Why has my medicine been swapped for one with a different name?

Why the pharmacy sometimes gives you another brand or a generic, what changes and what does not, and how to avoid mix ups with the new box.

If the pharmacy has given you a box with a different name, a different colour or tablets of a different shape, it is most likely the same treatment: the same active ingredient, at the same strength, made by another manufacturer. In Spain the law sets out when this switch can and cannot be made.

Even so, the change in appearance carries a real risk: getting confused and taking the same medicine twice, or stopping something because you think it is new. We explain why it happens and how to check in a minute.

Why does the pharmacy give you a medicine with a different name?

Because the law says so for most prescriptions in the Spanish National Health System. When the doctor prescribes by active ingredient, the pharmacist must dispense the lowest priced medicine in its homogeneous group, that is, the group of medicines with the same active ingredient, strength, form and route.

Royal Legislative Decree 1/2015 sets out three situations in which the box you take home may not match the one you had before:

That is why, with the same treatment, the box often changes from one collection to the next.

Is a generic just as effective?

Yes. The Spanish Ministry of Health explains that generic medicines are as effective and safe as any other industrially manufactured medicine and that they are interchangeable with the original. To be authorised, they must show bioequivalence, meaning that they reach a concentration in the body equivalent to that of the reference medicine.

• What stays the same: the active ingredient, its amount and the pharmaceutical form (tablet, capsule, etc.).
• What may change: the colour, size, shape, packaging and excipients, which are the substances with no therapeutic action that accompany the active ingredient.
• How to recognise them: in Spain they carry the letters EFG (Equivalente Farmacéutico Genérico) in the name and on the box.
• Why they are cheaper: according to the Ministry, their price does not include the cost of researching the active ingredient, which the original medicine already covered.

The Spanish Agency of Medicines and Medical Devices (AEMPS) requires generics to meet the same quality standards as the originals.

Which medicines cannot be switched without the doctor?

The law excludes from substitution the medicines that the Ministry of Health identifies because of their bioavailability or narrow therapeutic range. With these, small differences between products can matter, so the pharmacist cannot switch them without the doctor's authorisation.

According to the AEMPS, the list includes these groups:

• Biological medicines: insulins, blood products, vaccines and biotechnology medicines.
• Active ingredients with a narrow therapeutic margin (except intravenous use), for example acenocoumarol, warfarin, levothyroxine, digoxin, lithium, phenytoin, carbamazepine, ciclosporin, tacrolimus or theophylline. Others, such as flecainide, were added later.
• Medicines under special medical control, such as clozapine or isotretinoin.
• Respiratory medicines given by inhalation.

If you take one of these and notice that you have been given a different product, mention it to your pharmacist before you start it.

How can you avoid confusion when the box changes?

The main risk is not the generic itself but confusion: taking the old and the new box at the same time because they look like two different medicines, or dropping one because you do not recognise it. The answer is always to look at the active ingredient and the strength, not the brand or the colour.

1. Find the name of the active ingredient and the strength on the box (for example, 20 mg) and compare them with your medication list.
2. If they match something you already take, it is the same treatment: do not add it to the previous one.
3. Keep boxes of the same active ingredient together and finish one before opening the other.
4. If you are allergic or intolerant to an excipient, such as lactose, check the leaflet or ask at the pharmacy.
5. If in any doubt, ask the pharmacist before taking the first tablet.

It helps to keep your list by active ingredient, as we explain in your personal medication list, and to know where to find each detail in how to read the leaflet.

A practical example: Pilar and her blood pressure tablet

Let us take the example of Pilar, 63, who works in an accountancy office and has taken enalapril for her blood pressure for years. This month, when she collects her medication, she is given a white and blue box instead of the usual green one, with round tablets instead of oblong ones.

At home she still has tablets from the green box. She thinks her doctor has added something new and is about to take one of each. First, she compares the two boxes:

• Both say "enalapril" and "20 mg": it is the same medicine from a different manufacturer.
• The new one carries the letters EFG: it is a generic.
• She calls her pharmacy, which confirms that it is a price based substitution and that she should keep taking just one tablet a day.

Pilar writes "enalapril 20 mg, any brand" on her list and puts the new box behind the old one so she finishes that first.

How can IMA Health help you?

When your medication arrives prepared by day and time of each dose, a change of brand stops being a problem for you: the specialised pharmacy that prepares it works from the active ingredient and strength of your treatment. At IMA Health we coordinate that preparation in a personalised dosage system, deliver it to your home and provide personalised follow-up.

To find out more about this system, read what an SPD is.

Sources

• Spanish Ministry of Health: Frequently asked questions about generic medicines (in Spanish)
• BOE: Royal Legislative Decree 1/2015, Spanish medicines law (articles 87 and 89, in Spanish)
• AEMPS: Medicines that should not be substituted without the prescriber's authorisation (in Spanish)
• AEMPS: Legislation on medicines that pharmacists cannot substitute (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.