Is There a Difference Between Brand Name Medications and Generics?

We've already discussed drug names, generic and "brand" ones. But are there differences beyond the words? That's the topic of this week's Healthcare Triage.
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John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
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[@artzfreak]

The main thing I got from this episode is that we should develop a federal administration that ensures store-brand cereal tastes the same as name-brand cereal.

[@stg8385]

Equate lol

[@evilcam]

Another great episode. I study pharmacology as a hobby, and I knew that when you said you were going to devote a bunch of episodes to it that I was gonna dig every damn second of it. You and the HT team have done exactly that. Kudos, and never stop.

[@dcheverie]

I can tell you that not all generics are the same too. I am on anti-depressants. I was always on one specific generic, they ran out one day, and gave me a different generic. It didn't work for me at all and within 3 days I was having a severe depressive episode. I went in to talk to them about it, they had gotten a new shipment of my normal generic. Within a few days, I was back to feeling like normal again. Sometimes, it can be all about the binding agents, etc.

[@Truthist1776]

My ex-wife, who is now a pharmacist, benefited greatly from a migraine prescription but after her work changed insurance, the new coverage only provided a generic equivalent. The generic had a different secondary ingredient and gave her very little relief from her migraines. She did some research and found out exactly what was different and the interaction between the compounds made all the difference, even though the FDA treated them as equivalent.

[@dj.culture6590]

yep, I too have had similar experiences...

[@shellydavenport2786]

I believe you it's not the same .Brand name is better.

[@ljnv]

I'm on Sertraline and I've noticed a massive difference between eulera and Zoloft. I was starting to get better on urula then I switched over the Zoloft and I noticed a massive difference like scary difference . I then switch back to the first brand I took and it took about another month and a half to get back to where I originally was.

[@s.b.d.manager1272]

I have been verbally attacked by a pharmacist for asking for branded medicine.

[@ronch550]

​@@s.b.d.manager1272 wow that's crazy. You should've reported such rude behaviour to the store manager.

[@Rabbitthat]

Panadol, a "tylanol" brand in the UK and Ireland. have an ad campaign "Not all Paracetamol is created equal" And it makes me laugh because I assume legally the paracetamol part of their pill has to be equal.. but It's a much more effective ad than saying "we ad a few mg of caffeine so your blood absorbs it faster".

[@MiniDress360]

I work in a pharmacy and you see people getting attached to their 'usual' drugs. They like their usual pink pill and will swear down the yellow one doesn't work as well, if at all. I think habits and our expectation have to come into play when discussing the effectiveness of a drug. Very interesting!

[@thoperSought]

MiniDress360 yep, the placebo effect is a thing

[@MiniDress360]

+ThoperSought that's the word! I couldn't for the life of me remember the word when writing the comment. 😊

[@thoperSought]

MiniDress360 heh. well, that happens to everyone.

[@rdizzy1]

+MiniDress360 There is also a type of placebo effect when someone thinks very strongly they are going to be allergic to certain medications prior to taking them, it creates a reaction similar to an allergic reaction, but isn't really.

[@thoperSought]

rdizzy1 that's interesting, what's that called?

[@thewixter]

Thank you! Sometimes I worry about generics like allergy medicine and pain medication, but I don't worry about my generic BC. I can't tell you why that is other than fear. Thanks for clearing this up!

[@mdrajkhan5534]

thewixter,, I want make good body,,can you say me good medicine name,,,please,, because I can't eat food,,, now I am so thing,,,

[@argella1300]

I never buy brand-name ibuprofen any more. I always go with the generic version. It's usually WAYYYY cheaper

[@MiniDress360]

I work in a pharmacy and it drives me nuts when people won't understand that. Hahah. Also they don't understand that 400mg is the same as taking the normal 2x200mg dose hahha.

[@argella1300]

+MiniDress360 Exactly!

[@MiniDress360]

+Emily Burnette Exactly!! Hahah. I'm in the uk. So we don't have that whole insurance deal. But obviously if they have a script then that's what their care provider recommends. But I have the way some drugs companies literally con people out of their money with the 400mg /2x200mg ibprofen. Some people just don't understand. And some one profits from that. I think that's just so unethical.

[@MiniDress360]

+MiniDress360 I hate. Not have. Hah. Early morning here 😂

[@JoshRhoton]

@@MiniDress360 several years back I was in the hospital for surgery and when the nurse asked what I took I replied my list plus the OTC med acetaminophen 2x500's and she replied "never heard of that dosage". Lol😂

[@Deflin]

Excellent! So many people are regularly confused about this. Thanks for raising health literacy.

[@bestblaine]

I’m so glad you talked about NTI’s, specifically Coumadin/Warfarin. I need to do my research before spouting off numbers, but I seem to remember that AB rated drugs, bio equivalent generics, can be within 5% +/- of the brand. So the problem with titration is, patients being switched from generic to generic. Great video!!!

[@merrymachiavelli2041]

Things like this make me really appreciate government, for all the stick it gets, regulation is _really really_ important for some things.

[@HairyPixels]

+Merry Machiavelli Free market solutions would be better in my opinion because they aren't not prone to the problems that plague monopolies (like corruption and bureaucracy) and with more competition the best ideas would rise to the top. With the government monopoly on regulation we don't really know what the best more affordable methods would be because new entries into the potential market are prohibited by law.

[@MimouFirst]

+Hairy Pixels In theory free market is awesome, in practice, it's not that good. It only works if the market (companies AND customers) is completely free and it just is not. For example: there are commercials everywhere influencing people (thus they are not free in their mind to make their own rational decisions). People making their OWN rational decisions without getting influenced is one of the important pilers of a free market. Also to make real free decisions you need to be in a position where you can do that. If you are very poor, you can't. People are 'trapped' in jobs and situations that they can't get out of. Again not free. So yes, free market sounds great (in theory) but the reality is that it is just not going to work that well in every day life. Having some regulation is a good thing imo, but not too much.

