Increasingly, Americans are using generic drugs: More than 80 percent of prescriptions in the United States are now for generics. Nearly all generics are equivalent to brand-name drugs in effectiveness and safety—but generics are much cheaper because they must compete with other generics; brand-name drugs, by contrast, are patent protected and face no direct competition. Because of that cost benefit, unless your doctor has written “dispense as written” on your prescription, your pharmacist will typically substitute a generic for a brand-name drug every time—with certain exceptions.
As stipulated by the Food and Drug Administration, generics must contain the same active ingredients as the brand-name drug. They can contain different inactive ingredients, such as fillers and preservatives, and look different, but the dose, safety and strength must be the same. One area of caution however, concerns medications that have a narrow therapeutic index (NTI). These drugs require a precise dose to ensure they work properly and cause the fewest side effects. If you’re doing well on the brand-name product, you may not want to switch from an NTI drug to a generic. The following two classes of drugs may require special consideration before switching:
■ Anticonvulsants, such as Tegretol (carbamazepine) and Dilantin (phenytoin)
■ Immunosuppressant drugs taken after organ transplantation, such as Gengraf, Neoral, Sandimmune (cyclosporine)
Whenever your doctor prescribes a new medication, it’s imperative that you discuss brand-name versus generic options. Make sure you know why your doctor has decided on one or the other—and that you know what you’re getting at the pharmacy.