When Generics Don't Work

Generic medication for ADHD is often a good thing.  The FDA regulates generic prescriptions so that they contain an equivalent amount of the active ingredient of a drug in any generic, and generic medications are generally less expensive, especially as time passes.

However, in the world of ADHD medication, it is not uncommon for a generic medication to not be as effective, or effective at all, compared to a brand name medication, or for one generic to be effective when another is not.  There are many reasons for this.

1)  The FDA's equivalence rule allows for some variation in the amount of medication in a generic, so that a generic may contain 20% more or less than the amount in the brand name medication.
2)  Inactive ingredients may not be the same among different generics and the brand name medication.   This is particularly critical if you are dealing with a patient who has sensitivities to dyes or gluten.  Sometimes your pharmacist can help you identify the inactive ingredients, but sometimes it takes a call to the manufacturer to really be clear on what is in a pill besides medication.
3)  Sometimes the delivery system of the generic is different from the brand name medication.  Sometimes only the immediate release form of a medication is generic, such as with guanfacine (Intuniv, Tenex).  Sometimes the extended release form of the medication is a slightly different system, which creates slightly different blood levels.

For most patients, it is worthwhile to try a generic when it comes out because it is less hassle, and because it is generally a lot less expensive.  However, for some patients, going with brand or even a particular generic is the only effective way to go.  In order to get a particular brand or generic, the doctor must write "brand medically necessary" or "(company name) generic medically necessary."  Be aware that when the pharmacy attempts to fill this, your insurance company will not want to pay and will generate a bunch of paperwork for your doctor. It may take several days or weeks to get the prescription approved.  Sometimes the insurance company will require you to try other medications before allowing a brand name medication.


Everything ADHD Medical Disclaimer
Everything ADHD Privacy Policy