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Generic Drugs in Pediatrics

Childhood Medications

By

Updated September 26, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Generic Drugs

Some parents were once hesitant to get generic drugs for their kids.

With increased awareness that generic drugs are simply, as the U.S. Food and Drug Administration states, 'copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use,' more parents are choosing generic drugs.

Some are even asking if their prescription is available as a generic now.

This may have more to do with the high prices of brand name drugs, though.

High drug prices also have some parents searching for generic alternatives when a generic version isn't available. Unfortunately, some non-generic medications may be over $100 a prescription if you have to pay full price or they may have the highest copay (tier 3) even if you have prescription drug coverage. Either way, that may leave you unable to afford your child's medications.

If writing for non-generic, high tier 3, or uncovered medicines is often a problem when you go to the doctor, consider bringing an updated copy of your insurance company's drug formulary, which includes medication tiers, or a list of medicines on the Target or Walmart $4 generic drug list.

Keep in mind that just because you get a generic drug doesn't mean it is going to be cheap. Except for the oldest generic drugs and the ones on the national retail chains generic drug lists, even generic drugs can be expensive. The biggest savings is often for those on a prescription drug plan, since a generic drug will often cost you the lowest copay of your plan.

Generic Drugs - Antibiotics

With some notable exceptions, many commonly used antibiotics are now available as generics. Some newer forms of these same antibiotics are still name brand drugs and are not generic though, such as Augmentin XR and Zmax (azithromycin extended release).

  • Amoxil (amoxicillin)
  • Augmentin (amoxicillin and clavulanate)
  • Augmentin ES (high dose amoxicillin and clavulanate)
  • Bactrim
  • Clindamycin
  • Keflex (cephalexin)
  • Omnicef (cefdinir)
  • Penicillin VK
  • Zithromax (azithromycin)

Surprisingly, two of these antibiotics, Clindamycin and Bactrim, have made a comeback in recent years because they actually work better than newer antibiotics against MRSA.

Generic Drugs - Allergies

Since many allergy medications became generic and available over-the-counter, many insurance companies reduced their prescription coverage for allergy medications. This is especially true for many of the newer name brand allergy medicines, such as Clarinex, Xyzal, Omnaris, and Veramyst, etc.

  • Allegra (fexofenadine) - available OTC
  • Astelin (azelastine) - an antihistamine nasal spray
  • Claritin (loratadine) - available OTC
  • Flonase (fluticasone propionate) - a generic steroid nasal spray
  • Nasarel (flunisolide) - a generic steroid nasal spray
  • Zyrtec (cetirizine) - available OTC

Generic Drugs - Asthma

Unfortunately, there are few generic drugs to prevent and treat asthma attacks.

The switch to HFA inhalers from CFC inhalers in 2008 is likely why there aren't that many generic asthma medications.

  • Albuterol nebulizer soln - asthma reliever medicine
  • Pulmicort Respules (budesonide) - asthma preventative medicine

Ventolin HFA 60 is a newer, less expensive, 60-dose-per-canister version of an albuterol inhaler. It has much less albuterol in it than other inhalers, such as Proventil HFA and ProAir HFA, which have 200 doses per canister, but it may save you money.

Generic Drugs - Dermatology

The latest acne medicines are especially expensive and poorly covered on many insurance plans, which will have some parents looking to use the same medications to treat their kids' acne as they used when they were teens, such as Benzamycin and Retin-A.

There are many generic drugs to treat other common pediatric dermatological problems, such as eczema and ringworm, but many of the newest medicines are still expensive.

  • Bactroban ointment (mupirocin) - antibiotic cream
  • Benzamycin gel (Benzoyl Peroxide-Erythromycin) - acne
  • Cutivate cream (fluticasone propionate) - medium-potency steroid cream
  • Cutivate ointment (fluticasone propionate) - medium potency steroid ointment
  • Differin gel, 0.1% (adapalene) - acne
  • Lidex - high potency steroid cream
  • Loprox (ciclopirox) - antifungal cream
  • Minocin - acne
  • Nystatin cream - yeast infection cream
  • Nystatin ointment - yeast infection ointment
  • Ovide (Malathion) - lice
  • Retin-A cream (tretinoin) - acne
  • Retin-A gel (tretinoin) - acne
  • Silvadene - burn cream
  • TAC 0.1% - medium potency steroid cream

Generic Drugs - Drops

Unlike many other medicines, doctors have tended to avoid older ear drops and eye drops because the newest versions were really thought to be worth the higher price. Fortunately some, like Floxin otic and Ciloxan eye drops are now generic.

