Generic ADHD Medications Update: Caution

generic ADHD meds

To save money, many people with ADHD take generic medications. Is this a good idea? That depends.

Physicians—and pharmacists—tend to assure patients that generics are “exactly the same” as brand. Only cheaper. The official term is bioequivalence to the brand-name version.

Unfortunately, that is not always case—sometimes dangerously so. With ADHD medications, in particular, the most effective dosing tends to be precise.

For example, 36 mg. With generics, the effective ingredient has 20% wiggle room, up or down. That means you could get significantly more than 46 mg. Or significantly less.

Here at the ADHD Roller Coaster, this has been an ongoing concern.   I first reported on this topic in 2009 (yes, I’ve been here a while!).: Consumer Reports on Autos? Yes. On ADHD Medications? No!

Most recently, I am helping readers to stay current with the ongoing search for Concerta’s authorized generic—or at least finding ways to get brand more economically.

I’ve edited this post, in 2022, to provide a little history on this topic.

Ignore Consumer Reports On Rx

Consumer Reports press release was the catalyst: Parents: Don’t rush Children to Adderall, Concerta, Strattera.

I found it shocking. The magazine known for its reviews of cars and appliances was now issuing medical advice.  Even more shocking: CR actually warned consumers away from brand-name medications for ADHD.

Yes, you read that correctly.

Their rationale? 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?)

My blog post countered the nonsense, detailing the potential risks of using generic medications for treating ADHD.

With other readers, I left comments at the Consumer Reports  post. Unfortunately, as is increasingly the case, readers comments have since been deleted.

“A Gnawing Concern”

Later in 2009,  The New York Times article (“Not All Drugs Are the Same After All”) backs up the points I made in that post. 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.”

Hundreds of consumers posted messages about problems with the generic drug Budeprion XL 300 on Joe Graedon’s People’s Pharmacy Web site. In other generic versions, it is called bupropion, the  generic name for Wellbutrin. He then worked with an independent laboratory, ConsumerLab.com, to test the drug.  

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 reconsidering the issue!

Most Recently: Generic Concerta

About 6 years later, this Wellbutrin XL incident inspired me to launch a MedWatch complaint with the FDA, this time about the inferior Concerta generics trickling onto the scene. Two companies, Kudco and Mallinckrodt, exploited loopholes in novel delivery-system drugs.

That is, drugs whose delivery system—how the medication gets from the pill into your bloodstream—makes all the difference in how it works. That is, without Concerta’s  sophisticated osmotic-release system, it’s active ingredient (methylphenidate) operates like simpler delivery system,

ADHD Roller Coaster readers and others followed through and filed their MedWatch complaints.  In 2014, we won! (Victory! Concerta Generics downgraded.)

The battle waged on a bit more.  Mallinckrodt refused to accept the downgraded status—and threatened to sue the FDA.

For some time after, some consumers were still forced to accept them as generics. That is, these pharmacies weren’t playing by the rules. You can read the history in this post, where I also detail the difference between “true” and “authorized” generics:  Consumer Q&A On Generic Concerta.

Update October 2019

The Trump administration named a venture capitalist as FDA chief, Scott Gottlieb, MD. During his short stint, he pushed through dozens of generics.

The upshot: Gottlieb scorned FDA scientists’ concerns that some generic makers were exploiting loopholes in FDA guidelines.  These loopholes allowed drugs with bare-bones formulation to claim bioequivalence for drugs with sophisticated delivery systems. That included Concerta with its proprietary osmotic pump, Alza’s OROS.

Ongoing Concerta Issues

You can follow about the ongoing status of Concerta generics (and the authorized generic) here:  Authorized Concerta Update, 6/19.

I welcome your comments on generic medications and ADHD.

—Gina Pera

28 thoughts on “Generic ADHD Medications Update: Caution”

  1. Just dropping a note here that Mallinckrodt continues to be a terrible brand for ADHD meds in 2022. All of the local pharmacies near me switched to it as their generic for Dextramphetamine Sulfate ER, and worse than being ineffective, it actively makes my ADHD symptoms worse when I take it. I get stuck hyper-focus on the wall for 4+ hrs feeling like a zombie after taking a 10mg dose that would let me feel normal and able to switch my focus at will on the Teva equivalent.

    1. Nathan, thanks for the update.

      I remember Twitter-shaming the Mallinckrodt CEO. That and Kremers-Urban introduced the first two Concerta generics. We worked hard to get the FDA to down-grade them — and rightfully succeeded.

      But he grandstanded at every opportunity with his threats to sue the FDA, etc… His tax-haven company sociopathically exploits FDA loopholes on novel-delivery system bioequivalence guidelines …. and then wants to sue. Shew.
      g

    2. Nathan ,this is what I noticed. Teva the orange dexedrine worked so much better than adderall ,no matter what brand adderall. It was without side effects ,no harshness and was able to focus be motivated etc all that I lacked before dexedrine. But it’s hard to get Teva (I think it’s Teva I had) dexedrine apparently I went through two genetics malinkrodt and lannett which both were not affective , actually they were counter productive. Then I got ZENZEDI I thought ok I will give it a chance …well it is like Teva in a way it is dexedrine any way. But it does not help my frontal lobe function the way Teva did. I feel I’m missing something veith ZENZEDI even. Amazing, yet true. I would certainly vlime to go on the teva again. The large orange pills. Only thing that works.

    3. Matthew, it’s good to hear I’m not the only one with a similar experience. It helps.

      I just got my latest RX, so now begins the struggle to get someone to actually fill it with Teva.

      I’ve had some mild success by halving my dose of the Mallin Dextroamphetamine ER (you can get capsules that match the size of the RX, and use those to divide it up), which suggests that perhaps part of the problem is the release mechanism. Even with this, they’re still nowhere near as effective, however, so I’d only call it a last-ditch resort if you can’t get ahold of another brand that works for you.

  2. I was taking 15mg adderall pills by Teva they worked great. Walgreens and cvs just switched to elite pharmaceutical. They are sugar pills. I have narcolepsy. They don’t do anything not even if I take multiple pills. This is horrible and playing with people’s lives. How do we know what will work. I filed a complaint with the fda

    1. Sorry to hear that, Katie. You can’t know what will work….until you try it. And that’s the problem.

      See if your prescriber can specify Teva.

      g

  3. 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. Omg I thought it was just me! I tell people all the time I could take my Adderall and then go laydown for a nice nap. I have definitely thought the same thing like They were giving me placebo sugar pills. Or should I say salt… I’ve tried the X or the short term, lots of different things but never the name brand. I’m on a fixed income I can only imagine how much it would cost. If they came over And stayed with me for a week they would see what I’m talking about. SMH

    3. Hi Robin,

      You know, there might be reasons beyond the Adderall being a generic that lead you to feel nap-prone.

      Are you otherwise sleep-deprived?

      g

  4. 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

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