I received a question from a reader about generic drugs… Our generic/brand naming system for medications can be confusing, so I thought I’d try to explain it from a pharmacist’s point of view. All drugs have a generic name (the name of the actual drug) and a brand name (the name given by a particular manufacturer of the drug.) Sometimes the generic name is part of the brand name that the company uses to make it more obvious what the active ingredient is in the product.
Here's how it works...
The first company to market a drug generally applies for a patent on their new drug to prevent other companies from selling it for a defined number of years. This gives the company time to recover the costs of developing the product by controlling the price and being the only source of the medication. The price of a new drug is not just based on what’s in the pill – it also includes the cost of the experiments and testing that were required to invent the drug, to ensure it was safe and to make sure that it actually worked. Governments generally limit the number of years through legislation because they know the price will drop once the patent expires.
Once the patent expires, other companies can begin to sell their version of the medication. These other companies only need to show that their version contains the right amount of the right drug, and that it’s absorbed and distributed throughout a person’s body in the same way as the original version. This means they have far fewer expenses than the original manufacturer because the drug itself has already been shown to work. We refer to these subsequent brands as “generic equivalents” or “generics”, as these products contain the same drug (known by its identical generic name) and are considered equivalent to the original brand by governments and drug plans.
Of course, this increased competition tends to lower prices. I’ve noticed the price drops some when the first generic version hits the market, but then there’s another (sometimes larger) drop when a third brand becomes available. As a pharmacist, it was a bit of a balancing act to avoid having too much on the shelf at first, knowing its value would decrease soon. The original manufacturer, of course, must ensure they recoup their development costs before other versions are allowed on the market.
Ultra-generics and Authorized generics
There’s another somewhat odd situation that sometimes occurs. In some cases, the original brand name company will make its own generic equivalent and sell it at the lower price, while still making their original brand at its original price. Usually these are a completely identical product (including the non-drug ingredients and how the tablet is made) but sold through a separate branch of the company, under a different brand name and with different markings on the tablet or capsule. We call these “ultra generics” in Canada and I believe they are called “authorized generics” in the US. It seems strange to me that they wouldn’t just lower the price of their original brand to compete – and occasionally they do – but often they must have enough people willing to pay the extra cost of the original brand to make it worthwhile to keep manufacturing both.
Once in a while, a company will decide that it’s not feasible to continue manufacturing the original brand any longer, and it will be discontinued. This is what happened to the original brand of the blood thinner, warfarin, called Coumadin. Most doctors ordered the medication by its generic name, warfarin, so pharmacies could dispense any brand unless the doctor specified the more expensive Coumadin brand. However, when I did some relief work in the north of our province, I was surprised to find that doctors there still ordered it as Coumadin even though the brand had been discontinued years before. I couldn’t help thinking this must make it difficult for patients and new pharmacists – requiring them to learn, not only brand and generic names of drug, but brands that have been discontinued years before and wouldn’t be found in current drug references!
Non-drug examples
A non-drug example of generics might be Kleenex…many people (me included!) refer to our facial tissues as Kleenex, even when they’re a different brand…essentially a generic equivalent. We go “Skidooing” even if it’s on an Artic Cat or Polaris. But we always call other products, like Robin Hood flour for example, by their “generic” name. Interestingly, people are often willing to pay more for Robin Hood brand, though, probably because it’s perceived to be better (more expensive must mean better quality, right?). Whether it is or not, it’s hard to say… my bread and pies seem to turn out the same whatever flour I use!
Occasionally there are problems...
However, this double naming brand/generic system can sometimes create problems in communication between doctors and patients when the different names are used. For example, I once had a patient whose doctor told them to double their dose of Lasix (generic name furosemide). At home, his prescription bottles were labelled as Apo-Furosemide (furosemide) and Lanoxin (digoxin). Remembering the drug the doctor was talking about began with the letter “L”, he increased the dose of Lanoxin by mistake. Not only did he not get the drug action he needed, he developed a toxic reaction to his now overdosed Lanoxin. This is one reason we suggest bringing a list of your medication with you to all appointments, and that all medication changes should be written out by your doctor or nurse practitioner.
There is a trend, mainly promoted by hospitals who see the results of problems like this, to encourage everyone to use generic drug names all the time. Unfortunately, brand names are often simpler to pronounce and remember, so this can be difficult for many patients. But the more generic names are used, the more familiar they become.
Watch the suffix - the end of the name
The other interesting advantage to generic names, is that they usually have the same ending if they are in the same drug family. For example, beta blocker drugs (used for high blood pressure and to slow the heart rate) end with “-olol”. So, acebutolol, metoprolol, and labetolol are all beta blockers. Examples of other name endings are “-cillin” for antibiotics similar to penicillin, “-profen” for anti-inflammatories, “-vir” for antivirals, “-azepam” for the benzodiazepine tranquilizers (diazepam, oxazepam) and “-mab” for drugs to treat auto-immune diseases like rheumatoid arthritis and multiple sclerosis. You should never be taking 2 “-profens” or 2 “-azepams” as this would be a duplicate therapy that would increase your risk of side effects. There are a few exceptions to this naming rule however – one is triazolam, a benzodiazepine which ends with “-azolam” instead of “-azepam” – but it’s close.
Do generics work as well as the "brand"?
Finally, one question pharmacists are often asked is, are generics as good as the brand? In the vast majority of cases, the answer is yes. They contain the same medication in the same strength and are tested to make sure they are absorbed and circulated in the body the same way before they are approved. Essentially, they are the same thing, just made by a different company, and still a high quality product that has been approved by drug regulators.
Governments do allow a small percentage difference in the amount that is measured in the blood, but generally this difference is too small to make any difference in the overall effect of the treatment. A possible exception is with drugs that have a “narrow therapeutic range”. This means that the difference between a blood level that doesn’t work, and one that is too high and causes problems, is not very large. Two common examples of drugs with narrow therapeutic ranges are warfarin and the thyroid replacement, levothyroxine.
People taking either of these drugs need to have blood tests regularly to make sure the amount of drug is in the correct range. If the brand you are taking is changed, it is advised to have extra tests shortly after the change to make sure the new formulation is still providing the correct amount of medication. Tell your doctor if you have changed brands of warfarin or levothyroxine and ask him/her about verifying your blood level of drug.
Very rarely, people will report a change in how they feel after changing the brand of medication they take. In all my years as a pharmacist, I have only seen this happen once. Doctors have channels to report drug problems and, when a problem is identified, the government acts quickly to investigate and remedy the situation. That company's product is usually either removed from the market or made non-interchangeable with other brands.
Overall, generic equivalent medications have saved millions of dollars, allowing free market competition to do what it does best!
I hope this helps your understanding of the system of generic drug substitution. Generic equivalent medications are safe and help to keep drug costs under control, even if the system seems confusing sometimes.
Remember that any time you have a question about your medication your pharmacist is always happy to help!
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