The People's Perspective on Medicine

Why Pharmacists Are Wrong About Generic Drugs

Many pharmacists continue to insist that generic drugs are absolutely identical to brand name medicines. Do they really know how the FDA approves generics?

Most (but not all) pharmacists routinely tell patients that generic drugs are identical to brand name medications. That is hardly surprising. This is what pharmacy students are told during their education process. It is also what the FDA states on its website:

“A generic drug is identical–or bioequivalent–to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price.”

What Does “Identical” Really Mean?

Now we don’t know about you, but when we see the word identical we assume that means exactly the same as. Here is how Dictionary.com defines the word identical:

1. Similar or alike in every way
2. being the very same
3. agreeing exactly

Related Words for: identical
Indistinguishable, one and the same, selfsame

Medical Dictionary
1. Exactly equal and alike
2. Of or relating to a twin or twins developed from the same fertilized ovum and having the same genetic makeup and closely similar appearance; monozygotic.

In our opinion, the FDA’s use of the word identical, when describing generic drugs, is misleading. First, the inactive ingredients (colors, binders, fillers, etc) do not have to be “alike in every way” to the brand name product. In fact, they are often quite different. These so-called inactive ingredients or “excipients” may influence how the product affects patients. For example, a patient who is allergic to a particular color may develop a rash when switched to a generic product.

Different Formulations Between Brand and Generic Drugs:

The formulation may also differ dramatically from the brand name. Many pharmacists may be unaware that the physical characteristics or release properties of a brand name drug often stay under patent even after the active ingredient becomes available generically. This is especially problematic for slow-release or long-acting medications. Generic manufacturers may have to come up with different technologies to deliver the active ingredients. This means that the products are not always “indistinguishable or one and the same.”

To see this for yourself, visit the FDA’s website and report on the antidepressant bupropion XL.

If you look at the graph the FDA provides for Budeprion XL 150 you will discover that the mean plasma concentration of the two drugs is certainly NOT identical! The generic formulation (which uses a matrix technology to release the active ingredients) produced peak blood levels in 1.5 to 2.5 hours, whereas the brand name product (using a membrane technology) produced peak blood levels around 5 hours. This kind of information for other generic formulations is not always easy to access.

What Does “Bioequivalent” Mean to the FDA?

Pharmacists have been taught that generic drugs must be bioequivalent to brand name medicines. The FDA defines that as “an equal rate and extent of drug absorbed [from] the bloodstream.” We’re back to the meaning of the word “equal” or “identical.” The FDA’s understanding of these words is quite different from most other people.

Many pharmacists do not know how the FDA actually goes about approving generic drugs. For one thing, the FDA never releases the bioequivalence curves to health professionals or the public. We have already pointed out above that the rate of absorption for a drug like Budeprion XL 150 can be quite different from the brand name Wellbutrin XL 150.

The FDA relies primarily on two measurements to determine rate and extent of drug absorption. One is the maximum concentration of drug in the bloodstream (Cmax). This occurs at one point in time over 24 to 48 hours. The other is called the area under the curve (AUC) and it represents the total amount of drug absorbed over the length of the trial (usually a day or two). If these two numbers (Cmax and AUC) are “close enough,” the FDA says the drugs are bioequivalent and the generic gets a green light.

The Problem with the FDA’s Generic Drug Approval System:

Here’s the big mistake with this approach. It does not actually compare hour-by-hour rate of absorption. Let us share an analogy. Imagine two seemingly identical 2016 Honda Civics. The difference, not detectable to the naked eye, is the engine size. One has a 158 horsepower engine (Car A). The other has a special 385 horsepower engine (Car B). The cars must travel from Washington DC to New York City. They will be judged by two metrics to determine if they are “identical” cars. The first will be the time it takes them to reach NYC. The second will be how far they traveled in actual miles (a substitute for AUC).

Both cars leave DC at 2 am and both arrive in NYC at 6 am (four hours total driving time). Their average speed is the same, ie, 63 mph. They traveled the same number of miles. But there is a tremendous difference in how they got there. Car A with the small engine drove straight to NYC, never exceeding the speed limit. Car B with the 385 HP engine went at 120 miles per hour for two hours (it had a fancy radar detector to avoid speed traps). Then car B stopped for a leisurely breakfast for 45 minutes and resumed the trip at a more modest 95 mph. Again, both cars covered the same distance and achieved the same average speed over the four-hour trip (63 mph).

Clearly the two cars traveled the distance very differently. The cars were not identical! But without seeing the data from speedometer you would never know that one traveled the speed limit and the other hit 120 mph for long periods of time. The same thing is true for generic medications. By not allowing health professionals or patients to see the actual bioeqivalence curves we cannot see the true rate of absorption on an hour-by-hour basis. This may be especially problematic for long-acting, timed-release formulations. Tis time for the FDA to allow the American public to see the data for themselves. “Trust by verify!”

Manufacturing Quality of Imported Generic Drugs Remains Worrisome:

Here is something else a pharmacist might not realize. According to the FDA, 80 percent of the active and inactive ingredients in our pharmaceuticals come from abroad. It is estimated that 40 percent of the finished pills come from abroad including countries such as India, China, Brazil and Mexico. It is also very clear that the FDA does not have the resources to inspect all or even many of the manufacturing plants producing either the raw materials or finished products millions of Americans take every day. That means that there is no verification system that the pills are exactly what they say they are.

We have seen manufacturing problems with some of the most prestigious drug companies in the U.S. (Johnson & Johnson and GSK). These problems occurred at plants where the FDA visits on a regular basis. Do we really believe that chemical companies in China that are not inspected are producing perfectly identical generic drugs at cutthroat prices?

Perhaps it is time for pharmacists to acknowledge that there are no guarantees when it comes to generic drugs. Pharmacists must be the patients’ allies and advocates. When patients experience problems with certain generic formulations, pharmacists should offer a sympathetic ear and report the problems directly to the FDA’s website (MedWatch). Perhaps if pharmacists insisted that the FDA do a better job both approving and monitoring generic drugs, patients would have more confidence in these money-saving pills. Pharmacists should also insist that the FDA make all generic bioequivalence curves available for public scrutiny. Without that data they have no way of verifying that the products they are selling are indeed “identical.”

Learn much more about generic drug problems and mistakes that health professionals make in our book, Top Screwups. You will be amazed out how serious the problems really are. But there are many things that patients and their families can do to prevent health care harm.

Revised: June 8, 2016

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I’m curious if these authors have any financing or interests in any pharmaceutical company because this article is DRIPPING with “brand name bias”. Testimonials are the LEAST accurate form of data analysis and blind studies have repeatedly shown this article to be deceiving at best, manipulative at worst.

No financial interest of any sort in any pharmaceutical company.

No financial interest in any form of pharmaceutical company, brand or generic.

Aw, this was an exceptionally nice post. Taking the time and actual effort to create a great article… but what can I say… I put things off a whole lot and don’t seem to get anything done.

Hello.This article was really motivating, particularly since I was searching for thoughts on this issue last Tuesday.

Thank you for all information on generic drugs..this analysis of the differences of one generic vs. Another, makes me know I am not crazy. I had taken Atenelol made by Mylan for 7 yrs. With no problems. Recently my prescription of Atenelol caused severe stomach cramps, nausea continually, severe bloating and belching. This Atenelol was manufactured by Teva. Now thank you, I know how to be proactive with the Pharmacists who say Generics are just the same..no they are Not!!

I was on brand medication for years and now my insurance won’t cover it and I am so sick oh hearing pharmacist saying the generic is exactly the same! I went to the generic and stayed on it for 6 months. I gained 30lbs and feel like I am not on anything and I have other side effects and am going off the generic. I have reported this to the FDA but I know it will be dismissed. These generics are NOT the same and it’s all about MONEY. Until someone of importance stands up and gets the FDA to tell the truth and help patients it will never change! All these drugs come from foreign countries and who knows what is really in them. Very disappointed in the way healthcare has caused this to happen

Try being an epileptic and being dependent on name-brand Depakote. The first kind of generic I took made my legs shake something freaky; the second time it was given to me I ended up in the hospital for a week following a bad seizure.

You would be nuts to not take it if it’s possible. Depakote is exhorbitant. I’ve been in debt paying for it all my life. But it’s more expensive to go back in the hospital because I don’t want to pay for the name-brand.

Almost nobody in my town carries the drug. The drug store that should had been told to order name brand didn’t bother; just filled the generic. Like it wouldn’t matter. The doctor called a second time without success; this went on until I ran out today. I have spent two days finding a store that carried name-brand Depakote. Why, oh why, can’t any major drug store at least keep 6 or 10 name brand pills around? I know I am not alone with this problem. Depakote isn’t like aspirin. You’ve got to have the real thing.

Recently my blood pressure medication was changed from Benecar to a generics. Two generics were given one month apart. The first generic I did notice slight differences, next month I got a generic from Walmart, Wow, I developed a number of reactions. These varied from continuous vertigo to extreme fatigue and rapid weight gain just to name a few. I was also having trouble breathing. I am 74 years old and still very active and athletic bike riding, hiking and being outdoors. This drug changed my life and degraded the quality of my life.

Whenever I take a generic drug, within a day or two, I break out in terrible hives and swelling. This has happened even when I mistakenly took a generic believing it to be brand, so it is not something in my mind as many have indicated. My problem is that no pharmacy in Florida carries brand name antibiotics and they have indicated that they cannot even order them. I am left unable to take any antibiotics. I recently had a dental issue and the dentist assured me that penicillin was a “brand” name. I took the pills for two days and I developed hives and terrible swelling. When my dentist saw this, she told me to immediately stop taking it. I have paid huge co-pays to get brand names and have had to fight with every doctor and every pharmacy to get them to believe that I cannot tolerate the fillers used in generics. It is bad enough that on top of huge health insurance premiums that I have had to incur thousands of dollars to get brand name, but now I cannot even get brand names at all.

A delay of the time to peak does not necessarily reflect an alteration in efficacy in a maintenance medication. The peak plasma concentration is important primarily for the dose-dependent side-effects. Hence, the reason we look at the Cmax and not so much the Tmax. We are primarily interested in equilibrium plasma levels remaining within the therapeutic range.

Given that Wellbutrin XL is a 24 hour formulation, the Tmax is much less important than with an IR product (where the drug is immediately available for absorption via Fickian diffision after quick dissolution). In fact, this is one of the main benefits of extended release formulations (reduced dose-dependent side-effects) along with reduced dosing frequency which improves adherence. 1.5 vs 5 hours seems huge but it is not clinically significant in this case. Again, this is because efficacy is not reflected in the Tmax with this medication. Efficacy is reflected in the equilibrium plasma curve remaining within the therapeutic range.

I will concede that Tmax is more important in acute medications taken as needed and in medications with a very narrow therapeutic index. If a patient suffers from severe anxiety and/or panic attacks, they will often be given alprazolam (Xanax) because of its rapid absorption. In this case, the Tmax may be far more important because time is of the essence in treating such issues.

Additionally, there is reason to be concerned with medications that have a narrow therapeutic index such as warfarin, levothyroxine and phenytoin. Slight alterations in warfarin absorption can alter the INR very quickly and phenytoin has kinetics in which the peak concentration can run out of control very quickly. Thus, in cases of narrow therapeutic index, it is common practice not to switch between manufacturers unless absolutely necessary or if requested by the patient with their full knowledge of the potential issues. Where I live, a pharmacist may freely switch between manufacturers of these drugs but I personally do not switch manufacturers.

