Generic birth control prescriptions can save you money. And, in some cases, they’re all that insurance will cover. But, is generic birth control as good as the brand-name version? What types of birth control come in generics? How can you get a generic prescription?

Patents and Exclusivity

When drug companies develop new medicines, they patent them so that no other company can claim to have invented the drug. They also apply for what’s called “exclusivity,” which means that no other company can sell the drug for a certain number of years. Companies can charge high prices for these medicines because no one else is allowed to make them. The companies say that the prices must be high to cover the research that went into making the drugs, although the cost of advertising is also a factor.

Patents last for 20 years. Exclusivity depends on the type of drug, but in most cases it’s a shorter period of time than the patent.

Generics vs. Brand-Name Drugs

FDA regulations state that generics must contain the same medicines as the brand-name versions. The medicine must be absorbed by the body at the same rate and in the same amount. Basically, generic drugs must work just like the brand-name ones. It’s just that the pills and packages look different. Sometimes, you’ll need a bit of technical knowledge to see that the medicines really are the same: the brand name one might list ingredients in micrograms, while the generic uses milligrams.

In spite of the FDA regulations, patients and doctors occasionally report different results from generic vs. brand name pills. This may have to do with the “vehicle” the medicine is delivered in; although the drug is the same, the other ingredients in the pill might be different. Most of the time, though, you won’t notice any difference.

One particular concern about generic birth control prescriptions is that the actual amount of medication in each pill might vary more than in brand name medicines. Actually, this hasn’t been well studied. The FDA says that the medication should be equivalent to the brand-name version. If it’s true that there is a bigger difference from pill to pill, however, it could cause side effects in women who are sensitive to hormone variations.

GENERIC NAME: Oral Contraceptives or OCs (also known as Birth Control Pills or BCPs)

DRUG CLASS AND MECHANISM: Oral contraceptives (OCs) are medications that prevent pregnancy. They are one type of birth control. OCs may contain combinations of estrogen and progestin or progestin alone. Combinations of estrogen and progestin prevent pregnancy by inhibiting the release of the hormones LH and FSH from the pituitary gland in the brain. LH and FSH play key roles in the development of the egg and preparation of the lining of the uterus for implantation of the embryo. Progestin also makes the uterine mucus that surrounds the egg more difficult for sperm to penetrate and, therefore, for fertilization to take place. In some women, progestin inhibits ovulation (release of the egg).

The combination OCs are called “monophasic,” “biphasic,” or “triphasic.” Monophasic OCs deliver the same amount of estrogen and progestin every day. Biphasic OCs deliver the same amount of estrogen every day for the first 21 days of the cycle. During the first half of the cycle, the progestin/estrogen ratio is lower to allow the endometrium to thicken as it normally does. During the second half of the cycle, the progestin/estrogen ratio is higher to allow normal shedding of the lining of the uterus to occur. The triphasic OCs have constant or changing estrogen concentrations and varying progestin concentrations throughout the cycle. There is no evidence that bi- or tri-phasic OCs are superior to monophasic OCs, or vice-versa.

PRESCRIBED FOR: OCs are prescribed for the prevention of pregnancy. When taken as directed, OCs fail in less than 1 in every 200 users over the first year of use. OCs also are prescribed to treat mid-cycle pain which some women experience with ovulation. OCs, while regulating the menstrual cycle, reduce menstural cramps and heavy bleeding, and, because of the reduced bleeding, they may prevent the anemia that can develop in some women. Doctors sometimes prescribe higher doses of OCs for use as “morning after” pills to be taken up to 72 hours after unprotected intercourse to prevent fertilization and pregnancy.

DOSING: Many of the OCs come in easy to use dispensers in which the day of the week or a consecutive number (1, 2, 3, etc.) is written on the dispenser with a corresponding tablet for each day or number. For example, some Ortho-Novum dispensers are labeled “Sunday” next to the first tablet. Thus, the first tablet is to be taken on the first Sunday after menstruation begins (the first Sunday following the first day of a woman’s period). If her period begins on Sunday, the first tablet should be taken on that day. For OCs that use consecutive numbers, the first tablet (#1) is taken on the first day of the menstrual period (the first day of bleeding). Tablet #2 is taken on the second day, and so on. Still other packages instruct women to begin on day 5 of the cycle. For such products, women count from day 1 of their menstrual cycle (day 1 is the first day of bleeding). On the fifth day, the first tablet is taken. Tablets then are taken daily.