[@HairyPixels]

Mimou Free thought does not require an absence of influence. For example, I saw a commercial for a new video game and I liked it so I bought that one. Was I not free and did I not make the best possible decision given the my own knowledge and situation (being very poor perhaps)?

[@merrymachiavelli2041]

Hairy Pixels To have competition in regulation you'd have to have many different regulatory regimes. Can you imagine the chaos that would create for doctors? It already seems bad enough with the generic/brand thing. And the stakes with drug regulation are very high, if regulations are too lax, people could die and if regulations are too stringent, people could miss out on necessary medication and also die. Having some regulatory bodies better than others is literally a matter of life and death. A profit motive, to me, seems like it would motivate some bodies to be overly stringent in the name of PR and other bodies to skimp out on thoroughness to certify the widest range of drugs for the lowest cost. Neither of those two scenarios are in the public interest, particularly for poorer individuals without much choice but to accept the cheap, under-regulated drug. Plus, health is a field in which public perception of the effectiveness and safety of a treatment can be very different from reality. Hence why so many people turn to bogus natural remedies, diets and 'alternative' medicine. Or, to the other extreme, why people can shy away from somethings in bouts of public hysteria, like the MMR vaccine. The consumer is often a terrible decision maker in this case.

[@sunsetsoverlavenderfields]

+Hairy Pixels The problem with free markets is once a market reaches a certain point, it gets extremely difficult for new people to enter the market, thus preventing truly free competition. Look at the internet service providers in America. There's only a handful of major ISPs and very few regional ones anymore. It made more sense for them to all merge into super large corporations than to actually compete in a free market. Now they have shut out new competitors by already owning all the cables, and it is extremely expensive for new ones to be laid down. Not to mention the routing and server costs that go with it, or the fees higher tier ISPs charge to connect to them. As a result, we have maybe three real options for internet and they all suck, because they don't have to stay truly competitive with one another. This same situation has happened in a number of markets, and the government always comes in to break it down. Look at the railroad industry in the 19th Century, or Standard Oil at the beginning of the 20th Century.

[@randomfullywonderful]

Additionally, in the United States, physicians push the brand name on their patients because they can get paid by pharmaceutical companies. I've never heard of a doctor recommending the brand name.

[@WaskularnyPrawnik2003]

You meant they push generics instead of brand?

[@ErasmusTandF]

great video, people really get hung up on this at the pharmacy I work at. Really good for you to clear it up more for the people out there.

[@kujmous]

Your ability to explain complex subjects with understandable terms is perfectly suited for this passion of yours.

[@trafficjon400]

Strange passion

[@PotionsMaster007]

I just found this channel. This is great, clear and concise and cute animation. KZbin plus my uni lectures together make me so much more knowledgable when it comes to Medicine :)

[@sushicartman01]

Super informative and accessible to people like me who are not in this field. Great video!

[@benbarker8154]

I used to work as a case manager at a mental health clinic. When the usual medication changed shape or color or came from a different manufacturer compliance dropped through the floor. Trying to explain to a person with profound paranoid schizophrenia that the pill they have been taking for 25 years was now simply a different (blank) and NOT POISON is an argument very very difficult to win.

[@MaoRuiqi]

Another great service (show); very helpful!

[@ScholarlyPotato]

there's a reason that compounding pharmacies exist. just saying you can have reactions to the other ingredients. it may be chemically identical as far as the drug is concerned but individuals can have allergies.

[@Cantor214]

A good book on this subject released in 2019 is: "Bottle of Lies: The Inside Story of the Generic Drug Boom" by Katherine Eban

[@chelsealofton6905]

Though I knew that generic medicine had the same pharmaceutical and bioequivalence as name brand drugs, I didn't know the technical terms for it nor did I know that they weren't entirely the same in composition until recently. I certainly never realized that the bulk of a medicine's weight was actually inactive, coloring, and/or flavoring ingredients, and this realization is actually really surprising to me despite the obviousness of the situation in hindsight. The excipients lacking inert qualities also surprised me to hear out loud, though I suspected as much considering that some people can be allergic to one brand of medicine and not another despite the two medications having the same active ingredients. With the effects that certain additional ingredients can have on people that take a drug, I'm very glad that the FDA has specific guidelines that a drug must meet in order to make it on shelves for human use. Were there no guidelines, I'd be concerned that greater medical issues due to drug ingredient side-effects would rise. I also find it interesting that, despite people tending to prefer brand-names over generics because of generics being cheaper, those same people might be more likely to stick to a medical regimen when it involves these cheaper generics. It makes sense from an economic stand-point, but the idea that someone would change their opinion about a drug they might not initially trust based on price alone is almost laughable, for want of a better word. I do wonder, however, if there's any other reason a person might be willing to stick with the regimen outside of money or if that's the sole factor keeping them to it or not.

[@flashjack15]

This is actually hilarious. I'm a 2nd Year Pharmacy school student, and this week we have our Bioavaliability project presentations. In them we are paired up with a few other students and then paired against another group of students. Each group is given the same Drug name, but one has to argue pro-substitution, and the other has to argue pro-dispense as written. In order to argue your point you have to look at the pharmacokinetic and pharmacodynamic studies along with other studies that support your side. So if you are looking at Kinetic studies you will look more towards AUC (area under the curve), Cmax, and Tmax comparatively for bioequivalance of the two drugs. If you look at Dynamic studies you have to look at the measured value associated with the drug or the outcome associated. It is incredibly interesting topic to research into, especially in terms of how the narrow therapeutic index is measured and the whole orange/purple books of the FDA. Overall I think that the HCT Team did a pretty good job with this video as a little peek through the window for people to see this topic.

[@AJPlaysTodayandAJBuilds]

+Jack Thomas do you as a student in this field fully agree with the video? or have you been thought other things?

