Between branded and generic drugs in Nigeria

There is no doubt that even the richest person in Nigeria will be feeling the current economic austerity in the country, bought about partly by our free-falling Naira against the dollar and partly by the removal of fuel subsidies. Prices of commodities have skyrocketed by as much as as 500% while moving from one place to another using fossil-fuel powered vehicles is fast becoming a luxury.

Things in the health sector are much worse, especially when it comes to certain drugs. Recently, GlaxoSmithKline, one of the leading manufacturers and distributors of drugs in the world put a curtain over their operations in the country. While the reason for this remains a subject to be discussed for another time, their exit from the country has only gave room to foxes and scavengers that are ready to extract as much money as possible from people that are in need of the drugs produced by this company for one thing or the other. In supply and logistic terms, they call these people middle men.

Augmentin, one of the drugs manufactured and distributed by GSK, has been making the news headline recently due to a steep jump in its price. 1g Augmentin that used to be sold for roughly $7 is now being sold for as high as $56. By my estimation, that is about 800% jump in the former price, and this happened within a couple of weeks. Rightly so, the situation has been drawing hysteria from folks in the health sector.

In one of the Whatsapp groups that I belong, a medical Doctor wrote an epistle around the situation. It was more about fear-mongering that anything else. I respectfully informed him that Augmentin is not the only drug whose contents are amoxicillin and clavulanic acid. Augmentin is just a brand of GSK, and there are several other brands which are available significantly cheaper in the market.

My response triggered reactions from several members of the group. While some members were in agreement with what I said, some were not in agreement. Those that disagreed with me based their disagreement on the fact that I am not a professional in the field of health or drugs while some were of the opinion that generic drugs are usually less effective than their branded counterparts. The later opinion is the hill the medical doctor that started the whole brouhaha was ready to die on.

According to this doctor, when it comes to prescribing amoxicillin/clavulanic acid to his patients, he will only prescribe Augmentin, and may even pull a case with any Pharmacist that changes this prescription to another brand that is not Augmentin. He supported his stand with an opinion that generic amoxicillin/clavulanic drugs are usually less effective than Augmentin. I responded by asking him to bring a single peer-reviewed journal that supports his claim. Instead, he meekly alluded that his hypothesis is based on an anecdotal evidence that has been working for him for years.

Is he right to insist that he will only prescribe Augmentin? I mean we are in a country whereby an average citizen survives on less than a dollar every day. He even insisted that if he prescribed the drug to a patient that cannot afford it, he will rather borrow the patient the fund to buy the drug and detain such patients until they are able to raise the repayment. That's a bit to the extreme, you will all agree with me.

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Are generic drugs usually less effective than their branded counterparts?

No, generic drugs are not usually less effective than their branded counterparts. Generic drugs are required to demonstrate bioequivalence to the brand-name (innovator) drugs before they are approved by regulatory authorities. Bioequivalence means that the generic drug has the same active ingredient, strength, dosage form, and route of administration as the brand-name drug, and it produces the same therapeutic effects in the body.

Generic drugs go through rigorous testing and regulatory scrutiny to ensure they meet the same quality, safety, and efficacy standards as the original branded drugs. They offer a more affordable option while maintaining equivalent therapeutic effectiveness.

The doctor who insisted on sticking to branded drugs could be doing so based on the general distrust in Nigerian regulatory authorities. Many Nigerians believe that Nigeria is filled with substandard products because of the corrupt regulatory authorities that usually compromise on qualities after taking bribes from supplier or manufacturers. But does it means that all generic drugs in Nigeria will automatically be substandard? Unless there are numerical data to back this up, my answer will remain no.

But people take generic drugs and still complain of the ailments that the drugs are supposed to solve? This could be due to several factors, of which substandard drugs is just one of them. Unless all other factors have been isolated, pointing to substandard drugs as the culprit reeks of inferiority complex from the part of the consumers.

Are there no investigations to assess the effectiveness of branded versus generic drugs?

In 2020, Tian and his coworkers carried out a comparative effectiveness of branded vs. generic versions of antihypertensive, lipid-lowering and hypoglycemic substances. Their findings? The effectiveness of the two categories of drugs were comparable, with generic drugs even showing higher effectiveness in some areas. What an interesting finding!

Even though I couldn't find a research such as the above in Nigeria, a somehow relevant research was carried out in the Northern part of the country in 2013. A cross sectional survey of the perception of Pharmacists about generic substitution of branded drugs was carried out. Interestingly, results threw up a high support for generic substitutions among the pharmacists.

In summary, unless there are scientifically proven red flag about a generic drug, there is really no reason not to recommend such drugs to treatment of ailments. Preferring branded drugs over their generic counterparts even in the face of a huge price different is having a consumerism, or can I say, inferiority mindset.

Fun fact: Amoksiklav is a generic version of Augmentin and the 1g version goes for as low as $4. Imagine the huge difference between $4 and $57! However, one will not be alarmed by the time they realized that the exit of the manufacturers of branded drugs in Nigeria and the avarice of the middlemen that took over is what is responsible for the high price, and not the actual value of the drug.

Let's do away with consumerism mindset.