Prescription writing: Generic or brand?

“Are you taking Losartan at the moment?” I ask my mother.

“No dear, I haven’t taken that for years,” she says, as she empties a paper bag filled with medication strips, new, old and empty.

I see a envelop of losartan emerge from the bag and ask if she is taking them.

“Oh yes, I always take Resert tablets.”

It’s not just elderly people who can be confused about which medication they’re taking. Drug names are long, complex and there are usually multiple brands for the same product.

For any medication, there are likely to be 15 different brands available. People are likely to use these brand names to describe the drug, like my mother did with her Resert tablets.

This is one example for the confusion over brand name and generic name of drugs.

A study conducted by Ghosh R et al. in one of the teaching hospital of nepal  concludes that only 22.57 % of drugs  were presribed by generic name. Every medicine has an approved generic name. If it is made by several companies, each will also give the medicine a brand (trade) name. So one medicine may have a generic name and also have one or more brand names. This can sometimes lead to confusion. 

Generic name.

Each medicine has an approved name called the generic name. A group of medicines that have similar actions often have similar-sounding generic names. For example, phenoxymethylpenicillin, ampicillin, amoxicillin and flucloxacillin are in one group of antibiotics.

Brand (trade) name. 

Many medicines also have one or more brand names. This is chosen by the company that makes it. Several companies may make the same generic medicine, each with their own brand name. The name is often chosen to be memorable for advertising, or to be easier to say or spell than the generic name. For example, paracetamol is a generic name. There are several companies that make this with brand names such as Cetamol, Niko, Medomol etc.

The brand name is usually written most clearly on any packaging. However, you will always see the generic name written somewhere on the packet (often in small print). Some medicines only have the generic name on the packet.

The colour, size, shape, etc, of brands of the same medicine may vary depending on which company makes it. Do not be alarmed if your regular medicine seems to have changed colour or shape. It may be that the pharmacist is getting it from a different company, or the doctor has written the prescription in a generic way rather than using a brand name. However, the medicine will be the same if the generic name is the same as before.

Combination products

Some tablets or pills contain a combination of medicines. Combination products are often marketed and sold with a brand (trade) name. However, the individual ingredients (the individual medicines that are combined into the one tablet or pill) will all be listed in small print on the packet. For example, a popular painkiller has a brand name of Brucet. This contains two generic medicines - paracetamol and ibuprofen. 

Generic prescribing

Doctors are encouraged to prescribe by using the generic name. The newer act also speaks about the prescribing medicine in generic name too. This is because:

• The generic name is the one doctors are trained to use. There are sometimes many brand (trade) names for one medicine. Possible confusion or mistakes are reduced if all doctors use the same names when talking about and prescribing medicines.
• Generic medicines are often cheaper. Even for medicines that you can buy, such as paracetamol, there is often a big price difference between brands.

A few medicines, however, are always prescribed by the specific brand. This is because there are differences between the different brands in the amount you end up having in your body (bioavailability). Examples of these type of medicines are:

• some epilepsy medicine such as Lamotrigine
• Theophylline
• Digoxin
• Warfarin

Why do doctors use brand names when prescribing?

The generic name of a medication is often the last thing on the doctor’s mind. There are thousands of medications and even the most diligent doctor can’t remember them all.

Pharmaceutical companies have marketed brand name medication to doctors. But when doctors rely on using brand names in conversation and prescribing, this can cause confusion. Doctors using branded prescribing can lead to serious medication errors . This may be due not knowing the active ingredients in those medications, or mixing up brand names, which are becoming increasingly difficult to recognise when written in doctor’s handwriting.

So, to avoid confusion, medication errors and allowing for patient control over purchasing decisions, doctors should use generic terms when prescribing unless a specific reason exists.

Ashok Bhusal (Pharmacist) 

Annapurna  Pharmacy Pvt. Ltd