  • A/B otic - ear pain associated with a middle ear infection
  • Ciloxan (ciprofloxacin) - pink eye
  • Erythromycin ophth ointment - pink eye, especially in newborns and younger infants
  • Floxin otic drops (ofloxacin) - middle ear infection with ear tubes or outer ear infection (swimmer's ear)
  • Polytrim ophth soln - older pink eye medicine

Generic Drugs - GI

As with allergy medicines, many insurance companies reduced their prescription coverage for gastrointestinal drugs, especially those to treat acid reflux, as many have become available over-the-counter.

Unfortunately, it is usually only the capsule form that goes OTC, which doesn't help younger kids who can't swallow pills. Opening and sprinkling a Prevacid capsule on a tablespoon of applesauce, yogurt, or ENSURE pudding, or in a few ounces of apple juice or orange juice, might be a good way to get your child to take a reflux medicine as long as he swallows the mixture immediately.

  • Lactulose - constipation, available OTC
  • Miralax (polyethylene glycol) - constipation, available OTC
  • Pepcid (famotidine) - reflux, available OTC
  • Prevacid (lansoprazole) - reflux, available OTC
  • Prilosec (omeprazole) - reflux, available OTC
  • Zantac (ranitidine) - reflux, available OTC
  • Zofran (ondansetron) - nausea and vomiting

Generic Drugs - Psychiatry

Until Adderall XR recently became available, generic drugs for ADHD were limited to older, short-acting stimulants (lasting about three to four hours) and intermediate-acting stimulants (lasting up to four to six hours). This typically meant that kids would have to take a second dose at school.

  • Adderall (mixed amphetamine salts)
  • Adderall XR (mixed amphetamine salts) - extended release
  • Focalin (dexmethylphenidate)
  • Metadate CD (methylphenidate)
  • Metadate ER (methylphenidate)
  • Ritalin LA (methylphenidate)
  • Ritalin SR (methylphenidate)
  • Ritalin (methylphenidate)

While newer depression medicines are expensive, many of the ones that are approved for children and teens, except for Lexapro, are available as generic drugs.

  • Elavil (amitriptyline) - older tricyclic antidepressant that is more commonly used for chronic headaches and recurrent abdominal pain than depression
  • Prozac (fluoxetine)
  • Zoloft (sertraline)

Generic Drugs - Most Wanted List

Unfortunately, generic medicines aren't available for all commonly used medicines or types of medicines. Some of the more commonly used pediatric drugs that many parents likely wish they had a generic version, so that they would be cheaper, might include:

  • Advair HFA (asthma prevention)
  • Asmanex Twisthaler (asthma prevention)
  • Benzaclin (acne)
  • Concerta (ADHD)
  • Flovent HFA (asthma prevention)
  • Pulmicort Turbuhaler (asthma prevention)
  • Retin-A Micro (acne)
  • Singulair (allergy and asthma prevention)
  • Strattera (ADHD)
  • Symbicort (asthma prevention)
  • Tamiflu (influenza)
  • Vigamox (pink eye)
  • Vusion (diaper rashes)
  • Vyvanse (ADHD)
  • Xolair (allergic asthma)
  • Xopenex (asthma reliever)
  • Xopenex HFA (asthma reliever)

If a generic drug isn't available, should you ask your pediatrician for free drug samples or a coupon?

If it is the medicine that your pediatrician would have been using anyway, then sure. Otherwise, it may cost you more money in the long run. Since these are usually the newest and most expensive medicine, once the sample or coupon runs out, you might be left paying for an expensive prescription that has a generic alternative that might have worked just as well.

Drug samples can be a good way to demonstrate how to use an inhaler or nasal spray, etc., or see if a medicine even works well for a patient, though. And many pediatricians like having them for situations when a patient has no insurance or prescription drug coverage, or there is no generic alternative, like for asthma preventative medicines.

Still, if a patient can't afford their medicines, applying for the company's patient assistance program might be a better option than getting samples.



Sources:

FDA. Understanding Generic Drugs. Updated September 2010. Accessed March 2011.

Miller DP. The impact of drug samples on prescribing to the uninsured. South Med J. 01-SEP-2008; 101(9): 888-93

Prevacid Prescribing Information. Takeda Pharmaceuticals America, Inc. August 2010.

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