Generic or brand: is it really the same medicine?

Every medicine has a generic name — the name of the actual active ingredient, which is the same worldwide — and one or more brand names, chosen by whichever company packages it.

paracetamol is the generic name. Panado, Painamol, Tylenol and Pacimol are all brands of it. They are the same molecule at the same strength — someone holding a branded box and someone holding a plain generic tablet are taking the same medicine.

This is why the same medicine seems to have several names: amlodipine (Amloc) for blood pressure, simvastatin (Zocor) for cholesterol, escitalopram (Cipralex) for depression and anxiety are each sold under many labels here.

A generic is not an approximation. Before SAHPRA registers one, it must contain the same active ingredient at the same strength in the same dosage form, and it must be shown to be bioequivalent — to deliver the active ingredient into the bloodstream to the same extent and at the same rate as the original.

Manufacturing is held to the same quality standards. The original brand had patent protection for a period, which is why generics appear only some years after a medicine launches.

• The inactive ingredients — fillers, dyes, coatings. This matters if you have an allergy or intolerance to one of them, or if you avoid certain ingredients for religious or dietary reasons. Ask the pharmacist.
• Size, shape, colour and taste. Purely cosmetic, but genuinely disorienting when a familiar tablet suddenly looks different — and a real cause of missed doses in someone managing several medicines.
• The device, for inhalers and injectables. Two products can contain the same medicine and be operated differently, which matters a great deal. Ask to be shown the new one.
• Cost to you. Generics are generally less expensive, and your medical aid may cover one and not another.

In South Africa a pharmacist is required to offer you a suitable generic alternative where one exists, unless the prescriber has specifically excluded substitution. You are entitled to ask questions, and you can decline.

1. 1Ask what the generic name of the active ingredient is, and confirm it matches what you were taking.
2. 2Check the strength on the box against your previous one.
3. 3Ask whether anything about how you take it changes.
4. 4If it is an inhaler, injection or patch, ask to be shown how the new device works.
5. 5Take a photo of the new box, so you have a record of what you are actually on.