Wednesday, June 15, 2011

Generic versions of Antidepressants...Is it actually worthwhile?

Generics (non branded) are common these days and can be a safe and cheaper alternative to the "original medication" (branded).  However, there are some pitfalls which one needs to be aware.

  1. Generic medications are not always identical to their branded versions.  Yes, they contain the same amount of the active drug, however, they may vary markedly in the other components which make up the medication (what we call excipients).  These other components are fillers and binders etc which make up the medication, hence, generic medications will vary in shape, colour and tablet/capsule size.  This variation may give rise to allergies to adverse reactions to individuals who may not tolerate certain ingredients. 
  2. Accidental over-medicating is a very common and serious side-effect of generic medication.  All generic medications differ in packaging and labelling from their branded versions, and most generic medications differ in tablet / capsule shape and size (the only exceptions are those generics produced by the same manufacturer as their branded versions, in which they usually only repackage the box and labelling).  This causes a lot of confusion with those patients who take several different types of medications, as well as the elderly.  It is not uncommon for patients to be taking 2 or 3 generic brands of the SAME medication at the SAME time, and only discovering this to be the case when they are queried by their pharmacist or doctor, or when they develop symptoms of overdosing, or worse.  This issue used to predominantly affect the elderly and those on multiple medications, but now with the market being flooded with generics, these alternative brands can affect everyone.  Even those who only take the occasional course of antibiotic - the medication looks different, but is it the actually a different type of drug to the medication taken previously which caused a severe allergy?
  3. Generic medications contain the same active drug and dosage as their branded version, but they may not produce an identical clinical / therapeutic effect.  The FDA and TGA and other government bodies regulating medicines allow for a certain "window" of clinical equivalence (what we term bio-equivalence).  If the drug company can show that their generic version falls in this "bio-equivalent window" then they are approved to be a generic version.  As this "window" indicates a range rather than a single figure, this means that the generic may not produce the exact same therapeutic effects.  This is a problem with patients who take long term medications where their doctor has made dosage adjustments (termed "dosage titration") over the period of time to give the patient the most beneficial and appropriate therapeutic effect from their medications.  An example is an individual with Bipolar who has been titrated on "Epilim" for mood control, who may destabilise when changed to a generic version.

But generic brands have their place, and can save you a lot of money over time.  However, before you say "yes" to generics, it's important to understand what you are saying "yes" to.

My advice when considering a generic brand is:
  1. If it's your first time taking the medication, this is an ideal situation to start on a generic brand.
  2. Ask your doctor which of your medications your doctor would be comfortable for you to switch to generic brands and discuss these with your pharmacist.  Your pharmacist is a valuable source of information and can give you much detail about generics.
  3. Ask for a generic brand that is made by the same manufacturer, whenever possible.  The packaging is different but the tablet / capsule is likely to be identical in colour & shape because it is actually the same medication repackaged, sometimes with the exception of the imprint on the tablet / capsule.
  4. Ask to see the generic brand.  Have a look at the packaging and the contents.  Will you confuse them with other different medications that you currently take because they are similar in appearance?
  5. Ensure that the pharmacist clearly labels your new generic medication both on the outside packaging and on the internal packaging (because if you throw the outside packaging out, you still need a clear reminder of what the medication is).  This label should clearly show you which medication it is a substitute for.
  6. Always finish your previous medication pack before starting a new generic to avoid confusion.  Don't stock up on your medications as this causes much confusion when you switch generics and have several different types of packaging floating around.  This also imposes a danger when the doctor changes your drug strength.
  7. Insist on the same generic brand.  Avoid switching to different generic brands of the same medication as this will simply add to the confusion.  When you make a switch, stick to it and avoid changing unless therapeutically necessary.  Sometimes it's not possible for every pharmacy to stock every generic version of a particular medication, so often they will offer you a generic that they stock so that you don't have to search for it elsewhere or go without.  This problem can be minimised if you are a regular pharmacy customer of one or two pharmacies only, as they will always keep your medication on hand ready for your next refill.  Also, be organised and don't refill your script upon taking your last dose of medication, to enable you time to find the same generic brand.
  8. Try to stay with the same pharmacy and doctor.  This will give you a double checking safety measure, because if they are familiar with what you normally take, and have a reliable computer history of your medications, then they will be able to pick up any discrepancies including medication brands.
I hope this has been helpful.

UDinh Pharmacist
B.Pharmacy Qld

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