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Originally published Saturday, February 25, 2012 at 7:01 PM

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People's Pharmacy: Not all generics are created equal

People's Pharmacy answers reader queries on generics; an alternative to Flomax for painful urination; and privacy.

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Q: I am a cardiologist with a patient who had elevated cholesterol in 2010. Her total cholesterol was 245, and her LDL was 156. I put her on Pravachol. It brought her cholesterol down to under 200, and her LDL to around 100.

Last year, her insurance company switched her from Pravachol to generic pravastatin. It came from India. After two months on this generic medication, her total cholesterol had risen to 249, and her LDL was 151, basically back where she started.

I was not pleased, so I prescribed a generic from an Israeli company. Within six weeks, her cholesterol was back to 196, and her LDL was 113. While she was on the generic from India, it was as if she were taking nothing at all.

A: In the past decade, we have heard from thousands of people who have experienced generic-drug failures. Sometimes it happens when they are switched from a brand to a generic. Other times it occurs when one generic product is substituted for another.

One way to tell if generic drugs are doing the job is to test the results and keep careful records, as you did with your patient.

Q: I need cataract surgery and have been told I must stop taking Flomax pills two weeks beforehand. I need an alternative drug to help me urinate.

A: Tamsulosin (Flomax) is prescribed to alleviate difficult urination caused by an enlarged prostate gland. One difficulty with this medication may occur during cataract surgery. Men taking tamsulosin are at risk for something called "intraoperative floppy iris syndrome." This can complicate surgery and explains why you have been told to stop the medicine.

Ask your doctor about using the erectile-dysfunction drug tadalafil (Cialis) while you are waiting for surgery. The Food and Drug Administration recently approved this medication for urinary symptoms of prostate enlargement.

Be prepared for your insurance company to reject payment for this treatment unless your doctor intervenes on your behalf. Because Cialis is primarily prescribed for erectile dysfunction rather than prostate problems, insurance companies may try to deny it as medically unnecessary.

Q: I forward your electronic newsletter regularly to my husband, a doctor. He is skeptical about some of the entries because there are no names of the people submitting questions. How can we be assured that you are not just making up the questions? He is particularly peeved with the ones that disparage doctors!

A: We can certainly appreciate that your husband might be annoyed by critical questions. We assure you, though, that the questions in our column and website come from real people. We receive hundreds of inquiries every week at PeoplesPharmacy.com, as well as through the mail, but most people prefer to keep their personal medical problems private. That's why we usually don't include names.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 300 W. 57th St., 15th floor, New York, NY 10019, or via their website: www.peoplespharmacy.org

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