DRUG INTERACTIONS: Estrogens can inhibit the metabolism (elimination) of cyclosporine, resulting in increased cyclosporine blood levels. Such increased blood levels can result in kidney and/or liver damage. If this combination cannot be avoided, cyclosporine concentrations can be monitored, and the dose of cyclosporine can be adjusted to assure that its blood levels do not become elevated.

Estrogens appear to increase the risk of liver disease in patients receiving dantrolene through an unknown mechanism. Women over 35 years of age and those with a history of liver disease are especially at risk.

Estrogens increase the liver’s ability to manufacture clotting factors. Because of this, patients receiving warfarin (Coumadin) need to be monitored for loss of anticoagulant (blood thinning) effect if an estrogen is begun.

ETHINYL ESTRADIOL/DROSPIRENONE - ORAL

How to Use:
Take this medication by mouth once daily, or as directed by your doctor. The manufacturer recommends that you take this product after your evening meal or at bedtime to help you remember to take it and to minimize any stomach upset or nausea you may have. You may, however, choose to take this medication at another time of the day instead. No matter what dosing schedule you use, it is important to take this medication at the same time each day.

It is recommended to start taking this medication on the first day of your period (menstrual cycle). If it is not possible to start this treatment at the start of your period, consult the product information and/or your doctor or pharmacist for proper instructions. It is recommended that you use an alternative method of birth control during the first week of taking this medication until the full benefit of this drug takes effect.

Warning:
Smoking cigarettes while using this medication increases your chance of having heart problems. Do not smoke while using this medication. The risk of heart problems increases with age (in women greater than 35 years of age) and with frequent smoking (15 cigarettes per day or greater).

Uses:
This combination medication is used to prevent pregnancy. This medication does not protect you or your partner against sexually transmitted diseases (e.g., HIV, gonorrhea).

Other Uses:
This drug may also be used to regulate your menstrual cycle.

Side Effects:
Nausea, vomiting, headache, diarrhea, bleeding between menstrual periods (spotting), weight gain, acne, stomach cramps, rash, swelling or bloating, skin spots, breast tenderness, or difficulty wearing contact lenses may occur. If any of these effects persist or worsen, notify your doctor promptly. Tell your doctor immediately if any of these serious side effects occur: dizziness, flu-like symptoms (e.g., fever, cough, unusual weakness/fatigue, sore throat, muscle aches), mental/mood changes, trouble sleeping, hair loss, vaginal infections. Tell your doctor immediately if any of these unlikely but serious side effects occur: severe headache, pain in the lower legs or groin, trouble breathing, chest pain, vision changes, severe stomach pain, weakness on one side of the body, yellowing eyes or skin, lumps in the breast. If you notice any other effects not listed above, contact your doctor or pharmacist.

Precautions:
Tell your doctor your medical history, especially of: heart problems, stroke, gallbladder disease, diabetes, high cholesterol or triglyceride levels, high blood pressure, migraines, seizures, irregular vaginal bleeding, depression, any allergies.

This medication is not recommended for use if you have the following medical conditions: liver problems, kidney or adrenal gland problems, history of blood clots (thrombophlebitis), blood vessel problems (e.g., cerebral vascular disease, coronary artery disease), history of certain cancers (especially endometrial or breast cancer), heavy smoking (especially if older than 35 years of age). If you are near-sighted or wear contact lenses, you may develop vision problems or have trouble wearing your contact lenses. Contact your eye doctor if this occurs.

