Generic Drugs vs. Brand Names

[Spoon]

Dr. David Lipschitz

It always makes sense to go for the generic drug whenever you have a choice.

When it comes to choosing generic drugs over a brand name, American consumers are at a disadvantage. Through savvy marketing campaigns and strategic campaigning by generous pharmaceutical representatives, hundreds of millions of dollars are spent every year to promote the newest medications. Generics are thrown to the wayside -- no marketing, no promotions, nothing. The end result is patients requesting specific brand-name drugs. What's more, many patients insist that the generic simply doesn't work. And when insurance companies refuse to pay for the more expensive therapy, mayhem breaks out.

What's the deal? Is there any difference between generic and brand-name therapies?

Here's the bottom line: In more than 50 years of clinical experience, there is no scientific trial that has ever shown brand-name medications are superior to their generic counterparts.

The Food and Drug Administration requires that the active ingredients be identical. There can be a difference, however. The composition of the pill or the capsule may be different. It may vary in shape, have different fillers or flavoring and possess a different color. But, to fully understand the effect of any differences, the FDA also requires the makers of the generic drug to perform pilot tests to demonstrate that the subject's blood levels of the active ingredient, and the method and rate at which it is cleared from the body must be identical to the brand-name equivalent.

Despite this, many people -- doctors and patients -- refrain from using generic drugs. Detractors of generic medications often complain that the generic pill may be absorbed differently from patient to patient, or that there may be adverse reactions, such as allergies, to an ingredient in the generic drug. Another concern is that the source of the drug may change as one company competes with another to offer their generic at a lower cost.

Recently, Naomi Wax wrote an article in the Los Angeles Times in which she discussed the hidden downside of generic drugs. She has depression, and strongly felt that she responded differently to generic Zoloft, causing her symptoms to worsen. She then found out that many patients, when switched from the brand-name Wellbutrin XL 300 to the generic version of the antidepressant, complained of worsening depression, panic attacks, anxiety and thoughts of suicide.

Wellbutrin XL is a slow-release medication, which means that the drug is gradually released from the tablet over a 24-hour period. Studies by a private laboratory showed that 34 percent of the active ingredient in the generic drug was released in two hours, compared to 8 percent in the brand name. It was postulated that the difference in release was contributing to the symptoms. Wax states that the FDA is investigating this complaint.

While it is possible that a slow-release medication could be different from one pill to another, significant differences between generic and brand-name drugs are extremely rare. And for every one person who complains that the generic is ineffective, millions take it without any adverse reactions.

When it comes to choosing brand-name therapy over generics, many patients see the powerful effect of the mind over the body. If you believe that a medication will not help you, there is a good chance that it won't, and vice versa.

My advice about generic medications is simple: For most medical illnesses, the tried, true and older therapies are often as effective as -- or more effective than -- the new. If a generic medication is available, always insist on using it before trying a brand-name alternative. Because of the difference in costs, generic drugs must always be the first choice.

However, if you switch from a brand name to a generic, keep an open mind and rest assured that it will work. Be positive -- it helps. If the generic does not seem to work, discuss the problem with your pharmacist or doctor. Find out whether others are experiencing similar problems. If you are absolutely convinced that the drug is ineffective, do not count on sympathy from your insurance company. A better alternative will be to work with your physician, who can prescribe an alternate medication that hopefully will be more effective.

Choose generic. Not only can you have confidence in its effectiveness, you will also save money. In the end, differences between the generic and brand-name medications are so minimal that any other approach would be irresponsible.