Additionally, your car analogy doesn’t really work. A matrix or membrane formulation will not simply speed up and slow down in the way a car can. Instead, in an aqueous environment of relatively stable pH (as the body is), it will be released at a fairly predictable rate and will be absorbed in the small intestines at an even more predictable rate (within a single individual).

I agree generics are not the same as brand. I’m a very healthy person. I had to take an antibiotic after dental surgery and I was given the generic form unknowingly. I had a horrible painful reaction to my kidneys. I was then given the brand, and I was fine without discomfort. A few years later I needed to take the same antibiotic again. I was given the generic. I told the pharmacist I could not take it because the last time it hurt my kidneys. The pharmacist argued how generic and brand are the same, and my insurance won’t pay for brand. I tried the generic again and immediately my kidneys were hurting. My doctor had to fax an explanation to the insurance company as to why I could not have that form of generic, and I had to have the brand. If I had to use that antibiotic, it was a fight every time, or out of my pocket a couple hundred dollars. I have top insurance and I still go though loops, they still want to pay only for generic, not brand.

Until the “identical” Generic drugs are all made in the good old USA, I will not take any of them. Reading about all the side effects of all medicine, I will do without the Brand names as long as possible. I was brought up on home cooked food, vegetables and fruit and very little processed foods. Consequently, I still eat that way and at 75 years old and am doing very well.

Shouldn’t these types of articles be put on all national news networks and papers, so everybody can see how the FDA is either uninformed or just does not care?

80% of BCBS policies as of 2016 (at least in Texas) have inserted “member pays the difference” feature in their pharma benefits. If there is a generic and you want/need the brand, insurance pays close to zero. A 50mg Topamax tab will run you about 10 bucks or about $300/month.

As, has been mentioned on this site previously, some meds do have an authorized generic which usually has the exact same active and inactive ingredients as the brand due to partnership with the brand manufacturer. FDA just updated that list. If you see your med on there, tell your pharmacy to fill it with that maker. They may have to order or say they don’t have access due to their wholesaler. Just call another pharmacy or three. Do it all the time.

As to the India etal., manufacturing issues. You can look up where your drug is being made and tell your pharmacy no India or Ranbaxy etc. You need the “other one” made in the USA. There’s usually like four or five choices depending on med.

Also, sometimes you can find the brand in Canada, but there again check where it’s being made.

Many generics work, but some don’t. Synthroid is one that doesn’t work for me. Some others as well don’t work as well. I certainly don’t want drugs manufactured in other countries.

My husband is taking multiple drugs prescribed by his internist and also his cardiologist and his urologist. Prescriptions are filled by a company that provides a 90-day supply as required by our medical insurance provider.
My concern, which I have voiced to the provider, is that on several occasions, another generic is sent in place of the previous GENERIC received. This can be very confusing to the patient, usually elderly, and perhaps a lesser quality drug is provided. I, too, am concerned about the labs where these drugs are manufactured and prefer those made in the USA. When allowed, we pay the difference to get them but it is not always approved.

A number of folks have commented on adverse reactions due to generic drug switching. Here are some things that you can do as a patient that will help your pharmacist to help you:

1. Have the prescriber write the script as DAW (dispense as written) for the specific generic brand that works best for the patient. WHY? Many (if not all) state pharmacy boards prohibit pharmacy changes to DAW scripts, and are required to fill them as written.

2. If you have a reaction to a specific generic brand, make sure that the pharmacist documents that generic brand and drug as “Contraindicated” in your profile.

3. Do the same at the prescribers’ office.

I think you are being a bit conservative on English definitions. Go back to a college of pharmacy & relearn something. Only narrow therapeutic index drugs can objectively have a difference in therapeutic outcome when it comes to generic vs. Brand.

Besides, there isn’t enough room in most pharmacies to shelf BRANDS, many of which of no longer manufactured, again, because there is no incentive when competing with generics. Yes, excipients can be different but is not significant enough to affect plasma drug concentration. Enough with the BS conspiracy & overpaying for BRAND meds

After Reading much online, and talking with two older pharmacists, one retired after years in the business, and my own experiences, generics are not the same. Bulk orders from large chains usually shop the best price and there is no AA ratings in the FDA orange book on one in particular I looked up, showing there have been reported problems, although rectified at some popint. Without more FDA guidelines, percentage variances 20% high /low on main ingrediants, and with questions on fillers used having an effect, no, generics are not all equal.

This is unacceptable and I’m so tired of my generics making me feel more or less than I should. Zolpidem pisses me off the most! Teva brand may as well be a candy necklace. And it’s sold at so many pharmacies!! The only way I can get a desired effect is to take seroquel along with Torrent brand zolpedim. Teva is what Walmart sells and it’s annoying to find a place that offers something different ( and better). How do we pressure the FDA on this. I’m on a lot of Meds into the thousands out of pocket per month and I wanna know what the FDA and DEA are doing to ensure the American people are getting drugs with no more than an infraction of 10% off from the name brands. If they still say they strictly abide by the 10% or less fudge, factor they’re playing us as fools. I’ve had it!!

2 things need to happen. First, our FDA and DEA need to be doing their part to keep Americans safe from foreign drugs as well as tolerating no more than 9.9% difference from the Name Brand.

Secondly I’m asking the pharmacies to try different generics, do some research about how the a generic may perform vs another generic. Pharmacists and techs ask customers the good and the bad. Your pharmacy may narrow a drug down to one single generic or two different possibilities to find one works for 70% and the works other30%.

We all understand that the pharmacutical industry is seeing ungodly growth and good for them. As patients is it too much to ask that you help pharmacies pick the best generics and coupon cards straight from the manufacturer leaving the patient with a reasonable co pay of name brand drugs is always good too. The bottom line is we often buy brand name when able but mostly generic is all we can afford to not kill the families budget.

Manufacturers MAKE YOUR DRUGS TEST NO MORE THAN 10% As FDA allows.

Pharmacies. Do some research please. I’ve gotten bunk meds, I can’t even count. The pharmacies have a lot more muscle than you may think in this deal. Start small, none that tested out of regs. Deny to buy the pharms until they can show an independent studie showing the drug meeting regulationas. Turning from one manufacturer to another because the one couldn’t provide recent tests showing independent results. Your good relationships with the pharmacutical company will never be in jeopardy unless they knew their product was bunk. From the bottom up you, the pharmacutical stores and pharmacutical sales representatives. The public doesn’t want junk and more and more we can’t just call “our” pharmacy To get a script. A lot of comparing and leg work goes into getting the drugs to the families that are on a strict budget. To you, the pharmacies, you must no longer accept these so, so drugs and provide well priced, well made drugs. Start holding these Sun pharms, Merck, teva, Mylan or torrent accountable. They will sell what ever you buy. And unfortunately the standard in generic medicines has fallen as I’ve watched.

maybe if our politicians took generic drugs they would have a different attitude

Absolutely! That is the bottom line when it comes to generics!

I am confused about heart & blood pressure medication that I have to take. Lisinopril causes me to cough, which is terrible and keeps me awake at night.
Now I am taking Losartan which also makes me cough terribly. Is there no other blood pressure medication that does not cause a dry cough? My doctor told me I have to take the Losartan. I am certain they are all generic drugs, is there something in these drugs that cause this awful cough?

I have severe reactions to generic drugs. It varies per prescription for me:
1) Seroquel vs. Quetiapine: The brand name puts me to sleep; the generic brand does not put me to sleep.
2) Neurontin vs. Gabapentin: The brand name eases neuropathic pain; Gabapentin eases pain but puts me in ER room.
3) Benicar vs. Losartan: Benicar eases hypertension;the generic creates headaches which cause more tension.

When I am put on a particular medication– brand or generic– and I STAY on that medication, I’m fine. I decided to start asking for brand name meds only because I am fortunate to have good insurance that makes it affordable for me to obtain brand name medications. I did not want to deal with the switching of generics, as this had happened before and in each case, the side effects/withdrawal, etc. were too much for me to handle.

Much to my dismay, one of the brand name drugs I was on stopped being manufactured for 6 months. I was given the Teva generic. I had been on Teva before and it was okay. However, I knew it was weaker than the brand and asked my dose to be upped to account for the differences in potency that my body experienced. My psychiatrist treated me with very little compassion. Citing statistics that 99% of people have no problem with generics. I eventually adapted to Teva, but it threw my body out of whack for a few months. When they started making the brand name 6 months later, my body had a reaction. I said, “let me just stick with Teva.”

Just a month ago, I was given a new generic after taking the same one for 6 years. After a day, I began getting headaches and feeling dizzy. Battling flu-like symptoms and digestive issues. The pharmacist was so cavalier. Generics are 95% similar, he told me. He said that generic I was on was back-ordered for 6 months. I asked, “Why?” He said, “I don’t know, sometimes somebody doesn’t come into work for 3 days in a row and it throws the whole production schedule off”. I’m pretty sure he was mocking me.

I can’t speak for those who are on drugs for blood pressure, cholesterol, diabetes, and so on and so forth…..but I know that for me, having mental health issues, the generic/brand issue and all of the switching back and forth really messes my body up. I know I have sensitivity issues. I realize I may be part of that 10% or that 1% that reacts to different filler ingredients. Nonetheless, this in itself is not a reason to ignore the differences in how these medications are manufactured. Somebody should be able to take either formulation and know with confidence that they will get the same result.

Corinne in LA, I think it is much higher then 1 to 10%. I hear everyday of someone who is very unhappy with generic. I have a sensitive system too, and if we were used as drug testers that would not be a bad or negative thing. We could predict what a vast amount of people would have to deal with . It is however a bad thing for us personally because we keep being told what we feel is impossible. We keep getting labeled and treated as neurotic, crazy (yes I have been told that is crazy), stupid, and the worst of all; laughed at by the doctor and the pharmacist. One time, I had a pharmacist sit down next to me and apologize for what I was going through. He said he did not understand why the brand I had been on for a while and could purchase for just 10 dollars was not being prescribed. When I was just at the doctors office he shook his head yes and said OK I will write brand, but he ordered what he wanted the generic so I called and told the office he has made a mistake and they said it was fixed and after 3 visits to the pharmacy, an hour round trip it was not fixed . finally the pharmacist told me the doctor called and he won’t switch to brand with out you paying for and scheduling another visit. I was shocked , why did the office tell me it was fixed. He told me the doctor said now that it would be changing meds and I would have to see him to change it. I never got any meds I yelled . I have constant night mares because some generic make me vomit and sick only to be told I must have had the flu.. The insurance will do everything they can to make you give up . But for me I would rather drop dead then take something that does nothing or worse makes me sicker. . What is the point. I know so many, and over the years I see the numbers growing of people and doctors who are unable to take generic. More people need to stand up and there needs to be a place where people can file complaints that are counted. I am getting to a place where now my insurance will be too high a price and I will be with out meds. I am 61 and don’t expect to be getting a lot better anytime soon. I am dreading having to suffer with depression and pain and insomnia . But generics make me sick, really sick so I will not have a choice. When faced with projectile vomiting I guess I will just go with the suffering. I hope it changes for the better soon and you know there is may be nothing wrong with you and you may not even have a super sensitive system. It just might be the generics.

I believe you may be talking about Klonopin.

