Opinions about generic medications?

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Every official source I've been exposed to, either online or talking to an actual pharmacist, says that generic medications are almost always just as effective as brand name ones. There are a couple exceptions to this rule, for example I've been told that generic aspirin may be likely to cause stomach irritation because it may not dissolve as well. But it seems that half the people I know have stories about some instance where a generic medication didn't work or gave them bad side effects.

Are most, if not all, of these people experiencing the amazing power of placebo?

 

[npage148]

A pretty pill with a pretty name is pretty powerful. Especially when its for a subjective disorder.

I work with a pharmacist who seriously pisses me off
He get brand name Zestril and has to pay like 120+ for a 3 month supply. I asked him why. He clamed that his blood pressure when up when he switched to the generic and his blood pressure was too improtant to mess with🙄 . I also asked him why he just didnt up the dose then and he had no answer

His wifey got switched to generic pravachol when it came out and he insisted she goes back to the brand becasue he didnt think it was working and her cholestrol was too important to mess with. He did not have any labs to back this up. I asked him if his wife felt her cholestrol going up. He didnt think it was funny

In the end, the love you take is equal to the love you make. AND even educated people are fooled by brands and the placebo effect

 

[MountainPharmD]

Everyone should get brand name. Paint the whole world DAW=1!!! Those generiatrinic medications don't work. The brand name drugs that are far superior to their generic version are Percocet, Vicodin, Soma, Valium, Klonopin and the like.

 

[WVUPharm2007]

I like it when people tell me Greenstone's generic Zoloft isn't as good as Pfizer's brand Zoloft. When I reveal to them they are the same company and likely made in the same lab, they have this priceless look of confusion and anger on their face. People don't like finding out they are crazy. I don't mind telling them. They aren't my customer, they are my patient.

Generics are just as efficacious as brand drugs. Anyone who tells you otherwise in A) a drug rep or B) a physician brainwashed by said drug rep.

 

[DownonthePharm]

Different people may have different sensitivities to the non-active ingredients in the various generic formulations, but for most people and most drugs they are interchangable.

I personally have had a reaction with generic vs. brand for a particular medication, but it doesnt stop me from taking generic for others.

 

[sdn1977]

Yes...the placebo effect is powerful, but the economic effect is more powerful - just my experience.

However, there are a few medications I would never substitute & in fact, there are no therapeutic substitutions for some.

But...as long a someone makes an educated decsion...who cares? Certainly - I don't.

 

[All4MyDaughter]

I had some problems when I went from brand name Synthroid to generic Levo-T to brand again... and finally settled on using the Levo-T permanently. My TSH levels were all over the place.

They can be substituted in KY but most pharmacists I know won't switch someone who's been on brand Synthroid to generic without the OK of the doctor. Coumadin/warfarin same story.

 

[All4MyDaughter]

in fact, there are no therapeutic substitutions for some.

Pregnant mare urine, anyone?

 

[sdn1977]

Pregnant mare urine, anyone?

 

[All4MyDaughter]

I want mine on the rocks!

 

[eddie269]

Throughout my short time in the pharmacy, the only reason/complaint for generic over brand THAT MADE ANY SENSE was some generics' texture is different than brand name. For some patients, the "rougher" texture of the generic pill hurts when they swallow.

Well, if you want to pay out of your own pocket instead of having insurance cover it, be my guest.

 

[cycloketocaine]

Well, my grandma and grandpa will ONLY take brand name. My grandpa has been known to drive 45 minutes to find BRAND NAME BACTRIM. I mean, hello. It's just because they're "afraid" of the efficacy of the "generic". In other things, like food (and I know this is a bad analogy, but this is where he is coming from), "generics" aren't the same. Oh well, if he has enough money to shell out for Bactrim, then more power to him!!! (He is my most problamatic customer, and no one else in the pharmacy will deal with him. He's lucky he's my grandpa)

Oh, and I worked with a pharmacist that would only dispense brand name Dilantin. She wouldn't allow generic in the pharmacy. I didn't know there was a generic for the longest time, and I couldn't figure out why I kept getting the M/I DAW reject. Oh well, turns out she had had some bad seizures, started taking generic Dilantin, they kept on, switched to brand, and they stopped.

 

[Sosumi]

Oh, and I worked with a pharmacist that would only dispense brand name Dilantin. She wouldn't allow generic in the pharmacy. I didn't know there was a generic for the longest time, and I couldn't figure out why I kept getting the M/I DAW reject. Oh well, turns out she had had some bad seizures, started taking generic Dilantin, they kept on, switched to brand, and they stopped.

