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Defending Generic Drugs

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Q. I can't believe so many people complain about generic drugs on your website. Generics are required by law to contain the exact same active ingredients in the same quantities. What does it matter if the inactive ingredients differ? They're inactive.

I am really disappointed that the People's Pharmacy offers a forum to uninformed morons who don't mind paying 700 percent more for a brand name. Just because it has a name doesn't mean it's any better, only more expensive.

A. For 25 years we agreed with your position that generic drugs were identical to brand names and a great way to save money. Over the last decade, however, we have seen too many complaints about generics from patients and physicians to ignore them.

Comments like this scare us: "My epilepsy was controlled for five years on Keppra (brand name) until my insurance switched me to generic levetiracetam. I started seizing again. My doctor said the generic is less effective for other patients too and switched me back to the brand."

Hundreds of visitors to our website (www.PeoplesPharmacy.com) have reported similar failures with certain generic antidepressants, blood pressure drugs and sleeping pills. So many medications are manufactured overseas that the FDA has trouble monitoring their quality. There is an in-depth discussion of the generic drug controversy in our new book, Top Screwups Doctors Make and How to Avoid Them (Crown).

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The testing of generics is NOT what most people think it is. They think it's more rigorous and the drug has to be shown to be as effective, instead of having blood levels that are similar (NOT IDENTICAL, only SIMILAR). The excipients and release mechanisms can differ. The FDA is not really on top of the substitution or verifying the quality of excipients or even the meds themselves.

When there is a problem, it takes a long time (even after the FDA is aware of problems for action to be taken, let alone the public warned or medicine stocks pulled from sale (they have let medication known to be bad/ineffective/failing standards) to be sold to the unsuspecting.

See what is going on with Apotex, and what went on with Ranbaxy.

Generics for drugs where timing of delivery or fluctuations in the amount of active ingredient don't make much difference are one thing. But there are meds where very tiny differences make a big difference and alter control of disease. There should be a tighter standard for those drugs, and not one for all drugs.

The consequences in the case of seizure control or blood thinning (etc) are life threatening... and constant switching between brands of generics, (not just switching between brand and generic) can mean even wider differences in blood levels over time of the active ingredients. That's because generics are allowed to be at variance with the original brand by certain amounts - and that can be more or less. A generic that delivers more and a generic that delivers less can be far enough apart in drug deliver to mess up a stable dose for a given patient.

Generics are not IDENTICAL to brand drugs, unless they are an authorized generic (one authorized by the original manufacturer might be identical in formula). THEY ARE NOT IDENTICAL. They are NOT tested for effectiveness, and purity is essentially on the honor system, and when problems appear they are hidden by the FDA - the agency that is supposed to watch dog problems.

There are medications for many conditions where smaller differences can make a big difference.

Biosimilars are going to be even worse. Just wait and see.

I recently went to see an Endocrinologist for a thyroid condition that gravitated from hypothyroid to hyperthyroid this year. I was hypo for the last 5 years or more and was asked to take a brand name medication from Abbot Labs by my PCP.

After I checked the price for a 30 day supply I balked and asked my PCP for a generic prescription. To my surprise he refused and indicated the brand name was consistent from batch to batch while the generic fluctuated too much. After much research online I was not convinced and persisted in requesting a generic prescription.

Long story short after 5 years of consistent hypothyroid through blood tests for TSH, T3 and T4 and having few symptoms to back up the data my condition switched to hyperthyroid. Again very few symptoms to back up the data and just last week after a thyroid scan, ultrasound and yet another blood test am now Euthyroid!

I have been on zero medication thus far. On questioning my Endocrinologist about why not Generic I was told FDA does not regulate Generics to the same level as Brands. Brand names have to be within 1% of the formulation and Generics are only required to be at 10%.

Another surprise was that Abbot Labs makes the same medication in India as a generic and it costs way less than the US made brand name and the Doctor indicated she had a patient who traveled to India for a family visit and chose to get her thyroid medication from India. Now this is interesting that Abbot can charge US consumers a heck of a lot more for something that is off patent and sold as generics in other countries but not the US.

I was also told FDA is close to putting in additional guidelines to close the gap between generics and brand names. I'm not sure if this is true or the timeline for it and who knows how the drug companies lobbying will keep this from happening. In the meantime we consumers are left to fend for ourselves and wonder if the adage penny wise and pound foolish is true or engineered!

