Generic ADHD Medications Update: Caution

ADHD generic medications

To save money, many people with ADHD take generic medications. Is this a good idea? Maybe not.

Their physicians—and pharmacists—assure them that these generics are “exactly the same” as brand. Only cheaper. Unfortunately, that is rarely the case. Dangerously so, in some cases.

The more precise term is “bioequivalence” to the brand-name version.

The ADHD Roller Coaster covered this topic a few months ago: (Consumer Reports on Autos? Yes. On ADHD Medications? No!)

Ignore Consumer Reports On Rx

Consumer Reports press release prompted me to write that blog post. Shockingly, it actually warned consumers away from brand-name medications for ADHD.

Their reasoning? Brand-name medications are too costly and unnecessary. But more importantly: Your child can get “hooked” on these brand medications? (But not the generics of them? Can you believe how ridiculous that is?)

That blog post countered the nonsense. I detailed the potential risks of using generic medications for treating ADHD.

With other readers, I left comments at the Consumer Reports blog post (“Parents: Don’t rush Children to Adderall, Concerta, Strattera“). Unfortunately, as is increasingly the case, all readers comments have since been deleted.  (I have since learned to take screen shots!)

“A Gnawing Concern”

Today,  The New York Times article (“Not All Drugs Are the Same After All”) backs up the points I made in that post on generic medications for ADHD. Some snippets:

  • “There is a gnawing concern among some doctors and researchers that certain prescription generic drugs may not work as well as their brand-name counterpart.”
  • “Some specialists, particularly cardiologists and neurologists, are concerned about generic formulations of drugs in which a slight variation could have a serious effect on a patient’s health.”
  • “After hundreds of consumers posted messages about problems with the generic drug Budeprion XL 300 on the People’s Pharmacy Web site, Mr. [Joe] Graedon worked with an independent laboratory, ConsumerLab.com, to test the drug, which in other generic versions is typically known as bupropion. The lab found that Budeprion XL 300 released the active drug at a different rate than the brand name Wellbutrin XL 300. Mr. Graedon and the lab conjecture that the different dissolution rates might be to blame for the reported side effects and lower effectiveness of Budeprion.”

Kudos to Joe Graedon of The People’s Pharmacy for listening to his readers (despite his own longstanding support of generics) and probing the issue!

Updates:

Note: This incident with Wellbutrin provided the foundation for my launching a MedWatch complaint with the FDA, about the inferior Concerta generics. We won! (Victory! Concerta Generics downgraded.)

The battle is still waging, with one manufacturer unwilling to accept the downgrade. Some consumers are still being forced to accept them as generics, by pharmacies that aren’t playing by the rules. You can read the history here:  Consumer Q&A On Generic Concerta.

October 2019:  With a venture capitalist named by the Trump administration as FDA chief, dozens of generics were pushed through during his short tenure. Scott Gottlieb, MD, scorned the FDA scientists’ concerns about FDA guidelines being exploited by generic makers, especially when it came to sophisticated delivery systems (e.g. Concerta, with its laser-drilled osmotic pump, Alza’s OROS).

You’ll learn about the current status of Concerta generics (and the authorized generic) here:  Authorized Concerta Update, 6/19.

I welcome your comments on generic medications and ADHD. Please scroll down — no registration or codes required!

—Gina Pera

17 thoughts on “Generic ADHD Medications Update: Caution”

  1. Hello, I’ve been on ADHD meds for over half a year now and I have been having tons of issues with generic medications.

    I was prescribed Adderall as a kid and it was always clear as day when the meds start working. In a way where you notice your ADHD symptoms lessen quite a bit and you want to get your day started.

    With these generics I’ve been taking now they literally feel like placebo pills. I had to switch over to dextroamphetamine and the first generic was helping, then the pharmacy changed to aurobindo manufacturer and I swear these do nothing.

    You would think that taking higher doses of strong stimulants would be even slightly noticeable but no they aren’t. I’m going to talk to my doctor to try and get name brand Zenzedi but idk how it will cost with me using the Oregon health plan.

    The thing that bothers me the most is the thought they might actually be producing poor quality ADHD meds and it isn’t a personal chemistry thing. There are tons of people who get very helpful benefits from these meds in controlled doses and I would hate to think they ruined all of that for them just because it’s a medicine that “could” be abused.

