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Dear Dr. Kate: Is Generic Pill As Good as Brand Name?

Thu, Nov 5, 2009

Advice, What's Up Doc?

birth_control_pill_421photo by nateOne

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City and she answers your medical questions here once a week. To ask her your own question, click here.

Dear Dr. Kate,

A few months ago, I read (on a reputable website) that generic birth control pills can sometimes not be as effective as their name brand counterparts because they do not always contain the same amount or combination of hormones. I am a poor college student, so $5 for pills each month sounds way better than $30, but not if I’m not getting the same amount of protection. I’d gladly pay the extra $25 if it meant significantly higher protection from pregnancy. Is it true that generic pills are less effective? And if they are, are there any generics that are better than others?

– Scared of Generics

Dear Scared,

The FDA mandates that brand-name drugs and their generic versions need to be chemically the same drug. Generic pills have to have the same active ingredients, the same dosing, and the same kind of absorption. What’s different? Colors, shapes, imprints, and preservatives…but the medication is the same.

So why do some women claim to see huge differences when they switch to the generic form of their favorite pill? It may be a reaction to the inactive ingredients in the new pill; these ingredients don’t affect how the pill works to prevent pregnancy, but intolerance of them may cause side effects. The other reason is a bit more high-school-chemistry, and is related to the bioavailability of the drug. Bioavailability is the amount of time it takes the drug to be metabolized by the body. The makers of generic pills must show that the bioavailability of their generic is not significantly different (plus or minus 20%) from that of the name brand. So generics have the same amount of hormones, but it may take a different amount of time for your body to absorb it. This difference shouldn’t change the efficacy of the pill, either, but it may cause side effects in women who are sensitive to small changes in hormone levels.

All pill manufacturers have to guarantee that the hormone doses in each pill are what they claim they are, plus or minus this 20%. So that gets a little scary with any pills, especially the ultra-low-dose ones (with 20mcg of estrogen), because what if you get a batch that has a bunch of pills that err on the low side? That’s one of the reasons I’m not a fan of the ultra low dose pills…but the same concerns apply to generics and brands.

My advice is that if the cheaper generic pills don’t cause any crazy bleeding or other side effects, stick with them. And if one generic pill makes you feel bad, you can always try another — I’d hate for anyone to stop using the pill simply because of cost.

– Dr. Kate
Gyotalk

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City. She also lectures nationally on women’s health issues and conducts research on reproductive health. Check out more of her advice and ask her a question at Gynotalk.com.

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8 Responses to “Dear Dr. Kate: Is Generic Pill As Good as Brand Name?”

  1. Rebecca Says:

    I recently started taking the generic form of my birth control pill, and it has really affected my mood in the 3rd week. Like make me crazy and crying affected me. Everything else seems to be going fine, but I can’t handle the extreme mood swings and depression. Hopefully it will all balance out soon, or I am going to have to go with something else.

  2. Spes Says:

    I was on the generic version of Seasonel for 5 months and it was awful. The protection seemed to be the same, as in I haven’t gotten pregnant on either, but I gained a huge amount of weight in a relatively short period of time. I went from a size 2 to a size 8 within a month and a half. I was exercising and eating healthier than I ever had before. Within three weeks of getting off that pill and back on the Seasonel, I dropped to a 4. My physician told me it was all in my head, that generic and brand are the same. Their effectiveness may be the same, but the side effect certainly are not.

  3. b-b Says:

    Several years ago my insurance switched me from Alesse — the only pill I ever found that didn’t cause severe nausea and vomiting — to its generic Aviane, which immediately started the side effects again. It was a huge difference.

  4. Erin Says:

    Rebecca you sound like I did when I was switched to a generic pill. I was depressed, angry and went crazy. The last month of the pill I felt like ripping my skin off like it was too tight. My doctor practically ignored me until I was begging to be switched to the Orthtricyclyne lo that I had previously been on. They thought I was in a bad relationship, the fact was I felt like i was going crazy and instigated fights with my boyfriend and felt like cutting my self. Once I switched I was fine and was angry for the doctor not listening to me. I suggest you switch so that way you don’t get any worse.

  5. Katie Says:

    Switching from the actual brand to generic can be tricky; it was a pretty clear catalyst into a year-long depression for me. Even after I figured out the culprit and stopped using the generic brand, I had to eventually go on antidepressants for 9 months to even out the effect! It was absolute hell.

  6. Rachel Says:

    Wow, this all sounds awful. I just wanted to throw my 2 cents in for anyone reading this getting totally terrified of generic brands – I went on the pill 2 years ago and have always been on a generic brand, and as far as I can tell nothing is wrong with me! I am slim and healthy and happy! Also I have a friend who went on a brand name pill earlier this year and got so sick she stopped altogether after a month. So those are just my experiences with this matter.

  7. Sara Says:

    I was on Seasonale for several years with no problems. After I switched insurance, I was put on the generic Jolessa. Cue bleeding almost every day, mood swings, depression, etc. Luckily, I have a doctor who is very helpful and attentive, and I got back on the brand name pill. All the side effects stopped almost immediately.

    For anyone who has trouble convincing their doctor, check online for the listed side effects of the pill and circle those that have been happening to you. It’s a lot harder for a doctor to say it’s all in your head if you can show them proof it’s happened to other patients on the same medication.

  8. Spes Says:

    Oh no, I’m not trying to give generic a bad name. Generic can be great. When I used the 28day-cycle pills, I used the generic kind. I had no problems with them at all, and yay, no pregnancies. I just hate bleeding out every month so much that I switched to Seasonale since the docs refused to suck out my uterus. I know there are the IUD’s like the Merina, but docs are weird about giving those to someone who has never giving birth.

    I just don’t understand why women are so regulated with what they can do with their bodies. For now, we’re–just barely–able to have an abortion, but we can’t insist on having our tubes tied or better yet having our uterus removed altogether. We can decide to have a procedure that can possibly leave us sterile or dead (abortion) but we can’t take those same risks with a different procedure until some doc deems is appropriate.
    How about a clinic that does abortions AND tubal ligations AND partial hysterectomies! Now that would be honoring women’s rights.
    Sorry about the rant, it’s pet peeve.


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