Managing Medications

Name-Brand Prescriptions vs. Generic Drugs

Brand-name ADHD medications generally cost more, but before switching to the generic option you should learn how safety and effectiveness may also vary.

Family with ADHD walking up a grassy hill together.
Family with ADHD walking up a grassy hill together.

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.”

Side Effects of Generic ADHD Meds

Some ADD/ADHD patients have reported increased side effects, such as upset stomach and headaches. For those who do not respond well to generic drugs, Boorady speculates the cause could be more than just the speed at which a generic drug dispenses its active ingredient. “The difference in patients has to do with the differences in the fillers,” he says. Some patients are more sensitive to the colorings, binders, or other chemicals that are used in the generic and not the name-brand drug. Graedon compares buying generic medications to choosing a cheaper form of toilet paper. “It’s all toilet paper,” he said. “They’re all white, they serve the same purpose, but they have different comfort levels.”

How to Make the Switch to Generic ADD/ADHD Drugs

Most experts agree that many ADD/ADHD patients use generic medications successfully, and that these should remain options for treatment. Still, if you or your child is currently taking a name-brand treatment for ADD/ADHD and wants to switch to a generic, it is important to monitor any changes in behavior or symptoms. Outside observers – like teachers, spouses, or parents – often spot behavioral changes sooner than a physician, so it may be helpful to keep a log of your or your child’s symptoms to share with the doctor. Since many physicians now start an ADD/ADHD patient on a generic version of a stimulant, keep in mind that if the treatment seems ineffective, the name-brand version – or a different form of generic of the same drug – may work well. Orologio knows now to double-check prescriptions before having them filled, making sure that the right generic medication is listed, and that the “dispense as written” box is checked. As Orologio learned, even when something is “prescribed as the same exact drug,” he says, “it can be different.”

One ADD/ADHD Adult’s Story of Switching to Generic Meds

Dominic Orologio, 34, began treatment for ADD/ADHD symptoms six years ago. His doctor prescribed 30 milligrams of Adderall XR, an extended-release prescription medication. Orologio’s symptoms became more manageable. For the first time in his life, he was able to focus on work at the office.

After a few years on the medication, Orologio’s normal dose was no longer effective throughout the day, a common problem for people taking ADD/ADHD medications long-term. What once gave him relief from his ADD/ADHD symptoms for most of the day now worked for only about three hours. With his doctor’s advice, Orologio began to take a higher dose of a generic version of the drug.

On his first day with this new medication, he noticed that, after 45 minutes, the generic seemed to stop working. Conditions hadn’t improved with the switch to the generic; they had worsened. Seeking consistent relief for his ADD/ADHD symptoms, Orologio talked with his doctor and was put on Ritalin. The first version of Ritalin that he tried was a common generic that worked well. When he finished that prescription, he had a new prescription filled for what he thought was the same form of generic Ritalin. He noticed that his white tablets had been replaced by bright yellow ones, so he checked the label on the bottle. Sure enough, the yellow pills were also methylphenidate — the active ingredient in Ritalin — so he took one as prescribed. “Within a day it was a horror story, a complete nightmare,” says Orologio. “It was like I drank 10 cups of coffee; I was jittery and anxious.”

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