When I stay in France for long periods of time, inevitably I find that I have forgotten a medication I need. There, you rarely need prescriptions for the medications we get here. You just go to a pharmacy and tell them what you need. Of course, it is always a generic, and you have no idea what is in it. That seems disturbing, but are things really any different here at home?
We’ve all heard it when we pick up medications at the pharmacy; “get the generic, it costs less and is JUST THE SAME as the name brand”. Then, sometime later, your “same” medication will appear different again—different color, different shape, different size, etc. However, you are told that there is no need for concern, it is THE SAME medication, only from a different manufacturer. Sometimes, you may not feel quite the same while taking it, or it may not have the same effect. But, since you have been assured that it is THE SAME, you probably think you are imagining it. In fact, it is likely that you are not.
I recently moved here from Florida, where I spent decades as a state licensed medical risk manager. This meant that I was licensed to determine the appropriateness of physicians’ and hospitals’ treatments, office procedures, and medication protocols. I have performed drug studies for patient groups in physicians’ offices to determine the side effects of certain medications as compared with others, including brand vs. generics. I also was responsible for starting an in-office pharmacy that had to be overseen and licensed by the state. It provided me with a great deal of insight into generics, their effects, side effects, and the astonishing difference in profit to the pharmacy.
When a name brand medication’s patent runs out, it opens the door to generics. The name brand medications had to go through a rigorous research, development and testing process to earn FDA approval. The name brand drug usually has a generic scientific name in addition to its manufacturer-assigned name. Because the name brand has already gone through the approval and R & D, generics are not under that obligation. It is ASSUMED that, since they must use the same ACTIVE CHEMICAL INGREDIENT, the medication is ESSENTIALLY the same.
However, there are many things that can make the various generic versions of the medication act differently. Many of these are the reasons that generics usually cost considerably less than the manufacturer’s name brand. For instance, beginning with the exterior of the medication, the generic may have a chalky surface while the brand had a more sealed, coated surface. This can mean that the unsealed generic drug begins dissolving as soon as it meets the moist surface of your mouth, tongue or throat. Depending on the ingredients, this can be rough on those areas. Also, it may even dissolve completely before it ever reaches your stomach. Whereas the name brand coated its tablets so that it would not dissolve before reaching the stomach, the generic may have no such coating or protection for the esophagus. It could also mean that will inhibit the absorption and effect of the medication, as not all of it reaches the stomach, where it is intended to be dissolved and absorbed.
You can see this on some of the “purest” of the generics—aspirin. While a name brand might have an enteric or hard coating on the tablet, a very inexpensive generic will essentially not coat the tablet at all, leaving the chalky tablet to dissolve on the way to your stomach. This can cause irritation to the lining of the esophagus, and occasional ulceration.
Just because the ACTIVE INGREDIENT is essentially the same (within certain guidelines), does not mean that the INACTIVE INGREDIENTS of the medication are required to be the same in generics. These inactive ingredients do not tend to be regulated, and can make the difference in how a medication is absorbed, how quickly it works, and cause certain side effects resulting from the different choices of inactive ingredients. It stands to reason that in order to make the generic medications so inexpensively, their “non-essential” ingredients will vary greatly depending on the source and costs. Many large pharmacies continually change their suppliers for generic drugs based on the supplier with the lowest cost. This accounts for the changes you may notice in your generic medications from time to time. And, of course, the pharmacy will always say it is THE SAME, but that is often not the case.
An interesting experiment for anyone to undertake is to compare the INACTIVE ingredients in the generic for Benadryl, a common antihistamine that most everyone uses at some time or other. First, look at the inactive ingredients listed in the brand name Benadryl package, and make note of the generic name of the active ingredient. Then compare the inactive ingredients to various sources of generic Benadryl. When I did this, I compared the generics in local pharmacies, supermarkets, and warehouse stores such as Costco and Sam’s Club. I found the inactive ingredients in each varied greatly from each other. I then looked up the cryptic-sounding inactive ingredients in each, and found some very disturbing things. Aside from concerns such as the dyes used in each, the “filler” ingredients in some were alarming to me. When I looked up the ingredients in a supermarket’s own label of generic Benadryl, I found an ingredient that generally comes from China, and is used as a filler in any number of non-medical things, such as industrial uses, toys, types of wood, etc. Further investigation revealed it is not recommended for human consumption and could cause disease. One was classified as a type of tar, another had a type of silicone, another a type of vinyl. These “fillers” are used in Asia as a plastic fiber-filler for paper products, plywood, laundry detergents, glue, and putty—even reinforcement for concrete! And this was just in one of the oldest and most widely used and trusted antihistamines, commonly given to children.
So, it stands to reason that the same is done with prescription medications. The “filler” inactive ingredients are generally overlooked, but can be very important to the delivery system and resulting effectiveness of the medication. The way the active ingredient is released into your system depends on the inactive ingredients used. If the active ingredient is released too quickly or too slowly, it can affect the way you react to the medication and its effectiveness. This is particularly true of extended release medications, as the way they are gradually released is imperative to the proper sustained amount of the drug in your system. Less effective release systems may allow unequal amounts released at different intervals causing instability and the body to react differently.
This is sometimes why many name brand medication tablets are scored for easy breaking in two or more equal pieces. When they are scored, it usually means that it will not disturb the extended release system’s effectiveness. If you break an unscored generic tablet, you may get unequal doses and side effects from disturbing its delivery system.
