Many people wonder whether brand name medications are any better or even any different than their generic equivalents. After all, if two medications contain the same amount of the same active ingredient, theoretically, they should be equally effective.

Short Answer

The answer to this question is most often yes. The vast majority of generic medications contain the same active chemical found in the name brand product. When you buy generic acetaminophen instead of Tylenol, you’re getting the same active chemical and typically the same effect. Similarly with generic Prozac (fluoxetine), for example, the products are almost identical, and the effects are almost always very similar.

Exceptions to the Rule

While mostly subtle differences separate name brands from their generic equivalents, one area in which we see more pronounced differences is in extended release formulations, commonly labeled SR, XR, or XL. Sometimes, while the regular form of a medication is available generically, the pharmaceutical company comes out with a long acting (extended release) preparation of its name brand product, which isn’t available generically.

These extended release preparations can be very appealing – taking a medicine once a day rather than twice or three times daily makes a medication much easier to manage (and remember taking). So this may be a reason to use a name brand product instead of the generic version.

Even when the generic long acting version comes out, the slow release mechanism seems to be more difficult to reproduce exactly and so sometimes we see a more pronounced difference between it and the name brand product.

An example of this is the product Wellbutrin XL – a once a day version of Wellbutrin. The extended release form of the generic product is not exactly the same and has been found in studies to show some differences in effectiveness. In my clinical practice I use the name brand if I can, because many patients have noticed a difference in how they feel when they’ve switched to the generic.

Depends on the Class of Medications

Certain families of medicines have had some difficulties with being fully replicated generically; these differences have been reported in medical studies that support this finding. Two classes in particular come to mind:

• Some of the anti-convulsant products, including valproic acid (the generic for Depakote) and carbemazapine (the generic for Tegretol) have not seemed to be as effective in my practice, so I usually stick to name brand for these, although certainly not always.
• Keppra is an anti-seizure medicine that has been shown in studies to be less effective in its generic form (levetiracetam) than in the name brand.

The differences may again be related to how the chemical is released into the system, rather than differences in the chemicals themselves, but what causes the differences in these instances is not entirely clear.

Individual Responses to “Fillers”

While for most people, most generic medicines do just fine, everyone is different, and generic medicines often differ in the “fillers” they contain – the substances that actually make up the pill or capsule in addition to the active ingredient. Some individuals may not tolerate some of the filler. Some people find subtle differences between the name brand and generic of certain products and, in such cases, we stick with name brand.

Consistency in Appearance May Matter

Some people prefer to know exactly what the medicine will look like every time they fill a prescription. One downside to generics is that their appearance may vary depending on the manufacturer and formulation.

Bottom Line

Most of the time for most people for most medicines generics are equivalent products and will do just fine. I prefer to use generics when possible to help families save money when we can. But there are a minority of situations in which the generic, in general or in respect to an individual, just doesn’t work as well or causes more side effects, so we remain vigilant about these possibilities and adjust our planning when necessary.

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From Psych Central's website:
PsychCentral (August 24, 2010)

    Last reviewed: 24 Aug 2010