[@flashjack15]

+AJPlaysToday I agree with the video. I completly understand that the videos length has to be taken into consideration, and also the viewers interest in deep topics. I wish / Hope that they cover/covered more of the subject area at hand. Here a few of the things i'm talking about: The video talks about pharmaceutical equivalency and bio equivalency, but not therapeutical equivalency. I think that talking about the orange book would have been a good idea as well, and the A, AB, etc rating system that the FDA utilizes. Explaining how bioequivalance is established, utilizing AUC, Cmax, and Tmax would have been a good point to make instead of just saying that the excipients were responsible (which is what causes the differences). The AUC ratio being within 80-125% does make a fairly substantial difference on Narrow therapeutic index drugs. This rule is in place for Other generic manufacturers as well. So if the Innovator has a 100% BA, the SANDOZ generic has 90%, a Tarro has 85%, and a BARR has 110%, this can pose problems. A small lesson on where the FDA's policies came from (the laws that govern them) and the concept of DESI drugs, as well as which DESI drugs are still on the market even after having never proved their safety and efficacy. Elaboration on narrow therapeutic index drugs would be a great exploration on the show as well. For example, warfarin is does fairly small, (1-10 mg tablets). With so many things effecting its efficacy (such as dietary vit K, patient adherence, gut flora, age, protein binding, etc) it is hard to get patients stable on a warfarin therapy. Warfarin therapy is measured utilizing an INR, which is a ratio of the Prothrombin times of (patient/control)*ISI. The therapeutic range for warfarin is measured via the INR as a value of 2 - 3. Since it can take upwards of a week for the full effects of warfarin to start (some cagulation factors have longer T1/2's than others), it is important that once a patient is on a stable diet and stable dosage regimen that they remain that way. Since the FDA mandates that Bio equivalence is only met if a generic possess 80-125% the AUC ratio as the comparison manufacturer, this posses a problem. For example: if you have a patient on stable warfarin therapy of 10mg QD, and they are switched from the 100% BA innovator to a 80% generic, then they are now getting 8mg a day instead (Theoretically). This in tern could cause as much as a 20% decrease in INR as well, which could result in a clot in the patient. Its a really fascinating concept. I think that for NTI drugs the 80-125% Bioavaliability concept is the only really contested issue. And this is only really a matter of conflict when switching from innovator to generic, or from generic to generic on NTI drugs. I still support generic manufacturers all the way however. Because the Vast majority of studies show therapeutic outcomes being unaffected by any of this. NTI drugs are not the only ones however that can have pharmacokinetic/dynamic differences. The differences between different dosage forms are present as well. While i don't think that the difference makes much of a clinical difference, capsules, tablets, powders and liquids, transdermal systems, IM, IV, SQ, etc can all possess different ADME qualities. As well as the VAST multitude of ways we have to make drugs Immediate release, delayed release, sustained release, extended release, etc. So switching a patient from say Bupropion XL to Bupropion SR isn't feasible. Switching a patient from Tizanidine tablets to Tizanidine capsules isn't feasible. This is all due to their differences in pharmacokinetics/dynamics. Even though they all contain the same active pharmaceutical ingredient (API). One last area to cover for this is how it affects Biological drugs. Immunizations, insulins, Monoclonal antibodies, fusion proteins, and a multitude of other drugs are not considered the same thing as small molecular drugs. Biologics are complex, and many times are created by utilizing yeast, other bacteria, or Chinese hamster ovary cells. The more complex the protein, the more complicated the process. When a generic for a biologic is made, it isn't a generic. It is considered a Bio-similar. Just like how the Generics are tallied in the FDAs Orange book, the biosimilars are tallied in the FDAs Purple book. Many counties in the world are utilizing widely available biosimilars, but in the U.S. i think we currently have 2 available. If we can get Pharmaceutical industries to start making biosimilars that are safe and efficacious we can reduce the cost of many drugs to patients. For example: enbrel (enteracept). It is a Tumor-nucrosis alpha inhibitor fusion protein made via Chinese hamster ovary cells utilization. it is currently on SANDOZs research for biosimilar approval. It is expensive, like $1,500 a month expensive. A biosimilar may be able to cut that down to 3/4's of even half as much, which in turn saves the patient insurance company, or pharmacy benefits manager (PBM) money. The entire generic and drug equivalency topic is broad, and complex. I l personally really enjoy it, but i understand that it is a TON of information. And honestly I'm surprised they fit as much into 1 short video as they did.

[@AJPlaysTodayandAJBuilds]

Wow! I wasn't expecting a novel....good read though. You clearly know your shit.

[@sunnyjim6505]

+Jack Thomas Fascinating stuff! Thank you for putting all this out here. I've stumbled across an interesting problem recently: Diagnosed with Celiac disease, I was horrified to discover that my doctor/pharmacy couldn't tell me if there was gluten in the medication I was prescribed (for a condition that, thankfully, cleared up with adherence to a gluten-free diet). Even calls to the manufacturer (by the pharmacy) only yielded the cover-our-asses statement "there are no gluten-containing ingredients to the best of our knowledge, but we cannot control our suppliers' processes." It seems amazing to me that pharmaceutical companies have fewer rules for listing ingredients and potential allergens than what you find on a bag of M&M's! Do you have any thoughts on allergens in the bulking materials of medications?

[@jwt242]

+Jack Thomas This is going to sound flippant, but it's not intended to be, but what does a pharmacist actually do other than just take your prescription and fill a bottle with your medicine? Couldn't anyone _(within reason)_ just read the prescription, find the meds, produce the label, and deliver them to the patient?

[@JorgeSanchez-je4bt]

thanks for the great videos

[@TaroQuispe]

You guys are awesome, thanks for this video!!!

[@benaaronmusic]

Thanks for the thorough content.

[@therose9876]

I don’t have to see this video after watching ur previous video at the title drug names I got addicted to the way u give the information that smooth so I watch this video as well thanks ❤️👍

[@milowent]

very helpful video, thanks!

