Economic considerations have led to the increasing availability and use of generic medications to replace more expensive, branded drugs wherever possible. This therapeutic exchange raises the question of whether these formulations are equivalent. As psychiatric conditions often involve long-term therapy, cost-effectiveness is particularly important in this field, but nonbranded products typically provoke mistrust. Is general caution justified? Should prescribers and patients be prepared for the possibility that exchanging a branded drug for a generic one will lead to loss of efficacy or increased adverse effects? And if there is a change in the patient’s clinical status, is it because of lack of efficacy or enhanced intolerability of the generic drug? Potential reasons for a maintained or changed clinical outcome after a branded medication has been replaced with a generic one include psychological, attitudinal, and most relevant from a regulatory perspective, pharmacokinetic factors.
Christoph U. Correll, MD; Maren Carbon, MD