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Can pharmacists substitute generic drugs without telling us?

The question: Can pharmacists make generic drug substitutions without consulting me or my child's doctor? Our doctor told me to make sure the pharmacist filled my daughter's asthma prescription with Singulair and not the generic equivalent. But I got a lot of resistance from the pharmacy. I know the generics are cheaper, but the doctor's main concern (and mine) is keeping my daughter's asthma under control.

The answer: Many prescription drugs are available in both the original "brand name" version as well as in generic form. Because generic manufacturers don't have to spend years in the research phase of drug development, their production costs are much less. Hence, generic drugs are significantly less expensive than their brand-name precursors.

Generic drugs must contain the same active ingredient in the same dosage as the brand name product they are replacing. Although the size, shape and flavour of generic drugs may differ from their brand-name counterparts, all generics have undergone review to ensure that they are comparable to their brand-name counterparts. So most patients can be switched to a generic form of their medication without incident. There are, however, instances in which the brand name product is better tolerated.

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I am quite comfortable with patients switching to generic drugs when they become available, especially if it results in a cost saving. I do advise that people contact their prescribing physician immediately if they feel that the generic product is not as effective or not as well tolerated as the original brand-name medication.

But to your question, I do believe that pharmacists should inform patients when they are switching prescriptions from a brand-name drug to a generic one. Patients have the right to know which form of medication they are taking. Additionally, you always have the right to request brand-name product provided you are willing to pay the extra cost. Physicians also have the option to write "no substitution" on prescriptions, which directs the pharmacy to dispense the brand-name medication. Just be aware that the brand-name product may not always be immediately available, and that your insurance provider may only cover the cost of the generic drug, leaving you on the hook for any additional cost.

Send pediatrician Michael Dickinson your questions at He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail website. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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