[@sparksbet]

This explains why my generic Ondansetron ODT tastes different than the brand-name Zofran ODT I got at the ER - the sugar coating on one was an inactive ingredient! So cool to know!

[@Hechtie18]

Because some medications use inactive ingredients like gluten or lactose that may not be tolerated by some people, Are some generics/name-brands better for those people, or is the dosage too small generally to have a difference?

[@i_tarunxp]

This information helped me a lot

[@keira_churchill]

It's also important not to confuse "generic" with "counterfeit". Counterfeit drugs are not submitted for approval at all, and could be either completely worthless or just plain deadly (or both). Steer well clear of the counterfeits no matter how much cheaper they appear to be, and never ever self-diagnose and then order prescription-only drugs from a random supplier to treat that condition.

[@roxcyn]

We definitely need an update to this video.

[@Carol_Pearson]

There are some substances that do not have "generics".... Insulin, for example. And even switching between brands requires strict monitoring by a doctor. (Can you tell I've had to explain that one to my health insurance companies on multiple occasions. Usually after a letter saying, "Did you know, you could save money by switching to...." No. No, I can't.)

[@trafficjon400]

Not for long. what does it matter . they make it and we are to trust it.

[@krystalburcham6294]

This video does a great job explaining why generics and brand name drugs are equivalent. I studied Pharmacy for 3 years and during that time, I also worked as a Pharmacy Technician. There are many people that still believe that they do not work the same and are not equivalent. What I found astonishing was the percentage of physicians who are less likely to prescribe generic medications. I already knew, before watching this video, that generic and brand name drugs contained the same active ingredient and that the only difference(s) is/are the inactive ingredients. This is a great video to showcase how much time the FDA and drug companies put into drug equivalency. Maybe if skeptics watched this video, they would have a better understanding of generic drugs and be more apt to using them and saving money.

[@sarar4901]

Is it true (as I've heard from people) that patients with allergies to dyes will often respond differently to a generic than to a brand name drug? Obviously the medication itself is the same, but if the excipient materials in one or the other form trigger an allergic reaction then there COULD still be a reason to prefer one over the other.

[@Onikura]

Does this apply to OTC generic medication too? Do they have to follow the same procedures?

[@elmirekidd1731]

Wow! This was an excellent explanation.

[@annishacreary7077]

Very informative, thank you

[@03mayurchavanbeelex65]

The best researched video on this topic thanks 👍

[@GooserDaniels]

Great video. Mostly applicable to small molecule drugs. Suggest discussing large molecule and biosimilars for a future video. Regardless, love what you're doing here.

[@user-zw5ww9tz1j]

What do you think about findings like that in Kamenica, Naclerio, & Malani (2013) PNAS, "Advertisements impact the physiological efficacy of a branded drug" showing branded drugs could be more effective because they induce a stronger placebo effect?

[@ashleycaveda]

Rachel, you're so awesome!!!!!!!! I love you so much :)

[@PerFrost]

So when are we going to see an all Rachel episode? (Sorry Aaron)

[@TheDemofox]

Do you know how the approval process works in other countries?

[@bethnelson8497]

I've been lucky that all my physicians have been happy to prescribe generics! On a different note, there was a time when my mom and I were on the same dose of an antidepressant and the pharmacy we went to began use the same medicine but produced by a different manufacturer. (It's worth noting we were already on a generic and this was still the generic, it's just that the manufacturer of the drug changed.) A week goes by on the generic from the new manufacturer and she and I start having withdrawal symptoms, as though our brains were not getting enough of the SSRI's. We took it back to the pharmacy and we were apparently not the only ones with this problem. I know it's a shot in the dark, but do you know what could have caused this?

[@guyterrifico8293]

FDA approval requires only a bioavailability of the original active drug molecule to be 80%-125% (therefore leaves each company for 45% of "play" aka potency.) People who push all are THE SAME is some what true, but FDA even says this in its notes if you wish to look. I have had this issue with my ADHD medications where either one brand was so weak, and one was too strong - the brand name is only one that I can take without noticing an actual SIGNIFICANT difference , aka withdrawal... Dont believe these idiot pharmacists they just want to sell you the cheapest brands at the highest costs and they themselves dont even know this , read some of the pharmacists who have NO CLUE about this 100% factual regulation for generics. Take care man and if you can , always just use brand name OR a reputable brand otherwise. Always do your research and plenty of it since these companies are evil af. I had a drug I tried speaking about on Reddit and everytime id write it in any section i would see my comments being deleted/shadow banned right away. This was recently when again,pharmacy just randomly changed my med brand and know im very very particular. Anyway hope this helps... Heres a video that explains it better and links the FDA's statement of this ect. kzbin.info/www/bejne/jHXUpHuiaNF1oqM

[@bshay513]

Very well handled. This student pharmacist approves! (although I might have included discussion on synthroid vs. generic levothyroxine... that seems to be extremely controversial.)

[@angeluscorpius]

I am on Nifedipine/Adalat for my blood pressure (among other drugs). However when I was switched to generic Nifedipine from Adalat (brand name), I had side effects that made it harder for me to function. I switched back to Adalat and was fine. Then I had a change of doctors, and again was prescribed the generic Nifedipine. I REALLY wanted the generic to work (because, cheaper). But I felt tired, low energy, and just out of sorts on the generic Nifedipine. So the generic may be bio-equivalent - it lowered blood pressure as intended - but it had side effects for me.

[@bjkarana]

Back in college when I worked as a pharmacy tech at a chain drugstore, certain people would be upset if the lettering font stamped on their pill changed, which signified a different manufacturer (if the shape was the same). Having taken drug chemistry and pharmacology, I always got a kick out of it, but a lot of people still hold this belief.

