Expense vs. Effectiveness
Generic medications used to treat attention deficit hyperactivity disorder (ADD/ADHD) offer a cheap alternative to name-brand prescription drugs. For adults and children with ADD/ADHD who need medications as a part of their treatment plan throughout their life, generic drugs can save thousands of dollars in costs. These drugs have become so ubiquitous that, unless otherwise specified, some insurance companies and pharmacists routinely fill prescriptions with generic versions to save both the company and the patient money.
So are generics indistinguishable from their name-brand cousins -- and do all generic versions deliver the same results? The Food and Drug Administration (FDA) states that a generic drug is “identical” to a name-brand drug in terms of its “bioequivalence.” According to the FDA, bioequivalence includes “dosage form, safety, strength, route of administration, quality, performance characteristics, and intended use.” By these standards, the FDA seeks to ensure that the active ingredients in generic drugs are exactly the same as in their name-brand counterparts, but that’s where the uniformity may end. Compounds in generic drugs are allowed to include different binding chemicals, fillers, and colors. Generics made by different manufacturers can differ, as well, as Orologio discovered from his bright yellow methylphenidate pills.
“Identical does not mean ‘same,’” says Joe Graedon, of People’s Pharmacy, a consumer advocacy website. Graedon first learned of problems with some generics about nine years ago, from a parent whose child had switched from Ritalin to generic methylphenidate; the child’s teachers had noticed a difference in his behavior. Then Graedon heard from many other readers about the varied experiences they had with generic drugs to treat a range of ailments. Some recounted the success they had with the generic drug bupropion, an antidepressant, as opposed to Wellbutrin XL 300.
Concerned, Graedon hired an independent laboratory to test the two drugs. After a series of tests, the laboratory found that the active chemical in the generic form of Wellbutrin XL 300 was released at a different rate than in the name-brand medication. This variation is allowed according to the FDA, which states that a generic must provide “roughly” the same blood level of the active ingredient as the name-brand. Those blood levels can range between 80 to 125 percent of what the name-brand drug achieves. This could be the reason that people have different reactions when they switch from a name-brand drug to a generic, says Graedon. Differences in generic medications likely exist for all conditions and treatments. But, according to Graedon, it isn’t surprising that patients with behavioral, neurological, or mental health conditions will be more likely to notice that they act differently on a slightly different treatment.
Some ADD/ADHD experts agree. Roy J. Boorady, M.D., a psychopharmacologist at the NYU Child Study Center, says that he has seen some patients who do not respond as well to generic ADD/ADHD medications. Some have found generics to be less effective than their name-brand versions. However, Boorady notes, “A big proportion end up doing fine going from non-generic to generic.”
This article appears in the Fall 2010 issue of ADDitude.
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To discuss generic vs. brand-name ADHD medication with others, visit the ADHD Medications support group on ADDConnect.