    They are doing this tightening down thing for pain patients with opiates and so maybe they are clamping down on stimulant meds too. If that’s the case that’s so messed up, innocent people are getting effected by this war on substances, deal with the people who abuse it on the street not the genuine people who need it to function and go through the legal process to do things right and don’t abuse their prescription.

    You can look up online and so many people are writing about terrible experiences with generic Adderall/dexedrine. So many people are describing it that it concerns me that nothing is being done about it. Shouldn’t they be looking out for the patients? If they aren’t getting therapeutic effects then shouldn’t that be a concern to the quality of what they make?

    1. Dear Benjamin,

      Yes, yes, and yes. Yes to everything you write. Your concerns are why I, writing a non-profit blog, have spent so much time writing about these issues — and have been the first to write about many of them. Because it is overwhelmingly important!

      People with ADHD — and all people taking medication for anything — deserve medications that work as well as the brand’s original clinical trials show that they do. These medication make all the difference in a person’s ability to function in so many areas of life, including education, employment, driving, relationships, avoiding addictions, etc.

      Many factors have contributed to the rise in these inferior generics. Most of them, as you can imagine, involve money.

      I wrote about this first in 2009, when Consumer Reports magazine stepped way out of its lane to recommend generic medications for ADHD instead of brand.

      https://adhdrollercoaster.org/tools-and-strategies/consumer-reports-on-vacuum-cleaners-maybe-on-adhd-medications-definitely-not/

      I wrote about this more recently in recommending an excellent book on the rise of “Big Generic” (Bottle of Lies) and the rise of offshore generic manufacturers (e.g. Aurabindo):

      https://adhdrollercoaster.org/adhd-news-and-research/generics-bottle-of-lies/

      Since 2014, I have been reporting upon the inferior generics to Concerta, a game-changer among ADHD medications for many millions of people.

      Here is the most recent piece: https://adhdrollercoaster.org/adhd-medications/authorized-generic-concerta-update-6-1-19/

      When the first two inferior generics came out, I rallied readers to report adverse effects to the FDA. After speaking to a very helpful FDA representative, I opened a MedWatch case. That is where the public can report problems with medications. We succeeded.

      https://adhdrollercoaster.org/tools-and-strategies/victory-concerta-generics-downgraded/

      The FDA was in the process of updating guidelines for the generics of medications with complex delivery systems (e.g. Concerta) and also those where dosing must be more precise than the current bioequivalent standard for generics (e.g. all ADHD medications).

      THEN new occupants of the White House appointed a FDA chief who overrode FDA scientist’s concerns and pushed through hundreds of generics. That included about 11 of the current Concerta generics that are throwing so many lives off the rails. Then he high-tailed it back to the Heritage Foundation, an ultra-right “think tank.”

      Actions have consequences, including how we vote.

      I hope that you can find the medication that works best for you. It might be that you benefit from one of the newer brand-name formulations, many of which have savings programs.

      Good luck! Be sure to subscribe if you’d like any updates on this topic.
      g

  2. Hi! Love this blog and I was looking at the big Generic Concerta/Ritalin post you made. Do you think you’d ever consider making a similar post about Adderall generics? I have had lots of issues with them as well, and others have too. Do you think much of the same logic applies? And do you think manufacturers that are good for Methylphenidate generics would also be for Adderall? I’ve never seen such an in depth post or article on this subject and I’m very interested in it.

    1. Hi Maggie,

      I’m glad you find my work helpful. Thanks for letting me know!

      Yours is a good question.

      The reason I focused only on Concerta is because millions of people had responded very well to Concerta and had been taking it for years.

      Then there was this sudden entry of “true” (not authorized) generics that started sending lives off the rails. It was an emergency.

      It’s taken an enormous amount of time over the years, first lobbying the FDA to downgrade the inferior generics and then trying to keep up with the new White House administration laying waste to FDA scientists’ concerns about lack of true bioequivalence with the NINE (last count) new generics for Concerta.

      Did I mention this isn’t a paying gig? 🙂 Not even advertising (too distracting).

      But I have done a bit of research this morning and found that there seem to be some authorized generics of the other stimulants. I’ve put a call into one company, distributing an authorized generic for Adderall XR. As of 2016. Don’t know current status.

