Download generic prescribing - when not to do it!

Generic Prescribing: When not to do to do it!
Generic prescribing is generally more cost-effective than prescribing by brand name.
There are some circumstances however in which it is preferable to prescribe by brand name.
Some common examples are given below but note that this list is not exhaustive.
 Difference in bioavailability between brands, particularly if the medicine has a narrow
therapeutic index.
Generic Drug or Drug Class
Examples of Brands
Beclometasone dipropionate CFC-free pressurised
metered dose inhalers.
Clenil Modulite, Qvar
Lithium preparations
Priadel, Camcolit, Liskonum
Carbamazepine
Tegretol, Epimaz, Tegretol Retard, Carbagen SR
Phenytoin (capsules versus tablets)
Epanutin
Ciclosporin
Neoral, Deximune
Tacrolimus
Prograf (BD immediate-release preparation), Advagraf
(OD modified-release preparation)
Qvar has extra-fine particles and is ~ twice as potent.
Note: Loss of seizure control has been reported in patients after switching brands of antiepileptic medicines. Continuity of the same brand or the
same generic preparation is considered a clinical decision. Generic and branded lamotrigine are bioequivalent. See specific advice above for
carbamazepine & phenytoin
 Modified release preparations that are not interchangeable, particularly if the medicine
has a narrow therapeutic index, usually because of different release characteristics.
Generic Drug or Drug Class
Examples of Brands
Diltiazem modified release preparations
Adizem (SR, XL), Dilzem (SR, XL), Slozem, Tildiem (LA,
Retard)
Nifedipine modified release preparations
Adalat (Retard, LA), Adipine (MR, XL), Cortcten (SR, XL)
Theophylline modified release preparations
Nuelin SR, Slo-Phyllin, Uniphyllin Continus
Aminophylline modified release preparations
Phyllocontin Continus
Morphine oral modified release preparations
Morphgesic SR, MST Continus, Zomorph, MXL
Mesalazine modified release preparations
Asacol, Ipacol, Mesren, Mezavant, Pentasa
Note: different modified release preparations may have different dosing schedules, e.g. once daily or twice daily.
In general: SR / CR / MR / Retard = BD and XL / LA = OD
 Products contain multiple ingredients and brand name prescribing aids identification.
Generic Drug or Drug Class
Examples of Brands
Compound alginates and proprietary indigestion
preparations
Gastrocote, Peptac, Gaviscon Advance
Pancreatin supplements
Creon, Pancrex
Oral rehydration salts
Dioralyte, Electrolade
Saliva replacement products
Biotene, Glandosane
Preparations for skin and scalp conditions containing
multiple ingredients
Trimovate, Fucibet, Dermovate-NN
Hormone replacement therapy, oral & patches
Premique, Prepak-C, Premarin, Evorel
Oral contraceptives, combined & progestogen-only
Microgynon, Cilest, Femodene, Micronor
 Administration devices have different instructions for use and patient familiarity with
the same product is important.
Generic Drug or Drug Class
Examples of Brands
Adrenaline pre-filled syringes
Anapen, EpiPen
Insulin
Actrapid, NovoRapid, Humalog, NovoMix 30, Humulin M3
Note: Appliances and dressings are also cases where brand name prescribing aids identification and administration.
Adapted August 2003 (Updated December 2006) from “Generic Prescribing – When not to do it.” Guildford and Waverley PCT November 2002
Updated August 2010 from “Which medicines are not suitable for generic prescribing in primary care?” UKMi February 2009