[@tsukikage]

Aren't there cases where a drug has "excipients" that actually (potentially) have an additional effect, but the excipients in question isn't considered a drug by the FDA so it's not a required part of the generic? Like perhaps adding chamomile extract to diphenhydramine or something?

[@IsaacLevy]

Extended release medications have fewer safeguards. Generics do not have to use the same release mechanism. I recently switched between two generics for wellbutrin XL and swear one of them lasts longer. And it's not without precedent: several wellbutrin XL generics were recalled a couple years ago for bad release curves, a generic for concerta was blocked this summer.

[@PogieJoe]

This episode was so crunchy.

[@sneakerbabeful]

When it comes to Over The Counter drugs (OTC), ask a licensed pharmicist to recommend a few reputable generics for what you want. Virtually any OTC drug (unless it's new), can be found in a generic form. Pharmicists want to help you, and they have excellent guidance on generic drugs.

[@brwneyedgirlx19]

Weird store brand froot loops taste like actual cardboard. It was the saddest discovery of my young life.

[@biggayal4149]

ikr! it tastes like stale carboard! so not even close to what i was looking for...

[@biggayal4149]

kazooga 1234 they were called "fruit rings"... this was years ago but it was the save mart brand, and it said "fruit flavor" but it tasted like stale cardboard lol

[@TunaBagels]

if only generic cereals were regulated, lmao

[@Deadlyaztec27]

They're getting better about it. While a lot of stores used to make cereals that were really "meh". A lot of their copies are unbelievably similar not only in taste and texture, but often times in nutritional value. If it tastes so bad it gets a bad reputation then no one will buy it. Conversely, many large supermarkets like Safeway go out of their way yo make cheap yet still tasty alternatives.

[@Zeyev]

Thanks. Gonna share with my doctor friends to see what they think.

[@Dh-ne1np]

Can you go over the TPP and its affect on healthcare?

[@DanaBentley]

I have no problems with generics, I've generally had good luck no matter what I'm given at the pharmacy. Except for one rather important one: my emergency inhaler. The pharmacy switched me to a generic inhaler without telling me, and after a bout of flu I couldn't figure out why I couldn't get my asthma back under control. I went back to the pharmacy to get a brand name inhaler, and that calmed my asthma almost immediately. Since then I've been careful to make sure I get brand name on that inhaler on every pharmacy visit. If I get a generic of anything else I'm game, but I really need to be able to breathe so that's where I get picky.

[@MrXavierRose]

For those living in Australia, if you've ever had your medication subsidised, that means you've used the generic brand. Also, the same amount of ibuprofen in Nurofen is the same amount in Woolworths and Coles brands of ibuprofen. Brand names sell more because they have commercials -- that's my theory.

[@davidsnayiv]

I think this video is very interesting, a lot of people including myself sometimes buy the "Name Brand" product instead of generic because we feel its stronger or works better, but in fact by law they have to be just as pharmaceutic-ally and bio equivalent.Generic drugs must have the same strength, identity, purity, and quality as the Brand and product, with this being said why waist more money and feel you have to spend more to get more when you don't actually have to.

[@Joao-cl1xk]

I can confirm without a doubt that's not always true. Even between different generics there's differences.

[@gfifer1]

I've been dispensed generics that look 100% identical to the name brand pills before. How does that work?

[@theguy9208]

so basically the difference between brand name medication and generic meds is the same difference between a GMC sonoma and a chevy S10?

[@lizchavez95]

What you think about tea and essential oils?

[@MackenziesAnimationCorner]

What about thyroid medication though? I work as a pharmacy technician and the pharmacist always assures customers you can easily switch between brand and generic unless its levothyroxine. Is there something about thyroid medications that are different?

[@AndrewThibeault]

Mackenzie Robinson Great question! For thyroid meds, there may be some cause for concern when switching between manufacturers because of the very small doses involved. Levothyroxine is dosed not in milligrams, but micrograms (1 milligram is equal to 1000 micrograms!). Levothyroxine also has a very small therapeutic window, so if the difference in excipients changes the absorption by even a few micrograms, you could easily become sub- or supertherapeutic. For this reason, a typical pharmacy will usually stock only one manufacturer of levothyroxine and the brand (Synthroid), so they know for certain that all of the patients at that pharmacy will get the same dose every time they fill.

[@MackenziesAnimationCorner]

Andrew Thibeault that makes sense, thank you so much!

[@changeisnowpeople]

in my local pharmacy, when I ask him to give me subsidiary medicine/drug, he tells me to go somewhere else... They are focused on only selling expensive drugs.... In a local news paper, "augmentin 650 duo" which is an essential drug of the world, which I had to take for a COLD, there were subsidiary drugs mentioned on the paper... Most doctors prescribe this drug instead of the equivalent drug which is half the price... What do you suggest on this? and what are the ways to get the cheaper drugs?... how to save on the medical yearly expenses living in a city. Stopped having "curd,ice cream, any pepsi/coke related" n now have reduced cold(probably allergy, but IGE is negative) - so I just dont eat/drink those stuff.

[@changeisnowpeople]

I mean, IGE which is I guess allergy test is negative, but I have noticed that whenever I have curd, ice cream, soft drinks, I get cold symptoms, n one time when I followed it by cold medicine(when I did not think soft drinks/ice creams caused it) - the medicines caused a reaction causing scars around my body... What do you think is the real problem? - to be on safe side, I dont have Ice cream/soft drinks etc. - What is the problem you think here?... thanks in advance.

[@drdcs15]

Thanks for this, I'm a resident and I had heard so many different things from different people about the approval process of generics, I always believed they were equal but didn't really have anything concrete to support that belief.

[@seerofsorrow]

So here's what I'm going to suggest strongly, so so so so strongly that you read. Bottle of Lies by Katherine Eban for the love of all that's holy please read this book. There shouldn't be a difference, ever but sometimes there is not because of necessarily bad science but bad manufacturing.

