's Club Pharmacy. COSTCO Pharmacy raised their Metanx price to $149 for 60 tabs.

    I am calling my doctor Monday to get a 3 month prescription to submit on-line.

    Also, in CA, ANYONE of age, can purchase tobacco, alcohol, and prescriptive meds at "membership stores".

  48. The problem is that "Folast" and "Neurpath B" are NOT generic equivalents to "Metanx," although their manufacturer has tried to spin it that way. Law suits have resulted over this entire situation. It really peeves me when these substitutes are referred to as "generic" by medical professionals who should know better. Pharmacists have been notified of the discrepancies, but are not paying attention. On first look, the ingredients appear to compare as equivalent. But the formulation is different, and there are safety issues associated with one of the key ingredients (Xolafin-B) which is manufactured in China. My family member broke out in hives after taking "Folast," but has had no problems with "Metanx." FDA carries little weight in regulating this situation, since "Metanx" is a medical food and not an actual drug. It is up to the patients to educate themselves and assert for the name brand product when filling their prescriptions.

  49. Try getting the Metanx coupon from our site...

  50. You can get 3 month supply of metanx at for $132.99. FYI.

  51. There's also a link to the Metanx coupon from here. This website also has a bunch of other drug coupons.

  52. Took both Metanx and Folast for several years - saw no difference.

  53. The latest Metanax study (on rats):

    Diabetes. 2012 Aug;61(8):2126-33.

    Company PR release:

    As was pointed out above, one can by the individual ingredients of Metanx from companies like Vitacost or Swanson, at considerably lower cost.

    The same goes for Cerefolin NAC (sold for memory issues) which has methylcobalamin, L-methylfolate (Metafolin) and n-acetylcysteine (instead of pyridoxal 5 phosphate).

    This product description notes:

    "...Absorption of methylcobalamin may be decreased with ...metformin...", which suggests that sublingual methylcobalamin tablets might be the better way to go for individuals who take metformin.

    If one goes the individual supplement route, n-acetylcysteine would appear to be a worthy consideration to address oxidative stress.

    In PubMed, the search "(n-acetylcysteine OR n-acetyl-cysteine) AND diabetes" yields over 400 hits.

  54. BioActiv Health HS fighters has a B supplement homocystine complex patented metafolin folate w methyl B12 & B6

    I take it for double copy gene mutation MTHR 667

    I have bone infarcts in both knees...

    I am going to try Metanx to see if theres any difference in the way I feel.

    No thanks on the substitutes!


    The other day when my husband tried to obtain his routine Metanx renewal from Walgreens, he was flatly informed that "the manufacturer had discontinued this product." No reason or explanation was given by Walgreens. I knew that could not be true, and so I made a long distance phone call to the distributor and was given the following information:

    1. Metanx (in name brand) has NOT been discontinued. What they did was reformat it from a tablet to a capsule. I asked why they changed this, and was told that supposedly it was because some people were having problems swallowing the tablets. They say the active ingredients (and formulation) are still exactly the same as before -- the only difference is there is an additional filler in the capsule, called "Algae-S Powder" (a milk and soy product) which supposedly helps support brain function. The NDC number for the capsule form is: 00525-8049-90. It would be good for Metanx users to be sure and keep a record of that for future Metanx obtainments, in case their drug store is too uninformed or lazy to look into it.

    2. I was informed ALSO that PamLab, who is the distributor of Metanx, now does have an "authorized generic" tablet for Metanx, which is called "Foltanx." This newly authorized generic is reportedly the exact same quality and makeup as Metanx. I was told that when that product is obtained, the bottle may still reference "PamLab," but then next to that or just underneath, it should also reference the name "Breckenridge." Apparently these two companies have now joint ventured together. I looked on-line, and sure enough, found the following link confirming what I was told:

    Hopefully, the "Foltanx" product will not have any of the same inherent problems that the other company touted "generics" had -- those were Folast and Neurpath B (which are NOT true generics of Metanx). I kind of just wish they had left the Metanx alone and stop trying to change it. It worked fine the way it was.

  56. How are you all finding these coupons? I have googled thhe crud out of the comouter and have not gotten lucky. The metanx site is not helpful, and I am currently furloughed, so, money IS an issue, but so is pain and my family's way of life. Thanks.