There is definitely a difference between brand name and generic drugs. I was taking Topamax for prevention of migraine headaches and it was working beautifully - I had gotten my life back. When I picked up my refill, the insurance company had switched me to Topirimate, the generic. I took the generic and woke up with awful tingling in my extremities and a RAGING Migraine.

The Generic made me sick! When I talked to insurance company, the woman admitted that many people could not take the generic, they were not, however, going to pay for the brand name. I paid a very high price for the brand name, and after my doctor wrote a letter to the insurance company describing why I could not tolerate the generic, I now pay a $70 co-pay.

I am grateful that I can pay this amount to keep my migraines under control. Before I started taking Topamax, I told my doctor that I couldn't live like this any more. The pain was excruciating and I was waking up with migraines probably 5 days a week.

Insurance companies don't get it. They are committed to generic drugs, even when it has been proven that they do not work for an individual, they are unwilling to step up and pay for the proper medication that will truly help the patient. I understand trying to control costs. What I do not understand is how paying for a drug that does not work is cost effective? Is there an explanation for this behavior?

I am DEEPLY offended that the writer referred to me as a "moron". I have had numerous adverse rections to generic drugs, including: a severe allergic reaction (presumably from the excipients (inactive ingredients); generic drugs that did not work to relieve nausea while on chemo (the name brand worked), severe nausea from generic drugs, apparently from the excipients - or worse, contaminates.
I use generics, but with great caution. I am an RN and I know that the "inactive ingredients" can, indeed, be quite ACTIVE. They are SUBSTANCES that we put in or on our bodies. An example - Neurontin: "The inactive ingredients for the capsules are lactose, cornstarch, and talc. The 100 mg capsule shell contains gelatin and titanium dioxide. The 300 mg capsule shell contains gelatin, titanium dioxide, and yellow iron oxide. The 400 mg capsule shell contains gelatin, red iron oxide, titanium dioxide, and yellow iron oxide. The imprinting ink contains FD&C Blue No. 2 and titanium dioxide. The inactive ingredients for the tablets are poloxamer 407, copolyvidonum, cornstarch, magnesium stearate, hydroxypropyl cellulose, talc, candelilla wax and purified water.
The inactive ingredients for the oral solution are glycerin, xylitol, purified water and artificial cool strawberry anise flavor." http://www.rxlist.com/neurontin-drug.htm What if a person gets sick from corn or gelatin or xylitol or artificial cool strawberry anise flavor? To the writer: I expect a personal apology. I have sufferred greatly from the "wrong" generics. You do not know everything in the world.

Sorry, as I mention before in other section of this newsletter GENERICS ARE NOT THE SAME THAN THE ORIGINAL... at least with me. I can't have generics, make me very sick or do absolutely nothing. THEY ARE NOT THE SAME, please don't insist what you don't know. Some people can have generic and other don't Some people smoke and get cancer, others don't....some people get the flu and others don't....

This letter writer is ignorant about generics. Although many if not most generics work very well, there are others that not only don't work as the brand, but can cause other reactions as the writer above stated. Case in point - I used brand Ambien for years when the generic came out. The first generic my pharmacy used worked great and I was given this for several prescriptions. Several months ago I picked up my prescription and noticed it was a different shape and brand. I didn't even think about it not working as well since my old generic was great. I took it one night and was dizzy and disoriented, finally went to sleep around 4am. That was miserable. Called my pharmacist and doctor the next day and both told me they did have trouble with several generic Ambien. To the writer - generics are not fool-proof and some are very problematic.

It's not that generics aren't effective, it is the efficacy in in one's body over a set period of time as apposed to a brand name drug. Some of these drugs do not release and react in one's system as a brand name do for what ever the symptoms may be. I would tend to err on the side caution as apposed to giving someone a drug that slow acting and slow releasing for the sake of a dollar.

When you look at the price, that's the elephant in the tea shop, some of the drug manufacturer and the distributor's need to be prosecuted for over pricing of these drug's, some are expensive but some do not cost, what they are charging!