If you stop taking this birth control medicine and want to become pregnant, it may take a longer time than is usually seen with women not taking birth control medicine. Consult your doctor. Do not smoke cigarettes. Birth control pills combined with smoking cigarettes, especially in women older than 35 years of age, puts you at a much higher risk of developing serious health problems than with birth control pills alone. Consult your doctor or pharmacist for more information. If you will be having surgery, be confined to a chair or bed for a long period of time (e.g., a long plane flight), or have recently delivered a baby, notify your doctor beforehand. Special precautions may need to be taken in these circumstances while you are taking this drug. This medication must not be used during pregnancy. If you become pregnant or think you may be pregnant, inform your doctor immediately. This medication passes into breast milk and has had undesirable effects on nursing infants. Consult your doctor before breast- feeding.

Drug interactions:
Certain drugs can decrease the effectiveness of combination-type birth control pills by decreasing the amount of birth control pill hormones in your system (impaired enterohepatic recirculation or hepatic induction).

This can result in pregnancy. Consult your doctor or pharmacist for details. Drugs that may cause this effect include: many antibiotics (e.g., cephalosporins, chloramphenicol, macrolides, penicillins, tetracyclines, sulfas), aprepitant, bexarotene, bosentan, dapsone, griseofulvin, certain HIV protease inhibitors (e.g., amprenavir, nelfinavir, ritonavir), modafinil, nevirapine, rifamycins (e.g., rifampin), many seizure medications (e.g., barbiturates, carbamazepine, phenytoin, primidone, topiramate), St. John’s wort. Ask your doctor if you should use additional reliable birth control methods while taking any of the drugs mentioned above while also taking birth control pills. Before taking this medication, tell your doctor of all prescription and nonprescription medication you may use, especially of: ACE inhibitors (e.g., enalapril, lisinopril), angiotensin receptor blockers (e.g., losartan, valsartan), potassium-sparing “water pills” (e.g., spironolactone, triamterene), potassium supplements, heparin, NSAIDs (e.g., ibuprofen, naproxen), atorvastatin, cyclosporine, corticosteroids (e.g., prednisone, prednisolone) theophylline, ascorbic acid (vitamin C), acetaminophen, morphine, temazepam, clofibric acid. This product can affect the result of certain lab tests (e.g., liver function tests, blood tests).

Birth Control and Acne: How Does It Work?

The link between birth control and acne is surprisingly simple. Birth Control Pills prevent pregnancy by changing the level of certain hormones in your body. One of these hormones is androgen, which stimulates oil production and increases acne. If you’re taking birth control pills that lower your androgen levels, you should see a reduction in the number of breakouts you experience.

Generally, it takes between six and eight weeks to see results when using birth control to treat your acne. While most topical medications work to treat existing inflammation, the pill will prevent new outbreaks from happening.

According to researchers who have studied the link between birth control and acne, using birth control pills to treat your blemishes should produce results similar to that of treatment with benzyl peroxide and topical or systemic antibiotics.

What Prescription Do I Need?

Unfortunately, not every type of birth control pill will help you control your acne. While all birth control pills will work to prevent pregnancy, each pill has slightly different hormone levels.

The FDA has approved Ortho Tri-Cyclen and generic norgestimate/ethinyl estradiol for acne treatment. The FDA believes these low-dosage birth control pills are an effective treatment for mild to moderate acne. In clinical studies, nearly 90 percent of women taking Ortho Tri-Cyclen noticed an improvement in their skin.

Other birth control pills that are thought to improve acne in most women include Desogen, Demulen, Brevicon, Nelova 1/35, Ovcon 35, and Ortho Novum 7/7/7. However, there is some evidence to suggest these pills are more effective in younger women who have fluctuating hormone levels that are the primary cause of their acne.

Older brands of birth control pills that contain estrogen and progestin hormones with higher androgen levels may in fact make your acne worse. This includes birth control pills such as Loestrin1.5/30, Loestrin1/20 Fe, Estrostep Fe, Levlen, Alesse, Ovral, and Norlestrin1/50.

ide Effects of Birth Control Pills

You must be aware of any potential side effects when you considering using birth control pills to treat your acne. For example:

• Some researchers who study birth control and acne report certain women may experience a weight gain of up to 12 pounds.
• If you smoke, using the birth control pill may increase your risk of developing cancer.
• Certain women may experience dangerous blood clots.
• Some pill users report adnominal pain, fatigue, headaches, breast tenderness, mood swings, and irregular periods.