Should patients taking generic medications be managed any differently than patients taking brand medications?

More follow-up is needed

Elizabeth A. Davis

Not all generics have horrific complications, but they are all medications that have not been proven in clinical trials. More so, generic manufacturers are not required to report new side effects; they are only required by law to report side effects associated with the brand medication, and that can be somewhat misleading to patients.

Because of the different preservatives and inactive ingredients, absorption and bioavailability can vary significantly, and that will affect safety and effectiveness. Any time a patient gets switched to a generic, you have to watch closely to make certain it will be equally effective. In my practice, I try to have a follow-up visit for any patient on a generic medication. If the generic does not work, you have to switch back or try another medication and go through the whole process again.

It would be nice to see clinical trials comparing generic medications to brand name to see if they are equivalent. I am not sure of the reasoning behind the assumption that they are equal just because a molecule is the same. Getting them in the ocular environment is just as critical. Any number of inactive ingredients can affect solubility, penetration and potency.

We discuss with patients that there are no clinical trials with these drugs. But then they go to the pharmacist who tells them there is a cheaper version, and that is all the patients hear. They do not hear anything about effectiveness. Sometimes you get a phone call from the pharmacist, and sometimes the patient comes back and they have already switched.

But what this all means is that you have to be more proactive and explain why you are giving them a particular medication. Moreover, if a patient gets switched at the pharmacy, it is something I want to know about, because if the drug is not working effectively, it is almost like taking nothing at all.

Elizabeth A. Davis, MD, FACS, is an OSN Cataract Surgery Board Member. Disclosure: No products or companies are mentioned that would require financial disclosure.

Postop options may become the norm

Mark Packer

Our practice switched to an all-generic post-cataract regimen a while back due to cost concerns from patients. But my partners and I started seeing prolonged inflammation in eyes that we would expect to be quiet. As a result, we now have two options for patients in the post-cataract period.

For patients for whom a quick recovery is important, and that may include premium IOL patients, we instruct them that we prefer brand products because we know they will work and be safe. However, you have to prepare patients for this option because there is a bit of sticker shock. On the other hand, for patients who are routine in every way or who are cost-conscious, we let them know about the availability of generics.

Between patient requests, the end of post-cataract kits and the end of sampling, we will see more generics in medicine and in ophthalmology in particular. The end of sampling, though, may be a good thing, because now physicians will be making recommendations based on what is best for the patient, rather than what samples are most plentiful in the supply room. But the problem is that it comes with a price to the patient.

I do not think it is necessarily unsafe to use generics, but the truth is we do not know because there is no requirement for testing. I do not question the long-term safety of generics; it is just not the optimal path, in my opinion.

In our practice, we have adopted the practice of offering generic options and brand options, and I think that is going to be the paradigm going forward. I think it is reasonable, because it allows patient choice. I think you will see a lot of offices adopting something like that in the future.

Mark Packer, MD, practices at the offices of Drs. Fine, Hoffman and Packer in Eugene, Ore. Disclosure: No products or companies are mentioned that would require financial disclosure.