To quote one writer: "I am really disappointed that the People's Pharmacy offers a forum to uninformed morons."
I agree with the RN who wrote "I use generics, but with great caution."; we all should use generics with caution!
I have had many inferior "GENERICS"! And I consider myself a well informed NON-"moron" patient. I do a lot of research on my own and found a lot of reliable information about some very, very inferior, almost dangerous generics! I deal with a small pharmacy that also agrees with me & is super cautious as to where he gets his generics.
I suggest to the writer of: "really disappointed that the People's Pharmacy offers a forum to uninformed morons", do some research on generics also. Most doctors rely on the pharmaceutical companies to educate them on their drugs. Doctors usually do not do any research on his/her own. And pharmaceutical companies are not very well regulated by the FDA! I wish they were! We DO HAVE a VERY BIG PROBLEM with PHARMACEUTICAL COMPANIES NOT HAVING STRICTER REGULATIONS on WHERE they GET THEIR GENERICS!!

My experience has been that with some drugs the generics are fine, but with my Synthroid that is not so. I was born without a thyroid gland. When I have tried the generic, I get brain fog and problems with coordination. I am not convinced that even the active ingredients are equal.

Have a Happy and Healthy Holiday! May you have safe travels!

I too have had bad experiences with generics. I take daily doses of generic Plaquenil and there is only one manufacturer that is effective for me. Unfortunately this is such an old medication there is no name brand any longer. I have had to change pharmacies just to find one that carries the correct manufacturer (Ranbaxy) and expect I'll have to continue to do so in the future.

I've had trouble with some generics also. One of my doctors told me that while the active ingredients may be the same, the rate of absorption can vary by quite a bit. Drugs for depression and other mental illness especially have to have very finely calibrated doses.

I have had many problems with generics over the years. Not from adverse reactions but from them not working. I would take a name brand drug, get the results wanted by the doctor, feel better. Then at some point a generic would become available. I would automatically be switched to the generic and suddenly all my problems are back.

This has not happened with all generic medications that I have taken but it has been a problem with most. When I questioned the doctor about why the name brand would work and the generic wouldn't it was explained to me this way -at least the way I remember being told. The medications are researched and tested using a specific combination of active and inactive ingredients. The inactive ingredients create the pathway that allows the active ingredient to be absorbed properly and to what it's supposed to do. When you change the inactive ingredients that pathway is changed or possibly eliminated and the active ingredient is absorbed to a similar or lesser degree or possibly not at all. This name brand versus generic issue does not seem to affect all people. Some do not notice any difference when changing to a generic, others find its not quite as effective and the dosage needs to be increased.

With others the generics don't work at all - you might as well be taking a sugar pill. Everyone is different and everyone's body chemistry is different and even among name brand drugs not everything works for everybody. I would love to be able to take generics because they are cheaper but there's no point in taking something that doesn't work. In my case its not a life or death issue. But with some people the difference between taking a name brand drug that works versus a generic that doesn't work is a matter of life and death.

I am shocked to hear anyone refer to those of us who have had problems with generics as morons. When I took a store brand of Tylenol PM I had severe nightmares, which I have never experienced with brand name Tylenol PM. Thank you for the wonderful job you do of keeping us informed and answering questions for us "morons".

You can't generalize things like this! I have taken pravachol for years because it has the least affect on the liver (I have autoimmune hepatitis) but when my insurance company changed me to the generic automatically when it came out, I got so ill it sure was not funny.

Those "fillers" which are added to the generic caused a very severe problem with my liver enzymes. I was constantly feeling sick to my stomach and generally feeling poorly. At a visit to my rheumatologist I mentioned this and he had the enzymes checked and they were through the roof.

Continued taking of the drug could have seriously damaged my liver. So generics are not identical and the "fillers" can cause serious problems for some people. I take lots of other generics which save me a lot of money, but each case has to be handled independently.

I would like to hear more on this subject.

How very offensive that person is! I am on 3 generics that are okay but the one for my heart had me into the clinic after just ONE. They may have the same amount of a drug but the Brand name often dispenses it over 24 hours slowly. That one for my heart must have dumped it all at once- my heart just went crazy and I'll never try it again. Merry Christmas to a real grinch!

I have had real bad side effects from generic medications as well. My Effexor didn't work as well and I started having depression again, My Valtrex didn't work as a generic Valacyclover and that was a painful lesson. There are a few more that didn't work right or I had a reaction to it. That can be what happens when the fillers are different. People can have an allergic reaction to a generic when not to a brand name for that purpose alone.....