I had been on it for a Decade until they/Roche stopped making it and farmed it out to Genentech years ago. Production was interrupted at that time too. but it resumed the same.
In the short interim (search drug name an ‘shortage’) I was forced on a generic that wasn’t remotely the same.
Totally ineffective but short lived.
So ineffective I had to use Valium instead.

But the more recent stoppage lasted from March to November of 2014 and then Genentech/Roche resumed production of an obviously Very different; virtually No effect whatsoever.
I understand now made in Mexico.
The generics are rated on many sites, Mylan the worst on all.
Search ‘Mylan Klonopin’ problems.
Many had withdrawal symptoms from these generics, and at least one claimed seizures for that reason.
I ended up on Teva as at least it had some effect, if Not remotely the same overall relaxation of the original Roche.
The New “Brand Name” Genentech/’K-Cut’/Roche Klonopin is just another Generic now with even Less effect than some of the others.
You simply can’t move production and ingredients around the planet for cost sake and not expect vastly different results.

It’s not until you take a drug that you Feel that you ‘get it’.
You don’t know if/that Cipro you’re taking is crap, but it very well may be.

How do you think that Mexican Dom Perignon would be, made with the ‘same’ grapes’, ‘same oak barrels’, aged in in the ‘same conditions and time’?
LOFL.
Chemical bonds are tricky, and as the author says oft made with unknown ingredients by people who no doubt alosomake Fake drugs in their spare factory time in China, India, and Mexico. (as 80% of bogus generic is)

I had to pay for two of my prescriptions because the generics do not work for me. They are very expensive. It’s so sad that most people believe that generics are “identical” and if the generic isn’t working, they probably think they are getting sicker or something else is wrong with them. Generics should be mandated that they really do have to be identical but the FDA doesn’t care!!

what company in the US makes generics.

KVK Tech in PA makes oxcodone 10 & 30 mg that aint worth a crap. I had been taking a pink pill with NP12 on it for months and Saturday I went to get my refill and it said k56 on the pink pill but only after the prescribed time for my 4th or 5th one was when I noticed that it wasn’t controlling my pain as usual. So I started doing research on my oxycodone and found out out that there have been several complaints for the same thing as me. So I also did a report, sent KVK Tech an email and talked to my Pharmacist. But you know the worse part is that even though my script is only 2 days old, they wont exchange it, I’m stuck the whole month with pain because the med aint worth a crap. I think the fda should have an exception on circumstances and do a swap to the better pills. The NP12 pink 10mg Oxycodone by zydex pharmaceuticals has always been the best to control my pain.

I was in a car accident(Sept 2014) that caused a brain bleed, that resulted in a hemorrhagic stroke, I had to relearn how to walk and talk again.

As, a result of brain damage from my stroke I have seizures. It is very important that I take medicine that works. I’ve gone through several generics and NONE worked for me. I took generic Keppra, I broke out in a rash, then my neurologist played around with the dosage of oxcarbazepine generic (Trileptal)

While on oxcarbazepine I broke out in sores on my forehead that wont heal, I could not increase the dosage pass 150mg otherwise I could not pee, it literally stopped my urine flow. I had two break through seizures a month a part while I was taking generic oxcarbazepine.

Now my neurologist write on the prescription (DAW) dispense as written, it now cost me $188 for brand Trileptal and $261 for brand TopAMAX that is the price for the American way if you want to stay alive.

This article is unbelievably fallacious and biased…in both tone and content. I don’t understand how any rationally-minded person could take this seriously. Regardless…

If you truly are concerned about the bioequivalency of a generic of a medication, discuss it with your prescriber. Everyone is different in the way they metabolize any medication, much less generics, of which there are many different manufacturers. The point of producing generics is to help the patient population in having access to and affording medications they truly need.

For example: a patient that I regularly serve at my pharmacy was not pleased with the effect of tramadol, a generic for the medication Ultram. She is a chronic patient of tramadol- she receives 270 tablets per month and has been for years. Her insurance covers the entire 270 tablets of the generic for a $0 copay. Her insurance covers 270 tablets of the brand name Ultram for a $100 copay.

Bottom line: She discussed the issue with the generic medication with her prescriber, and got a prescription for the brand name medication. As a pharmacy staff, our job is to provide FDA-validated information to help our patients, not have a crutch to swing at patients when discussing brand name vs generic drugs.

Nick,

As a pharmacist you are in the trenches every day dealing with generic drug issues. You have been told that the FDA knows what it is doing when it comes to approving and monitoring generic drugs. Have you ever actually seen a bioequivalence curve? Except for the antidepressant Budeprion XL 150, we have not seen any bioequivalence curves released by the FDA. The agency says in essence, trust us, we know what we are doing, but you can’t see the data upon which we base our decisions because it is proprietary.

Nick, you would not accept that kind of response from car manufacturers or the makers of other critical products. Why accept it from the FDA? All health professionals (physicians, pharmacists, nurses, etc) and patients should be able to actually verify that generic drugs are bioequivalent to brand name products by seeing the data and the bioequivalence curves for themselves. Without that, you are taking the FDA’s word it knows what it is doing. The agency didn’t when it came to Budeprion XL 300.

You also assume that the agency is monitoring manufacturers in India, China, Thailand, Brazil, Slovakia and other countries. Reports from India over the last few years suggest that there is an unreasonable amount of fraud and that many generic drugs have not been of the quality expected by Americans. That is why so many generic drugs have been banned from this country.

Yes, we all need affordable drugs, but we also need transparency so we can look at the data to verify that the products truly are bioequivalent and we need better monitoring of drug companies abroad…in our opinion.

Is a pharmacy permitted to refund you your paper prescription for Adderall so you can try a different drug store to get the brand of generic which works well for you, but which was not in stock at the time you needed to fill your prescription?

There are no refunds and no ‘do-over’s on prescriptions, especially on a controlled substance like Adderall! You have to drive around to one pharmacy after another (since most won’t discuss availability of controlled substances over the phone), as long as it takes, until you find one that has your preferred brand in stock. Once you fill, that fill is gone.

An adverse reaction to any medication, brand or generic should be reported to the manufacturer. The generic market has changed over several years as around 50% of the generic manufacturers are now owned by a major brand name manufacturer.

One of the concerns expressed today has to do with obtaining raw materials. More and more raw materials are coming from outside of the US. How well are the raw materials being screened or tested? Shortages in raw materials have caused back-orders in the final products.

In recent years it was stated that most of the plants making generic products were more modern than the older brand name plants. More than one study has shown that the actual variance in generic vs brand is only about 4%. Of course there are exceptions especially in those products that are delay release or time release in nature. Though the active ingredients are shown to be the same other non-active ingredients being used in make up of the product can vary. Adverse reactions can be shown to be caused by dyes and fillers.

Stabilizing a patient on a medication whether it is generic or brand should be of great importance especially in those medications that require monitoring with lab tests. If there is a problem report it to the manufacturer and your pharmacist should be able to tell you which manufacturer’s generic is being used.

In over 40 years in this profession I have seen a lot of changes however profit was not the most important motive. Getting to know and talking with patients about their own personal situations has always been of utmost importance. Also important was seeing that patients could obtain and properly use their medications.

In my experience these two situations are starting to disappear in pharmacy today. Profit and volume have taken the place of patient care. Too many times patients are being told that their insurance will not pay for a medication and they are not given any suggestions or options-just pay for it or go without. The pressure today is placed on the patient to resolve the problem like “talk to your doctor” as if he is going to know what formulary options or restriction overrides may be available. I know because I do not dispense medications anymore. I instead work with patients on a daily basis as an advocate in dealing with these and other issues.

The CVS Pharmacist by my house treated me like I was an idiot when I asked what brand they could get. Of course he also threatened to report me for getting prescriptions from my PCP and my specialist because he stated it was illegal to get different prescriptions from two different doctors. Go back to school is what I say!

My son was recently diagnosed with epilepsy and was put on Keppra XR. I had to ask the doctor to please allow him to take the generic, otherwise I have to pay almost $400 for a month’s supply. This is something he will be taking for a LONG time and I can’t afford the brand name. I just keep my fingers crossed that the generic will do the job. Thanks pharmaceutical companies for making your brand name prescriptions so expensive that the average middle class family can’t afford them.

I want to ask why my pharmacy continues to change my prescriptions. With mental problems this is a problem. I get one generic (Sandoz) for 6months and they change to another.
The first generic is long lasting with a hard coating on it. The 7th month, they give me the generic from ( Mallinckrodt ph ). This generic does not have any coating, and looks like they were homemade. I took them for 5 days and returned them to pharmacy, they told me Sandoz was on back order, so I finished out the 30 days. I was a horrible person to my children by screaming and crying all day every day. I could not function. The next two months I got the Sandoz. Now they have told me they are on back order and cannot get the Sandoz generic. I refuse to take the other generic, I will be depressed and suicidal with or without the low budget generic, which I have no idea where it comes from. It is obvious to me and should be to them that it is not made in a safe environment.

I am on Norvasc for Blood Pressure and have been for over 20 years. I had trouble finding a product that worked for me without side effects and I will continue to use it. My concern here, is when I put a prescription in to be filled at the pharmacy, I am often given the generic brand, WITHOUT prior consultation. I always refuse it and they have to give me the one on the prescription. They will get away with it if they can. I am told it is their “policy” not to ask anymore. Well, excuse me! This is something I am putting in my body and I therefore deserve to be given the choice. I wonder WHY they don’t ask. I do know of a few who do ask and in the future I will be shopping at those pharmacies instead. Generic is NOT an identical product. Identical drug maybe, but not identical recipe.

Your doctor has to write “DAW” or “dispense as written” on the prescription to dispense the brand name. Otherwise the pharmacy will dispense a generic.

The bonus is on the patient to ask for the brand name product. Over 99% of patients respond well to generics and it saves them money as well. Hence, they are given the generic without consultation.

Well, I work in a pharmacy. When the doctor writes out the prescription, they will state whether or not the generic may be substituted (its a dispensing DAW code). In your case, I am assuming that the doctor did allow it. Most cases, the doctor will put a DAW 0, meaning that the drug may be substituted with the generic.

If you wish to only receive the brand, let your doctor know and they can specifically write that the patient requests the brand. A pharmacy can only fill what the doctor allows, but at the same time, they want to help you save money. So, most times the generic will be switched out IF the doctor approves. Also, I would let your pharmacy know that you do not wish to get the generic. They would be more than happy to give you what you want. They can even leave a note in your profile for the future, so this does not keep happening.

I have done so much research, but I don’t have time to put it all in. FACT: SFDA leader in China was publicly BEHEADED because he took bribes allowing factories that did not even meet standards to manufacture. The CEO of their 3rd largest pharmaceutical company was later found to do the same thing but because of bad publicity, China commuted his sentence to life.

Some of the worst problems are with mass produced old timers such as diazepam and phentermine. If they are all the same, why did the FDA come out with a new test for diazepam (their fourth).

Mylan is a high quality manufacturer but their generic diazepam is THE WORST ON THE MARKET. They are green, fall apart like chalk and do nothing. My doctor has heard nothing but complaints. I had to be approved for brand name Valium since my pharmacy started changing every month. Same with phentermine but I have to get generic, pay for it myself, but I can have my drug store special order from any manufacturer in 24 hours no charge. Reason? The other types cause me rosacea horribly. The one I order does not.
The FDA on average hits a foreign manufacturing plant once every 9 years, American twice. Companies warned for potential contamination ignore the FDA warnings and it has resulted in many deaths and mass poisonings. They happen in the US a lot and people don’t pay attention.