Yeesh. One personal anecdote shouldn't be construed as fact. It's bad that it happened to her, but you'd think they taught her evidence-based medicine in pharmacy school -- especially since there are various manufacturers of phenytoin, and for all we know, it could have been due to many reasons, including a bad lot, that particular manufacturer, or other excipients on that particular formulation.

 

[All4MyDaughter]

Yeesh. One personal anecdote shouldn't be construed as fact. It's bad that it happened to her, but you'd think they taught her evidence-based medicine in pharmacy school -- especially since there are various manufacturers of phenytoin, and for all we know, it could have been due to many reasons, including a bad lot, that particular manufacturer, or other excipients on that particular formulation.

They told us in class that many pharmacies refused to stock the generic dilantin for a long time, but I don't remember why.

 

[psychoandy]

The best part about working in an outpatient pharmacy where everyone that's not an employee is either on medicaid/medicare or free care is that we don't carry any brand name items unless, of course, there isn't a generic. It's fabulous, no DAW anything, and patients can't demand for brand name meds unless they wanna pay out of pocket and wait til we get it. The whole daw thing was a foreign concept to me until people from other states told me about their pts getting brand name klonopin and Z-Packs and whatnot.

 

[sdn1977]

Well, my grandma and grandpa will ONLY take brand name. My grandpa has been known to drive 45 minutes to find BRAND NAME BACTRIM. I mean, hello. It's just because they're "afraid" of the efficacy of the "generic". In other things, like food (and I know this is a bad analogy, but this is where he is coming from), "generics" aren't the same. Oh well, if he has enough money to shell out for Bactrim, then more power to him!!! (He is my most problamatic customer, and no one else in the pharmacy will deal with him. He's lucky he's my grandpa)

Oh, and I worked with a pharmacist that would only dispense brand name Dilantin. She wouldn't allow generic in the pharmacy. I didn't know there was a generic for the longest time, and I couldn't figure out why I kept getting the M/I DAW reject. Oh well, turns out she had had some bad seizures, started taking generic Dilantin, they kept on, switched to brand, and they stopped.

Sorry - Dilantin is one of those drugs you can't change to generic without informing the physician. It requires an evaluation of blood levels.

That doesn't mean you can't ultimately switch it - it just means you must stay within the brand & if you change the brand you must inform the prescriber so the pt doesn't experience blood level changes which could result in changes in therapeutic effectiveness. The prescriber & patient need to know & want to enter into lab draws.

The Orange Book gives you the AB ratings....other than AB, you shouldn't change brands unless you inform the prescriber when you have a narrow therapeutic index drug such as phenytoin or warfarin.

Even within the AB equivalencies of levothyroxine...there are blood level changes which result when changing brands. That's not to say it can't be done because of marketplace issues - but you need to make all players (the prescribers) be aware.

 

[Hokie Grad]

Every official source I've been exposed to, either online or talking to an actual pharmacist, says that generic medications are almost always just as effective as brand name ones. There are a couple exceptions to this rule, for example I've been told that generic aspirin may be likely to cause stomach irritation because it may not dissolve as well. But it seems that half the people I know have stories about some instance where a generic medication didn't work or gave them bad side effects.

Are most, if not all, of these people experiencing the amazing power of placebo?

I am drug formulator in the pharma industry, I work for a contract development lab, so I deal with generic as well as branded companies.

Instead of boring you with all of my personal experience formulating generic drugs, just read the passage below from the FDA website, and click on the link for additional clarification.

"In order to be deemed therapeutically equivalent to brand products, generic drugs must have the same active ingredients, same dosage form, same standards for purity and quality, same standards for manufacturing, and same amount of drug absorbed over the same time as the equivalent brand product. Generics are also required to meet the same stringent government standards for strength, purity and potency as the brand version.

The Food and Drug Administration (FDA) has repeatedly affirmed that the generic approval process is as rigorous and thorough as the process by which brand drugs are approved. When a generic drug receives FDA approval, research and clinical experience indicates that the generic drug is not only bioequivalent but also clinically equal to and as safe and effective as the brand name drug it is a copy of.

In order to market a generic equivalent to a brand pharmaceutical company’s drug product (once the market exclusivity on the innovator's product has expired), a generic pharmaceutical company uses the Abbreviated New Drug Application (ANDA) process of the FDA."


http://www.fda.gov/cder/consumerinfo/generics_q&a.htm

 

[Glowwyrm]

I had some problems when I went from brand name Synthroid to generic Levo-T to brand again... and finally settled on using the Levo-T permanently. My TSH levels were all over the place.

They can be substituted in KY but most pharmacists I know won't switch someone who's been on brand Synthroid to generic without the OK of the doctor. Coumadin/warfarin same story.

My mom had the same problem when switching between Synthroid and Levo-T. She has also now switched to Levo-T permanently with much better results.

