Well, yes and no.

The U.S. Food and Drug Administration (FDA) requires that generic versions of any drug contain the same active ingredients in the same proportion as the original, patented medicine. But generic drugs can have different fillers and binders—substances that hold the pills together—and different dyes.

by Dick Broom

For most people taking most types of drugs, the differences in these “inactive” ingredients do not affect how well the drug works or whether it causes side effects. But that is sometimes a possibility.

“One company might use lactose as a binder in a tablet, for example, and somebody might be allergic to that,” says Brad Pusser, R.Ph., director of Pharmacy at FirstHealth Moore Regional Hospital. “But the active ingredients have to be identical.

The generic manufacturer has to be able to prove the same level of purity, and the absorption properties should be exactly the same.” Pusser usually advises people to give generics a try, because they cost less and nearly always work just as well.

“Ninety-five percent of the time you’re going to do just fine,” he says. ”If it’s a medication that you’re taking for only a short time, like an antibiotic, you’ll never know the difference. If it’s something you take routinely, for high blood pressure or diabetes for example, then you and your doctor will be able to tell whether it works for you. If it doesn’t, you can always get the brand-name.”

Brand-name drugs are more expensive because of the tremendous amount of money that goes into the research, development and marketing of new products. The patent on a new drug lasts 17 years; but for most drugs, there are only seven to 10 years left on the patent by the time the drug comes to market. It is during those years that the patent-holding company needs to recoup its investment and turn a profit because, once the patent expires, other companies are free to make less-expensive, generic versions.

Increasingly, pharmaceutical companies are making generic versions of their own brandname drugs in order to capture as much of the market at they can.

When doctors write prescriptions, they often use the name of the brand-name drug, but that doesn’t necessarily mean they don’t want the patient to take a generic equivalent. On doctors’ prescription forms, there is a box they can check to tell the pharmacist to “dispense as written” or a box that says “substitution permitted.” If the doctor checks that box, the pharmacist typically asks the patient if he prefers the generic. Most people say yes because it saves them money.

“We have a few patients who simply don’t want generic, because they are convinced they don’t work as well,” says Angela Elkins, R.Ph., chief pharmacist at FirstHealth Standard Drug in Troy.

There are a few categories of drugs that have such a narrow therapeutic index—meaning that the dose that helps patients is extremely close to the dose that could harm them—that physicians and pharmacists generally stay away from generics. The narrow therapeutic drugs include thyroid medications and some heart medications.

“We don’t want to be swapping back and forth between drugs when just a little bit of change in the drug level could be the difference between being therapeutic and being harmful or not being enough in the patient’s system,” says Jason Joyce, Pharm.D., director of the Pharmacy at FirstHealth Richmond Memorial Hospital. “We want patients to stay on the same medication throughout their therapy.”

What you should know about tablet splitting For years, physicians have used tablet splitting to help their patients—particularly those without prescription drug coverage. Sometimes tablet splitting is used to get doses of medications that are not commercially available; at other times, it’s a way to save patients money. Tablet splitting can be a safe, effective way to decrease the cost of certain medications without compromising the treatment, but it should be discussed with your physician first. For tablet splitting to save money, the medication must cost the same for all dosage strengths. This allows the patient to buy half as many double-strength tablets and split them in half. The result is a month’s supply of medication in the same dosage that was originally prescribed by the physician. Some of the most common medications involved in tablet splitting are the cholesterol-lowering statins. Many physicians have their patients split these medications in half to save money. For example, Lipitor 10mg tablets cost the same as Lipitor 20mg tablets. If a physician feels that a patient can safely split the tablet, he or she will prescribe 15 Lipitor 20mg tablets. When the tablet is split, the patient has a 30-day supply of Lipitor 10mg as originally prescribed. Pharmacists and physicians recommend that patients use a tablet splitter, instead of a knife or razor blade, to safely split tablets. Tablet splitters are inexpensive and can be purchased at your local pharmacy. However, it is important to remember that tablet splitting is not right for every medication or for every person. Extended-release or enteric-coated medications and capsules are a few examples of medications that are NOT safe to split. “There are some extended-release tablets that are formulated to provide medication over 24 hours,” says Brad Pusser, R.Ph., Pharmacy director at FirstHealth Moore Regional Hospital. “If you cut the tablet in half, it could dump 24 hours worth of drug into your body in an hour or two, and you could have serious side effects from an overdose.” Just as all medications are not safe to split, all people are not candidates for tablet splitting. People who have trouble seeing or using their hands may not be able to split the tablets accurately, which could compromise their care. This is why it is always important to talk to your physician or pharmacist about tablet splitting or any other changes in your medications.