When a pharmacy employee tells you that a generic is JUST THE SAME as the name brand, it is almost always inaccurate. Only the active ingredient is the same, and even pharmacy employees are rarely aware of the inactive ingredients or how they can adversely affect you. There is usually no verification system to determine the quality of generic drugs, as a high percentage of the generics themselves, as well as the ingredients for other generics come from China or India, and are not supervised or inspected by their own governments or our FDA. The FDA likewise does not have the resources to inspect imported drugs. And, even if the generic says it is made in the US, its ingredients may come from China or India with the same lack of quality control. In some cases, the packaging and/or storage of the medication may be unsuitable, leading to contamination or degradation of the medication.
As much as I would love to stay with all name brand medications because of what I know about generics, insurance companies usually will try to force you into generics because of the lower cost. Unless a physician tells them the brand is medically necessary, they won’t pay for the brand, in many cases. And, even if they do “cover” it, it will likely be at a much higher cost to you. I have accepted generics in several cases out of a cost concern. I have also encountered some pretty horrible side effects from the generics (or just some manufacturers of the generics) that I did not experience on the name brand.
One of my first experiences was when a pharmacy switched one of my husband’s medications, again assuring him it was THE SAME. It looked like the same generic he had been taking. But, when a serious condition necessitated a visit to the Mayo Clinic, the physician there was very clear to say that it wasn’t even a generic for the medication he had been taking, but another medication altogether. And there was only a single letter different in the name of the medication, so that most people would not even notice. When we researched this medication as compared to the others and even that generic, we found a host of disagreeable side effects experienced by patients who had likewise found out the differences the hard way, on online forums. Many experienced depression and weight gain, as well as other adverse effects.
I had been successfully taking a generic medication before moving here, but when I had the prescription filled here, the generic was from another manufacturer and gave me debilitating stomach cramps. I asked that they get the same manufacturer’s generic in, but they said they only order in bulk, and whatever the going manufacturer is what is available.
From running a pharmacy myself, I know this translates into which generic costs less. Pharmacies tend to “push” generics on you because that is where their profit is. And the profits can be astronomical. For instance, in the pharmacy I started, I carried the name brand medication for the practice’s specialty, but also carried the generic for people who wanted to pay less. The brand offered very little profit for us, but the generic would offer exponential profit. If a name brand cost us $18, we could only charge about $20 to be competitive; but the generic could cost as little as $1, and we could charge at least $12, making a huge profit for us, and making the patient happy with the lower cost. Generics are hugely profitable to pharmacies. However, many drug studies I conducted showed markedly poorer results in patients on the generics, and more side effects. But it was often hard to lure patients away from the lower cost of the generics, even to their own detriment.
My most recent and life changing experience with brand vs. generic was when I began getting chronic, vicious, and seemingly out of control migraines, when I had previously only had them a few times a year. I began having them daily, and often several times a day. I spent a fortune on migraine medications which, depending on the generic, either had awful side effects, were ineffective, or caused rebound migraines. I began scrutinizing my other medications, especially the generics, since they were the only ones that had changed. I kept a migraine diary, so I knew precisely when the migraines started. I cross-referenced my medications, and was surprised to see that I had not caught the pharmacy’s switch of one of my meds to generic at about the time the migraines began. The names were similar, and I overlooked it. The pills actually looked the same; same shape, same size and same color. I was never informed that they switched me to a generic. I researched and found that a growing number of patients complained online about their awful headaches when they were switched to the generic. I asked the pharmacist not only to switch me back to the name brand, but also to inform me if they considered a switch in the future. I had spent almost 2 years in agony, and a fortune on doctors and other medications. But, when I switched back to the name brand, the migraines all but disappeared. I could reclaim my life!
Another incidental shock I received when I was reviewing the generics I am taking, was with a statin prescribed by a physician. When I researched the generic I was taking, the forum participants again complained of headaches and dizziness. I called my doctor asking for a change, and she was surprised to learn that I was taking the generic I had, as she said it is the generic of an entirely different kind of statin than she had prescribed. Another time, I even caught a prescription that was deemed “name brand medically necessary” filled with a generic.
As part of my research, I read an article written by a doctor for the Harvard Health Newsletter in answer to whether the generic would be the same as the name brand. He acknowledged that the generic is supposed to contain the “same chemical” as the name brand, and that the FDA is legally required to determine that generics are “bioequivalent”; but conceded that generics are generally made in other countries where “mistakes” can be made, and, although the FDA is supposed to regulate all drugs sold in the US, it does not have the budget required to oversee this.
Aside from being frightening, this should make everyone aware and become a diligent participant in their own medical care, including reviewing and supervising medications. Know what you are taking, and know what the typical side effects are. If you are issued a different generic from the pharmacy that claims it is THE SAME, ask where it was manufactured and be suspicious of any new ills or side effects that you would ordinarily think just coincidental. Also, the inactive ingredients are NOT listed on the pharmacy’s prescription bottle, so you can ask to see their main bulk packaging to find out what the inactive ingredients are. Or, sometimes you can look it up on the internet if you know the manufacturer, which is usually on your prescription bottle label.
Generics are NOT the same as the name brand; they just are required to contain the same active ingredient. And, there may be a huge disparity among generics with the same active ingredient, some of which may cause you side effects or harm not experienced with the name brand. Sometimes it may be a choice between health and cost; but check around with different pharmacies. If you are lucky, you may find one knowledgeable about their generics, and unwilling to sell them solely based on cost.