I am a school nurse, and it’s very common to hear people in and out of the medical profession say generic medication is “the same” as the brand name equivalent. Although I’d never researched this issue before, I started investigating generic verses brand name medications when one of my staff member’s blood pressure went sky high after changing to a generic. 

I came across an article written by Dr. Tod Cooperman, MD, “What You Need to Know About Generic Drugs” and found some interesting and upsetting statistics. As a nurse, I think it’s important that we’re all educated consumers and should be aware of discrepancies. Here’s what I found. Later I’ll explain why these findings are so upsetting to me as a school nurse.

• Eight percent of drugs we take in the US are now generic versions of the brand name medication.
• Generic drugs are required to provide 80% to 125% bioavailability to your bloodstream.
• Generics can contain very different other binders and fillers than their brand name counterpart, which can impact how fast or slow the active ingredient is released into the blood stream, especially in extended-release forms of the medications.
• The FDA requires that the package inserts for generic drugs show the same data as the brand name drug. However, this isn’t always true and that information is not always released.

So, this information is upsetting to me for a number of reasons, but most importantly, the issue of bioavailability. Some medications, such as thyroid, anti-seizure, blood thinners, antidepressant, antipsychotic, asthma, and immunosuppressant medications, must be kept in a narrow blood level range to be safe and effective. If the bioavailability of these medications fluctuates, the efficacy and safety of the medication also fluctuates, and can be harmful to the patient.

As a school nurse, this impacts me greatly because I’m responsible for the health and welfare of our students, as well as our staff, who take quite a bit of medication. So, not only am I paying attention to the fact that my co-worker’s blood pressure spiked, but I’m focusing also on students with a variety of needs. Especially working with Special Needs students, we have many, many students taking the SSRI’s (Seratonin ReUptake Inhibitors) for depression and OCD (obsessive/compulsive disorder).  Also, many of our students are being prescribed blood pressure meds, like Clonidine and others for ADHD, instead of the Stimulants, like Ritalin. If these blood pressure meds are different in bioavailability that implies tremendous variations in efficacy of their administration.

My goal here is to raise awareness. If medications aren’t working as intended, we all need to know – not just those of us in the healthcare profession, or those children affected using some of these meds for behavior and mood change, but everyone. You never know when a twist or turn in life may require you, your child, or a student under your care, to begin using a medication, and we should all be informed to ask the right questions when accepting a prescription for a generic or a name brand.

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About the author

Pamela Barnes, RN, CSN-NJ, M.Ed is the School Nurse and Health Educator at The Children’s Institute in Verona, NJ, and has over 18 years of school nursing experience.