Be your own pharmacologist when choosing your drugs!
Apr 03 '01 (Updated May 08 '01)
The Bottom Line As long as you match up correct drug and strength, your best bet is to go generic unless you have other concerns (coatings, etc.)! Be educated about your drugs!
Note: I am not a physician. If you have allergies or sensitivities to certain medications please consult your physician. This epinion is geared mostly towards over the counter medicine, but it does apply to most prescription medication. Please consult your physician about any questions you may have regarding OTC or prescription medications.
Pet peeve
I'll be honest. This is a bit of a pet peeve of mine. Sometimes I hear people say something like "Motrin/Nupren, etc. is so much better than Advil." Well, it doesn't peeve me when someone has a preference because of caplet shape or cherry-coating, but usually, when such a sentiment is expressed, it is because the person really thinks that one medication works better than the other medication.
OK, you're probably wondering why this bothers me? I think the main reason is that I am in the sciences, and I think of things in a more chemical reaction type perspective than anything else, and thinking that the ibuprofen in Motrin is better than the ibuprofen in Advil is just not rational/scientific! I also expect solid evidence before I believe (almost) anything as fact (which, I freely admit, can be a very annoying trait, so I apologize in advance). As for my training in drugs, no, I am not a pharmacist, but I did take a pharmacology class as part of my graduate training, and as an undergrad I had to take more biochemistry than I ever wanted to. Even with those classes, I am certainly not an expert in drugs; I am probably just a little less intimidated by the labels than the average Joe. Also, let me state that I am not an MD, so I do not diagnose & prescribe drugs, nor will I ever do that. I remember enough details to make educated decisions about drugs; that's it. Your pharmacist and your MD-type doctor, more than your aspiring PhD-type doctor, typically know all the details I don't wanna remember (which is a very good thing!). However, classes/training aside, good common sense will allow anyone to "be their own pharmacologist" when purchasing over-the-counter meds.
The placebo effect
OK, let me just get this out here in the open. The placebo effect is real, but it is in your mind. I have heard people defend the placebo effect because it can help make people feel better. While it is true that people may feel better from a placebo effect, I personally think doing yoga or some type of meditation exercise is a better way to get a mind over body effect (this certainly can have all sorts of long-lasting, stress-relieving advantages, while the drug effect is gone once it you think it has left your body). If you truly believe Advil is better than a generic ibuprofen, or Motrin is better than Advil, it is possible that you will feel better if you take the one you believe to be better. However, be aware that such a feeling is not rational and may not always be the healthiest for your bank account.
Generic vs. name-brand
A long time ago, there actually could be a difference between name-brand drugs and generics. The way a drug is packaged in a tablet can affect drug bioavailability (i.e. how much drug you get, and also over what time period you get it). Now, the FDA requires standardization for generic drugs, so if you see 200 mg in one product, it will be just as good (with the same approximate bioavailability) as the 200 mg of the same drug in another product. When you take a drug, your body doesn't care what brand you took; it just cares what particular drug you took. Your body will use acetaminophen the same way whether you took a Tylenol or a generic acetaminophen pill.
Read your label
What is the active ingredient of your favorite pain medication? If Tylenol works well for you, then look at your Tylenol label, see what dosage of acetaminophen works well for you (extra strength [500 mg per tablet] vs. regular strength [325 mg per tablet]), and save some money next time by buying a generic with the exact same dosage of acetaminophen. The generic will have the exact same effect on your body!
You can do this for other medications. Do you like Motrin? You really just like ibuprofen in 200 mg per tablet. Do you like Motrin Migraine? You still just like 200 mg/tablet ibuprofen, but you like it better in a box that says "Migraine" on it. (Yup, that's the only difference!) Like Extra Strength Excedrin or Excedrin Migraine formula? You are just taking a blend of acetaminophen (250 mg), aspirin (250 mg), and caffeine (65 mg), and there are generics with the exact same formulation.
