Trouble with generics

Ten years ago, I began taking Synthroid for hypothyroidism. This year, my doctor gave me a prescription for a generic equivalent.

By the fourth day, I couldn’t sleep, I had diarrhea, I was sweating more than usual, and my heart felt as though it would pound out of my chest. I finally contacted the pharmacist and went back to the brand-name Synthroid.

Immediately I was back to my normal self. I thought that generic drugs were supposed to be identical to brand-name drugs. What happened?

The symptoms you describe are typical of excess thyroid hormone, suggesting that perhaps the generic pills you were taking were not dose-equivalent to Synthroid. We have heard similar accounts from others.

The Food and Drug Administration encourages patients, physicians and pharmacists to report such cases so they can monitor quality problems.

Is it necessary to have a prescription for prenatal vitamins? My obstetrician-gynecologist sent me home with eight varieties and asked me to choose one. She’ll send in a prescription. The vitamins vary in the amounts of most ingredients (all have 1 milligram of folic acid), so it is difficult to determine which one is best.

There will be a monthly $25 co-payment for any prescription. Am I better off buying a nonprescription brand?

Prenatal vitamins generally contain more folic acid (800 micrograms to 1 milligram) and iron (40 to 60 milligrams) than typical multivitamin formulations. Nonprescription prenatal vitamins approximate these levels, but you could also take an ordinary multivitamin and add separate folic acid and iron supplements if your doctor approves. The extra folic acid and iron come to about $8 for a three-month supply, so this might be the most cost-effective option.

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Joe Graedon, a pharmacologist, and Teresa Graedon, an expert in medical anthropology and nutrition, can be reached at People’s Pharmacy, King Features Syndicate, 888 7th Ave., New York, NY 10019, or at pharmacy@mindspring.com.