The Elderly are often on a fixed and limited income and their medications can often be quite expensive. When I first started homecare back in the 80′s I had more than one patient tell me they could buy food or medicine but not both. Thankfully our elderly have more assistance and choices now, including the choice to save by buying generic.
Generic medications are cheaper than name brands and that makes them attractive to any caregiver on a budget. Also, most insurance companies will not pay for name brands if a generic is available or they will only pay a small amount of the cost. Seven out of ten prescriptions sold in the United States are generic. Over the last few years some controversy has arisen over the use of generics. In this post we will look at some of the issues and the information out there. It is beyond the scope of this blog to give an in-depth evaluation on this topic but I will give you a few places to start your own research.
The Federal Drug Administration, FDA, is the governing body for the approval of new medications in the United States. The FDA has a strict approval process designed to protect consumers. They are also the ones to pull medications off the market if an unforeseen danger arises.
The FDA requires the same standards for generic medications that it does for brand name drugs. This means the FDA requires generic medications to have the same “identity, strength, quality, purity and potency” as the brand name medication. There are no requirements for the same inactive ingredients and there is a slight risk for reaction to some dye or filler that was not in the brand name drug.
Generic medications are required to provide the same therapeutic blood levels as name brand medications. Yet there are many sites that claim the generics are not comparable. Some of the concerns are legitimate; others are just pure scare tactics.
The FDA has addressed some of these concerns here though not completely to my satisfaction. There have been instances where the generic was not equivalent to the name brand and the FDA gives some examples on the above referenced site and the actions the FDA took to remedy the problem.
One of the concerns that have been raised is that many generic medications are produced overseas where the FDA has no authority and there is no way to sample every shipment received in the US. I really do not see where this issue is adequately addressed on the FDA’s website.
One doctor pointed out to me that when it comes to extended release medications sometimes not only the medication but the way it is released into the bloodstream is patented. When the patent expires it is only for the medication, not the mechanism of release. He felt that when the generics were manufactured they were released into the bloodstream too soon leading to problems such as rebound depression. He cited the controversy over generic antidepressants as a possible example of this.
Even minute changes in dosage can lead to problems with some medications, such as Synthroid, a medication given to treat hypothyroidism. I was taught in nursing school that if you were taking a generic form of Synthroid, it was fine as long as you always took the same generic brand and apparently this is still true today. This article explains why. This information is not always shared with patients and caregivers.
I work with a nurse who was recently switched to a generic form of her heart medication and began having problems and returning to the brand name medication relieved those problems. The internet if full of anecdotal incidents such as this but what they do not take into account is that there are also other factors that influence how a medication works.
There really is not a one size fits all answer here. If you or your parent are taking generic medications without problems, there is no reason to stop. You, as a caregiver, might want to note the manufacturer of the medication (it is listed on the label of your prescription). If later on you notice the medication is not working as well you can check to see if the pharmacy has switched to a different manufacturer for that drug. It could also be something else entirely but this will give you a starting point to discuss with your doctor and pharmacist.