Any truth to what my pharmacist is saying?

Factual Questions
1

I got a prescription for Cefuroxime last week, and when I went to fill it, I saw the brand prescribed (Zocef) was ridicuously expensive. I asked for a cheaper brand with the same strength of cefuroxime, and my pharmacist said this:

To this sounds like complete BS. If I buy cefuroxime 500mg, I get N number of molecules. A brand may contain varying amount of “fillers” but I still get N molecules of cefuroxime, and so each brand must be equally effective.

Is my pharmacist just BSing me? Straight dope please!

2

He is BSing you. There are a few - a very few - drugs where the generics may not be bioequivalent to the brand name, usually time release drugs which release at a different rate than the name brand. This can be of concern for things like anti-depressants and seizure medications. This is not one of them. Generic Ceftin Availability - Drugs.com

3

It really varies. In some cases they are essentially the same. In others the generic is crap. There was a big scandal a few years ago with thyroid hormones where some generics were found to be really poor. (Despite this, many health insurance companies refused to add the name brand to their approved list. You want real medicine? Pay for it yourself.)

The pharmacist has a vested interest in upselling you. Get a less biased opinion on your particular drug.

4

At least in the US, it is law that generic medications are exactly equivalent to their brand name - same molecule, same strength, everything. That’s not optional, and it’s not up to the individual companies. Some more minor details, like coating that make it easier to swallow, are allowed to vary, but not the medication itself.

5

I don’t recall there being a “big scandal”, unless you mean that the general public became aware of an issue that thyroid patients have always known. Certainly it’s true that thyroid hormones are a known exception to the “generics are the same” rule, but it’s one that every doctor, nurse and pharmacist knows and we’re taught to teach our patients to immediately report to all of us if their pills look different than the last refill so we can account for the differences between manufacturers or run a more frequent blood test to check the levels.

Cefuroxime isn’t a thyroid hormone, though.

6

Zocef is manufactured by Alkem Laboratories Ltd., Mumbai, India.

7

Someone ping me when we hear good news about Big Pharma. Every story, large and small, just seems to get more appalling. The arrogance and disregard for patients is breathtaking.

8

One example is Metformin/Glucophage. I have definite side effects on the generic that I don’t have on the brand name. My doctor has seen this before and when I reported significant side effects he switched me to brand name and it’s been good ever since.

The active ingredients are the same by other components can have an effect on how you tolerate the med.

9

Google ‘Pharmacy Reviewer.’ Best message board there is for comparing Internet pharmacy prices, and the legitimacy (or lack thereof) of individual online suppliers. Some of what is discussed there is illegal, but the vast majority of it isn’t; board policies permit both types of discussion. A quick search for your drug showed an offshore supplier charging $0.61 for a 125 mg. tablet. Can’t personally vouch for that particular vendor, so you’ll have to do your own research.

10

You’ll be married, have kids, and see them through college before you’ll ever get that ping. My mother died and left maybe a couple thousand unfilled 'scripts, she lived to 80 smoking a pack a day

To the OP, are you allergic to Penicillin? Did your doctor mention taking a Vitamin C supplement and a serving of protein four times a day along with the medications?

Does your doctor own shares of Alkem Inc?

11

I would have been dead years ago if not for the medications Big Pharma makes and sells to me. I consider that fairly good news, though others may differ.

12

We all would, to differing degrees. But the behavior of the industry, as a whole, has reached levels the mob would find disturbing. It seems to get worse whenever anything that might clamp down on the worst practices is discussed - it becomes a frantic “get it while the getting’s good” mentality.

13

I hear the entire Board should consider that fairly good news: Smeghead is an amazingly wonderful person!

14

Depends. Who makes the generic?

The pharmacist may have meant the manufacturer of the generic has recently found to have fabricated data, or some other problem.

15

We would all be dead, but to differing degrees? Or are you referring to the ‘good news’ that Smeghead has not (yet) shuffled off this mortal coil?

16

I used to believe generic/brand were exactly the same, but they aren’t - nor are they tested to be so. They are required by law to be bio equivalent, but guess what - they aren’t always - and despite for years, and years - well known problems have occurred - most often having to do with time release medications - which is becoming more and more what is being produced due to patenting effects. They can’t protect Ritalin, or Amphetamines anymore - so they add some special coating - some literally containing special holes in them - that are very difficult to reverse engineer.

The FDA and the companies sometimes test -as they did on Wellbutrin - but they did so only at one dose - and guess what - at other doses - the exact same generic versions people were complaining about to “Peoples Pharmacy” were off.

Also bio equivalence doesn’t mean exact. They have a pretty big leeway - about 20% I believe on most drugs (there are some held to a stricter standard).

To me - 80 is not equal to 100.

Also note in that people’s pharmacy editorial half of doctors expressed concerned about the quality of generics in a survey (done by what sounds like a medical journal to me) . A quarter of docs try to avoid them for their own family.

Yes - 25% is in the minority! but these are doctors - this is nothing to be sneezed at - and 50% are “concerned” or whatever the word was.

Now don’t get me wrong - I think the vast majority of stories of generics not working as well are just the same type of stuff you hear about people getting the flu when they got a flu shot.

However - the landscape has changed. Pills aren’t what they used to be. Some of these time released mechanisms are extremely complex. They didn’t exist 10-20 years ago. I am guessing the percentage of people exposed to one of these types of drugs is much, much, much higher than it was when the rules were first written.

I have no problem going into CVS and buying generic Tylenol. There isn’t much to screw up. Maybe I will get 20% less - but my understanding is that 20% is for both brand name and generics - it isn’t that there is a seep rat rule for brand names. It’s just that the brand name using facilities X were able to get approval for that drug - so I think it is more likely to be at the dose the was found “safe and effective”. Especially where coatings come into play.

There have been some cases where generic manufactures have reached agreements with brand names to do their generic for them - as the generics were (in part) having problems reverse engineering the way the pill/injectable/whatever was put together.

Anyway - I have no idea if the drug the OP is talking about is complicated or not - or if their have been complaints or not, but from what I’ve read - more and more docs are believing their patients when they say “generic X” didn’t work for me and are likely to starting writing for the brand name only (if they hear the same from others) when 20 years ago - they would have chalked it up to being in the patients head.

Obviously there isn’t something “magical” about brand names in and of themselves. Some people seem to think there are - and you hear stuff like “well generics don’t work on me”. Obviously those people are kooks, but not everyone who questions generics is.

17

And Big Supplement is run by non-profit seeking saints, right? :rolleyes:

18

But what does this have to do with the OP? Some independent pharmacist says that, in his professional judgement and experience, name-brand drugs are usually better. How on earth does this connect with Big Pharma’s “breathtaking” “arrogance and disregard for patients?” That post is a complete non sequitur.

19

I have to take four fish oil capsules per day. My endocrinologist insists that I take the brand name Lovaza rather than one of the dirt-cheap generics. He says the generics are too unpredictable. My copay is anywhere from $11 to $103 for a month’s supply.

Of all the meds I have to take, this is the only one that’s not generic. My endocrinologist has kept me alive for 18 years, and I’m not about to start doubting his judgment now.

20

I take one med (Paxil) that absolutely MUST be the brand name. For a while it wasn’t available and I tried several generics. One generic was like taking nothing. I finally found one that was almost as good, at an increased dose. It was, of course, the most expensive and difficult to get. My pharmacy had to special-order it sometimes. Then the brand name came back and all returned to normal. I don’t know what the difference between the brands is, but for me they were definitely not equivalent to each other.