Generics = sickmaking, not brand?

In the course of doing my crappy job, pretending to help people with the new Medicare prescription drug plans, I hear frequently from callers that they are unable to take the generic form of some drug or another because it makes them sick, where the brand doesn’t. This doesn’t make a lot of sense to me, since the idea behind generics was that they were chemically identical to the brand name drug. The only thing that occured to me was that the non-drug filler portion of the pill would make them sick, but that doesn’t make a lot of sense either. One would think that the generic manufacturer would use the same filler as the brand manufacturer, or if not, some chemically innocuous substance. Why would a generic make someone sick if the brand doesn’t?

One legitimate reason is like you say, part of the non-drug portion bothers the patient. I had a job not too different from yours once, and there was an instance where a woman was allergic to the dye used in the generic. This was a pretty serious, obvious allergic reaction. In that case, the insurance company was able to cover the regular drug at the generic price, with the proper documentation from the doctor.

One common filler in prescription drugs is lactose, which bothers some people. Maybe in some cases that could be used in the generic when something else is used in the brand name?

Also, some drugs have controlled-release formulas that are not available as generics. If the patient went from that to a generic that was immediate release, they might notice side effects. In that case they aren’t really the exact same drugs, but the patient might not understand that.

Could part of it also be placebo? An aversion to taking the “poor” version of the drug perhaps? Maybe I’m just cynical.

My understanding is that at least some generics are not chemically identical to the branded (and patented) drug. They are similar, supposedly similar enough to act the same way, but not precisely the same. I believe that sometimes when physicians specify a particular brand it’s because they do not trust a generic version to do the job just right.

I don’t understand how this is possible. If the generic wasn’t the same as the brand name, how could both substances share the same name?

(Here is how it works, for people who just got completely confused: Each drug has three names: the chemical name, the generic name, and the brand name(s). The chemical name is usually too long and hard to pronounce to ever use outside of a chemistry lab, but it uniquely identifies the molecular structure of the active ingredient. The generic name is what people use when they describe the drug in settings where using a specific brand name might not be the best idea, or when they don’t want a brand name drug. A brand name is what a specific product is marketed as. A drug may have more than one brand name if multiple companies are marketing the same thing.)

What is the incentive for making a generic exactly the same as the name brand?

I contend with the growth of generic drug programs where people are forced to buy generics (or pay the full tab themselves) there is a forced market for them and it doesn’t really matter if they work all that well.

It’s the same substance, and therefore the same treatment power, at a reduced cost to the consumer.

I disagree. People have been buying store brand ibuprofen and aspirin (hasn’t been a trade name for decades) for decades now, and they have worked well for the same things Advil and Bayer Aspirin work for.

But this is marginally off-topic, and GQ isn’t the place to debate the use of generic drugs.

Then why is there a place on the prescription slip where the doctor can check a box that says “ok to substitute generic” (or something similar)? I don’t think I’ve ever had a prescription that didn’t have that box checked.

The box says just the opposite: the physician must initial it if the generic is not to be given. Otherwise, by law, the generic equivalent must be dispensed in order to save the customer money.

This obviously assumes that the generic is the identical drug as the brand name. It should be in all legitimate cases. However, as Harriet says, the fillers and dyes can differ and these can in rare cases cause problems. The box gives the prescribing physician an out to “fill as directed.”

My hunch is that most people who complain don’t trust generics (for any of a million reasons) and a powerful placebo effect takes place. Or maybe they simply lie because they believe the brand name is better and they feel cheated or unsafe with the generic.

But I would need lots of proof that legitimate firms make generics whose active ingredient are in any way different from the brand name.

I take a daily medication. One brand of generic gives me heartburn and another does not. The name-brand medication does not. All three types have vastly different flavors and coating types. That IMO, but I think it’s relevant.

There was a news story a few years ago tha suggested that generics truly were not being manufactured correctly and were inferior. Lemme go look for it.

My guess–and that of my parents, both retired medical professionals–is that generics are not always manufactured at the same standards as brand-names. Just like many Old Navy and Gap products are the same, but the sizing and work of the Old Navy products is not as precise and accurate as that of Gap.

For many sledgehammer-style drugs (antibiotics, painkillers), this may make little difference. But for more delicate drugs that affect hormones or neurotransmitters, the differences are often noticeable. My father, whose Parkinson’s medication is very carefully timed and monitored, notices a significant difference in effectiveness with generics, and can’t take them. My mother, too, has had problems with generics, only with her thyroid meds.

It’s always been explained to me that the difference is in the coating - the drug patent is up for duplication but not the coating. That’s why, like in Apricot’s case, the generic can’t be use because the coating gives him/her heartburn. I dated a guy who had to use the brand name of his epilepsy drugs because the coating didn’t agree with his stomach.

The coating also makes a difference in the time release, i believe. The name brand drug will take effect after X mins but the generic after Y, and the doctor won’t want the effects of the Y time.

When I buy OTC stuff I compare both active and inactive ingredients. The inactive ingredients are indicative of the coating.

FWIW, I knew an epilectic who told me that they had to have the name brand seizure medicines, not the generic versions. They said that the generic versions didn’t work for them, and that this was not uncommon with epilectics. This was back in the late 80s, so the knowledge base may have expanded beyond this idea. Another thing, sometimes the generic version comes in lower or higher dosages, and maybe the person needs a different dose. Maybe they need a version of the medicine that only comes in the non-generic form, for example maybe they need Clariten D, not just Clariten? (I don’t know if they put out generic Clariten D now or not, but the example of antihistamine versus antihistamine/decongestant is a decent one to show what I’m getting at.) Also, sometimes the flavorings are different as well, and that might cause problems.

Another factor in the non-active fillers and coatings can be the presence of glutens or wheat products. A person with celiac disease can have serious problems with taking a product that contains an unidentified “starch.” Friend of mine can only take certain brands of meds because of this.

Actually, it wasn’t quite that simple.
The brand name pills I used to take were divalproex sodium in tablet form with a buffer. That made them the pill referred to by brand name as Depakote. I could take those on an empty stomach, full stomach, whatever. No problem.
There is no generic drug delivering divalproex sodium. Nada. Zero. Zilch.
Insurance companies nonetheless tend to herd you towards the generic drugs containing the “same” chemistry, which are clones of a medicine called Depakene. The active ingredient appears to be valproic acid and it is delivered in little gelcap things. No buffer in those that I was ever able to detect.
Folks, generic valproic acid medications will kick you in the guts, turn you over and beat you in your kidneys.
I generally have a fairly robust digestive system if I avoid the two or three food allergies and intolerances I have. Nonetheless, when I tried taking off-brand Depakene with small snacks, medium-sized meals and big meals it still doubled me over with stomach pain. Empty stomach, soda, glass of water, whatever. Same effect.
So, I switched over to Depakote and life was much better. I later went to Depakote ER (extended release).
Incidentally, if you’re reading this and on Depakote, I suggest consulting your physician about trying the extended release format of the drug. Simplifies your life and with less frequent dosing, increases your compliance and does a better job of helping you suppress whatever disease you were actually taking the pills for to begin with.

I had problems with generic birth control pills, so I won’t use them anymore. (No, I didn’t get pregnant, but the mood swings…egad.) Generic antibiotics or something, sure, though samples from the doc are even better…

This is my experence as well. Could it be a placebo effect, perahps, but with general pain killers and antibiotics generic vs brand doesn’t seem to make a difference. I always wanted to try to have my SO give me either the brand or generic w/o telling me which one was which and see if I could tell.