Wow. Has this person not read about the problems with Synthroid. I tried the generic 3 times, and almost ended up in the hospital with erractic heart palpitations. When tested, my results were that I had close to zero thyroid in my system. For me, it has to be the real thing, although my insurance will not pay for it.

"What does it matter if the inactive ingredients differ?"
Well, it matters very much in some cases. NTI (Narrow Therapeutic Index) drugs are used when a constant blood level of a drug is needed. Meds such as those used for seizures, hormone replacement and the theophyllines are some examples of drugs that need close monitoring. IMO it is brand name only, for those type of drugs. It is the INACTIVE ingredients that cause the absorption or release of the drug into the bloodstream to differ from the brand name drug.

In addition, I heard a guest on People's Pharmacy who was (I believe) a retired FDA inspector. He stated that he would never buy a generic brand over-the-counter drug because of what he'd seen in his inspections.

I'm an RN and in addition to being very cautious about the use of generics, I try not to use any drug that has been on the market less than 5 years. It can take that long (or longer) to really find out about a drug's side effects over time in the general population.

The writer says, "Generics are required by law to contain the exact same active ingredients in the same quantities." Well, drivers are required by law to stop at red lights and drive the speed limit. Required by law and reality can be two very different things. Your average people and your average businesses will sometimes get away with whatever they can, despite the requirements of law.

How much do you know about the country these drugs were manufactured in? How much do you know about the cleanliness of the plant?

Wake up you're taking a chance with your life every time you pop one of these pills. Is it worth this? You need to take some time and reread all of these comments and consider how important it is to you to save a few pennies taking a generic.

On my records at the doctors office I insist they write in large letter NAME BRAND ONLY, NO GENERICS. and then I carefully check my prescription before I leave the pharmacy.

Sometimes the extra ingredients in Generics do make a difference. For years I took Benedryl for various allergies. When the generic came out and I tried it, I developed severe stomach cramps and diarrhea just like with my lactose intolerance problem. When I read the label I found it contained a milk product. READ LABELS!!!!

I'm absolutely amazed at the number of people who are so personally outraged by this one comment which was obviously issued to extract extreme reactions from readers. From the reactions of the readers it was wildly successful. There is no argument that there are definitely people who take generics and have experienced problems, but there are also many people who take generics without problems and for many of them the decreased cost of generics has been a life saver.

Many of these people could not afford these drugs without generics. Why people feel they need to justify their positions on thoughtless comments like these is puzzling to me. There are more important issues in Medicine to concern yourselves with than foolish comments by people who just say things to see them in print. One example, the FDA's sometimes lax regulation of Drugs especially those coming from foreign countries. Now that is a problem to be concerned about.

I do have one comment I would like to address to AMS' comments about the "inactive ingredients" in prescription drugs. I am sure there is a group of people out of a universe of billions of people taking drugs that will be allergic to any given substance no matter how inert it is to others. Unless extensive testing and past experience shows a substance to be dangerous to a large number of people when taken alone or with another substance, how does one determine which filler or binding agent is the safest to use for a given drug?

There will always be someone allergic to something. The best we can hope for is for the drug companies to produce drugs that are helpful to the majority of the people who take them with minimal risks to the others and for the FDA to do it's job of testing and regulating. The Salk Vaccine saved hundreds of millions of lives worldwide, but there were also reports of a small group of people who received it and developed Polio and died. These deaths do not negate in any way the value of that vaccine in saving most of the world from a deadly killer.

I would like to respond to this about my experience on ; Coumadin vs Warfarin - About ten years ago I started taking warfarin and had my INR blood checked as needed to be in the range of 2 and 3. The heart clinic I go to has this service available to it's patience's. About a year later the readings were going all over the place - first thing that was asked was if diet had change, your diet must stay the same or the warfarin levels will change!

The nurse tried for several weeks to get this under control - well - she called me back and did another reading which was off - so she said she would be right back - she had a talk with other heart doctors - came back and said I would be put on Coumadin. I asked what was going on and this was her reply -- bsides myself she had other patience's that are going through this same thing - they found in the med journal that there had been findings of the warfarin not doing its job.

The warfarin was the correct level but the binders that were being used were NOT! When this drug was sent overseas to be made they never checked on the binders being used - this was backed up later by having each prescription written down with it's code and watching what the patience's levels were. I have been on Coumadin ever since and have not had any problems .

