Diabetes Self-Management Blog

Are generic drugs as good as their brand-name rivals? Hopefully yes, as millions of people rely on generics to make medicines affordable. Is the claimed superiority of brand-name drugs just advertising, or is there a real difference?

An awful lot of people with diabetes are taking generic drugs. Most people take metformin, not Glucophage. (Generic names usually don’t have a capital letter, while brand names typically are capitalized.) Many take glipizide, a generic sulfonylurea drug, while few take Glucotrol, its brand-name version. Are there any differences in effectiveness?

Under federal law, generic drugs must be chemically identical to the FDA-approved brand-name drug. According to Melissa Stopler MD, generic drugs “are copies of brand-name drugs that have exactly the same dosage, intended use, effects, side effects…risks, safety, and strength as the original drug.”

So they ought to act the same in our bodies. Usually they do, but some people think there may be significant differences between generics and brand names. How could that be if the ingredients are the same?

All the active ingredients could be the same, but the inactive ingredients could make a big difference. According to Drugs.com “Examples of inactive ingredients include binding materials (which may be excipients), dyes, preservatives, and flavoring agents.” “Excipients” are bulking agents and fillers that give pills their size.

Those don’t sound like they could affect a drug much, except maybe if you’re allergic. But not all inactive ingredients are always inactive. According to Wikipedia, excipients can serve in various ways to strengthen or weaken a drug’s effects. These powders might “facilitate drug absorption or solubility.” They might slow down or speed up a drug’s passage through your system.

It’s not only excipients that can make a difference. Drugs.com gives the example of alcohol as “an ingredient that may be active or inactive based on the specific formulation of the medication.”

I never thought about this until my neurologist (a specialist in the nervous system) told me that over-the-counter generic melatonin pills don’t work. They’re not even real melatonin, he says. He wanted to give me a prescription, which would have cost ten times more than the generic. It’s funny, though. The OTC melatonin seems to work fine for me.

The different versions of drugs really are different. An eye-opening article in Fortune magazine explains that a drug patent

reveals the components of a drug, but it doesn’t explain how to make the drug. In reality, manufacturing a generic requires reverse engineering, and the result is an approximation rather than a duplicate of the original.

As a result of these differences, generics may get into the blood faster or slower and last longer or not as long. You can see how this would make a difference in a drug that, say, lowered blood glucose. This can be especially true with time-release medicines. The rate of release can vary greatly.

How important is this to you in practice? Do you trust generic drugs completely? I tend to, because the price advantage of generics is hard to ignore. But if they’re not as good or not safe, you would have to think twice about using them. On the other hand, some generic formulations seem to absorb better than the brand names and might be even more effective.

What do you think? Have you noticed a difference when you take a generic drug? What about when your pharmacy switches from one company’s generics to another? Are there any specific drugs you have found work better in their brand-name versions?

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