      Stay tuned for updates!

      g

  3. Pingback: ADHD Roller Coaster: "Is It You, Me, or Adult A.D.D.?" · A Recap: Consumer’s Guide to Generic Concerta

  4. I take 10 mg Dexedrine tabs and it comes in 3 brands (barr, something called Zenzedi and Mallinckrodt)… 2 of them last longer so my dosing at the max is still 80 mg but my doctor allows me to do a 30, 30, 20 regimen because they both are also weaker. (barr and zenzedi)

    The ones I usually get are the white diamond shaped 10 mg Mallinckrodt and those are more potent feeling mentally (not euphoria wish but the amount of focus I can use) and they wear off fast so I need a 4th dose.

    I also take in reality 5-30 mg, depending on the brand for specific situations. I think the flexibility of the IR Dexedrine is that it will teach myself the skills because it was 100% pills as a kid

    1. HI Mat,

      Everyone has to figure out what works best personally.

      In general, though, it’s best to keep the medication at a steady level in the system — not up and down all the time.

      The brain and body has to go through all kinds of adjustments to accommodate medication in the system, so it’s best to keep things stable.

      best,
      g

  5. Pingback: ADHD Roller Coaster: "Is It You, Me, or Adult A.D.D.?" · An Update on Generic Concerta

  6. Pingback: ADHD Roller Coaster: "Is It You, Me, or Adult A.D.D.?" · What’s Up With Generic Concerta?

  7. This is a very, very interesting and very important post Gina – thank you for talking about this.

    I suffer from SSRI withdrawal syndrome after taking a prescribed generic SSRI. It has lasted nearly 3 years and has only let up for short periods of time. I wonder if it will ever go away. However, I have no way of knowing if this is due to ‘generic’ or not, but it would be interesting if there was a study conducted by those with SSRI withdrawal syndrome or discontinuation syndrome to find out how many were taking the ‘real’ stuff and how many were taking the ‘generic’ stuff. Lately, I may have found some hope, but then again maybe not. It seems the SSRI may have triggered migraines. I had a history of migraines from my youth, but only 1 or 2 attacks a year. Since the SSRI I get the attacks almost daily or rather an attack can last for prolonged periods of time. Checking my vitamins it seems that I also have low magnesium levels in my blood which could be a culprit, so with that I have taken magnesium the last few days, but it seems to be getting worse. Hopefully this is a worse before better scenario but regardless of what I have tried nothing has really ‘worked’ – so I think it is very, very important that generics get thorough testing with comparisons to the originals. Again, I don’t know if it is because of a generic, but I would be interested in finding out – not that it would help me now, but it might help others.

    Thanks,

    Bryan

  8. Hey Gina,
    Happy New Year! Great post, – right on with the caution.

    Just thot your readers might be interested in some additional ideas on how to adjust IR [immediate release] products – so will send along this link to an article I did awhile ago on thinking scientifically if generics are your only alternative -http://ezinearticles.com/?ADD-ADHD-Medication-Treatment—7-Tips-to-Solve-Immediate-Release-Confusion&id=1739408

    Hope these suggestions help! Best to you and all of your team over here.
    Chuck

  9. Gina,

    Thanks for such a thoughtful post. It is frustrating that there is no good way of sorting out drugs that work from drugs that don’t other than trial and error. Some generics seem to be just fine; we do get a lot of reports that others are not providing the expected benefit. If only the FDA were able to monitor such medications, consumers could have a lot more confidence.

    Terry Graedon

  10. I mentioned this to my doctor, regarding my generic Ritalin, but she disagreed. It’s an awkward position. This is the doctor who diagnosed my ADD, and I’m grateful to her. I’m also grateful to you for suggesting other options. When I’m more sure of my footing, I’ll be sure to press the issue.

    1. HI Mark,
      I wonder what she could disagree with. In general, generics aren’t as reliable.

      Maybe your doctor feels your generic Ritalin is working just fine for you. How would she know, though, if you’ve tried nothing else? Do you feel that your medical treatment is as good as it gets?

      Of course, inexpensive generic Ritalin can be a huge help to people who don’t have insurance and can’t afford otherwise. But if one has insurance coverage and can afford the co-pays, I can’t imagine why any physician would prefer generic medication for ADHD. It’s just reckless, IMHO.

      Gina

  11. Hope it is helpful! I think esp for people with ADD/ADHD that cycle of starting something and not being able to sustain it is huge. Working with adult ADD clients is what helped me really realize that the routine is a real secret. Best of luck!

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