 

[WVUPharm2007]

They told us in class that many pharmacies refused to stock the generic dilantin for a long time, but I don't remember why.

The same reason many physicians write DAW:1 Synthroid and Coumadin. It's because dilantin has a weird kinetics profile where the more you add, the faster the plasma concentration accelerates upwards. They feared the generic wouldn't be measured correctly or whathaveyou and people might be harmed.

I toured Mylan personally (right accross the street from school) and looked at their phenytoin making area. They have a scale that is accurate to 1 ng or something ridiculous like that. I doubt their generic is causing any morbidity....but who am I...?

 

[WVUPharm2007]

Sorry - Dilantin is one of those drugs you can't change to generic without informing the physician. It requires an evaluation of blood levels.

We switch from Dilantin Kapseals to Mylan Extended-Release Phenytoin all the time. I'm not sure about IV formulations, but the PO is definately rated AB.

 

[letjin]

for example I've been told that generic aspirin may be likely to cause stomach irritation because it may not dissolve as well.

My pharmacology teacher is very fond to cost-effectiveness and use of generics. BUT he recommends brand name Aspirin... not because generic does not dissolve well. He told us that ASA decomposes as it get exposed to heat, moisture & light. If it stays long enough on the shelf, it will be decomposing and it will have increased % (close to 5% if its very old) of salicylic acid which is very irritating. Bayer company actually buys back their old ASA if they are running close to expiration date, and he explained that generic companies are not likely to do that - and so generics are more likely to be decomposed and more likely to cause stomach irritation.

 

[cycloketocaine]

We switch from Dilantin Kapseals to Mylan Extended-Release Phenytoin all the time. I'm not sure about IV formulations, but the PO is definately rated AB.

That's the switch I was talking about. We do it all the time too.

 

[dgroulx]

I had some problems when I went from brand name Synthroid to generic Levo-T to brand again... and finally settled on using the Levo-T permanently. My TSH levels were all over the place.

They can be substituted in KY but most pharmacists I know won't switch someone who's been on brand Synthroid to generic without the OK of the doctor. Coumadin/warfarin same story.

Synthroid/Levo-thyroxine/Levoxyl can't be switched in Florida. There's a few others but nothing that's prescribed often.

 

[SomeGuy]

Here's an interesting article about Dilantin substitutions:
http://www.medscape.com/viewarticle/414647

One of our frequently tangential profs also showed us a case study about a patient that was once switched from capsules to tablets when capsules suddenly became unavailable. The problem is that the patient was switched from the salt form to the free form, but as if they were equivalent mg for mg, so the patient started accumulating the more potent free form drug in their body with not so good consequences.

Along the lines of Levothyroxine, there was a case several years ago of Boots funding and DESIGNING an experiment to test the bioequivalence of Synthroid along with generics at UCSF. Despite Boots' influence, the study still found no significant difference, but the researcher had agreed to not publish without Boots' permission. Boots then published the study with their own favourable results. When Knoll bought out Synthroid, they published the unaltered article in JAMA.

See here for more details:
http://jama.ama-assn.org/cgi/search...quicksearch_submit.x=0&quicksearch_submit.y=0
http://scholar.google.com/scholar?hl=en&lr=&q="betty+dong"+synthroid&btnG=Search

Oh, and as for ASA, I could only wonder why some of them smell like vinegar, hydrolysis or bad manufacturing?

 

[sdn1977]

This has not been the real highlight of our profession!

The levothyroxine (hmmm - scandal could be a good word!) started in the 60's & 70's....indeed with research conducted in concert with UCSF.

It was found years later that some pertinent data had not been released & altho it was not necessarily germain to the the actual topic being (no generics at that time...) it still smacked of industry influenced research - which it was. Much of that research was later redone - some was documented & some was not.

So....now with levothyroxine - we have three reference drugs:
Unithyroid, Synthroid & Levoxyl. Each have their own generic equivalents - so for levothyroxine...there are AB1, AB2 & AB3 ratings depending on which reference drug it is related to.

Have any of you been involved in the recent issues with the difficulty obtainng not just generic levothyroxine, but also some of the brand names? Some of my pts have had to switch brands for a number of months & have not just had symptoms, but have had blood level changes.

For my own personal, professional opinion on phenytoin interchanges....if a pt is stabilized on Dilantin...I would never, ever change the drug to the generic equivalent unless I had the ok from the prescriber & full knowledge of the pt. I feel they both need to be aware of the change with the possible need to follow with drug levels to prevent significant morbidity. If you are ever in a position to follow blood levels after the switch...pay close attention!

You can't switch from po to liquid without blood level monitoring or dosage adjustment - that's due to the difference between extended release & the suspension which is immediate release.