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I think the natural engineer intuition is that if a drug is just a chemical, and generic and name-brand drugs are the same chemical, how could there possibly be any difference? Don't be duped by advertising, save the money, be rational, etc.

One interesting case where there was a real problem was with generic extended-release bupropion (an antidepressant). The time-release mechanism on one of the generics didn't work correctly, although the manufacturer managed to get it past the FDA (they actually tested only a 150mg dose, and extrapolated the results to approve the 300mg dose).

https://blogs.sciencemag.org/pipeline/archives/2012/10/18/th...



It gets complicated fast.

Sometimes small differences in formulations will be mostly irrelevant (oh no, your ibuprofen takes a few extra minutes to absorb, but will 99% absorb under almost all circumstances).

But other times, a new crystalline form exists that you weren’t aware of and destroys your entire ongoing production. Same molecule, but different structure that’s too stable and doesn’t dissolve effectively. See: ritonavir.


This was one of the cases discussed in the book.

The book said the manufacturer didn't test the 300mg because it might cause seizure.




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