I understand that some physicians prefer to presecribe some brand name medications over their generic equivalents because for some reasons, the brand name meds seem to perform better than the generics. I’ve never understood why that would be, but if it’s so, then it would stand to reason that it’s also possible for generics to perform BETTER than brand name meds, isn’t it? In other words, if there is a difference between generics and brand name medications, why should that difference ALWAYS favor the brand name? Are there any cases where that’s not the case? Qadgop? Chief Pedant? Anyone?
yeah, they perform better all right.
by having hot drug reps come by every fortnight and line his pockets with generosity.
I would respond by suggesting that, short a placebo effect, drugs are drugs. I highly doubt the inert binders they use (and are different between manufacturers) have any bearing on the efficacy of the drug.
There may be placebo effect benefits, which would always favor the “brand” over the generic.
Generics need to prove that they perform statistically the same as brand name drugs. They need to yield doses in similar time frames, degrade similarly/pass same stability requirements, have statistically similar results at all levels of clinical testing, have the same (or fewer) side effects with statistically similar occurrences, etc. In short, they need to be exactly the same as the brand name in all but colour and name (and part of the testing indirectly proves that changing the colour doesn’t cause effects with the dyes, and even things like friability testing shows that any different scoring/stamping doesn’t make the tablet break).
Any difference observed by individuals is either due to some level of placebo effect, or simply an individual lying outside the normal reaction range (one person is a terrible statistical model!) Or the influence of marketing.
Sorry for the double post, but I wanted to address this specifically and type too slowly for the edit window!
The inert ingredients (the excipients) in a drug don’t so much vary by manufacturer, but rather by drug product. Taking, for example, a drug with 28% lactose vs 30% vs 33% may actually alter the performance of the drug in certain testing or in the organism. I once worked on a product with 7 different formulations (recipes) - they all had 25mg of active product, but the remaining ingredients changed in relative proportion (same set of 5-6 excipients, different ratios). The work I did was mostly on the dissolution profiles, and they were significantly different, especially in the amount of time it took to get to 100% dose release (varied from about 3 minutes to more than 15).
Part of designing a drug product involves testing the active product with each possible and likely excipient, to make sure there are no unwanted reactions and that the drug is stable over a reasonable amount of time. Then formulations are developed, and each combo is studied and eventually one or two make it to testing, and if it gets to market, the best single one is selected. That same product I mentioned above had degradation issues when there was too much magnesium sulfate in the mix.
So really, the inert ingredients are selected as a function of the drug product, and the generic and brand name company could very well end up with the same ingredient list and even in the same proportion. Reverse engineering the tablet/cream/ointment/injection/ophthalmic/suppository/whatever is the easy part of making generics!
In case it matters, I’m about 3 years out from having worked for 4 years as a chemist in a pharmaceutical lab - analytical testing on new drugs, and then about a year at a generics company (quality control).
It is my experience that at least one generic brand – on two different meds – does not perform as well. I looked up the company and they had been cited numerous times for not having consistent dosage in their product. In one instance the company’s right to distribute the generic was challenged because the processing method used, while cheaper, was alleged to result in a slightly different composition. Sorry, I don’t remember the details, but it was a manufacturing method, not just the filler. Other generic brands of the same stuff worked adequately.
Also, the fillers CAN make a difference for some people. Those with celiac disease, for example, must have a version that has no wheat starch in them.
so … sort of along the same vein -
I take clonidine .3 mg in pill form. We tried me on the patch version, same dosage but over the course of the 7 days not one single day after the 3d day [according to the paperwork it takes 3 days to suck out the actual dosage] did I actually manage to get a theraputic dose out of the patch at all … but if I pop the single pill, voila!
WTF? How can a patch not work? I thought that it was some magic chemical that slurps the meds through the skin - am I really chemical proof?
There are minor differences in the way the law regarding generics is put into place in some states.
For instance in Illinois, the law requires that each generic drug that is substituted must perform the exact same way as the name brand. But a presecribe generic must perform in similar but not exact fashion.
For instance, if my doctor writes out a prescription for Valium and checks “may substitute,” on the prescription pad, that generic substitution must perform exactly as the generic does.
BUT if the doctor wrote the prescription for diazepam, (the generic for of the drug Valium) that drug must perform similarly to Valium.
I don’t know exactly or if it makes any difference, but it does come up from time to time.
How did they determine that you didn’t get a therapeutic dose? I ask because I take it too, but I use the patch. Now you’ve got me wondering.
I take the clonidine patch too. Interestingly, it is a drug I can say that the brand name is better than the generic. The brand (Catapres) is about postage stamp sized. The generic I got is almost twice as big and falls off easily.
Doctors usually prescribe the brand name over the generics for the same reason people call ibuprofen “Advil” or ask for a Kleenex when they’ll take any tissue. Habit.
The major drug companies tell doctors about their medications, and the doctors know those names. The drug companies even will give out prescription pads with the medication’s name on it. Doctors get free samples of the medication, and cups and other knick knacks with the name of the med on it. All the doctor remembers is that this particular medication is good for this particular problem.