Teva brags they try to make better meds than FDA standards. BS. The Welbutrin 300 was a great example. Some manufacturers put plants in Puerto Rico and hire 3rd party QA inspectors who get paid by that company. They seldom respond to citations.

If you look, you can find hundreds of plants closed that were making phentermine. The plant closes, and they open or use another one. It’s disturbing. I had some twit young pharmacist try to talk down to me over the issue and I reported him to his district manager and she talked to me for over an hour on the phone because she knew nothing about it.

Different manufacturers may use different fillers that cause you nausea or other symptoms.
I can’t believe the FDA and the AMA keeps up this facade. But some ridiculous coverage about Red Bull because it gets news coverage all of the sudden garners attention when it’s been tested all over the world (very extensive tests). If people are drinking red bull in their alcoholic drinks hospitals would still list it. Red Bull (small can) has less caffeine than a cup of coffee. It has taurine which helps prevent certain heart diseases, Inositol which helps with depression.

Meanwhile the FDA shoves out drugs in high dosages like Serzone and Cymbalta that caused liver failure and death because they did not test enough nor start out moderately. I could go on but don’t have time.

“IDENTICAL” is a correct word, but it is true that we have to be very careful about patients being allergic to the non-active ingredients, as they may be the one causing the problem.

So if you are comfortable taking generics, go for it, as it will not do any harm to you.
But if you are allergic to, or have history of being allergic to particular agents in the product, you must stick with what you take.

P.S. Panadeine forte in Australia is made in India where its generics are also made in, such as Comfarol Forte or Paracetamol/Codeine GH tablets. So talking about the country where the drugs are manufactured in would lose some persuasion in this context.

My insurance has referred to chemically different antibiotics as “generics” – in other words, an older drug which is used for the same infection, which is NOT the same drug. How can they do this? That’s like calling aspirin a generic for ibuprofen.

It is true with the drug Dilantin, my doctor requires I only take the brand name. He wrote a letter to my insurance company to have them pay for the band name, but they didn’t approve it. So I have to pay more but it’s worth a piece of mind.
Dilantin is an old drug but the extended tabs probably all work the same. He even said the generics differ from name to name. If I were to get the generic brand all the time it would be ok. But you get all different names.
So definitely ask for the brand name from your doctor and insist for the brand name.
Good Luck, I wish your family the best!

JW… I also “unfortunately” have been taking “brand” name Dilantin for nearly twelve (12) years now. “Expensive”
My neurologist and I have attempted numerous times over the years to switch me over to the generic. It always ends up in severe seizure. I am extremely thankful this medication exists. However, it is certainly true that not all “generics” are the same as their brand counterparts. Even more alarming is that pharmacies will “often” change manufacturers from which they purchase their generics at any given and many times due to their price. On the surface this may seem fine, but when one truly realizes that not all generics function the same in one’s body and may in fact have up to an 80% leeway. In my opinion, it’s not responsible. I’m fortunate, I guess, that I can often tell of a change in medication. (outwardly ending in a seizure)
However, just think of how often a pharmacy may change the manufacturer of a “generic” blood pressure, asthma, cholesterol, etc…(the list goes on) medication and that person does not realize any change until it’s too late!
The solution is simple. An 80% leeway from brand is simply not acceptable. I believe, if attending school or college, a grade of 80% is a C or C-? Is that acceptable?
Generic medications should function within a 99% tolerance of brand at worse or else not be approved by the FDA. In addition, individual pharmacies should self-impose their own strict testing and compliance along with FDA standards to assist. This only makes sense and creates safety within the industry. Anything less is careless, dangerous and deadly.

I take Ef….r it is costly. I tried a generic equivalent for two weeks because the pharmacist claimed it was the same, but I felt very different, dizzy, not well; I went back to Ef….r brand. I feel sorry for people who can’t afford the original brand medication. The generic medication should have to go through the very same research protocol as the branded original medication before going to the market, otherwise the patients are the lab-rats of the generic pharmaceuticals company.
Is there a committee where those who suffered bad effects of a generic medication can send a summary of their case? If several people react poorly using a specific generic product, some changes could be done to improve the generic formula.

Insane. Pure insanity. It should be ILLEGAL to prescribe any generic drug to people who have epilepsy. This isn’t like a pain pill, where if it isn’t the correct dosage you will go into a tonic clonic seizure or possibly DIE from hitting your head as you fall on the ground during a DROP seizure. GET A F&^%$% clue people. NO GENERICS for epilepsy!!!!!!!!!!!!!!!!! PERIOD> This is just so lame and idiotic it defies logic. BRAND name ONLY for epilepsy patients. Quit playing games with people’s LIVES you incompetent fools.

I have been on the name brand of Cymbalta for 5 years now. Suddenly, my insurance company has decided that because there is now a generic for Cymbalta that I now have to take it instead.
I have tried 4 different kinds from different manufacturing companies, and NONE have worked. Only the BRAND Name Cymbalta works on me!
After months of fighting with my insurance company and with my wonderful Drs help and constantly writing on the Rx for “Brand Name Medically Necessary ,” my insurance company still will not pay for my Cymbalta anymore! I have even had blood work done while on each generic, proving that it wasnt working or even showing in my system!
GENERICS DO NOT WORK ON ME AND THEY ARE NOT THE SAME OR EVEN EQUIVALENT TO BRAND NAME MEDICATIONS!
That is all….

Generics from China and India…2. I know I only can use non generic, only brands with some of my meds.

Watch your dosage with Cymbalta. It was originally prescribed at high dosages and has been shown to cause liver damage (failure, death). Many pharmacies will not except the maximum dosage doctors were prescribing not realizing that the FDA lowered the max dosage.

I got my insurance company to put me on Brand Name VALIUM instead of the crappy diazepam they kept giving me. I take a lot of meds so these variances are no small issue.

It is unbelievable the people posting that generics are identical is not misleading. IT IS! Identical is as it says, identical. Not a copy, not close too, but identical. As in many other areas of manufacturing when products come out of the same line, say Air Conditioners, and the only difference is the label at the end, one says Carrier, the other Bryant. Yes, they are identical. This is NOT how non-authorized generics are created. To expect Americans to settle for trickery is what has made millions for those producing inferior products. My stance is if I can’t sue the generic manufacturer for a faulty drug, how stupid am I to take it? If you allowed the slightest accountability for wrong doing, including jail time, we might actually be protected. Instead, you take self reporting from the conflict of interested manufacturer of the medication for face value and do not require independent testing to verify it is correct. Crazy. Why don’t you allow students to grade their own SAT’s while your at it? Same thing. Thank God it’s coming to light that while not all Generics are inferior, the checks and balances is so far off of protecting consumers we should boycott generics until the FDA actually lifts a finger in advance and tests whats already out there, brand too, and whats coming in the future. It is insane that they do not test after the product comes out too.

You’d crap yourself if you saw the 4 different companies that manufactured the four doses of your IV antibiotic in your hospital– of course, when you don’t see the bottle or drug, you don’t know any different– we can monitor blood levels and do for most serious antibiotics (ie vancomycin) and they are all equivalent. There is something called science, ya know.

Well said. Thank you for summing it up so perfectly!

Generic drugs = brand name drugs. Generic drug PRODUCTS are not the same as brand name drug PRODUCTS.
Drugs are the same. Products are not. Remember that RPhs dispense drug PRODUCTS not drugs. This is how we can say generic DRUGS are identical, but we can’t say drug PRODUCTS are identical. The title of this article should be “…. generic drug products”.

The FDA does check after the drug comes out. Usually given to four major companies and tested vigorously. However, it then drops to 2 visits a year, and as for foreign they only manage 1 every 9 years and cannot hit them all.

If your pharmacy chain wont order a generic that works for you, switch. Some phentermine causes my rosacea. Red nose with a rash around it. I found one that doesn’t do that, I special order from Rite Aid with a 24 hour turn around and no extra expense. When I forget to remind them back comes the red nose and rash.

This article scratches the surface. Check for the plants that just get shut down after manufacturing inferior meds and another one opens. When people say “My medication doesn’t seem to be working, their could be a very good reason.

People’s Pharmacy please respond.
The article argues an important point about the role of pharmacists in advocating for better drug safety reporting and ensuring the best possible treatment for patients. However, the article does not really provide any clear answer on its original point and the point brought up by many of the comments which is “What should a pharmacist say when a patient asks if the generic is ok?”
My answer is customarily “The active ingredient in this generic is equivalent to the brand name product as per the FDA. There are differences in the inactive ingredients and the effects of these inactive ingredients can vary with each person.” Of course, this has to be varied so that the person getting the medication understands what I am saying, but the gist remains the same.
If a customer calls to complain about a side effect they developed from a generic that they did not get from the brand, I inform the prescriber and the manufacturer (calling their drug safety department). If the patient is okay with talking to the company directly, I also pass along the patient’s contact information (only after explicitly getting permission from the patient). If the medication is not working, I try my best to find something else for the patient and also start the drug safety report with the company. I consider this an appropriate response. I hope that all pharmacists follow these basic steps and the pharmacists I know do follow these steps because this is what we studied 6 years to do.
However, the article and following comments miss 2 major points in this discussion:
1. Incorrect Incentives
In the current healthcare system, the pharmacist salary is based on prescriptions sold. The legal and ethical expectations placed on pharmacists to counsel, ensure optimal therapy, and be the patient’s advocate is not reimbursed by insurance companies or any other entity to the pharmacy organization. Pharmacies make money almost entirely moving product-just like t-shirts. The amount of time I spend looking into any questions or issues with medicines patients have directly reduce my productivity because in those periods I make the organization $0.00 per hour. Consider the sheer stupidity of that point. I studied in school for 5 years and spent a year working for free to be able to help people make the most of their drug therapy. I am expected to do get people their medications, make sure they use it right, make sure doctors do not write for interacting medications, and watch out for abusers. All that is for not reimbursed. BUT, the insurance company will pay me to be a glorified vending machine.
2. Patient/Citizen Responsibility
This applies more to the responses I read after the article. Since all of you are well-informed enough to read people’s pharmacy and motivated enough to reply to this article, have you also filed a report with the manufacturer in question? The companies have entire departments (called Drug Safety, Pharmacovigilance, etc) dedicated to getting your phone calls. Major adverse effects reported are by law required to be processed in within 2 weeks. A quick google search will bring up the company’s corporate phone numbers.
Also, I read a lot of complaints about foreign manufacturing (which, on a side note, brand manufacturers do as well). Why not write to your Congressman or Senator? Ask them to increase funding for the FDA rather than cutting its budget. Ask them to change the law that requires pharmacies to dispense generic unless specifically instructed by the patient or the doctor. In fact, ask them to stop imports of drugs from out of the country. Congress members will actually listen to you especially if you write a letter or show up at their office.
As a pharmacist, I try my best to do right by my patients. I come to work every day to help them. If I wanted to cut corners and hurt people to make some more money, I would have become a Wall Street banker. However, I am also subject to the financial pressures of the time. Ordering brand medications and dispensing them at a financial loss is a great way to become unemployed. Generic medications have been a blessing to a lot of people who may not have been able to afford medication 40 years ago. Clearly there is room for improvement at every level of the system. Pegging pharmacists with the job to “tell the FDA” to regulate generics more is not helpful.

Wow! I wish you were my pharmacist. I had no idea it worked that way, and the reason it’s so difficult to get a brand name. Thank you for a very informative response. And I also notice your post was at 2:47 a.m. I hope your job wasn’t keeping you awake!