What about cold meds? Again, it works the same. Like Nyquil Liquicaps? Find a generic with acetaminophen (250 mg), dextromethorphan hydrobromide (10 mg), doxylamine succinate (6.25 mg), and pseudoephedrine hydrochloride [HCl] (30 mg). Need a sleep aid? Again, check the label. Wow! The sleep aid (Simply Sleep/Unisom) just contains diphenhydramine HCl (the same stuff as brand name Benadryl), so just find a generic diphenhydramine HCl. The advantages to reading labels is that you will soon be accustomed to those long drug names, and you'll actually know what each ingredient does. You'll learn that OTC antihistamines, in addition to helping your allergy symptoms, will also make you tired, etc. This helps make you a much smarter consumer!
When the brand may actually matter
There is an exception to the generic rule. (All generic rules must have exceptions!) Sometimes, a name-brand medication may have an enteric coating (to keep it from irritating your stomach). Most OTC drugs do not have coatings, so this is not much of an issue (this is more of an issue with name-brand prescription meds), but if they do have a coating, the generic may not be exactly comparable. If you have stomach sensitivity, you need to be alert to this and either find a generic with a coating or you may want to stick with the name brand. It is also possible that an individual may have an allergy or some other type of adverse reaction to an inactive ingredient (coating, dyes, etc.) in a medication. This is a rare occurence, but it can happen. Also, with cream medications, there is a slim possibility that a different ingredient could cause skin irritation if you have sensitive skin. Just make sure that you carefully read labels to be alert to any possible differences such as these.
There are a few prescription drugs that have a narrow therapeutic index (this does not apply to OTC drugs, which all have a very broad range of effectiveness, so even minor variations between pills do not matter). What this means in plain English is that you pretty much need an exact concentration in your body, and if you have a teeny bit too much or a teeny bit too little it will not be effective. Getting just the right amount is often dependent on your own individual makeup. In these cases, whether you take a generic or take a name-brand, you will be monitored by a physician to make sure you are getting the proper dosage. For these narrow therapeutic index drugs, switching brands could have a subtle effect on your dosage, so you should be monitored again. If you are currently taking a brand-name prescription medication and would like to take a generic, talk to your physician.
Another thing important to note: although it is possible that a particular drug has multiple uses, the box labeling tends to only address the main indication/use. For example, diphenhydramine HCl can be used for allergies, cold symptoms, and as a sleep aid, but the box labeling of the generic will most likely state dosage/indications for the most common use (cold/allergies) rather than for the alternate use (sleep aid). Make sure that you always take the appropriate dose for your purpose.
Compare apples to apples
I saw a commercial a while back, and for the life of me I can't remember which drug it was for, but the main gist of the commercial was that if you took this certain drug, you only were taking so many milligrams of medication, whereas if you took a competing formula, you would need way more milligrams of medication. What kind of crap-o advertising gimmick is that? That's like saying that Vitamin E must be stronger (and therefore better) than Vitamin A because the RDA for Vitamin E is only 400 IU, whereas the RDA for Vitamin A is 5,000 IU. Different drugs act differently upon your body, and the dosing will therefore be different. A certain drug is not necessarily better just because the dosage in milligrams is lower.
Bottom line:
As long as you match up correct drug and strength, your best bet financially is to go generic unless you have other concerns (coatings, etc)! Be educated about your drugs!
See comments
Some people have made some very good comments on this epinion, mostly regarding prescription medications. While my epinion is mostly geared for OTC meds (I am not really advocating for everyone to be their own physician), this epinion does apply to most prescription medications. There are a few prescription drugs where even slight differences are important. I tried to addressed these issues in a minor way in my epinion, but I do go into a little more detail in the comments. One of my favorite writers here at Epinions, craigmoosh, even left a comment with some examples of prescription drugs where generics should not be substituted. My bottom line for prescription medications is talk to your doctor and pharmacist.
related links
Center for Drug Evaluation and Research
http://www.fda.gov/cder/ogd/
Letter to Health Practitioners on the Therapeutic Equivalence of Generic Drugs
http://www.fda.gov/cder/news/nightgenlett.htm
Note: All warnings and contraindications still apply to generic drugs. Don't take anything you shouldn't!
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