[@hollowbones3515]

Could you do a video on biosimilars for large molecule drugs? I work in the biotech industry and I know this will be an upcoming issue as more biosimilars goes to market. Of course large molecule products affect a small population as it mainly targets grevious illnesses, but this is a very fascinating topic for me. Thanks!

[@supersmart671]

What about generic medicines from india?

[@tlpo9426]

This helps, I could not get a straight answer from the pharmacist about the generic teva-divalporoex sodium vs apo-divalporoex sodium generic. On the teva I would have small seizures when on it but not on the apo. I thought it had to do with the excipients, but they told me no. I figured I could be having a reaction to an ingredient. You should do a presentation on this drug for me. Thank you

[@charlietuba]

Is it possible there may be a placebo effect with name brand drugs. My wife swears that she doesn't get the same effect with generic Ibuprofen as she does with the name brand Advil®. The same thing goes for acetaminophen and Tylenol®.

[@cDayz]

So whatever they use to make up as the bulking up agent can be different between the generic & own brand name tablets. I'm guessing that would mean there's a higher chance it could affect you worse as it's unregulated?

[@lookingupwithwonder]

Then why is the generic escitalopram not working for me all of a sudden?? I have taken lexapro for years and now I’m experiencing anxiety, depression and exhaustion on generic after 17 days of use??

[@narason9940]

I love this channel!

[@benlee8040]

really helpful. every people in the world must watch this video

[@philipjeffmicalizzi8422]

in 2011 this ruling came out. Why is there no labeling to tell us if you take this generic drug and are harmed you have no legal rights this needs to be placed on the generic as well as the brand name. This is truly important information that the Supreme Court should and the FDA are responsible to keep the public informed about. Its a health concern. Your mental and financial health too.

[@---Free-Comics---IG---Playtard]

Most excellent information! +1

[@WordUnheard]

Several times, I have had my Alprazolam prescription from Walgreen's that was as worthless as baby aspirin. I even went so far as to buy a benzo test, take the Alprazolam, pee on the test the next day, and not a trace of benzos in my system. I reported this to Walgreen's, and they told me my test was probably faulty. A friend of mine gave me one of her Alprazolam, and it knocked me the fuck out, because I had been taking bunk pills for a week. I took the same test the next day (I'd bought a 10 pack of benzo tests), and tested positive for benzos. Generic, name brand, the point is, you never know whether or not what you're taking is even real. I mean, it's one thing to buy bunk pills from dealers. That's almost a given. But a pharmacy? Seriously?! I suffer from severe anxiety, and had to illegally buy Alprazolam each time I was given pills that did absolutely nothing, just so I could make it through the month without winding up in a padded cell.

Yes I feel your pain. Somthing has been going on with the Xanax the last few years. I been prescribed for a long time and some funky shit is going on. Some generics are way better. Then others or that same generic will be different then it use to be in the next batch. It’s crazy that we can’t even trust pharmacy’s anymore for legit medication I need to live I couldn’t survive with out my medication. Actavis is been orettt good to me right now been getting them constantly from my pharmacy past few months. Greenstone 2mg are good too. But they definitely changed the Xanax it’s not like it use to be and I’ve heard of other people gettin duds from a pharmacy which is insane. It’s a sketchy business. Especially with this medication. It changes so much over the years and from brand to generic they all so different it’s crazy. Brands made here in USA I find are better but not always. What’s you favorite manufacturer of alprazolam? Really wish they still made brand name 2 mg they were the best.

[@pwsalc]

The graphic just kinda failed at 1:13 and 1:24

[@habebalhead652]

It's a great gob what you present..👌 All my respect..

[@trafficjon400]

GOB?

[@JoshRhoton]

Who makes the call for generic or name brand Rx(in the US)? The doctor, insurance company or the pharmacist? Just curious and thank you!

[@alexh5725]

This is pretty late, but i can give a response from personal experience. From start to finish, there's many factors. First, the doctor can write a prescription that essentially tells your pharmacy "only dispense name brand medication". Then, the pharmacy has to dispense name brand. HOWEVER, and this is important, your insurance may not cover the name brand, and because of that, may end up not paying anything. This leads to a call on the pharmacists end. As long as the doctor has not said "name brand and only name brand", the pharmacist can dispense a generic. If the insurance company is only covering the generic, then they dispense the generic. At the end of the day, the doctor is the one making the final call, but your insurance may say "nope" and not cover it. The pharmacist will dispense it, but (if it isn't covered) you could be looking at 5-10x what you might pay with insurance/for the generic. For me, I've been forced to navigate this nightmare. For me specifically, this nightmare isn't over, and is compounded by constant shortages and by my medication being CII (controlled substance). For me to get brand name concerta, which when you look into it is actually different from the generic, i have had to go through this process: request brand name from my doctor. Get brand name prescribed. Call pharmacy "we're out of stock, but x pharmacy has it in stock". Call doctor again, and explain the situation. Get prescription rewritten for different pharmacy. Call pharmacy "insurance won't pay, you can pick it up, for $560". That's where I'm at now, so i have to now call my insurance support, explain the situation, etc... My personal recommendation is to just take the generic, unless the generic really isn't the same, but be prepared to fight bureaucracy at every level except your doctor's office.

[@JoshRhoton]

@@alexh5725 Thank you for the info. Have a great day!

[@davidrust3169]

I completely agree with this! I take generics and have been assured by my GP and psychiatrist about equivalency. That said, I did have one bad reaction to the generic version of Topamax, Topimirate. Apparently, I was one of a very, very tiny percentage who reacted badly to the generic. But even knowing this, I understand it was a fluke. I tend to go with the generic whenever I can.

[@jojodelacroix]

in fact I would wager that it is entirely possible that there are some people that cannot take a certain innovator drug but can take generic versions of it for a similar reason, rare as that !might also be.