The reason why you have trouble finding brand name medications is because too few people are willing to buy the product like you are. The pharmacy is not going to order a bottle of 100 tablets a brand medication which will likely cost them 10x the cost of the generic medication they have on the shelf only to dispense 7-14 tablets to you and the remainder of the 100 tablets sit on their shelf until it expires and they have to throw it out. It would be a huge financial loss and therefore probably would not be ok in any corporation.

I had a local pharmacy ordering a brand-name product just for me, in the quantities I needed, that I reliably paid the higher (and ever-increasing) price for due to problems with the generic… until their wholesale distributor decided to stop carrying the brand-name product! Most of the other pharmacies in the area use the same major nationwide distributor. So now, in a mid-sized city, I’m left with only two places (at even higher prices, of course) to buy a non-controlled substance that’s been on the market for decades.

Will someone (hopefully People’s Pharmacy) please tell us how to find out where a drug -generic or brand name- is manufactured? There must be some way of getting this information. Remember too that many of us don’t get our medications from a pharmacist rather they are mail order per our insurance’s requirement.

I was told by my endocrineologist that he wanted me on brand. He said (unless you’re looking for change in your sofa, go with brand) He & his administration have told me (Big Pharma, ins. Co’s & pharmacies make more $$ off generics. He has been head of endocrine for 25 yrs. I do have problems with generics & would like advice on the ones that I am on. Thank You

I am taking 3 generics all made by Ranbaxy. I would like to take generics made in the United States like Mylan, which makes all 3 of my generics. My pharmacist says she can not change, how can I gen U.S. made generics?

I have been taking Dilantin since 1956. Once under control, I have not had a grand mal seizure since 1963. At one point while hospitalized I was given a generic which is “exactly the same as Dilantin”. After a bad night but no seizure, the pharmacy “examined” the meds I had with me and allowed me to take them.
When I returned home, I called the Neurologist for an opinion. His reply was “The active ingredient may be the same, but it may have released at a different date in your system. Always ask for DAW and use the name brand!” (DAW is “Dispense as written – in other words NO GENERIC!

To me the biggest fraud is when generic companies are allowed to change the dispersal method of a pill and still call them equivalent. This was the problem with Wellbutrin XL. The Teva version of the 300mg didn’t have the same plasticky coating that the others have, including other generics. The Teva pill was this huge pill that very obviously relied on the size of the pill to take time to release. I noticed almost immediately that the Tevas just didn’t work, and I had to call all over god’s green earth to find a generic version that did have the right coating. The Tevas were so much cheaper for the pharmacy to buy that eventually no one carried any other brand. The 150mg Tevas on the other hand DID have the right coating. So I got my prescriber to give me a script for 2 x 150mg.
I’m having the same problem with my husband’s Concerta ER, and he noticed the very first day. He says it’s not as bad as taking nothing but it’s not nearly as good either. The first “generic” was actually a re-branding of the brand name, which was fantastic for us. But now, other companies have developed methylphenidate ER pills. The dispersal method is different on the new ones. They don’t have the same coating! Again! I fail to see how these can be considered equivalent. If they’re going to make a methylphenidate extended release with a different dispersal method they should be required to NOT call it generic for Concerta ER. And since I’ve learned from the Wellbutrin fiasco, I have called all over again looking for the original “generic”. ONE pharmacy in the area carries it, because it’s more expensive to stock. I bet everyone is surprised by that, huh?
My main point is that it took me a lot of phone calls and a lot of experience to figure this stuff out. How can we possibly expect everyone to be able to do what I managed to? Seniors who are starting to have memory problems? People who just plain don’t know it’s a possible problem? People who take 15 pills a day? People with 3 jobs who don’t have the time to call 8 different pharmacies every time they get a refill?
It’s disgusting, and I personally find it reprehensible that we allow the race to the bottom price to have priority over people’s welfare.

THE FDA will NOT do anything if we all don’t complain every time we have a problems with a drug, especially if it came from China, India etc….

Have been recently prescribed Chemist brand Efforxor 150mgs. Took one yesterday and within an hour I felt sooooo sick! Heartburn and continual vomiting within an hour of taking this medication. I was shaking, red in the face and thought I was going to die! I will never take chemist brands again. I have been told that the red dye for the capsules is imported from China and so is the rest almost imported from overseas at cheap prices for Chemists in Australia and sold at Chemists own. Beware, pay the extra two dollars and you will feel better. Have not taken medication today and feel better

My husband and I have always had to fight with our insurance company over brand name medications. No matter how many medical reports we submit, they deny coverage. Now the problem is the pharmacies. Despite the fact that we have agreed to pay exorbitant prices for brand name medications, the pharmacies are now trying to take away our right to do that. They make more of a profit off of generic drugs. We have to speak to the manager each and every month to get our prescriptions filled with the brand name despite the fact that our doctor has indicated filled as prescribed. As long as health care and prescriptions are primarily about money rather than the health of the people, the people will suffer.

There are 2 drugs I must take BRAND NAME because the fillers in generic cancel the drug. It is like taking a sugar pill!

After years of fighting with the recommended medications for fibromyalgia my physician started me on Oxycontin, as chronic acute pain is my most serious presenting complaint. I had gained over 100 pounds from all the antidepressants, and this was an amazing relief. I took 60mg O/C am/pm with 2 OxyIR for breakthrough. Over time with relief of pain I regained my life, lost almost all of the 100 pounds.
A divorce in 2009 left me without insurance. I tried but did not qualify for Purdue Patient Assistance, and since this name-brand extended release rx was now going to cost me almost $900/month, my doctor switched me to an equivalent amount of oxycodone. I found an online prescription assistance program and have paid cash since.
A move to a different state left me in the care of a new doctor and a new pharmacy. Without any problems, this pharmacy filled my rx every month with a generic that worked *almost* as good as the name-brand. Since I’ve taken this generic for so long I was used to the decrease and compensated.
About six months ago I began a journey to decrease the amount I was taking. With my doctor’s blessing I started cutting tablets, increasing times between doses, and successfully got down to about 45% of the prescribed does.
Until last month.
The pharmacy where I have filled this prescription for years made a change in many of their generics based on corporate bottom line. Within three days I was taking full doses again and even that was not completely meeting the pain.
This month, with my doctor’s approval, and the name of the pharmacist, who suggested I call around to make sure someone both took my rx plan and had a different generic, I spent nearly 7 hours on the phone. Sometimes I was met with suspicion (I’m a little old lady in my 60s, for Pete’s sake!) and sometimes no one would talk to me. I kept at it until I found what I needed.
This month I’m back at it, working my way back down. Six months of progress was wiped out by one bad month of an inferior batch of a different generic (which, btw, that lovely pharmacist told me she’s received numerous complaints about…)
Pain meds are tough because pain patients have to deal with doctors and pharmacists that not only have to cope with FDA, but the DEA as well. We often get treated as addicts, though I account for every single pill to my physician. They are often in fear of losing their licenses. It’s ugly.
Nevertheless, it’s pain and discomfort, not life-threatening danger that problems with some of the other medications can cause.
Thanks for keeping this line of communication open.

quack quack

I myself have to go to the pharmacy to get my pills changed. I was switched from a generic time release hyoscyamine made by Paddock laboratories to one by Franklin pharmaceuticals and I noticed more pain, like the pills aren’t working right, and I had the same reaction I had to a few OTC generic medications. I had figured out the problem with the OTC drugs were the binding ingredients, so I switched to the liquid caps and have been fine. I googled the ingredients of the new pill, and lo and behold, they were the same binding ingredients that I had trouble with on the OTC meds.

this article was helpful in the fact that about two weeks ago the cvs pharmacy I was going to ran out of the Avapro I was taking for my blood pressure… they told me it would be a couple of days, in the meantime they gave me a few pills to suffice… I was taking brand name Avapro not the generic, and so when I called on the day they promised me, they said “oh there has been a change in the number for the order of the pill so It is not ready just yet….so when they finally said the order was ready I went in to pick it up and (my fault to assume) that the order had been filled properly… on the outside of the bottle it said the brand name Avapro and nothing else… I can’t take the generic as I am allergic to it… so I have been taking pills for about a week and half and started to develop dry cough and getting hives but it never occurred to me it was the HBP meds… so didn’t think to check the actual pill since the appearance of the pill is similar to the brand name pill… I though I was getting sick from something else…. then two nights ago I had my “epiphany” moment and remembered 4 years ago when they tried me on the generic first I had this same reaction that I am having now.
So I get up and look at the actual pill and notice that the number is different from the one I normally take but by one digit… the same heart imprint on the other side… I get on the internet, I call the doctor and discover that Avapro generic is ibersartan which is what that filled the bottle with but labeled and made me pay for it as the brand name… Avapro brand as opposed to irbersartan which was the generic… to my knowledge if you put a generic in the bottle to fill you have to label it with the generic name… what they manipulated the label is put the brand name on the outside and then put the generic in the small writing on the back of the bottle… which to me is like a knock off… so I went to the pharmacy and one of the pharmacist was very condescending and belligerent about it and pulled out the bottle as it said irbersartan and in parentheses (Avapro) making like I was wrong and this was the actual brand name of the drug and showing me the bottle of the generic… very snotty about it… I took my bottle back, and don’t know where to go or do but am now feeling really crummy and going to visit the doctor in the am… then I am going to go back to the pharmacy store manager and make a complaint.
What this pharmacist is doing is misrepresentation of what she is filling the bottle with and charging me brand name price for the generic form… I understand product labeling very well but if she is going to put half of one info and half of another and fill it with the knock off, that is illegal and also I might add dangerous.. just to cut a corner! and you are exactly right.. generic drugs are not the “identical” to the brand name…..

If it was clearly not labeled correctly AND you were charged for brand name AND after the way you were treated did you become proactive and report this to your state pharmacy y board? I sure hope so.

I don’t need a damned doctor or a pharmacist to tell me that the new med I’m taking, which is a different brand of generic drug, is vastly different from both the brand name AND the generic from a different maker of the drug.

I have a question concerning generic medications and which pharmacy carries which manufacturer of the drugs.
My wife has been taking Roxicodone manufactured by Activis and would like to change to see if another manufacture’s product would be more consistent.
She has found that using the current product that on a month to month basis using this medication, the effects had changed drastically. She filled her three week prescription and the drug is not working as it did before and due to the nature of the drug, the prescription cannot be changed mid stream.
We did some research and found many different manufacturers of generic forms of this drug but we are at a loss for finding a pharmacy which carries a different brands.
Short of calling all different pharmacies in my area, is there somewhere I can get this information from one place? We asked our current pharmacy but they said they only carry one brand.
Please help.
Thank you
PEOPLE’S PHARMACY RESPONSE: This would be a great idea for someone to undertake as a business, but we have not seen it. I’m afraid you’ll be using the phone.