I have had extensive experience over a period of 50 years with both generic and brand name medicines. The problem as I see it: drug manufacturers are required to disclose to the FDA the active ingredients in a compound, while they do not have to disclose any info. on the inactive ingredients in their medicines. This has led in many cases to abuses in their choosing the cheapest material as fillers in their prescriptions--- even harmful ingredients.

We don't know what they have put into their medicines, and for all that we can know they might as well have put powdered Chinese wallpaper paste! I have found from experience that several generics nor only do not perform as well as the brand, are often harsher on your stomach or other organs, and are often not as effective.
Inactive ingredients do matter. Consider carefully when purchasing a generic.

I feel the quality of generic drugs has gone down. They may say it's the exact same ingredients but I question the origin of the ingredient. If China can put plastics in baby formula then what's stopping them from grinding foreign materials into generic drugs?

The companies get these ingredients cheaper and cheaper and "pass" the savings onto us, but we don't know where an ingredient originated from and just how they are regulated. Try eating a homemade Toll House cookie and compare it to a cheap store brand... but then, maybe us morons don't know anything about chocolate chip cookies...

I know for a fact that despite my pharmacist's protest that generic PPI are the same as the brand name; they aren't, I have given generic teva-pantoprazole several tries and have suffered from reflux every time, pantoloc works, my sister suffered hot flashes every time she was put on generic hormones and her hypothyroid was not controlled on generic synthroid, anyone who believes that all drug companies are honest should do research.

With all due respect I called the FDA and generic drugs only have to be 85% as effective and can have different delivery mechanisms! 4 of us went from name brand to genneric Prozac and the dose had to increase. I went from 20 to 60! There is a difference!!!

This writer is totally uninformed. I took Cozaar for years with no adverse effects. The generic contains 4-5 inactive ingredients more than the brand name. I am highly allergic to one or more of those. NO generics are not always the same as the brand name! Also, losartan comes in 2 colors...the green/blue one causes an allergic reaction, the white one does not. The pharmacy cannot guarantee from one month to the next which one they will be stocking. So, my option is to buy the brand name at about $150 a month! Not my choice...the only way to prevent an allergic reaction.

I took Synthroid for many years for thyroid problems. This January I had to change to levothyroxine since I retired. I have had nothing but problems since. My TSH number fluctuates up and down. The last time they were at .36 and anywhere to 12.2. I cannot believe they work the same as Synthroid.

The writer says, "Generics are required by law to contain the exact same active ingredients in the same quantities." That's not really true.
There is variance allowed by the rules. Generics can vary in either direction. Switching among generics (common at pharmacies) can mean even bigger variances.

Generic Allegra caused the blood vessels in my eyes to burst. I looked like Dracula. I also quickly stopped taking it. Obviously the quality of the 'exact same ingredients' is not the same.

Hi, The FDA allows a 20% window (ie 80-100% drug released in 30 minutes and the stirring requirement should be at 50 rpms). Also the pills are tested in a liter of 98.6oF water. The crystal drug habit and drug particle size distribution cannot be matched exactly company to company. The drug is exactly the same and I mean exactly company to company.

The impurities may not be the same but are less than FDA limits. My take on all this is to drink the same adequate amount of water each time and raise the temperature of the water till you get a reproducible response at preventing a seizure or whatever your trying to do. They do have to work. pg1246 o&o

The FDA recently posted that it is considering tighter requirements and controls on generic drugs. In particular, "critical dose drugs" or Narrow Therapeutic Index (NTI) drugs. This is because current bioequivalence requirements aren't sufficient for NTIs. The current list under consideration includes warfarin, levothyroxine (Synthroid), carbamazepine, lithium carbonate, digoxin, phentoin, and theophylline.

Gynecologists have also told me no generic birth control.

Google "FDA Mulls" and there are articles on this.

What is quite inaccurate about this thread is that so many drugs are made in so many places without the sort of regulatory oversight needed. Pharmacist daughter tells me that weekly they get lists of recall, and it is not confined to generics. All drugs are vulnerable to being poorly made.

My daughter went from a brand drug to the generic and it was not the same. We immediately switched back to the name brand. How do you know find out where the generic is manufactured? I called my pharmacist about two other generics we use and all she could do was to read me the label and it didn't specifically say where it was manufactured. I go to an independent pharmacy but it is very large so there's not a personal touch. I need to call around and find a pharmacist who has time to put in the extra effort to find out where the drugs come from. Or I'm going to order the name brand from Canada.

