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Discussions For Professionals Hypertension Questions
Discussions For Professionals Hypertension Questions
What is the difference between different types of angiotensin receptor blockers?
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Accepted Answer
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For simplicity, many physicians believe in the 'class effect' of medications. So that all ARBs are created equally when it comes to blood pressure reduction and/or disease protection. This is likely false, though proving small differences among the compounds is difficult. Therefore, when it comes to over all organ protection, I don't practically distinguish between medications within this class.
Having said this, there are likely differences within this class when it comes to blood pressure reduction. Later generation ARBs (like olmesartan) are likely more potent from a BP perspective than, say, losartan (both drugs interestingly made by Merk when they acquired Schering Plough). So in my practice, I do often switch to later generation ARBs when BP is still not at target.
Lastly, I do not prescribe like prescribing generic medications when it comes to treating cardiovascular illness. Despite what some might say there is no evidence to say that generic medications are in fact similar to originator molecules when it comes to disease outcomes. Generic medications should be avoided when treating illnesses where mortality is a possible result because quite simply, the entire spectrum of generics is untested in terms of actual patient outcomes.Dr. Jordan Weinstein likes this post.
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In order to get FDA approval to market a generic drug, it has to be proven to the FDA to be "essentially equivalent" to the branded drug. It is subject to the same level of manufacturing inspection and control as the branded drug. Check the FDA website for this. There may be some cases where due to manufacturing/compounding differences the drug will behave differently with some persons. If your doctor agrees to try you on a generic, a 30 day trial to be sure that you are getting adequate BP reduction from the new drug is in order. If it does the job and causes no other problems, I'd go for it. Losartin (Brand name Cozar) is now available as a generic and my Medicare part D provider has it on the tier 1 list (lowest copay). I think you can get it pretty inexpensively at Walmart or Walgreens. Ask your doctor!-
Hello,
Your statement is not true.
"Essentially equivalent" is not the standard the FDA uses. Bioequivalence is the standard they use which indicates that between 80-120% of the parent compound is in the generic pill (http://en.wikipedia.org/wiki/Bioequivalence). Firstly, there are no data - none - that indicate whether this difference is clincaly significant. So asking one's doctor will be of little help since they would only be speculating. In addition, there are numerous additional compounds in most pills whose properties and how they interact with the parent compound are not known and not subject to any review process. And of course, every generic company has different acceory compounds in their version of whatever pill they are imitating. Lastly, to your comment that same manufacturing quality and control exists with generic pills, this too is likely false. I can provide you a reference (if you contact us on the contact form below) showing marked differences between generic ramipril (as one example) and name brand altace from a large number of different manufacturers (from a European study on generics).
Bottom line, generics are not identical, the companies making them acknowledge they are not identical and there is no rigorous proof they are anything more than approximations of the originator pill, where there differences known to exist produce unknown potential harms.
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