Although many experts warn clinicians not to substitute brand-name cardiovascular drugs with generics, results from an extensive literature review of available evidence raises questions about this conventional wisdom. Surveying peer- reviewed publications from January 1984 to August 2008, researchers compared generic and brand-name cardiovascular drugs for safety and effectiveness. They found clinical equivalence in all randomized controlled trials for beta-blockers, alpha-blockers, statins, antiplatelet agents, and angiotensin- converting enzyme (ACE) inhibitors. In addition, they found equivalence in 91% of trials involving diuretics and 71% of those involving calcium channel blockers. However, the number of trials studied for some drug categories was small (three or less).

Noting that use of generic drugs can significantly cut drug costs, the researchers concluded that the evidence doesn't support the superiority of brand-name drugs. Yet over half of 43 editorials in peer-reviewed journals expressed a "negative view" of generic substitutions. Nearly all failed to disclose funding sources.

Source: Kesselheim AS, Misono AS, Lee JL, et al. Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA. 2008;300(21):2514-2526.