Brand vs. Generic

I provided you with the generic name for each drug, and I list the generic names in the navigation panel of this site for all meds. If a generic version is available, you may not have a choice, that is what your HMO or insurance carrier is going to demand you take. We’ve been told since forever that there is no difference between brand and generic drugs.Guess what?

That is absolute BULLSHIT!

There can be a difference, a big difference for some people.

The law of the land in the US is there can be a plus or minus of 20% of bioavailability of the active ingredient! “FDA still uses the plus-or-minus-twenty percent test to determine blood serum bioavailability (i.e., the amount of active ingredient in the blood over a period of time has to come within plus-or-minus twenty percent of that which is observed when the innovator’s drug is ingested.” This is from an overview of the Hatch-Waxman Act of 1999, the last major overhaul to patents involving pharmaceuticals. I’ve been all over the FDA’s Office of Generic Drugs site looking for that 20% figure myself, but all I could find were weasel words. Amidst all of the hard & fast numbers in the FDA’s Guidance for Industry Bioavailability and Bioequivalence, they’re pretty damn vague as to the exact bioequivalence and bioavailability required when comparing “pioneer” drugs with generics! Thanks to the Freedom From Information Act, they don’t seem to be keeping it online anywhere.Картинки по запросу Brand vs. Generic medication

Hey, this isn’t just some rant that Mouse and I are making.  This issue has been studied.  A peer-review study found up to a 31% lower plasma-level concentration in the old-school anticonvulsant Dilantin after switching from the brand name drug to the generic phenytonin.  That’s far below the 20% allowed under the Hatch-Waxman act of 1999.

Not only that, manufacturing processes can differ. Inactive ingredients can differ, albeit slightly and rarely. There is a difference between brand and generic. Will that make a difference when you metabolize the med? Probably. Maybe. I really don’t know. Does that mean the brand name is better? Not always. Mileage always varies!

Some examples from the world of consumer experience:

