Harvard Heart Letter

Generic heart drugs as good as brand names

"You get what you pay for" doesn't apply to prescription drugs.

Open your medicine cabinet or pill drawer, and you're likely to find at least one generic drug. That's a good thing for your bank account — generics cost less than their brand-name counterparts. But some people worry that these low-profile drugs aren't as effective or as safe as brand-name drugs. An analysis of head-to-head comparisons of generic and brand-name cardiovascular drugs shows no cause for concern.

Generic drugs are chemical clones of their brand-name counterparts. By law, a generic drug must

  • contain the same active ingredients as the brand-name drug

  • be identical in strength, dosage form, and administration

  • work the same way in the body (be bioequivalent)

  • meet the same standards for identity, strength, purity, and quality

  • be made by the same rules the FDA has set for the brand-name drug.

What's different is the "look" of the drug and the inactive ingredients. Generics contain different coloring agents, binders, and preservatives than the brand-name drug. These might make a difference in how the drug works for you, but that's uncommon.

To the test

Researchers from Harvard-affiliated Brigham and Women's Hospital identified 38 randomized controlled trials (the gold standard of medical research) that measured a clinical or safety endpoint in tests of ACE inhibitors, beta blockers, statins, and other cardiovascular drugs. In 35 of the 38 studies, the brand-name and generic drugs worked equally well. In the other three, the differences were small and unrelated to the drug's action (Journal of the American Medical Association, Dec. 3, 2008).

For example, Cardizem, a brand-name calcium-channel blocker, was no more effective than generic diltiazem. Brand-name Toprol XL, a long-acting beta blocker, was no better than metoprolol. And simvastatin, a generic statin, worked just as well as brand-name Zocor.

Despite the evidence showing that generic cardiovascular drugs are safe, effective alternatives to brand-name drugs, the researchers found that fully half of the editorials and commentaries on generics published in medical journals expressed reservations or hesitations about using generics.

Generic possibilities for heart disease medications

Drug class

Popular brand names

Generics available?

ACE inhibitors

Altace, Accupril


alpha blockers

Cardura, Minipress


angiotensin-receptor blockers

Diovan, Cozaar



Isordil, Nitrostat



Norpace, Cordarone





beta blockers

Toprol, Coreg


calcium-channel blockers

Norvasc, Cardizem



Lasix, Aldactone



Tricor, Lopid



Lipitor, Crestor


Making the switch

Most people who change to a generic drug notice only the savings. Sometimes they're modest, sometimes spectacular. Take Toprol XL, for example. Instead of paying $520 for a year's supply of this beta blocker, you could get generic metoprolol for $240. WalMart, Target, Safeway, and other chains offer an even sweeter deal — hundreds of generic medications, including metoprolol, for just $48 a year. The savings on Pravachol, a cholesterol-lowering statin, are even more impressive. A year's supply of Pravachol costs $1,500 or more, while generic pravastatin costs $200, or just $48 at one of the big stores.

Generic versions are available for almost every kind of cardiovascular drug (see table). There are some big exceptions. There isn't yet a generic version of Plavix available in the United States. This $4-a-pill antiplatelet drug must be taken after getting an artery-opening stent. A generic version is due in 2011, along with a generic version of Lipitor. Another gap is in the angiotensin-receptor blockers (ARB), a class of drugs used to fight high blood pressure. There aren't yet generic versions of Atacand, Cozaar, Diovan, Micardis, and other ARBs. Most people who take an ARB could try switching to a generic ACE inhibitor.

If you aren't sure if there are generic alternatives to brand-name drugs you are taking, ask your doctor or pharmacist. You can also check for yourself. Reference books such as The Physician's Desk Reference or The AARP Guide to Pills, which your public library might have, list generic alternatives to brand-name drugs. If you have access to the Internet, several Web sites offer similar information. The most detailed, though hardest to use, is the Food and Drug Administration's Drugs@FDA. Web sites such as Rxaminer.com and DrugDigest.org also have generic checkers. You can find links to all of these at health.harvard.edu/140.