Harvard Health Letter

Ask the doctor: Generic vs. brand-name drugs: Any difference?

Q. Some doctors strongly advise against the use of generic drugs with the argument that manufacturing processes are better controlled in branded medicines. What is your view?

A. Over the past several years, the FDA has found manufacturing problems at some of the factories that make generic medicines. The agency has also come under some criticism for not keeping up with inspections of the growing number of factories overseas that make generic drugs for the American market. We need a strong FDA to ensure that drugs are safe. But the problems are actually pretty rare, and there are, of course, lapses and quality-control issues at factories that make brand-name drugs, too. Odds are that there will be more problems identified with generics than with brand-name drugs, simply because there are so many more generic drugs manufactured.

I almost never prescribe brand-name products when a generic is available. I did have one exception last year, and it illustrates the need for doctors and insurers to be flexible. The patient used a patch placed on the skin that delivers clonidine, a medication that lowers blood pressure. We switched to a generic patch when it became available. But the generic patch just wouldn't stick to the skin, and the patient's blood pressure became notably higher. So I requested coverage for the brand-name patch, and it was approved by the insurer.

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