[@MrJoseautotech]

David Rust www.google.com/amp/s/www.forbes.com/sites/davidmaris/2012/10/10/fda-recall-points-to-serious-problems-at-the-fda/amp/

[@rosapolo8573]

i didn’t notice a difference but both made my hands and face tingle, appetite disappear, and anxiety go through the roof

[@valerieevanier9632]

OK. Correct me if I am wrong, but everyone here seems content that it is the patient that is crazy and not that there is something wrong with the generic because 1. there have been a handful of studies over the past several years on a very limited number of meds, and 2. the drug manufacturer says they are ok after testing themselves. I have never in my life been suspicious of generics until several months ago when a med I am taking, which is now being sourced from a new overseas manufacturer, has become noticeably less effective. I did an internet search and found a number of similar comments from people about this company and their meds. The generic manufacturer for this med has been changed a number of times over the years and I've never noticed a problem until this one. So, for a person taking a certain generic med, is there anything other than the company's word for it that can be presented as evidence that the drug is ok? If you say it is impossible for the FDA to routinely test these drugs themselves, then the answer is...because the drug companies say it's ok.

[@Jess-ky8mp]

I was on a brand medication for 5 years with no ill side effects. When the generic came out, all I could think about was the money I was saving. Two years later, I was addicted and going through mine and my sons prescript. (mom of the year right here) within 2 weeks. I was taking anywhere from 80 -200 mg when I was prescribed 40mg a day. I turned into a desperate junkie, stealing money my husband had hidden so I could buy from other people. During these two years, I managed to gain 40 lbs on a medication that usually reduces your appetite. During one moment of clarity, I started talking with my Dr. about switching my meds. His first comment was, well, we can increase your dose. (obviously I knew that wasn't the answer) When I told him I just didn't think it was working for me, He asked me, well, what would you like to try? REALLY?! I'll try to shorten this, But I changed Dr. who has more understanding and told him of my addiction. I Got myself into a treatment to handle the addiction part of it. We tried different meds, and even had a month back on the brand name (it was wonderful) but now I have been taken off of the med all together, in order to let my brain heal. After researching, I found more and more people having similar problems. I was never looking for a 'High". But after living my life with undiagnosed ADHD I fell in love with relief I felt with the medication. Now I am left with this frustrating, overwhelmed brain, a brain that knows how green the grass is on the other side. I am scared now to ask about going back to the brand name of the Drug, but I really miss the feeling of "normal" I am also so frustrated by the people who think it is crazy, and generics are equal. It wasn't until I was already so deep in a hole that I realized what had changed and in my mind started a downward spiral.

[@dj.culture6590]

@@Jess-ky8mp heh, how you doing now? I really hope your ok...i have had kinda similar problems... If you want to touch base with me - please do... Doctors haven't a clue... I had a pharmacist accuse me of taking more than I needed and wrote a 2 pages letter to my Doctor...Thankfully my Doctor wrote a 2 pages letter back to him correcting all his errors...

[@puffygirl2527]

not all generics are equivalent to the name brand. when switching from cymbalta to a generic i experienced symptoms of withdrawal because of this.

[@dj.culture6590]

I experienced less pain relief (hence a little withdrawal too) from taking Oxycodone generic. Had similar problems with cortisteroids i took... This has happened 3 times over a few years..

[@sara_sah-raezzat5086]

Could you elaborate on the ones in which it might make a difference? I had an awful experience a few years ago when my province switched the type of generic Fluoxetine (Prozac) made available. Even though the change was between types of generic, it still made a difference and I developed Serotonin Syndrome. I have been super suspicious about changing generic types since then. Was I just unlucky, and had one of those drugs in which it makes a difference?

[@InorganicVegan]

+Bluestocking Sara Yeah, you were. You probably had one with a narrow range, and different inactive ingredients probably changed the bioavailability. Combine that with the fact that people of different sizes require different effective doses, and you probably got the short end of the stick.

[@bi1iruben]

+Bluestocking Sara Very very few drugs actually are affected by this. As General Practictioner in UK, the drugs I think of are Diltiazem, Phenytoin and some other anti-epilepsy medications, Warfarin... and then I start to struggle to think of others (our electronic prescribing systems will advise us on this). Perhaps more frequently might be one product as tablet and generic as capsules and patients express a preference of what type of item to swallow (gelatine capsules can be an issue for vegetarians, or Jewish/Muslim faiths). For children issue is more to do with flavouring and which the child will accept.Typical advisory list as per www.northoftyneapc.nhs.uk/wp-content/uploads/sites/6/2012/03/APC-Guideline-on-Medicines-that-are-Not-Suitable-for-Generic-Prescribing-January-2014-update-May-2014.pdf

[@Ellyerre]

+Bluestocking Sara Exactly what Inorganic Vegan (awesome name is awesome), the different inactive ingredients changed how you absorbed the drug and you got Serotonin Syndrome, which is pretty rare but is always a risk, especially when changing meds (even just the brand). I also take a generic SSRI (Escitalopram) and I am always a bit reluctant to change it but I think if you just keep an eye out in the first 2 weeks for new side effects or change of symptoms and, if you so, talk to your doctor about it, it's probably gonna be fine.

[@InorganicVegan]

Ricardo Lopes Thanks! I like my username too.

[@sara_sah-raezzat5086]

+Ricardo Lopes the really destressing part is that my pharmacy didn't tell me they changed it (I'm sure it was an honest mistake). I had no idea what was going on. I was lucky my doctor had had another patient who had had the same experience with an epilepsy medication.

[@WarrenGarabrandt]

This fully justifies the money I've saved by buying all generic medicines. Thanks for alleviating my concerns on this!

[@jeremywvarietyofviewpoints3104]

Someone I know insisted that cheaper brand paracetamol doesn't work as well. He said that a pharmacist told him that the expensive brands are always improving their paracetamol formulation.

[@jeremywvarietyofviewpoints3104]

He also said that cheaper sugar isn't as sweet.