It took years for the FDA to admit that the generic Wellbutrin made by Teva was not working, was not “bioequivalent”. Think how many people were pushed onto this generic — often for treating depression — and were not helped because of the fraud of both Teva and the FDA. The FDA only investigated because of the overwhelming complaints from physicians and patients could no longer be ignored.
Anytime your generic does not work in the same way as your brand name, you should file a report with the FDA. They don’t seem to care, and they won’t respond for years, but if enough people were filing these reports, they would have to take notice.
https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm

My prescription plan requires me to use mail order pharmacy for my medicine. I was taking a generic medicine to treat heart arrhythmias for over six years, and they kept switching manufacturers. Then they switched to one manufacturer (which made the medicine in America), and began having many problems (angina pain, dizziness, difficulty breathing).
The cardiologist put me on the name brand, and within one hour I could breathe easier, and had a huge reduction in symptoms. I thought maybe I would feel better in a few weeks, not in an hour. Was on the name brand over 2 years, and felt so much better.
Now the manufacturer for the name brand has stopped production, and I must go back to a generic. I have nothing against generics, if they work. I take another medicine that is generic, and have no problems with it. The differences in manufacturers of medicines can make a huge difference for some patients.

how can a pharmacist tell me my dose is too high when I was on brand name switched insurance and now on bad generics. It’s the same dose it’s identical. What’s up and why can’t I have the brand name at the generic price if they are both made by the same company they are identical right? I think I’m done taking meds. Pharmacies and drug companies are jerks they want money and that’s it they could care less if someone takes a med goes nuts and shoots a bunch of people this is messed up I have had severely different reactions to different generics cause the pharmacy can’t carry the same one all of the time because they have to get the cheapest one. So what if the dye gives me a rash or it sends me into instantly feeling like crap they don’t care they say the same thing they are identical.

“The requirement applies not to efficacity, but to “bioequivalence”–the amount of drug that gets into the bloodstream has to be between 80 and 125 % of the stated amount, subject to a lot of statistical qualifications”
Actually, it’s the 90% confidence interval of the CMax and AUC that has to fall within the 80-125% of the branded product for it to be considered bioequivalent, which makes it a bit more stringent. Not sure if that’s what you meant by “statistical qualifications”. There’s a lot less variation than it sounds like when you throw around 80-125%. Plus, the brand name manufacturers are allowed the same variation from lot-to-lot as well.
That being said, are all generics exactly the same as brands? No, with one of the main differences being that as long as the CMax and AUC fall into those ranges, the TMax (time to maximal concentration of the drug) can vary. Can this have an effect? In certain situations (i.e., where the effect of a drug is needed right away), possibly. In most situations though, we’re dealing with chronic medications that reach steady state concentrations in the body (and don’t have narrow therapeutic indices), so the Tmax essentially becomes irrelevant.
As for different inactive ingredients, obviously a patient always has the potential to be allergic to something in a generic medication, just like they could be allergic to something in a brand name medication. But looking through the comments, it’s ridiculous that people think just because one generic medication caused an allergy that all generic medications will cause that same allergy. It’s not like brand name manufacturers use one particular set of inactive ingredients and generic manufacturers use another- they’re all basically mixing and matching the same inactive ingredients to make their products.

I just found this site while trying to decide whether to insist my Dr. put me back on brand-only medications entirely, having discovered that I’ve been swallowing glass for at least a few weeks in my atorvastatin. It amazes me that they make these recalls at the retail level, but patients who are taking the drugs are not alerted. Just because there are not yet any confirmed reports of injuries? How can it be OK that my insides are now swimming with GLASS?! How big does a piece of glass have to be before it’s not a good idea to swallow it? How many in each pill before it adds up to a problem?
I was “lucky” enough to obtain a refill on November 8; the pharmacy was alerted to pull the drug from their shelves on the 9th. So I have been taking these for weeks.
My husband takes Depakote ER for a seizure disorder. The pharmacy switched him to a generic, and it wasn’t long before he suddenly started having seizures again. After realizing the drugstore had made the switch, his neurologist started requiring BRAND ONLY, and he has not had a seizure in the few years since then. The neurologist said the meds are NOT the same. Even if the active ingredients are the same, they’re not necessarily absorbed the same way. I’d say seizures are a pretty clear piece of evidence this is not something patients are imagining.
My bigger general concern is oversight. Yes, things can go wrong in US factories too, but let’s face it. There is no way the same kind of US oversight occurs in factories located in India, China, etc. Look at the melamine incidents, and the lead paint in toys. They just don’t care about anything but the bottom line in those countries, because they are unregulated and they don’t have to care.
I am very close to insisting my Dr. put me back on brand name drugs for all of my medications, and just find a way to deal with the cost. I’d rather lose money than my health.

When I went to the pharmacy to refill my latest Venlafaxine (generic Effexor), I received one 225mg pill instead of 3 75mg pills. I started feeling dizzy and extremely nauseous within a few days. I initially thought the side effects might have been due to the change in dosage size, but it didn’t make sense to me that taking 3 75mg pills and 1 225 mg pill would contain different active ingredients or dissolve at such different rates to cause such miserable problems.
After research, I found that changes in the manufacture of a generic can also cause problems, which is what happened to me. Plus, it’s now 5-6x more expensive for me to get the prescription because this particular “formulary” is not covered by my insurance.

Just learned this plant is under investigation AGAIN for glass shreds in their generic Atorvastatin very concerning.

Generic Drug effectiveness is a mystery which in more serious cases is probably a death sentence. I found in taking doxazosin to reduce night time trips to urinate that Apotex C did not work at all but it took several weeks after I switched pharmacies to realize that it was the cause of my increased night time trips to the bathroom. Mylan was fairly effective reducing the night time wake ups and TEVA was the most effective. It makes me wonder about trying Cardura but even if it was better I don’t know if the patented version would be worth the extra cost to reduce the night time trips by another one or, less likely, even two times a night.
I think generics could be rated more accurately by a reporting system in which the makers were noted as helping more or less than the previous source of the drug. This may not be helpful on some generics that are used only briefly but for those used repeatedly a very inexpensive data base could build up a record for pharmacists and interested patients to review when selecting the manufacturer of their generic

From the age of 84 my mother lived with us for 7 years. She took Lasix (Brand) daily. When the mail order pharmacy sent her the generic Furosimide, we noticed her ankles would swell horribly. She asked our doctor to write “no substitution” on her scrips. I saw for myself the difference. When we would forget to ask for the “no substitution” on the scrip the ankle swelling would happen over again.
Now that she is on a state run program, I cannot get her on Lasix even though Lasix is very cheap. I even offered to pay for it but they will not budge. Not only does this new doctor dismiss our problem, she had someone call me and talk to
me as if I was a little child, totally discounting our findings over the 7 years my mother lived with us. She is now 94 and when I visit her at the facility it breaks my heart to see her feet and ankles so swollen.

First, I would be highly surprised if Texas tests each and every drug. I don’t know of any State that has the resources let alone the money to support such a horrendous task. It was my understanding that was the primary purpose of the FDA, however I recently read that the FDA rarely tests any drugs, relying on the pharmaceutical companies to submit testing results and to self police. That includes the foreign drug makers. So much for the government protecting us from bad drugs. I did not read it on the internet, and if I did, would probably not trust it. The article was in our local newspaper, and was backed up by numerous professional sources, including an interview with an FDA official.
Second, there was a comment by a reader (a pharmacist) that he knew of no pharmacist that would put greed before customer safety. I have seen numerous news stories of U.S. Pharmacists that have done exactly that. Remember the pharmacist that was caught adulterating cancer drug formulations? The pharmacist mixed drug was less than 1/5th the appropriate strength. That pharmacist is now in prison. I wonder how many more would come to light if not hushed up by corporate interests. Or gagged by a Tort Lawsuit settlement. And how about the recent revelation that there was a black mold fungus in a large batch of steroid medication used to treat a meningitis outbreak. Was that an innocent mistake or did greed make that manufacturer cut corners. So far 29 people have died.
Here is a quote from the New York Times, “Compounding pharmacies, which mix their own drugs, have had little regulation from either states or the federal government, and several others have been shut down recently after inspections found sanitation problems.”
I would hope that this isn’t becoming the new norm. I still believe most pharmacists are caring people who do put their patients interests before anything else.
Most of the pharmacies I’ve done business with in the past have been very good, but I recently changed pharmacies when I felt the generic drugs they were selling me were less than effective. So far the new generics I’m taking seem to be working better.
I think everyone would benefit from the words “Caveat Emptor” Let the buyer beware.

I too worked in the pharmacy industry for a while, went to school for it etc. Like everyone else who went to school for it, I was taught that generics are equivalent to the original brand name versions and like my fellow class mates and coworkers, I actually believed it. At the time, I had never personally had a problem with any of the generic medications I had been prescribed, but I did hear many complaints from customers. I chalked it up to a psychosomatic issue. It was a very ignorant assumption on my behalf.
I have since personally run into a generic medication that was complete garbage compared to the other generic I had been taking prior to that. I didn’t even notice the switch when it happened at first because both pills were so similar in appearance. What I did notice was all of a sudden my old symptoms started coming back. I couldn’t for the life of me find a reason until I compared a couple of old left over pills lying around from my prior months prescription and realized they weren’t the same and I decided to look into the new generic brand and sure enough there were dozens of other people ranting about how it didn’t seem to work properly.
For those who doubt that generics aren’t necessarily the same go actually read what the law dictates and how it defines “bioequivalence.”
Then more importantly read how the studies are set up to prove bioequivalence. (It’s ridiculous how flawed the design of these “studies” are. I mean we are talking about the pharmaceutical companies who are trying to get their drugs stamped with approval using a tiny group of a couple dozen healthy test subjects. Until recently the drug companies didn’t even have to disclose how many times their drug failed this test to the FDA before they found a batch of pills and test subjects that would pass.)
Then read about how often product is tested after its initial approval. (I’ll give you a hint, basically once approved the drug manufacturer is basically on the honor system after that due to how behind and understaffed the FDA is in its work.) Other sobering material to look into is all the various instances of fraud and corruption that revolve around this issue that have come to light over the year.
Then finally just read through a few online forums filled with hundreds of very real and sane people who have personally suffered due to poorly made generics.

I am so put out with doctors getting irritated at me for acting like I’m crazy when I tell them I cannot take generics. They do nothing for me. I don’t get better I just keep getting sicker.
I’m so glad to see postings from people stating the same problems. They act like there is no way anyone couldn’t take a generic. Today I went to the doctor and she said she was putting me on a steroid. I told her that the last time I took one, my throat felt like it was closing up. She actually got angry and let me know right away that there was no way anyone could be allergic to a steroid. That’s funny, because that’s not what the pharmacist said.
We are just a number to doctors and they don’t give a care for us. I’m SICK OF IT. A real doctor will listen to you and try to help you instead of getting angry when you NICELY try to tell them something. I think I know my body. And why in the world would I want to pay more for medicine if I didn’t have to. Plus all the time it takes to find a pharmacist nice enough to help order the name brand for you. The people who say that generics are the same need to shut up and do their research.

I have taken a generic medication and then was able to afford the brand. Whatever, the schools are telling pharmacy students, is totally not true. Even my doctor said,”yes, the generic brand is SUPPOSED to be the same, however the ingredients have been slightly changed in generics, so the lay person would not even know these “words”.
Have someone show you a Brand Name ingredient pill, and have them show you generic ingredients. Again, as a lay person, we won’t understand the “words’, but your doctor will.