I took Fosamax for many years with no side effects. When the generic came on the market I took it and experienced such severe chest pains that I thought I was having a heart attack. It was the generic that caused the pain. The writer who referred to people as "morons" for not trusting generics was operating on limited information and was showing ignorance.

You are correct: they are required by law: but if you have worked in a Pharmacy lab, there are a couple of test that are done on tablets, one is how it dissolves. Ten tablets are placed in wire basket and dipped into a slightly acid solution, like your stomach. It is dipped every 15 seconds. Some pills dissolve in 20 minutes, some in 2 days. It depends on the binder placed in the tablet to hold it together. Also there are few test for one tablet, it is usually 10 tablet that are crushed in mortar and pestle and ground to a fine powder, then assayed. You get the results of 10 tablets.

There are so many things that can go wrong, from mixing, to hardness of the compression in making the tablets. BF

I would like to thank the Graedons for providing this area for feedback. And to thank them for letting all us "morons" chastise the original moron who stated: "Generics are required by law to contain the EXACT same active ingredients in the same quantities."

Obviously, as some have pointed out, this is not the case.

I'm also an RN with a bachelor's degree, so I'm not just your average "moron". I remember the pharmacy course (perhaps the original writer would like to inform us which course he took) teaching us that generics only had to conform to a 'window'. This could be 20% off in either direction. Therefore, some meds would be 20% stronger in some cases or 20% less effective in other cases.

This is crucial many heart meds. What if someone was used to 100 mg of solatol (for heart irregularities) but the next time was given 80 mg of solatol, then next time given 120 mg? Betcha they're in the ER...

HI: your inactive ingredients are called tablet binders, that hold the tablet together, they are usually starches and they make up most of the pill, the active ingredients are very small when you are talking about less then 100 mg. A plain aspirin is325 mg and the tablet is mostly aspirin a very little binder. When you are talking about 10 mg you are talking about a amount that is just able to see on table. BF

I had a generic version of Darvocet when I had bunion surgery. Why not? It was a lot cheaper than the name brand.

The second day I took it, I sat in my family room with a cat on my lap, a cat sitting on the back of the recliner nuzzling the back of my head, and a third cat running across the floor. Nice image, eh? Not really. I only had 2 cats.

That night I thought there was someone in my bedroom. I also heard huge wings rustling on the other side of the bed. I was terrified.

The next day I contacted the surgeon, who had performed several surgeries the same day he did mine; we all were prescribed Darvocet, and all of us reported having hallucinations apparently due to the generic drug.

The inactive ingredient only means it was not the pain killer itself, but a binder to bulk up the drug. Be careful out there!

I worked about four years in retail pharmacy. Didn't think much about it at the time, or about a possible reason, but people who took Synthroid typically had little change in the drug strength, even over a period of years. Not so with generic forms. For many patients M.D.s had to change the strength frequently, up-down, down-up.

When I left pharmacy work, the inferiority of generics really became crystal clear. I handled the medical appointments and medication tracking for residents of a group home for developmentally delayed adults. So you see, these people wouldn't realize changes, so it wouldn't be a case of anyone fussing just because they thought they were too good to take generics.

Everything was based on my and staff observations, and results of blood work. One man who'd maintained well for years on his brand name antihypertensive had to have the strength and frequency increased with the generic. One man who took Zonegran for mood stabilization had the same results with generic Zonisamide, and it really never seemed to keep his mood as stable, even though the dose increased dramatically on generic. One man demonstrated self-injurious behavior (SIB) which was well-controlled with Zoloft 50 mg QD. When it went to Sertraline, he just about knocked himself into the next county, so Dr. upped it to 100 mg, and then to 150 mg QD. That seemed to keep SIB from surfacing, but just barely. I had two guys on Synthroid, and with that drug there were never any strength changes. On the generic it was always up-down, down-up.

It really doesn't help that for many years pharmacists have told their patients that generics ARE the same. That does a huge disservice to the patient. But it does put more money into the pharmacy's pocket, since they pay more for brand name drugs, there's much more profit in generics. As a rule, the pharmacy buyer, when selecting available medications to order from the wholesaler, will choose the absolute cheapest generic they can find. Of course insurance companies won't pay for brand if a generic is available, which (I think) puts the insurance company in the position of practicing medicine without a license. Another reason that brand name meds cost so much is the drug companies pay drug reps big bucks to woo doctors to prescribe their drugs.

