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Is there a Difference between Generic and Brand Name Drugs?

by Dr.Sal MD on author

generic vs brand medications

Yes. And it's more than just cost. While on paper there's no apparent difference between say, 100mg of Viagra and 100mg of Sildenafil, in practice there often is a difference between generic and brand name medications, and even from one generic to another. What is this madness? Consider the example of generic methylphenidate versus the brand Concerta. Both use the same methylphenidate as their active ingredient. But in clinical practice, many patients mine included, report that the generic just doesn't cut it. At first I thought it was some kind of mass hysteria but similar feedback over and over has boomeranged back to me for many other ersatz knock-offs too. The problem is that generics use their own blends of cheaper binders and fillers wrapped around the active drug making them the low cost alternative. But performance suffers. They may not deliver the drug at the same rate, they may disintegrate prematurely in the gut, they might bind the dosage too tight, and a myriad of other performance inefficiency issues. It's like buying a knock off designer handbag from a street vendor. It may look the same, but an expert can show you all the corners that were cut and the poor stitching built into the lower cost. In the case of Concerta, the difference in effectiveness came down to a sophisticated slow release system in the brand version, with a poor replication in the generics. Generic manufacturers also get a free ride through the regulatory process as they do not have to demonstrate the safety of their products the way that the original patent holders did, further reducing their production cost - but also their efficacy. So I've also seen side effect complaints in some generics that do not fit with the brand profile. When it comes to prescription drugs, like most everything else in life, you often do get what you pay for. But because the margin in cost can be so wide, I still try generics at least once in my patients because if it works nearly as well as the brand competitor, you can stand to save some real paper.


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