If you've paid for a prescription drug lately you probably winced. Prices are high and show no signs of coming down.

That's why those who pay the bills favor generic drugs: insurance companies, HMOs or senior citizens on Medicare. Sometimes the savings are dramatic. A woman who's had breast cancer is often prescribed tamoxifen to prevent a recurrence. At $52, the generic drug costs less than half as much as the brand name Nolvadex ($107). Over the course of five years, such savings equal thousands of dollars.

The FDA insists generic drugs are just like their brand-name counterparts. Manufacturers submit data proving that generic drugs are identical before they receive approval.

But some readers have found that a generic drug doesn't always have the same effect as the branded original. One woman wrote, "My husband has been taking Prilosec for several years. Recently our local pharmacy substituted the generic form, omeprazole. He experienced itching on the palms of his hand and developed large raised red patches on his upper arms, thighs, groin and trunk within a day of taking the generic drug. The reaction went away after he stopped the omeprazole and resumed the Prilosec."

A reaction like this makes us suspect that some ingredient, probably considered inactive, included in the generic pill is not in the brand name product.

Other people report that a generic medicine does not work as well. According to one reader, "My wife has been taking Prozac for several years. When the generic became available she tried it for a month or so but had to return to Prozac brand because the generic didn't do the job. Several months later, she tried the generic again with the same result. Her psychiatrist told her he had other patients with the same complaint."

Another reader found that a generic substitute did not work as well as her brand-name anticonvulsant: "I have been on Dilantin for 50 years. A couple of years ago, the mail order pharmacy sent me a generic called phenytoin instead. I went ahead and took it and began having seizure activity I'd not experienced in years. My doctor wrote me a prescription for Dilantin, no generic substitution. I got better right away."

When an anticonvulsant does not work, the consequences are serious. Sometimes that is also true with an antibiotic: "A month ago I had a very painful bladder infection and took SMZ/TMP, the generic for Bactrim. I have had many bladder infections over the years. Bactrim ALWAYS eased the pain within 1 to 3 doses, though I took the entire regimen. This time the generic Bactrim didn't help at all. The third day my doctor put me on Cipro, which eased my discomfort within 2 doses."

Why might generic drugs not perform as expected? Although they're scrutinized carefully before approval, monitoring them afterwards can be difficult. The FDA is supposed to inspect all manufacturing facilities every two years. But too many plants and too few inspectors mean this goal is not always met.

If you would like to report a problem with a generic drug, email us: pharmacy(at)mindspring.com or write People's Pharmacy (Dept. Generic); PO Box 52027; Durham, NC 27717-2027. We will pass your report to the FDA.

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