That’s why most states have substitution rules that state if a doctor prescribes a particular brand of medication, the pharmacist can make a substitution unless the doctor specifies on the prescription pad that no substitution is allowed. The AMA usually supports this type of law because they know most doctors would prescribe the generic if they know the name.
The latest trend is for the major drug companies to make new formulations that are then patented. For example, your medication is in tablet form, make the same medication with quick dissolving tabs and re-patent it. Now, you convince doctors to prescribe the quick dissolving tabs. When the patient takes the script to the pharmacist, there is no generic quick dissolving tab, and thus the pharmacist uses the brand name.
when i drop the pill my diastolic drops from 110 to low 80s, on the patch it did not drop at all.
what i would love to know, and nobody seems to be able to answer me is why cozaar and toprol work on my systolic but do absolutely nothing to my diastolic… i would love to be able to find ONE freaking pill that will do both systolic and diastolic … I am tired of horking down pills by the handsfull
…and what I would love to know is are there any generics that work *better *than the brand names?
I think that the generic store brand bran flakes are better than the kelloggs or general mills brands.
Heh - I thought this was going to be about groceries, too. You know, thinking about it, I’ve been more than willing to try generic food, and I have almost completely gone back to brand names for various reasons - taste, texture, value, etc. I just try to buy everything on sale.
You’d have to get that information directly from a generics company, and I’m pretty sure they aren’t gonna talk. But it doesn’t matter - they aren’t testing their generic competitor to see if it’s better than something that works well (the brand name), they are testing to see that it is the same. And to get approval to be sold, it must be the same.
While a bunch of people will come in with anecdotes about how “this generic didn’t work for me” or whatever, the fact of the matter is a single person is not a statistical representation of the intended drug using population. Hundreds or even thousands of patients are tested for both the brand name and generics and while one patient may have dry mouth and another get more headaches or whatever, when averaged over the entire study, the generics are exactly the same as the brand name. The percentage of people with dry mouth in both studies are statistically the same. The percentage of people with headaches in both studies are statistically the same. The medical benefits are statistically the same. The pharmacokinetics are statistically the same. When you take a generic, you are taking the same medication as the brand name, and on a statistical level they are the same.
While is is true that some people might have to watch out for an excipient in a generic that isn’t in the brand name, I feel the need to point out that had the brand name company simply selected that excipient instead when making their formulations, the same people would have to avoid the brand name too, and perhaps the generic would have ended up as the safer and better one for them. It’s just a recipe and not a measure of the efficacy of the drug itself.
Companies put a lot of effort into finding new dosage forms for the same drug - just look at the range of Tylenol produced by McNeil. They lost the patent on that decades ago, but by constantly changing how the tablets look (or making gel caps or whatever) they can keep the marketing monkeys churning out new reasons for you to go with Tylenol rather than generics. Of course, there are differences between the quick acting and long release formulations, etc, but there are many versions that are the same as previous/concurrent ones but are simply shaped differently.
That is truly strange. Clonidine knocks my systolic down, but does nothing whatsoever to my diastolic, and I use the patch.
What I found in an abstract of an article on comparing generics and brand name meds is this:
"For the purposes of drug approval, the interchangeability of a generic drug and the corresponding brand-name drug is based on the criterion of “essential similarity,” which requires that the generic drug have the same amount and type of active principle, the same route of administration, and the same therapeutic effectiveness as the original drug, as demonstrated by a bioequivalence study. However, bioequivalence and therapeutic effectiveness are not necessarily the same." (Italics mine).
I raised the question after hearing my doctor say that he preferred a brand name med to a generic. The above quote supports my question - if the two formulations are bioeqivalent, and a doctor prefers the brand name because, as he says, it seems to be more effective, then isn’t it also possible that a generic medicine could also wind up - for reasons that have been mentioned in posts above - more effective than a brand name med? And, as I’ve asked, does anyone know of any cases of this?
Everybody is different=) I love some SF novels, they hook someone up to a machine that does something arcane, and they get a custom blend med specific to their metabolism for whatever their problem is.
I would love that!
Or a new body without the health problems
I knew this intellectually, but meeting my husband has really driven it home. I’m sensitive to everything (I can take an aspirin as a sleep aid, I can’t drink alcohol or caffeine), and he’s not affected by anything - painkillers barely make an impression on him, he can ingest huge amounts of caffeine then go straight to bed (and sleep), he can drink copious amounts of alcohol without getting drunk. We’re not even significantly different in size, age, or ethnicity.
Here is an actual example. My wife used to take a drug called losec in Canada and prilosec in the US. It is now OTC in the US, but still on prescription here. At some point, the original version changed from a timed-release capsule to a pill and my wife swears it just didn’t work as well after the change. Then a generic, omeprazole, came out and that is a capsule and she swears it works like losec used to. Of course, this is all anecdotal and I have no idea if it has been studied.
I have a friend who will not take a generic under any circumstances. When I told her the story above, it only hardened her resolve since it only confirmed her feeling that generics are not the same as the proprietary version.