People treat BRAND drugs as safety blankets and are fooled into believing BRAND drugs are above and beyond SUPERIOR to their generic (IDENTICAL) counterparts. A good chunk of brand companies are actually WORSE than generic companies where they have LAX REGULATIONS by the FDA and the government.
If you do not believe me read this article about Mcneil’s mess in 2010 which lead to a shortage of many BRAND NAME DRUGS (TYLENOL,MOTRIN,ETC.)
http://www.washingtonpost.com/wp-dyn/content/article/2010/05/27/AR2010052705484.html

I have experienced time and time again the affects of generic medication being prescribed to me by my local doctor. After informing him of the trigger of asthma, and getting a guarantee from him that it would never happen again and he would mark my medication record as such, I now am informed that the doctors are ORDERED by the Australian Gov. to prescribe at least 1 in 10 patients with scripts for these generics WITHOUT informing them whatsoever of the possible reactions. Sadly our pensionsers are the prime target. What a bloody insult.
The consequences of people not being fully informed can be life threatening, as I have just found out. It should be law that every ingredient in medication be clearly and honestly indicated on the packaging of every prescribed medication and associated product. What is actually in these generics medications, other than the active ingredient, and again I believe there is not the quantity of this either, cannot be the same, after all who in this day and age “provides the same for a lessor price”…..time to tell the truth doctors, chemists and companies.
Knowingly taking someones life is not legal either all in the name of profits, and in Australia our Government lying as usual to the public with the same outcome is not either.

I’m unable to take the generic version of the brand medication “Lamictal”. It’s used to control my epilepsy. I have taken the generic version in the past and my seizures were not controlled. Pharmacists and insurance companies have routinely recommended generic brands to me for cost effective reasons out of ignorance. However, my doctor is aware of this problem.
This 15+ year old Lamictal brand medication has cost my family over $1,200 per month. It is medically necessary to survive. Today we have insurance and I cringe when it’s refill time just in case the insurance company decides not to cover the brand. This financial burden has put us in a hardship position many times. Please note that due to the cost of medications, anyone who is medically treated for epilepsy will be declined from a private insurance company, period. Sometimes a high price brand medication just has no generic comparison and this should be noted within the health care industry. I do wish for more competition in the pharmaceutical manufacturing to bring down the price.

I have tried to go generic for Keppra (Levetiracetam), an epilepsy drug. I have been on Keppra without a problem for eight years . But I am jobless and Keppra costs thousands a year. To save money I have tried two generics. Neither works. Both cause itching, burning, and lethargy.
Thank you for your support.

The FDA is having problems regulating drug manufacturing for the same reason the USDA is having problems regulating food products from agricultural production, and other regulatory agencies are having problems in carrying out their responsibilities- BUDGET CUTS. Right-wing political groups want to reduce the size of government, and reduce regulations on business because they mistakenly believe those things are preventing economic recovery. They are not.
Grover Norquist said he wanted to shrink government to a size where he could “drown it in a bathtub”. This wrongheaded attitude is exposing the American public to more and more dangers from the drugs, food and products they purchase. The outsourcing of manufacturing to other countries not only costs Americans jobs, but increases the risk of contaminated or dangerous products because very few of those countries even have any FDA or regulatory body looking out for public safety. When are people going to realize that one of the best functions of government is to protect the public from the effects of shortsighted and careless corporate actions?

When prozac became generic, I was immediately switched to using the generic because it was now available by my health care plan. At the time, in order to have the name brand – I was paying an arm and a leg for it. Then my doctor insisted that they were ‘exactly the same’ – so I went onto the generic form. I experienced anxiety, sleepless nights, and tremors which led to me to think I had something severely wrong with me and get misdiagnosed with another ailment.
My best friend is a pharmacist and when I told her my issues, she explained that generic was NOT, in fact ‘exactly the same’. Thus began the task of paying more for my prescriptions to be name brand, although it’s a price I’m willing to pay. The biggest inconvenience is to see when my doctor faxes or emails in a prescription that states on it “refill with BRAND ONLY!” to get to the pharmacy and see it filled with a generic.
I’ve actually watched my doctor write specifically or send with those instructions – the tragedy here is that for those of us that NEED the actual brand name, we are being forced to pay higher prices and are still facing the attempt of getting those generics rammed down our throats, LITERALLY! I think most ‘brandies’ will agree with me that if they could pay $4 and utilize the generic, they would – but not at the cost of their own health and well being.

As a Registered Nurse and Disease Management Patient Educator, I speak by telephone with thousands of patients around in 17 states year after year, teaching them about medication, medication safety, things to ask the pharmacist and physician or provider to remain safe and get the most out of their treatment. I also help them find ways to save when they can so that they can afford the care they need.
For me as a nurse and patient, the issue of generics is NOT confusing nor controversial: It’s a no-brainer. The drugs are not the same, and won’t usually work exactly the same. Usually it will be very similar, and that’s it. Because the generics use cheaper inert ingredients, they carry some risk of mildly inferior overall effectiveness and safety. Occasionally they be much inferior and could even in some cases (rarely) work better.
I look at it the same way I would a food or cosmetic product, because the principles are the same. Most hand lotion, for example, is made from some sort of animal, vegetable or petroleum-based fat to replace oil and soften the skin, and various types of wax, and chemicals aimed at dispersing ingredients, trapping water near the skin, etc., to keep it plump and soft. There would be fragrance, dye, and preservatives. The quality of those ingredients could vary widely, from dirt cheap to rare and precious. Basically, though, it’s oil, water, chemicals and wax.
Now let’s say that “medicinals” like vitamin E or botanical extracts are added. These parts are identical in each bottle of lotion. If we bought the lotion for the effects of the “medicinal ingredients”, the effect of any of them on our skin ought to be identical. But they’re not, because of the “vehicle” they’re riding in. Some inert ingredients melt better on the skin, hold the medicinal in place on the skin, make it absorb more slowly or quickly, etc. The “inactive” ingredients could range from additionally soothing and moisturizing in effect, all he way up to as harsh and irritating as any cheap floor detergent would be, and we could be allergic to ingredients–especially dye or fragrances– used in any of them–expensive or cheap.
In short, the quality and actions of the inactive ingredients could help or hinder the overall intended effect, and greatly alter the behavior of the “active” ingredients you purchase the lotion to get. Although the analogy is not exact, it seems logical to me that when you switch to a generic, you may experience a change in how well, or in what time frame, you absorb the medicine because of the change in the entire formula or physical construction of the medication. Because cheaper ingredients may be used, they may be ones more likely to cause side effects, allergic reactions (like yellow dye no. 5) and less predictable absorption, too–though not always.
I experienced a dramatic drop in the effectiveness of one medicine I take when the first generic became available, and the pharmacist kindly clued me in that often the solution is to switch to another manufacturer’s version, as maybe I can absorb the fillers or my digestive system better dissolves the coating on “generic #2”. If it’s a hormone like thyroid or estrogen, or a drug that requires a narrow level range in the blood, like warfarin, then the blood levels will need to be checked to see if the required dose is the same on your new brand.
I have heard a few stories where the generic worked BETTER than the brand name, presumably because those inert or structural aspects just worked better in that particular patient’s body.
I tell people to try the generics, with these thoughts in mind each time their pharmacy uses a different manufacturer’s version, and to report it to their doctor right away if something doesn’t feel right, or the blood tests will need to be done.
Of course, I would like to make it be required that drugs used in the US be inspected every day at the manufacturer by an American-paid inspector for safety and quality. That’s a serious issue, and I know standards are abused in many places or ignored altogether.
And if I could, I would lobby for restrictions on forced use of generics over the doctor’s objection. I would make it a requirement that when a pharmacy starts you on a generic that works for you, they be required to continue supplying it to you from the same manufacturer, for consistency and safety, even if they can save themselves money by making a switch.
AND!
It seems to me we have another new and very scary situation, too, with the “generic brand” drug manufacturers no longer satisfied with being called or (as they see it, stigmatized by) the term “generic”. Now they want to give a single drug hundreds of brand names, one for each manufacturer of the same drug. In a day, the number of named drugs can grow exponentially.
In a day, an old and common drug could could become unrecognizable by name to nurses, doctors and pharmacists, unless the patient himself can say, “oh, that’s my warfarin,” or “my new Coumadin generic”. This means a huge loss of protection in emergency situations, even just doing a medication history interview with a patient can much less productive.
As a nurse of 20-plus years I have 1000s of drugs filed in my mind with most of what I need to know about them, and I work hard to stay on top of new developments. I have a computer database I can search. And STILL, when another brand of good old warfarin came on the scene, I had to say, “Huh–what’s that??” because the latest brand name wasn’t in my database. Not very confidence-inspiring, either.
With no way to recognize a drug that is reliable–color-shape, size, name, ANYTHING!–mistakes will happen more often, and be harder to sort out in an emergency. I see this as potentially very dangerous, especially to people with vision, memory, or language barriers, such as immigrants and the elderly.
When drugs are sent by mail, too, it’s a great convenience, but no discussion or even just casual questions between patient and pharmacist happen to provide a second “safety check”. (As you know, healthcare workers count on these automatic double and triple built-in safety checks. They’ve been considered indispensable for safety in healthcare.)
I’ve seen patients on the same medication from 2 different pharmacies or providers, where no one caught it because when a drug has a brand name, the patient can’t say, ” what’s this the generic of?” and would never know to ask, which is the understandable, but dangerous, intent of the manufacturer.
For those reasons I would also insist that for safety, every patient be taught to use and rely on the generic or chemical name of each drug they take, and this be written in HUGE letters prominently on the center label, in front of the brand name, of EVERY medicine dispensed, whether original “brand”, generic, or the new “alternate brand” generics. I would require a red alert notice to be given along with the drug information when the drug was dispensed, so the patient would take note.

I am writing to all of you who have experienced differences between the brand name and the generic medication. We are not imagining it, it has nothing to do with the cost and we are not morons like “generics” thinks we are. I am a 58 year old female who happens to take Ritalin LA for Adult ADHD. You can ask anyone in my family, any of my friends, my doctors and the people who work with me and they will all tell you that there is a world of difference when I take the medicine and when I don’t.
Just several days ago I received Methylphenidate ER from my pharmacy (a generic) instead of the usual Ritalin LA. I had been taking two 10 mgs per dosage of the Ritalin LA and to simplify things my doctor wrote the prescription for one 20 mg per dosage. It seemed like a good idea because I would require less pills! I didn’t realize I had something different but my behavior over several days was as if I wasn’t taking any medication at all.
I started to wonder what it was I was taking since I was struggling so much and to my surprise I was taking the generic medication instead of the brand name. So “generics” please explain why this would happen to me if the are exactly the same?

The pharmacies, health insurance companies do what ever they dam will please.
You no longer have choices. Brings one to the question what are THEY really dishing-out. Like the chemo drug being given to children – diluted. One use to have to worry about counting pills and checking the label and color were the usual. Now “take at your own risk”.
Doctors no longer have the prestige and respect they once were awarded. Used to be doctors had the final word. Even if you are willing to pay an inflated price to receive the name brand, THEY will conveniently not be able to get the name brand. Bet the slime elites do not have to deal with this corralling of the cattle and in regards to the congress and others, we the people pay for them to have the best. Unbelievable.

I am from Canada and was checking up on my mother after her doctor appointment, who has high blood pressure. Her doctor mentioned to her yesterday that the pharmacy changed her blood pressure medicine to a generic prescription without telling her. Her doctor was livid!! and told her she could have had a heart attack or a stroke!! Who then would be liable if this happens?
I noticed on her pill bottle that they put the name of the prescribed drug on the bottle, then underneath the generic form they substitute it with. How are we to know? Are we pharmacists?
The pharmacy won’t change the prescription back to what the doctor prescribed, they say that is up to head office. If these big pharmacies are crowding out the smaller pharmacies, why does that give them free license to prescribe whatever makes them more money without taking into consideration the health and well being of their customer?
This is the second time this pharmacy has done this, they also switched her ant-acid from zantac to ranitidine, which gives her worse heartburn from the filler that is used to make the pill. Who is going to help control this? I think a poll should be started to track these pharmacy companies, this feels illegal, they are pedaling drugs at their own discretion, without consulting the prescribing doctor, or patient!!

