Prescribing by generic or brand name

Key terms

Generic prescribing

Generic prescribing uses the recommended International Non-proprietary Name (rINN).

Brand prescribing

Brand prescribing uses the branded (proprietary) or branded generic name.

Benefits of generic prescribing

Generic prescribing is generally preferred. This is because it:

Reduces risk

Each drug has only one generic name, but may have many brand names. Generic prescribing can reduce prescribing and dispensing errors. It can also reduce confusion for patients, carers and healthcare professionals during transfer between healthcare settings.

Enables quicker medicine supply

If a medicine is prescribed by generic name, the pharmacist may dispense any suitable generic or branded product. This can reduce delays in supplying medicines to the patient.

In primary care, if a medicine is prescribed by brand name, the pharmacist may dispense only the specified brand, unless a Serious Shortage Protocol (SSP) is in place.

Offers value for money

It is usually more cost-effective to prescribe generically. In primary care, the dispensing pharmacy is reimbursed at a set price, listed in the Drug Tariff.

Increasing the level of generic prescribing in the UK has long been encouraged. The NHS has a policy of prescribing medicines by their generic name unless there is a clinical reason why the medicine must be prescribed by brand.

When to prescribe by brand

There are situations where prescribing by brand is necessary to ensure the person receives the intended product.

Circumstances include:

Bioavailability differences

Where bioavailability differs between brands, particularly if the medicine has a narrow therapeutic index. Lack of clarity over which preparation is required can lead to the patient receiving a sub-therapeutic or toxic dose.

Examples include: ciclosporin, lithium, beclometasone pressurised metered dose inhalers, carbamazepine for epilepsy

Release profile variations

Where modified release (MR) preparations are not interchangeable. Differences in release characteristics can lead to different therapeutic effects.

Different MR formulations may need different dose administration schedules. For example, morphine MR tablets are available as 12-hourly and 24-hourly formulations. Confusion over the preparation required can lead to the patient taking a sub-therapeutic or toxic dose.

Some medicines, for example methylphenidate MR tablets and capsules, contain an immediate-release and MR component. The proportion of each component varies between brands.

Specific devices

When administration devices have different instructions for use and patients require training to use them.

Examples include: adrenaline auto-injectors, dry powder inhalers, insulin injection devices

Biologics and biosimilars

The MHRA advises that biologic medicines, including biosimilar medicines, should be prescribed by brand name. You can find more information about biologics and biosimilars in our article Understanding biological and biosimilar medicines (SPS page)

Examples include: insulins, low molecular weight heparins, somatropin

When to consider prescribing by brand

Ensuring supply of a consistent product can be helpful in some other circumstances, depending on the medicine and the patient.

Multi-ingredient preparation

Where products contain more than one ingredient. Brand-name prescribing aids identification of the correct product.

Examples include: multiphasic combined oral contraceptives, combined HRT, pancreatin supplements

Licence variations

Where branded and generic preparations have different licensed indications.

Generic preparations are licensed on the basis of bioequivalence with the branded product, and it can be argued that brand-name prescribing is not necessary. However, a medicine should not be used ‘off-label’ for an unlicensed indication when a suitable licensed alternative exists.

When a medicine is given for an unlicensed indication, the patient information leaflet may not provide relevant information.

Buprenorphine 400mcg sublingual tablets is an example where licensed indication differs between brands.

Patient factors

For some patients, differences in product name, presentation, appearance or taste may lead to anxiety, confusion, dosing errors and reduced adherence.

There may also be occasions where a particular product is required, for example due to severe allergy to an excipient. Searching for presence or absence of an excipient in medicines (SPS page) explains how to identify appropriate products.

Local formulary

Medicines formularies may recommend particular brands of some medicines.

Example medicines

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