Marie-Laure Laroche, MD; Louis Merle, MD, PhD
Potential Financial Conflicts of Interest: None disclosed.
Laroche M., Merle L.; Generic Drug Savings. Ann Intern Med. 2005;143:844-845. doi: 10.7326/0003-4819-143-11-200512060-00019
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Published: Ann Intern Med. 2005;143(11):844-845.
TO THE EDITOR:
We agree with most of Haas and colleagues' statements (1) regarding the benefits of substituting generic drugs for brand-name drugs; however, we would like to stress that the authors assume that both the quality and the composition of generic and brand-name drugs are equivalent. From our pharmacovigilance experience in France and in Mauritania, we do not think this assumption applies everywhere. The use of poor-quality generic drugs could have obvious consequences when the long-term treatment of a serious condition, such as epilepsy, is at stake (2). Excipients that can induce cutaneous allergic reactions, such as macrogol, starch, indigotine, carmine indigo, or povidone, are frequently found in generic drugs but not in brand-name ones. The change in excipient content that occurs when shifting from a brand-name drug to a generic drug may modify bioavailability, generally reducing it. With such substitutions, we observed hyperglycemia with gliclazide and blood pressure increases with diltiazem and verapamil.
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