This is a very interesting and informative Discussion – thank you. I’m glad to know I’m not alone in having a problem with generic drugs. Can I find out what pharmacies support American-made generics?

Generics:
Some understand what you are saying. They both contain equal ammounts of the drug. However…. the fillers and releasing agents used in such meds (like Wellbutrin) can be different.
Example – I was on Wellbutrin XL 300mgs for over 2 years and was doing just fine. When I was switched to a generic brand, the release of bupropion was much faster, causing me to have bad reactions to it. I know what you’re thinking… Placebo? I was on the generic for over 4 months. When I couldn’t take the rush of meds being dumped into my system anymore, I tried another generic. I found that this too didn’t help.
My doctor now prescribes brand only for me. I order through Canada. The difference to me, is there.
I will not say that is true for ALL meds. I have been on generics before for other things and it worked just fine. The problem I had with this one was the time release agents being used.
You can believe me, or think I too am a moron. I was just sharing my life experience.

Does the pharmacist know in what country the drug is made? How can I find out the maker of two generic medications?
People’s Pharmacy response: The pharmacist can check on the maker if you ask when the drug is dispensed or right afterward. S/He may not know where the maker is based, but you may be able to find out by looking for the generic maker online.
If several weeks have passed since the prescriptions were filled, it may be difficult for the pharmacist to figure out which maker was used.

I read the People’s Pharmacy column today in my local paper where someone wrote in & said: “I can’t believe so many people complain about generic drugs on your website. Generics are required by law to contain the same active ingredients in the same quantities. I am really disappointed that the People’s Pharmacy offers a forum to uninformed morons who don’t mind paying 700% more for a brand name”
I find it very odd this person calls those who complain about generics “uninformed morons” (perhaps this is “generics” who is posted here?) I am sorry to tell this person but they are the uninformed moron in this case. They should go to the FDA website & read information about generic drug approval requirements as well as the Code of Federal Regulations (CFR Part 314.92 -314.94) to understand what the requirements truly are and the variances allowed.
The costs to bring a drug to market (not to mention the time, usually 7 – 10 years) are high, often well into the triple digit millions. Many studies are conducted for safety & efficacy in both healthy subjects and in patients with the indication the drug is intended for. All of the FDA requirements must be met & are quite strict. After the drug is approved (if it even gets to that stage!), the drug company has 7 years to recover their investment into the development & extensive (expensive) clinical trials of the drug. Then a generic manufacturer can come in, do 1 (ONE!!) clinical study to test ONLY to prove bioequivalency/bioavailability in their version of this drug and request approval. The generic manufacturers DO NOT have to prove safety or efficacy of their generic version of the brand drug, only BE/BA.
While the active pharmaceutical ingredient (API) may have the same chemical formulation, it likely is not manufactured in the exact same manner & specifications as the branded drug (that information stays proprietary to the brand manufacturer), in addition, the inactive ingredients (chemicals used to make that tablet bind together for example) are often not the same & many of those “inactive ingredients” are now being manufactured in countries where the laws governing standards are lax (China, India, etc). Those inactive ingredients often can radically influence the effect of the drug (again, remember! no studies are required for efficacy/safety to get a generic approved).
So bottom line, while you pay less, you do not know if you really are getting EXACTLY the same drug. The generics are not “exactly” the same, they are “identical”; which does not have the same definition.
In addition, when you get your generic drug, it may not be manufactured by the same company each time your prescription is filled. Pharmacies purchase the lowest cost generic available at the time they are placing their orders, that means you might get your generic manufactured by Generic Company 1 and have no problems but then you get your next refill now it is coming from Generic Drug Company 2 and suddenly doesn’t work the same.
So my response to the person calling those who question generics is they need to do some research before calling others “uninformed morons”. There are issues with generics and while the Waxman-Hatch Act (Drug Price Competition and Patent Term Restoration Act of 1984) was originally intended to offer fair pricing so no company had a monopoly on a drug & able to sell it at whatever price they chose for as long as they chose (beyond recovering development costs & making a profit… yes, it is ok to make a profit, we are still a capitalist society), it now has been abused and we receive generics with ingredients from who knows where. There needs to be modifications to the CFR to address these issues.
So, “generic”… how would you like to come up with an idea, you create it, you manufacture it, you spend years & lots of money on it, then someone comes along & makes something “identical” but not exactly the same (i.e., doesn’t use the same quality parts/materials that you did), sells it for less, and now everyone is complaining about how you ripped them off all those years making them pay more for your original idea than for the knock off?
Same idea… except these are things we are putting into our body… there needs to be more standards and laws controlling generic drugs.
There is a need for generics, and there are many generic manufacturers that comply with all GMP & GLP requirements, but as noted in earlier posts, there are many that do not. The FDA does not have the staff to audit every facility as often as should be done not to mention any overseas manufacturing facilities. People make nasty comments about “greedy Big Pharma”… well generics are right up there too!! Do not think for one minute that the generic manufacturers are making them “out of the goodness of their hearts”!! HA!! They cut corners to cut costs (and thus sell more) and it is the consumer who suffers… in the case of drugs, that would be you & me!! No one is without blame in the issue of pharmaceutical drugs.

Something not mentioned above is that generic drugs are only required to be 80% efficacious, not 100% .
People’s Pharmacy response: The requirement applies not to efficacity, but to “bioequivalence”–the amount of drug that gets into the bloodstream has to be between 80 and 125 % of the stated amount, subject to a lot of statistical qualifications. That also applies to brand-name drugs, but most brand-name companies have quality control measures that don’t allow so much variability. It is actually pretty complicated.
Generic drugs are assumed to be just as effective as their brand name counterparts, but that might be a whole lot less than 100 %.

Wow, now there is an example of someone not paying attention to what is being written, and who has a scary high opinion of themselves and their assumptions.
But back to the subject:
I proudly pay for my subscription to Consumer Lab. The company was apparently started by a doctor who got sick and tired of the lack of regulation and oversight for herbal drugs in America. Thanks to their testing, I feel I can successfully stay away from the supplements that have lead/mercury/etc or do not contain what their labels claim they contain.
I don’t suppose there’s a doctor (or pharmacist) out there who is sick of the lack of oversight of the prescription drugs out there and wants to start a similar company testing brand names and generics? If you do at least a decent job, I will happily pay a reasonable yearly subscription fee.

Wow, there is so much idiocy in the comments here. What do you morons not understand about generics being required by law to contain the EXACT SAME ACTIVE INGREDIENTS AND BE ADMINISTERED IN THE EXACT SAME WAY, AND TIME FRAME?
I can’t wait until the day when you morons realize that you’ve been overpaying for drugs by up to 1000% in some cases just for the brand name. That’s all your buying….THE BRAND..

Sorry, but you’re wrong. They are the same. You carry this silly idea that generics are inferior just like 95% of the other morons who gladly pay 700% more for the same drug.

I have had problems with generics, the same medication made by different manufactors. I have had problems from one brand but when I go for a refill and given a different brand I shape and color I am told that I is the same medication but the effect from the different brands hasent been the same. I am talking about generics mfg. Also I you find a generic that works, why is it that when it is time for a refill the pharmacy dont carry it anymore wont order it and can not find it at any other pharmacy. talked to the company that make the medication was told by them that the medication is still being made and that I should be able to get it, there is no back up orders. there need to be a solution to this problem. it you have a medication that works with no problem you should be able to continue to buy it. How can I find which pharmacy that carry a certain generic brand. Help!’

some people are allergic to the fillers… which are different.

Just heard the same thing for the generic/name brand being the same via one of the big mail order prescription distribution centers. The difference in price is considerable. It’s not for most drugs but there are a handful that the generic and name brand are the identical pill.

PEOPLE’S PHARMACY-PLEASE ANSWER!!!
My problem IS NOT Brand vs. Generic, but Generic vs. Generic. I have severe back and knee pain. When I refilled my pain med about 4 months ago, I noticed it was from a different Manufactuer. I didn’t think anything of it. After I took it I became extremely sleepy.(never happened before).Also it only helped my pain a little, about 10%. My other Generic helped about 75-80%. Big difference. I called my Pharmacist(known 16Yrs.)
He said he was having trouble getting Med from other Co. but would keep trying. I have heard about shortages of Generic Meds, caused by the Drug Companies themselves, and it’s all about money. People are suffering because of the
policies of the Insurance and Drug Co. Is there anything I can do??? I can’t change pain med because others have side effects.
PLEASE ANSWER!!! Thank You!
PEOPLE’S PHARMACY RESPONSE:
We have heard similar stories many times. Although the FDA insists that all generic drugs are identical to the brand name, we have our doubts. Since the FDA cannot inspect all the manufacturing plants abroad (where so many generic drugs are made) we have no way of knowing what is going on in some of those Chinese and Indian chemistry plants.
Botton line: people report changes when they are switched from one generic manufacturer to another. We suspect that there are differences that account for the clinical outcomes. When you find a generic that works, ask the pharmacy to stick with it for you!

Here’s a good one – I started on a medication ordered by my MD and because I requested brand name only from the pharmacy, I was told to go some place else for medication. Not that the pharmacy could not acquire the brand name, they just did not want to. I recall the days when a consumer was given the choice prior to being filled.

CPMT— did you ever stop to think that all GENERIC drugs were BRAND NAME drugs until the patent time ran out and then they magically became GENERIC DRUGS at a 1/10 of the cost!!!!!

SOME PEOPLE (LIKE ME) can’t take generic drugs.

I was switched from one generic brand of ranitidine to another cheaper for the pharmacy brand, I noticed side effects, reflux, acidity that I was unfamiliar with, I called the pharmacy and they told me they had been having problems with that brand and then tried to get me some of the previous stuff even went as far as calling a competitor for it, told me to maybe get a different prescription from doctor, as they cannot get previous brand anymore, I wasn’t expecting that response I was expecting them to tell me that there was nothing wrong with drug and maybe I had an ulcer or something like that, so there is a difference between generic brands and they don’t seem to care about my health only making money.

I am another person who cannot take generics. I have tried, over the last 5 years to go generic for my meds. I have had a rash and welts on my body for 5 years. I took name brand (same brand) blood pressure and cholesterol meds for about 10 years with no problem. When these same drugs went generic my insurance company automatically switched me to generic. That’s when my problems started.
I actually went off all of my meds for one month and all rash and welts disappeared. But that could have been disastrous. Also, I did take generic acid reflux meds for 6 months with no problem. When I renewed the 3rd time, I got a roaring red rash all over my body and switched back to Nexium. So they can’t tell me they are identical.
I can’t afford the blood pressure meds on my own and my insurance doesn’t carry them anymore in their formulary. I’ve switched to another brand blood pressure med, that my doctor gave me samples for and my insurance covers. I’ve been on it for a week so far and no change yet. But, I know it takes longer than a week so I’ll wait and see. But it sure does get to be a challenge.
I also wonder about the generics that are made in other countries like China and wonder, since they are not checked by the FDA. Could it be something like the dog food problem we had awhile ago? Who knows.

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