[@justinnorwood5477]

I like how the first thing that was covered was in regard to things other than medication. Cause I can tell you, there is for sure a big difference in name brand cereal and the generic brand. And that is how I thought medication would be, but its said that this trend is not universal. At the same time, it makes sense that that medication is not like cereal. That would mean that we have medication that is not very beneficial at all (not to rag on cereal). I was not aware that the generic brand of medication is almost identical to the brand name medications in every way. The only thing that is different is the excipients that are involved (inactive ingredients). Its nice to get the background information on brand name and generic items, especially with medication!

[@ElLeon7x7]

As a pharmacist, I agree that there is really no difference between the Brand and Generic of many medications as long as they are AB rated by the Orange Book. However, I do want to make a note/question as a pharmacist: What about the interchangeability of Synthroid/Levoxyl/Levothyroxine? I was taught/am under the impression that these need to be closely monitored if switched.

[@mawer55555]

Very imformative thx

[@bonafidelane2848]

What about concerta and generic concerta ?

[@monicasmith3544]

I have always been curious at whether or not named brand medications were the same as the generic brand. I am definitely one of those individuals who like name brand products. For some reason I believe they are of better quality, but have no information to back up my point of view. I never knew that when a drug first came out it was allowed to be sold by a single company, so I found this information very interesting. I knew generic drugs were cheaper to buy, but I never knew they were pharmaceutically equivalent as named brand drugs. They also have to be bioequivalent which I think is outstanding. I still cannot get over the fact that there is no significant difference between brand name and generic drugs. I am not surprised that so many people believe that generic drugs are not as good as name brand. I was very interested when the drug Coumadin was mentioned. It states in the video that this drug is a blood thinner, but I was always told that it affects the clotting factor of blood which people often get mixed up. Another reason this drug interested me is because I know individuals who are on Coumadin. It makes sense that pharmacist are more likely to know the difference between generic drugs and brand named drugs than physicians. Pharmacist work around these drugs all day and physicians just prescribe them.

[@CharlesVonAgar]

Can you do an episode on drug patent ever greening?

[@bertrandspuzzle]

Note to self, always buy the cheapest version of the drug.

[@ElLeon7x7]

Ayup.

[@HarperNguyen]

Generic asthma inhalers have a slightly rotten tangerine smell. They work just as well, but the smell is not something I want to deal with.

[@robertaylor9218]

god i love this channel!

[@kaylakincaid2972]

This video was very informative! I really wish more people realized that the generic and the brand-name drugs are basically the same thing. I feel that people should know about this so the next time their doctor prescribes them something, they can ask for the generic brand. Even if the physician says no, they could still try. Even though more people should know this, unfortunately, I'm sure the pharmaceutical companies do not want you to know this. They still want you to spend the money on the name-brand. What is surprising to me is that insurance companies do not push doctors harder to switch to generic versions. This would save them money in the long run. However, if the contents of this video are more widely known, it will save a lot of people tons of money.

[@trafficjon400]

Nice to know'. if a simple fact.but not all the case .

[@greg9069]

I don’t care if the pill looks different, but when I take it, I better feel the damn effects. I’ve had generics that are completely bogus, and the pharmacist (who doesn’t actually take any pharmaceuticals) trying to tell me otherwise. It’s outrageous.

[@adamhetz3839]

How about defining the wiggle room concerning proving bioequivalence. The FDA allows for a large margin of difference between brand and generic "bioeqivalence".

[@lisaschuster9187]

Right!!! It’s something like 45%. This guy is pitifully naive.

[@RyanMan767]

@@lisaschuster9187 wrong, thats not true at all. the tolerance as defined by the FDA is actually a max of *25%* . and that margin also applies to *individual batches of the same brand's product*. not just between brands. and in actuality, the variance almost *never* exceeds even 5%. there is literally no reason to believe that the name-brand and generic drugs would have any difference in quality. they are almost certainly made in the same region, with the exact same synthesis process and quality standards. these are drugs that have been made for decades. differences between brands are equivalent to differences between individual batches, and its insignificant its not like manufacturing drugs is difficult. even in the worst possible case scenario, the difference would be negligible at best. and you would *still* be taking the same regular dose, because refills come from the same batch. it's not like it fluctuates pill to pill.

[@dr.bonscott3962]

Agreed, this is not a good video in reguards to several medications. Hope people do thier research.

[@dr.bonscott3962]

@@RyanMan767 not everybody is going to metabolize the same way. Therefore toxicity is risked when switching from brand to brand. If you're on 10mg of blah blah blah & doing well, then switch to 10mg generic blah blah blah There is a chance everything is perfectly fine... but what happens when it isnt? Maybe a filler/binder used in this generic blah blah blah medication helps that same 10mg ingredient metabolize faster, maybe its slower... either way now what was expected to happen is changed. Most OTC medications, probably wont have a huge impact but more powerful class medications... that 2% speed up metabolism could lead to cardiac arrest or numerous other unknown efffects.

[@drupy1992]

So are all my doctors wrong when they say there can be a 20% difference in effectiveness between generic and brand name? And it's not like I asked one doctor. I have asked my neurologist, endocrinologist, urologist, orthopedic surgeon, psychiatrist, psychologist and my general care doctor and they all say the same thing. I've lost a lot of faith in how up to date my doctors are if they are all wrong.

[@trafficjon400]

20 % or higher. why not if a Docs said it.

[@trafficjon400]

one of my docs said it .

[@dj.culture6590]

in Australia all Doc's n Chemists say they are all the same.. I have had both (oxycodone) and there is a 30-50% difference in pain relief - bra d beingthe strongest..atleast for me anyway...

[@KenGreen-tm7si]

Kickbacks/commission for slinging/prescribing drugs is a real thing

[@Tanzu15]

Facts!

[@jessegaronband]

Straight from my Doctor's (published surgeon). by law generic drug only has to be at least 80% as potent as the name brand!