Weddingbee boards

In order for generics to be dispensed instead of the brand product, they must be bioequivalent, meaning the active ingredient(s), the dosage form, the quality and effectiveness must be the same.  I do not have concerns about taking generic medications and recommend them for my patients due to tremendous cost savings. 

In my personal opinion, I prefer to take older, generic medications that have been on the market for years rather than new drugs - more is generally known about the safety and effectiveness of older drugs than brand new drugs (ex. post-marketing surveillance may reveal new info about a drug - it's not exclusive to new drugs, but more likely).  With time, some brand medications are no longer produced due to lack of use as a result of high generic use.

@AB Bride: I'm really curious with what you mean about "the placebo effect isn't as strong for generics."  Placebos aren't typically used as a comparator for studies with oral contraceptives.  We know that they are uneffective at preventing pregnancy (obviously - they are inert).  Most studies are head-to-head with other contraceptives. 

@carrieknitscake: "They're are more likely to cause a reaction or react differently than the hormone itself." 

I'm curious where you got this information from.  Do you have any primary literature to support this statement?  There are only so many excipients (the inactive substances used to carry the active ingredient) on the market.  I have never seen any evidence to suggest that the generics are using worse excipients or ingredients that would cause reactions.  Inactive ingredients typically do not cause any reaction unless you have a true allergy (ex. allergy to a certain color).  They are inert.

In actuality, they do have to be careful about which excipients they use (just like the brand manufacturers) because excipients do affect the physical properties of the medication.  For example, if an excipient caused the active ingredient to bind together, the dissolution rate would not be the same as the brand, and therefore they would not be bioequivalent, and thus not approved as a generic.

I feel like I should clarify why this topic interests me.  I have spent the last 7 years preparing for my career as a pharmacist.  This is what I deal with for a living...

@JenEliza55:  While you might not notice it with the people you are around, in many pharmacies, more generic birth control pills are dispensed than brand (by far).  In terms of cost, it a medication has been on the market for many many years, the marketing and research has been paid for, and often the brand name manufacturer isn't even making the drug any more.  When multiple generic companies are all making the same product, they are competing for their share of the market, therefore costs drop for the consumer.

As an example... a certain blood pressure medication went generic a few months ago.  When there was only the 1 company making the brand product, it was about $2/tablet.  When 1 manufacturer started to make the generic, it went down to about $0.50/tablet.  Now there are several generic manufacturers and the pharmacy can buy the medication in bulk for 5 cents a tablet. 

@AB Bride: I read the article, and it was basically an opinion statement.  There was no prospective, randomized, clinical trial actually testing their beliefs.  At the end of the day, birth control is effective because of a pharmacologic effect on the body (negative feedback on hypothalamus, changes in FSH and LH, changes in cervical mucus, etc), not because women hope that they don't become pregnant magically. 

This is a little known journal - the impact factor, for example is 1.225, compared to the New England Journal of Medicine which has an impact factor of 53.48.  Impact factor is used as one tool to quantitatively look at citations from the journal and be able to compare it to other journals.  In general, journals that have articles that are more frequently cited have a bigger impact on clinical care, are well respected, etc.

Well, I have to work in the morning, so it's bedtime for me!

@JenEliza55:  I would really appreciate it if you don't suggest that I "think deeper."  I am well versed with reasons why medications do not work effectively for patients.  I have a background formally studying medication adherence.  In addition, the primary patient population I work with is the underserved (i.e. low income patients, homeless, those without medical/ prescription insurance, etc).

Where are these statistics from, first of all?  These are my questions based on that information...

• Define birth control.  Different forms of birth control have different failure rates.  It's well known that using condoms results in higher pregnancy rates than using an IUD (for example).  Condoms are often less expensive than medication.
• Many women can not afford to pick up their medication on time at the pharmacy.  Even missing 1 pill increases your risk of pregnancy.  Do these statistics include or exclude individuals who are unable to afford their medication (i.e. it was prescribed but never taken, or taken late).
• How is failure defined?  By an unwanted pregnancy?  Are more affluent women more likely to be able to purchase Plan B if their primary birth control fails?  This would prevent pregnacy, therefore not be counted as "failure."
• Do women with a lower income have a harder time getting to a pharmacy to pick up their medication?  Using public transportation can often be more of a burden than owning a car.

I could go on and on, but I won't.  There are a number of reasons why patients are either non-adherent to the medication or the medication fails. 

I am not going to respond to any more questions/ comments on the post because I don't think it would be productive for anyone.  I have formally studied pharmaceuticals/ pharmacotherapeutics as well as social factors that affect medication adherence, effectiveness, etc. for years.  I am not interested in starting a debate.  Have a good night!