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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  1. CPhT
    Reply

    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!

  2. MG
    Reply

    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.

  3. Nancy
    Reply

    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!

  4. June
    Reply

    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.?

  5. bittid
    Reply

    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!

  6. anonymous
    Reply

    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.

  7. Vicki G.
    Reply

    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.

  8. DWD
    Reply

    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.

  9. LD
    Reply

    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.

  10. JMK
    Reply

    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!

  11. Bob F
    Reply

    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

  12. Patty V. A.
    Reply

    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…

  13. Bob F
    Reply

    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

  14. LH
    Reply

    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.

  15. NP
    Reply

    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.

  16. RobLL
    Reply

    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.

  17. jpm
    Reply

    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.

  18. Paul C. G.
    Reply

    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

  19. MHO
    Reply

    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.

  20. SarahW
    Reply

    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.

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