Generic drugs are as good as brand names for heart problems

When your pharmacist says there is a generic version of the branded drug your doctor prescribed, have you ever wondered: Does this generic drug work just as well?

A review published in the Journal of the American Medical Association this week suggests that generic cardiovascular drugs—specifically, beta-blockers, calcium channel blockers, statins, and the blood thinner warfarin—are just as effective as their brand-name versions. Cardiovascular drugs were the focus of the study since they are the greatest total prescription drug expense for patients not in the hospital.

The study, by researchers at Harvard Medical School and Boston's Brigham and Women's Hospital, looked at several classes of drugs used to treat chest pain (angina), blood clotting, coronary artery disease, high blood pressure, and high cholesterol. Examining 47 studies that compared generics with brand names for more than 20 years—between 1984 and the summer of 2008—the researchers found that generics yielded the same clinical benefits to patients as the branded drugs.

For example, the brand-name drug Cardizem, a calcium channel blocker, was no more effective than its generic version, diltiazem. A long-acting beta-blocker metoprolol also worked as well as brand-name Toprol XL. And Zocor, a statin used to reduce cholesterol, performed no better than its generic version, simvastatin.

It's important to note that generic drugs are not like a "generic" version of a common household product like cereal, soap or canned food, where a brand could be a better, or even a different, product altogether. Although a generic drug can look different—another shape, size, or color than a branded drug, and will probably not have a sweetener on the outer shell—it is, by law, the same drug.

CR's Take: Talk with your doctor about your prescription as it is being written in his or her office. Ask whether the prescription is for a brand or generic, and learn why your doctor has prescribed one or the other.

Also, educate yourself about medications. Consumer Reports Best Buy Drugs, a free public education initiative, offers a number of drug reports, including ones on ACE inhibitors, antiplatelet drugs, beta-blockers, calcium channel blockers, and statins. These reports analyze drug effectiveness using evidence-based reviews and drug price information to identify "Best Buy" drugs—good-value drugs that are known to work well, are less expensive, and have a known safety history.

—Lisa Gill, Web writer and producer, Consumer Reports Best Buy Drugs

Comments

[ZemtizEffemiA]

Yes, I agree.

[steve suzor]

Sorry guys,I have to disagree with you regarding the substitution of Toprol XL with generic Metoprolol.Having taken Toprol for 15 years,I was
happy with the release of a cheaper generic,but it just doesn't work the same.I experienced two major problems with time release Metoprolol,beginning with serious heartburn which was controllable with Prevacid or Prilosec,but this is just adding another expensive drug which negates the savings of switching to a generic and adds the possibility of new side effects.The other problem,even more serious,was the release of the drug over a 24 hour period.Metoprolol seems to work fine for the first twelve hours,then I observed blood pressure rising considerably,which forced me to take more of the medication after 12 hours.No savings there.Finally,my doctor put me back on Toprol Xl and my blood pressure returned to normal(with no heartburn)It's tempting to go for the cheaper drug,but it doesn't work the same on everybody.

[Hershl Hartman]

After my Plan D provider discontinued coverage of Zocor because generic simvastatin became available, my cholesterol level climbed. Though previously on 20 mg of Zocor, my cardiologist doubled, then re-doubled (to 80 mg) my prescription. Fortunately, no side effects have been detected, though the provider's costs have gone up, perhaps reflected in a (slight) premium increase for 2009.

[Andrea Fisher, RN, BSN]

Generic drugs, by law, do have to have a certain percentage of the active ingredient in each dose, but that percentage does not have to be as high as is required with a brand name medication. The problem arises, as described above, when switching from name brand to generic, or vice versa. As the doctor above stated, some medications have a very narrow margin of efficacy, and the slight change in the active percentage in generic vs. name brand could be hazardous. It is important to use caution when changing from name brand to generic, be aware that the dosage may be slightly different (even though it says it is the same), and to stick with one or the other, and not to switch back and forth. Generics are here to stay, and most people use them. It's just important to know the differences.

[Samuel Barns]

Generic drugs in our present economy are frequently going to prove to be the only medicine that many will be able to purchase. With the high cost of medication, generic drug companies are embraced by the consumer looking for the often discounted generic brands which as you have said, must meet all the requirements that the brand named drugs follow.

[India travel]

I am agree with you.

[James Hubbard, M.D., M.P.H.]

I think this may remain a little controversial in medications with a narrow therapeutic range (where a little change in the dosage the body gets can make the difference between effective treatment and toxicity).
Mostly because of patients like the one in the comment above. Why did she have the problems, coincidence or problems with generic quality? By law all generics should be equivalent.

[Arlene]

I beg to differ with this report. This Summer, Medicare switched my mother's blood pressure to a presumably-equivalent generic. Shortly after, this previously vigorous wmoan developed significant difficulties breathing or exerting herself, even walking from her house to the garage. This progressed and she ended up in the ER and then hospital for over a week, having to have her heart shocked (atrial fibrillation) and both lungs aspirated. Since then, she continues to have problems and must now take the blood-thinner Cumadin, requiring frequent blood tests (for which she must now pay herself). Ironically, that month Prevention referenced one of the drugs in an article related it to serious health issues and shortly after I found an adverse report on the FDA site. Apparently there were 2 generics--one produced by the manufacturer, which was a true equivalent, and one that was 'less' equivalent and connected to the serious health events suffered by my Mother and others. RE the numbers of events--I wonder how many elderly patients were not counted when their decline in health and/or death was 'assumed' related to their age.