Those generics are a cheap form of medicine is indisputable. Whether they always represent good medicine or the best medical value is more controversial. There are four main aspects to be considered:

1 – Are generics safe?
2 – Is their quality as good as that of the corresponding brand?
3 – Is your doctor or pharmacist wise in switching your usual brand to a generic?
4 – Are generics as effective as newer, medically innovative and more costly drugs that your doctor could prescribe for the same illness?

Provided you live in a country with strict regulatory control of medicines, the answer to the first two questions is “YES”: generics are safe and their quality is not inferior. Unregulated Internet trading of prescription drugs from sources that are outside the grasp of national regulatory control could cast doubt on their safety and quality. However, that applies not only to generics but also to counterfeit brands. That said, generics from respectable suppliers are safe and of good quality.

The answer to Question 3 is less clear-cut. Doctors are sometimes reluctant to switch your prescription from a branded drug that ‘works’ and has never given you any trouble, to an equivalent generic, even though that generic is chemically and pharmacologically identical with the brand. The doctor may be quite happy to prescribe the generic to a new patient, but may be reluctant to switch existing patients on the principle “if it ain’t broke……” - Why take a chance that you will come back and say “Doctor, I used to have the green tablet: this one is white, and I don’t think it works quite as well….?” The doctor will want you to stop worrying, even though you may just be imagining a problem. On the other hand, the doctor will also be under pressure not to exceed his budget for prescription drugs, or the pharmacist to substitute a generic for the brand. Finally, if you are a new in-patient in hospital, you will probably never be aware of the fact that, in many countries, hospital pharmacists regularly switch brands to generics according to hospital rules and budgets, because you will not actually have seen your prescription.

Undoubtedly, the trend in most countries is to increase generic prescribing and dispensing whenever possible, certainly for new patients but also increasingly by switching. Most patients will accept that this is a reasonable economy measure and that it will not harm them.

There are exceptional situations for some drugs where it is difficult or impossible to produce a generic that is in every respect identical with the original brand in terms of its availability within the body. That can lead to serious adverse reactions in some patients. Three old-established drugs where brands and generics are not regarded as automatically ‘switchable’ are digoxin, phenytoin and theophylline¹.

Footnotes

[1] Carlen, “Kosten sparen mit Generika?”, Schriftenreihe No. 47, Schweizerische Gesellschaft für Gesundheitspolitik, Muri, Switzerland 1995

Related article

Generics and You (Part 1): What is a generic drug?
Generics and You (Part 2): The doctor’s choice: brand or generic?
Generics and You (Part 3): In which countries are you most likely to receive a generic prescription?
Generics and You (Part 5): Biosimilars
Generics and You (Part 6): The fourth question about generics
Generics and You (Part 7): You and generics