When doctors and pharmacists are in school, we are taught that brand and generics for medications are “therapeutically equivalent”. Then we get out in the big world.
In my professional experience, the first issue I had was with birth control pills. Women would be fine on the brand pill. Then, usually for financial or insurance reasons, they would be switched to a generic pill of the same thing. The bleeding, spotting, cramping and irritability would start.
We saw the same thing with hormone replacement drugs. My dear departed office nurse used to argue with her pharmacy student daughter about these medications at the dinner table. Finally, exasperated, she said, “then you answer my phone and tell all the patients that they are not having problems!”
I had issues with my “fluid pill” for my blood pressure, ending up with gout. Fifteen years later, I still take medicine for this problem. While I do have a family history, I had not had a problem until I went on the generic for the blood pressure medication.
Patients tell me that “the green generic” for their medication works fine, but “the blue pill” doesn’t seem to work as well or at all. Some patients will pay extra for brand medications because the generic doesn’t work. Others have to increase the dose of the medication to get the same effect when they switch to generic.