3 ms·

It's very frustrating. I know people who cannot tolerate some of the fillers and other additives put into some medicines. They end up trying various generic a

It's very frustrating. I know people who cannot tolerate some of the fillers and other additives put into some medicines. They end up trying various generic and non-generic brands until they find one they can use. In most cases, the name brands seem to use better quality ingredients because those are the most likely to be tolerated. It's amazing that the FDA requires an ingredients list on food but not on drugs. Additionally, the manufacturing standards can really vary. If the active ingredient is measured in micrograms and the FDA allows 10% variance, then you can be really screwed if the generic manufacturer is sloppy, while the name brand is manufacturing to tighter than FDA specs. A 10% difference could be the difference between one dose and the next higher dose. Seen this too.

slackingoff2017 9y ago
Almost everything in this comment chain is incorrect. Manufacturers do list all ingredients including fillers and inactive ones. Ask for the "package insert" and the pharmacy will give you the sheet with that info. Also, brand name and generics are tested to the same tolerances. If the generic is allowed 10% margin the brand is too. In fact, sometimes they're made on the same production line. A few years back when generic Protonix came out it was a huge issue, as it was extremely easy to mix up the "brand" and "generic" because they looked identical and came in similar packaging. I remember hearing about pharmacies getting fined for supposedly mixing them up. If there is any chance of a mixup between brand and generic (missing DAW is a common typo) you had to throw them away because there was no way to tell them apart. Something else you overlooked, related to the above, is that "Brand name" companies typically own as least one subsidiary that produces generics. For example, GreenStone is 100% owned by Pfizer, so i have doubts their generic products could be any different. I'm not normally a dick on HN but I don't appreciate people blowing facts out their ass when it relates to common misconceptions. The drug companies want you to believe generics are inferior, and they spend more on marketing than drug research. You should speak to some pharmacists if you want honest opinion on the matter. They're easy enough to talk to and I think you'll find that the vast majority share my opinion.
- briandear 9y ago
  I am going to strongly disagree with you, it seems as if you are guilty of blowing facts “out of your ass,” we the the implication that bioequivalence is the same as therapeutic efficacy. Because that isn’t always true, especially in psychiatric drugs. It could be true in many cases, but it isn’t always true – which means there is sometimes a clinical justification for non-generics. Here’s one study addressing that specific issue: https://www.ncbi.nlm.nih.gov/m/pubmed/12860486/ https://www.ncbi.nlm.nih.gov/m/pubmed/12860486/
- dalacv 9y ago
  Avoid generic drugs if you can. I've got lots of first-hand experience in this matter. It's not a matter of efficacy. It's a matter of quality. That's all I will say.
etrevino 9y ago
Everything is measured very accurately. The 10% variation is in bioequivalence, not in the amount of the active ingredient. For people taking drugs with a narrow therapeutic index, though, that variation is huge.
- briandear 9y ago
  Correct, and bioequivalence is not the same as therapeutic efficacy.
deleted 9y ago
[deleted]
anonmoose123 9y ago
I know a guy with for-real celiac disease. Although the active ingredient may be the same, not all generics are certified as safe for celiacs thanks to the additional padding in the pill. Generics and brand name are NOT always equivalent depending on the drug and condition, and spreading this lie is incredibly dangerous to many people. This is what happens when CEOs, politicians, and pundits are deciding health policies rather than the properly informed health officials. Now if the insurance policy would be that a doctor must write medical necessity for avoiding the generic, go for it. But mandating that people can only take generics will cause harm.

slackingoff2017 9y ago

Almost everything in this comment chain is incorrect. Manufacturers do list all ingredients including fillers and inactive ones. Ask for the "package insert" and the pharmacy will give you the sheet with that info. Also, brand name and generics are tested to the same tolerances. If the generic is allowed 10% margin the brand is too. In fact, sometimes they're made on the same production line. A few years back when generic Protonix came out it was a huge issue, as it was extremely easy to mix up the "brand" and "generic" because they looked identical and came in similar packaging. I remember hearing about pharmacies getting fined for supposedly mixing them up. If there is any chance of a mixup between brand and generic (missing DAW is a common typo) you had to throw them away because there was no way to tell them apart. Something else you overlooked, related to the above, is that "Brand name" companies typically own as least one subsidiary that produces generics. For example, GreenStone is 100% owned by Pfizer, so i have doubts their generic products could be any different. I'm not normally a dick on HN but I don't appreciate people blowing facts out their ass when it relates to common misconceptions. The drug companies want you to believe generics are inferior, and they spend more on marketing than drug research. You should speak to some pharmacists if you want honest opinion on the matter. They're easy enough to talk to and I think you'll find that the vast majority share my opinion.

briandear 9y ago
I am going to strongly disagree with you, it seems as if you are guilty of blowing facts “out of your ass,” we the the implication that bioequivalence is the same as therapeutic efficacy. Because that isn’t always true, especially in psychiatric drugs. It could be true in many cases, but it isn’t always true – which means there is sometimes a clinical justification for non-generics. Here’s one study addressing that specific issue: https://www.ncbi.nlm.nih.gov/m/pubmed/12860486/ https://www.ncbi.nlm.nih.gov/m/pubmed/12860486/
dalacv 9y ago
Avoid generic drugs if you can. I've got lots of first-hand experience in this matter. It's not a matter of efficacy. It's a matter of quality. That's all I will say.

etrevino 9y ago

Everything is measured very accurately. The 10% variation is in bioequivalence, not in the amount of the active ingredient. For people taking drugs with a narrow therapeutic index, though, that variation is huge.

briandear 9y ago
Correct, and bioequivalence is not the same as therapeutic efficacy.

deleted 9y ago

[deleted]

anonmoose123 9y ago

I know a guy with for-real celiac disease. Although the active ingredient may be the same, not all generics are certified as safe for celiacs thanks to the additional padding in the pill. Generics and brand name are NOT always equivalent depending on the drug and condition, and spreading this lie is incredibly dangerous to many people. This is what happens when CEOs, politicians, and pundits are deciding health policies rather than the properly informed health officials. Now if the insurance policy would be that a doctor must write medical necessity for avoiding the generic, go for it. But mandating that people can only take generics will cause harm.