Brand vs. Generic: Is there a difference?

So I guess the answer to the question is the same as almost every question in medicine... it depends.

For example, I would never touch Marshmallow Mateys but I love Lucky Charms and I am a big Coke fan but I hate the generic colas. Strangely enough I can't stand brand name Mac and Cheese but I love the Western Family Mac and Cheese.

So... it must be the same for things like drugs, right? Once again, the answer is, it depends.

For most medications generic is no different than the brand name drug. The brand and the generic are so similar in most cases that you are not even given a choice as to which you receive the pharmacy just gives you the generic. It has gotten to the point that many brand names have been nearly forgotten of certain drugs.

Now, for the exceptions to the rule. There are drugs that are referred to as narrow therapeutic index drugs. These drugs have huge differences in efficacy, side effects, and toxicity with very small changes in the amount of medication.

For the legal stuff, the FDA tightly regulates drug companies and their products. Most of the time when a new drug comes out it has gone through years of tests and reviews. When a generic comes out it also has to pass many reviews and tests to prove that it is within a 20% window of similarity to the brand name it is copying. So it can achieve drug levels in the blood between 10% above or 10% below the levels achieved by the brand name. For example, lets say you take Paxil 20 mg (a common medication used to treat depression, OCD, or anxiety) and then we draw your blood an hour later find you have 10 mg in your blood. Generic Paroxetine (the generic for Paxil) could have drug blood levels after one hour that could legally range from 9-11 mg. So there could potentially be a difference but it would be incredibly small, far too little for anyone to feel. Something we also have to remeber is that all generic companies are trying their hardest to get as close as possible to exactly the same, so often times they don't use the range the law allows them.

An interesting fact is that many generic companies are owned by the brand name companies so the brand and generic are made in the same factory bu just put into different packages, so they are the same.

An example of one of those narrow theraputic index drugs. Lets say you have epilepsy (you have seizures often enough to require treatment), and you are taking Depakote ER and you transfer your prescription to a new pharmacy and they fill it with generic Valproic Acid. There should be red flags shooting up everywhere! All drugs for epilepsy should never be switch without a doctors supervision. Even though the difference is incredibly small it is enough of a diffrence that many people have seizures despite taking their medication religiously after being switched to generic.

Now it goes both ways if you are well controlled on generic don't let the pharmacy switch you to Brand without talking to your doctor.

What it boils down to is if you are given generic medication right of the bat, don't worry, it is just as effective as brand. If you are on brand and are switched to generic chances are there won't be a difference but don't be shy about asking. Ask the pharmacist if you will be okay, it is his/her job to know, make them earn their money. Also remember that for everything other than drugs brand versus generic does matter, at least to me.

Do Herbals Have a Place in Modern Medicine?

Yes, the answer to my title is yes. Herbals do have a place in modern medicine whether health care professionals like it or not. People love herbal medications because they are all natural. I have never really understood that reasoning. My question to them is, why does all natural = good? I have never had anyone sufficiently answer that question for me, but in this blog I will answer for you why all natural doesn't always equal good, effective or even safe.

I guess my main problem with the attitude that all natural = good is that I can name hundreds of things that are all natural but are definitely not safe to be ingested. For example, lead, Cyanide, Uranium, etc.

Something that many people don't realize is that 99.9% of all medications are derived from something that is "all natural" but have been chemically tweaked to make them safer, more effective, more potent, or patentable. I can also name many all natural poisons that modern medicine has turned into powerful drugs to help keep people alive and well. For example, Rattle Snake Poison (Blood Pressure Medication), Mustard Gas used in WW2 (Cancer Chemotherapy), Fungus Poison (Antibiotics), etc.

There are times where these chemical modifications are impossible and there are the situations where herbal medications are the most effective thing we have possible and thus your doctor or pharmacist will recommend them.

I will not lie to you, herbal medications do have effect in the body. Many of them even have the effect that they claim to have. The problem is that the companies that produce these medications have no incentive to test the effects of their products, to prove that they contain they same amount of different chemicals from batch to batch, or that they have the chemicals at all. For example, the medication Mevacor (Lovastatin) is a cholesterol reducing medication that can be found in Red Yeast Rice, which is an herbal product. There is no difference between the chemical you will find in prescription only mevacor and the herbal product Red Yeast Rice. So why doesn't your physician tell you to buy Red Yeast Rice? The reason is that you can go buy some Red Yeast rice today can send it for chemical analysis can find it contains 15 mg of active ingredient, then buy some more in a month and find it contains 48 mg of active ingredient. Some batches have been tested to find that they contain none at all! Your doctor writes you a prescription for Mevacor because he wants you to get the exact amount you need every month.

Herbal companies also have no responsibility to test for side effects or drug interactions. One of the most popular herbal medications is St. John’s Wart, it is an herbal used to treat depression. Studies have shown that it does have an effect on depression, it really does help. The problem with this one is that St. John’s Wart interacts with almost every drug you can imagine, it interacts with Warfarin (a blood thinner), it interacts with almost Phenytoin (a medication used to treat Seizures), and it interacts with birth control (it makes birth control much less effective). That is just a few of the medications that it interacts with.

The final reason that your doctor or pharmacist won’t recommend most herbals is we don’t want you treating yourself for serious problems. If you have high cholesterol, depression, arthritis, osteoporosis, irritable bowel, or any other disease your doctor wants to see you. Most of the time he will even save you money by writing you a prescription. When it comes to St. John’s Wart you will pay about $15 every month if you take it how the bottle suggests, but generic Prozac, Paxil or Celexa will only cost $10 every 3 months! So even with your doctor’s visit copay you will save money by getting the prescription medication, not to mention you will have the support of your doctor and pharmacist to make sure you are adequately treated and taken care of.

I both do and don’t include vitamins in this, every doctor or pharmacist will recommend a good daily multi vitamin but you do need to tell your doctor or pharmacist if you are taking a multi vitamin because they too can interact with your medications. Like I said there are herbals that we will recommend, like Acidophilus, it is very good to take when you are taking an antibiotic to prevent stomach problems. Vitamin D and Calcium are essential to treating osteoporosis, but we still want to know you are taking them.

Always make sure to ask the doctor or pharmacist before you start taking an herbal medication and if you ask questions about herbals be prepared to hear, “I don’t know,” because once again companies are not required to study herbals so not much is know about them. Even though it is still important that someone knows you are taking it.

Sorry for the extra long blog this time, I try to keep them short. There is just a lot to be said on this topic. If there are any requests on what you would like to know about I am glad to blog about it.