  • Benzodiazepines – as a class most people can’t tell the difference between brand and generic. But benzos are one of the simplest and safest meds around, other than drug-drug interactions that usually make the one med or the other unexpectedly work better, nothing much happens with benzos. So if you’re paying out of pocket, you may as well ask for the generic. If your HMO or evil, uncaring insurance carrier demands you take a generic benzodiazepine, just go along with it.  The one exception to this is Klonopin.   There are some forms of generic clonazepam that are not as good as the brand, and the brand is just superior over all.  But how many of you have ever had brand name Klonopin with the ‘K’ punched out in the center of the pill?  That’s what I thought.  We’ve had generic versions that are good and we’ve had generic versions that are just complete shit sugar pills.  Sorry, too many pills, too much memory weirdness to give you any sort guide as to which manufacturers to avoid.  But the sad fact is that there’s a lot of clonazepam out there that is practically worthless, and the FDA doesn’t seem to care one way or the other about it.
  • Conversely the lithium variants, as a class, are far better when they are branded. Really. Fight tooth and nail for branded Lithobid, Eskalith and even the yummy (and I mean that in a non-sarcastic way, Mouse found it to be quite tasty and orangelicious) lithium citrate syrup. Under FDA guidelines old meds, pre-1962 meds, are grandfathered in with all sorts of waivers. The manufacturers of the generic versions, even of extended release versions, get to skip a lot of the steps that other meds have to go through. Do you honestly think they’re going to cut into shareholder profits for your comfort? The same applies to the old antipsychotics that have been around forever like Haldol (haloperidol)and Thorazine (chlorpromazine hydrochloride ). If those are the meds for you, and for many people they are the right meds, ask for them by brand first, and not generic.
  • One of the members of my online support group took generic fluvoxamine maleate and responded well to it for awhile. The pharmacy was out when she had to get a refill, so they gave her brand name Luvox instead. She had a nasty reaction to it. She responded much better to the generic form than the brand name form. For her the generic was better.
  • If you read a lot of PI sheets you’ll see that people over 65 have poor clearance of medications.  In some cases they may need to take a little less than the normal dosage.  Often this would be a 10-20% reduction.  Sometimes you can adjust dosages by that much, sometimes not.  Now a generic version might just do the trick.  So for poor metabolizers of all ages the generic might be better.
  • Carbatrol vs. Tegretol.  In most forms of epilepsy where one is effective the other should be just as effective.  However, in bipolar disorder there have been reports that the Carbatrol form of carbamazepine does not work as well to control symptoms as the Tegretol form does.  Is it a question of bioavailability, or do they do things differently at Shire than they do at Novartis?  I don’t know.  But if you’re finding Tegretol to be effective and you’re required to switch to Carbatrol, fight it however you can.
  • I take Neurontin. To save money I bought generic gabapentin from Canada. I noticed no difference. Now I can get brand name Neurontin for less than the Canadian generic, however I had to switch from 300mg to 400mg capsules. No big deal, I’ll switch from 4 to 3 times a day dosing (QID to TID in medical lingo). Ah, that I noticed. It didn’t work as well that way. As my doctor explained the metabolism of Neurontin is such that although the half-life should cover the switch, the half-life data are suspect. Fortunately it’s still cheaper for me to take 1600mg of brand name Neurontin than 1200mg of Canadian gabapentin, and I’m responding even better to more Neurontin.
  • Most extended/sustained/controlled release forms of meds are still under patent and are thus brand name. Not all, just most. There is a huge difference between immediate and extended release medications. Besides not having to take as many pills a day, and thus making med compliance easier, extended release forms usually don’t have as many, or as harsh of side effects as their immediate release counterparts. However I’m a bit leery of Wellbutrin SR (bupropion) being less apt to cause any sort of seizure event. The are often just as effective, although Paxil CR  isn’t approved for nearly as many applications as immediate release Paxil (paroxetine). Mileage always varies of course. I know people who respond better to the immediate release forms of med than to the XR/CR/SR/XL forms.
  • Here’s Nick Holland’s report of comparing generic methylphenidate vs. brand Ritalin.  Stick with brand, folks, even if it does cost more.  Nick tells you why and how you should fight with your doctor to make sure you get brand and not generic.
  • Abbott no longer manufactures Desoxyn (methamphetamine).  They’ve sold the rights to another company who are doing a shitty job with it.  It doesn’t work as well for Mouse any more.  She feels like crap now.  She may even go back to Adderall – a suboptimal solution for her ADD – because this new form of Desoxyn(methamphetamine) sucks more donkey dong than Adderall does.

Florida Family Magazine covered this issue.  Although they’re 10% off in what the FDA allows, hitting the numbers what studies are finding the drug companies are getting away with instead, the same basic idea applies.

Here a nurse weighs in on how generics save money with little difference in efficacy.  However note the key point in this article, it’s all about over-the-counter medications, comparing Tylenol to acetominophen.  In this case I agree!  Buy generic and save!  For some people there is enough of a difference where brand-name OTC meds are superior enough to warrant spending the extra cash, but I’m happy enough with the generics.  Remember, if you notice a difference, it is not in your head!  To quote from the article, “This is significant with blood thinners and other drugs where levels are really really important.”  Yeah, like with psychiatric meds.

I’ve known plenty of people who’ve tried brand and generic meds. Some have noticed a difference, some haven’t. The fact is the difference is real. It exists. It is not in your head if you notice a change. If you change from one to the other and notice new side effects, change back if you can! Otherwise it’s a matter of putting up with the side effects just like any other new med and hoping they’re the type that go away after a couple weeks. But if the generic doesn’t work as well as the brand name and you can’t change back, see if you can get a dosage adjustment, up or down. The magic number is 20%, but a lot of meds don’t come in 20% increments. You’ll be lucky if you can get a 25% difference somehow. If the med comes in a tablet and it’s immediate release, you have the option of splitting one to get a 25% difference. But that might mean getting some wacky combination of big and small pills that could wipe out any potential savings made by switching to the generic.

Isn’t that crazy? Of course it is! These are crazy meds! They’re almost as crazy as the US health care system, which is way crazier than any of us.

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