When Generic Medicines Don’t Work as Expected
A 35-year-old man came to me with severe nerve pain that had troubled him for nearly nine months. His story was complicated by long-term alcohol abuse and uncontrolled diabetes, both of which are known to damage the nerves. Despite quitting alcohol (with medical help), bringing his blood sugars under control, and taking several medicines commonly prescribed for nerve pain, such as gabapentin, pregabalin, and duloxetine, he continued to suffer. The pain was so intense that it interfered with his daily activities and even robbed him of sleep.
At the time he consulted me, he was already taking pregabalin (300 mg/day) and duloxetine (60 mg/day), but with very little relief. Since his condition was stubbornly resistant to treatment, I even considered doing a nerve biopsy to check for less common causes of neuropathy. Detailed blood work, already done, were negative. However, the patient wanted to wait for a month before undergoing any invasive procedure.
During this time, I decided to make one change: I switched his pregabalin from a generic version to the innovator (original) brand, keeping the dose exactly the same. When he came back for follow-up, the transformation was remarkable. He reported 80% improvement in pain, and his quality of life improved dramatically.
The takeaway:
While generic medicines are effective and affordable for most people, occasionally they may not work as well as the original brand in certain individuals. If symptoms don’t improve despite the right treatment, it may be worth discussing, whether switching to the innovator brand is an option, even if it comes at a slightly higher cost. Sometimes, that change can make all the difference.
Dr Sudhir Kumar MD DM 07-10-2025