Can't tell you how many times I've been waiting to see a doctor and here comes a drug rep with some kind of high-dollar lunch for the entire office! Years ago I heard about a shindig one of the drug companies had at a very high-dollar steakhouse in my city. Based on the menu prices and the number of doctors and pharmacists they hosted, that bill must have been ridiculous. I never could figure out why pharmacists were included, since in this state, pharmacists do not prescribe.

Who do you think pays for all of this luxury? That would be you and me. Maybe if the drug companies knocked off that kind of nonsense, they could charge much less for brand name meds.

Not all generics are bad (I take 4 with no problem), and I suspect that even the bad ones give relief to some people. Everyone has to be on guard of their own health and aware if your generic is switched to another. If the "new"generic does not work then sound off to your doctor and to the pharmacy. Persistence in demanding a drug that works as well as the previous one or insist you be switched back to the previous generic.

I was prescribed Ambien when it first came on the market. I have chronic insomnia. It worked well for me for 15 years (I used to take tiny pieces at first) and worked up to 10 mg. When the generics came out, I was awake all night plus I tried every generic out there without any luck. So instead of paying 6.00 I have to pay well over 200.00 a month, one pharmacy charged me 226.00.

Insurance will not pay for name brands.

Does anyone have any advice for me. I sleep fine on name brand so it's not a tolerance issue.

Have 5 heart stents....have been taking "Plavix" for the last 5 years, since the first stenting.....

Now worried that Plavix is being dispensed in the generic form. APO-Clopidogrel 75 mg once daily... is this generic med as good as the Plavix pill? Please help, don't know where to turn.

Thank you.

I know it will be pointless to try to argue with you considering you think we are morons how ever I simply cannot resist due to the importance of the subject matter.

"Generics are required by law to contain the exact same active ingredients in the same quantities."

Since when did having a law guarantee anything?

"What does it matter if the inactive ingredients differ? They're inactive."
Inactive by what definition? Yours, Mine, Medical community,? What if a patient is allergic to the inactive ingredient? Is it still inactive for them?

"I am really disappointed that the People's Pharmacy offers a forum to uninformed morons"

The only morons I know are the ones who actually believe that laws guarantee people always do the right thing and that the government and the pharmaceutical companies really are looking out for our best interests!

Who is the moron now!

PS one more than one occasion I almost died from taking a generic drug!

If it is considered there is no difference between Brand and Generic drugs other than cost , why are people charged the same for NHS prescriptions.?

Inactive ingredients can have drastic consequences on your health. I take Pravachol and when a generic appeared I was automatically changed to it. I have liver problems from my Lupus and the "inactive" ingredients caused severe problems with my liver enzymes. The readings were off the chart and I was constantly ill from them. I had blamed it on a recent trip out of the country, but my rheumatologist recognized the symptoms immediately and figured out that the "inactive" ingredients were the problem. I was lucky that my insurance company allowed me a generic exception for the branded drug. I pay the highest copay but it is worth it to feel well. So even though they are inactive, they can be bad for some people!

So glad to read these comments. After receiving generics for two medications after our new health insurance plan switched me, I spoke to the pharmacist and he told me that "generics are the same as brand. If you are having some reaction, then its psychosomatic."

No joke, he said that.
I then emailed him the Forbes article on generic 300mg Wellbutrin and another article/comment from the People's Pharmacy.

For those of you saying "insurance won't pay for brand", you are mistaken. They will, but your doctor has to write the prescription as a "DAW 1" or "Brand Only". You may have to also get a Prior Authorization, but if you (and your doctor) are willing, they WILL pay for it 99% of the time.

I work in a pharmacy and have NEVER seen a PA denied for a brand vs. generic drug when the doctor writes for brand only (and it rarely even needs a PA). Yes, you pay more, but it's worth it. I currently take brand versions of some meds that are available in generic and gladly pay the additional $$.

Btw, after I started working at my pharmacy, my pharmacists stopped saying "brands and generics are exactly the same" and started saying "they SHOULD be..." Personally, I say "they have the same active ingredients", which is true, they just may not have the same amounts.

I have also have blood levels drawn for my meds to compare the brand vs generic meds and my body basically shows 0% of the generic after 4 hours....it is an XL medication and the brand is still detectable after 18!

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